I congratulate those involved in the Australian vote for same-sex marriage, especially the 61% who voted in favour of it. I am proud that some of the Irish method was replicated in the campaign and that it was led by many Irish living over there. I hope Australia will legislate for it before Christmas.

I wish to highlight the alarming rise in attacks on mental health staff, as reported today. The number has gone from three in 2010 to over 150 thus far this year. This is violence on our front-line staff. I know there are challenging environments, especially in mental health settings. The decrease in staffing levels, ageing staff, younger staff walking away and volatility has contributed significantly to leaving many of our nurses disabled for life. The volatility has been caused more recently by the intensive laboratory-grown potency of synthetic drugs. Many cannot go back to work. I have represented several in the Labour Court while trying to make people accountable for what happens.

We need to address the main issues of recruitment and retention of staff, reopening closed beds, adequate step-down facilities and stopping the hundreds of thousands of elderly who have to wait more than 24 hours on trolleys or plastic chairs. This is causing at least 350 deaths per year in medical deterioration. I call on the Minister to come to the House so that we can ask about the protection of front-line workers, especially in mental health services.

Once again we are facing into a winter where the only things accident and emergency doctors have are flu jabs and prayers to help them with the inevitable onslaught.

We have fewer hospital beds now than we had in 1980 and nearly 200 beds are out of action. These are statements we have all heard before and we can say them until we are blue in the face. An article some weeks back entitled, This is the winter our health system will finally collapse, should have somehow resonated with the powers that be in the HSE and the Department of Health. My comments are directed towards those officials in the HSE and the Department of Health and not necessarily towards the Minister. I have no vendetta against the Minister - that is not my style - and I think he is a good Minister. His heart is in the right place and I have great respect for him.

In the article, medical journalist Dr. Muiris Houston warns:

A slow collapse of the health system this winter will likely look like this: the influenza epidemic begins; attendances at emergency departments increase as the flu hits vulnerable groups; patients with flu complications who require admission will fill up trolleys; some people who develop respiratory and cardiac failure will be moved to intensive care; the already inadequate number of ICU beds will fill up quickly, forcing intensive care specialists to ventilate people in operating theatres and even in emergency departments. There will be no spare intensive care capacity in Northern Ireland or Britain to tap into.

As a result, even urgent cancer surgeries will be cancelled, as many patients who undergo major surgery cannot be safely operated on without an intensive care bed to transfer them to post-operatively. All elective surgery is likely to be cancelled for a period of eight to 10 weeks, adding to the already enormous backlog of people waiting to be treated in the public health system. Emergency departments will choke up and some will be forced to close. Already overstretched GPs will not have the capacity, and for seriously ill people, the facilities, to offer treatment.

These are not the words of some dystopian novelist. His comments are accurate, realistic and utterly terrifying. There are enough faceless Department and HSE officials on large salaries to get on with the work in hand. I want to see some proactive solutions rather than reactive commentary from them, which we have seen previously. I look forward to hearing what solutions they come up with in the coming weeks.

Today sees the commencement of the global forum on human resources for health. This is a four-day conference that will begin in the RDS. No doubt the World Health Organization, which is one of the co-sponsors, will be pointing out to us that the problem of a shortfall in health care workers is worldwide.

There are some other issues. The WHO will also tell us, by reference to reports in advance of the conference, not only that we have a problem with a shortfall of health care workers, including nurses, doctors and so on, but that this can be compounded when Brexit comes. Basically, we are looking at a situation where there will be a concerted effort on the part of the NHS in England to recruit our nurses and doctors and, in effect, poach them. That would put us in a critical position with regard to providing the proper health service we need.

We know the HSE has published the Health Services People Strategy 2015-2018 in response to the depletion in numbers of front-line health care workers, especially nurses. We know the executive is having difficulty in achieving targets in recruitment. This is because people have retired and young graduates are going abroad. An Irish Nurses and Midwives Organisation study showed that many young nursing graduates intend to work abroad and that the net increase in nursing staff numbers from September to December this year was only a net figure of 13. Clearly, there is a major problem here.

One particular issue of concern is that in response to this departure or planned departure by nursing graduates from the country, the HSE has basically agreed that from now on permanent contracts should be offered to nursing graduates for 2016 and 2017 such that they would have reason to stay and build their lives here.

I am very concerned about the operation and implementation of this objective by the Saolta hospital group. It is not offering permanent contracts despite the need for nursing staff. Contracts for a maximum of two years is the most which people are being offered. We all know that anyone who is looking for a mortgage or is trying to establish him or herself needs greater certainty than two years. I am aware of people in other hospital areas being given permanent contracts rather than for finite periods. The Saolta group must be taken to task over this and I ask that this matter be taken up with the Minister to ask about recruitment and how nurses who graduated between 2016 and 2017 are being treated, in accordance with Government and HSE policy.