I welcome the Minister of State to the House. It is always good to see her here, and I am delighted she could come here on behalf of the Minister for Health. I seek a statement on the fact that more than 70,000 people left accident and emergency departments without being seen in the first seven months of 2026. We have to ask ourselves why this is the case.

I had the opportunity to be in St. Vincent's hospital last week and to see at first hand for many hours the enormous waiting times. Before I talk about the health services, I will start on a very positive note by acknowledging the amazing work done by our front-line healthcare workers: our nurses, orderlies, catering people and all the auxiliary and support staff in our public and private hospitals. They do an extraordinary job in extremely difficult circumstances. We all read in the newspapers the response to a question that had been submitted by the Chairperson of the Oireachtas Committee on Health, Deputy Pádraig Rice, which was astounding. We were told that 70,100 people did not wait or left before completing their treatment in emergency departments in the first seven months of this year. The data has been obtained and verified by the HSE. Hospitals are operating under enormous pressures, so there are a combination of things. There is effectively a difficulty with recruitment. We will leave it that rather than call it an embargo. There is a process of now going back to the Department for approval, and while there may be a good reason for doing that, it is slowing down the process, and that is the problem. The HSE is saying it is committed to improving patient flows through emergency departments. We know that both public and private patients are trying to access hospitals through accident and emergency departments, and it begs the question why everybody is clogging up accident and emergency units. I accept that, in time, there will be more local clinics and all the supports that go with those, but the problem is we have so many people going to accident and emergency units, which are under-resourced, do not have sufficient staff and do not have the bed capacity. I have spoken to a number of staff. Indeed, I acknowledge and thank the chief executive of St. Vincent's hospital, Philomena McGrath, who I had a long conversation with. She rang me, actually, and I acknowledge and thank her for that. She pointed out a few issues in terms of the beds. They do not have the bed capacity and there is a need generally for improved bed capacity in all of our hospitals, and that is a challenge. There are issues there.

I will briefly quote what the general secretary of the INMO has called for in terms of the HSE. She has called for the target to address the dangerous levels of overcrowding in our emergency departments. She goes on to say that the HSE cannot continue to operate on a keep calm and carry on basis while patients and staff are exposed to unacceptable risks. She goes on to say:

Given the level of overcrowding we have seen in our emergency departments throughout this year, the HSE must have a plan to ease the pressure across the acute hospital system. The current situation is dangerous and requires immediate action.

The HSE and Department of Health must be honest with the public about the dire situation facing the majority of our emergency departments. Patient safety must come first, and that means taking decisive action now to address overcrowding.

I do not want to spend my time looking back. I want to look forward and I know the Minister of State is the same. We must recognise that there is a crisis within accident and emergency departments. We have a lot of people who are waiting ten, 11, 12 and 14 hours to be triaged in these units. We have people over 75 years of age queuing for hours. I could go on and on but that is not going to get us anywhere. I want to hear from the Minister of State how we are going to plan and tackle the issues that the general secretary of the INMO has indicated are a problem. I support healthcare staff and I know that the Minister of State supports them but let us map out a pathway to end the chaos in accident and emergency departments around this country.

I can see the passion and commitment of the Senator, as he always has, for this very important matter, which I am taking on behalf of the Minister, Deputy Carroll MacNeill.

Patients are everyone's priority. I agree with the Senator that there are challenges, such as long waits in emergency departments, which can be distressing for patients and their families, particularly for older people and those with complex healthcare needs.

The figures referenced by the Senator must be considered in the context of a health service experiencing unprecedented growth in demand. Emergency department attendances continue to increase significantly. From 1 January to 28 October of this year, attendances were up by 7%, representing almost 98,000 additional presentations compared with the same period in 2025.

Presentations by patients aged 75 years and over increased by 9%, which is equivalent to almost 17,700 additional older patients. These patients are more likely to require admission and they have longer stays in hospital, as we know. While attention has focused on patients leaving emergency departments before treatment is complete, it is important to note the vast majority of patients remain and receive the care they need. While the proportion of patients leaving emergency departments before treatment is complete remains above target, improving patient experience and reducing waiting times continue to be priorities for both the Department and the HSE.

The challenges facing emergency departments cannot be viewed in isolation. Patient flow throughout the wider hospital system remains a critical factor. Very high and sustained levels of delayed transfers of care, DTOC, continue to impact bed availability. Between January and October the average daily DTOC number was 516 patients compared with a system threshold of 300. This resulted in approximately 150,000 bed days of lost capacity and represented a 26% increase on the same period last year.

The Department and the HSE are responding through a range of measures for the winter period. This is what they are working on now. These include strengthened operational oversight, enhanced discharge planning, senior clinical decision-making, expanded use of virtual wards, increased community supports and greater focus on seven-day working. Daily oversight arrangements are now in place across the system. In preparation for winter, the Department of Health has asked the HSE to identify critical clinical safety posts that would have the greatest impact on patient flow and patient safety, having regard to the sustained increase in demand experienced throughout 2026.

We are also working with the HSE to develop a targeted GP respiratory illness support programme ahead of the winter season. The programme is intended to support the management of respiratory illness in the community, reduce avoidable emergency department attendances where appropriate and help reduce pressure on acute hospital services during peak demand.

Importantly, performance varies considerably between hospitals. We can look at the regions. A number of hospitals, including University Hospital Waterford, Midland Regional Hospital Tullamore, Cavan, Drogheda and Portiuncula, have demonstrated strong patient flow remains achievable even during periods of high demand. Reviews of these sites indicates that success is associated with strong seven-day discharge planning, effective use of surge capacity, balanced admission and discharge activity and active oversight of patient flow throughout the week.

The Government is also investing in alternatives to emergency departments, as the Senator spoke about. Injury Units continue to provide rapid treatment for minor injuries while virtual wards have delivered more than 45,000 virtual bed days and supported almost 5,000 patients nationally.

These initiatives help ensure patients receive care in the most appropriate setting while freeing capacity within acute hospitals. There is no single solution to emergency department crowding. Addressing these pressures requires continued investment in capacity, discharge pathways, community services, workforce and hospital productivity. That remains the focus of the Department and the HSE.

I hear what the Minister of State is saying and will take that response back to the INMO but the public is losing confidence in the Government's capacity to address the chaos and crisis in our emergency departments. I am not happy to say that but I am happy to say I spoke with nurses in St. Vincent's hospital last week. They are at the coalface and they told me there are issues with recruitment. We know there also are issues with the cost of accommodation for those working in the Dublin hospitals, which is feeding into the dilemma.

There is a lack of other preliminary options to go to. Our public emergency departments are filling up with private patients and the private sector is letting down private patients because it should be taking up that element. If you are sick there is no better place than a public training hospital but we need to call the private sector to account to provide emergency department services to the people who are paying huge premiums for that. My understanding from the nurses, doctors and practitioners I spoke to in the last week is 50% of the people have private health cover and they should have another option to in some way dissipate the huge crowds.

I will finish by saying our nurses are doing an exceptional job.

Our nurses are under pressure. Hundreds of our nurses are leaving this country because of the pay and conditions of their employment, and we are losing out. The public at large are with the nurses, these public sector workers. I do not like the term "public sector". They are our nurses and our carers. They are our assistants. They are our orderlies and caterers in our hospitals. Morale is at an all-time low with them, and morale is low with the people we all seek to serve. I know the Minister of State is committed to this area, given the work she has done as regards her local hospital in Kilkenny. Will she please keep the pressure on and ask the Minister to get up one night and walk into an accident and emergency department? I know she is committed to that and has done it in the past. She should keep on the floors of our hospitals and send a clear message that we support our nurses in our hospitals.

I will be speaking to the Minister, Deputy Carroll MacNeill, to highlight the issues. Our front-line workers do excellent work. My eldest daughter is a nurse. I appreciate their work and that of all front-line workers. I assure the Senator that the Government is committed to working on the challenges where we see them. While much work remains to be done, improving patient flow, reducing delays and ensuring timely access to safe care remains the Minister's priority. The Department of Health and the HSE will continue to work closely to deliver improvements required across the urgent emergency system. I will highlight this. I thank the Senator for his commitment and passion for this.