My question relates to delayed transfers of care and nursing home capacity. I understand that yesterday marked the highest number of delayed transfers of care across our acute hospitals in the year to date, with 555 patients who should have been discharged and were not. This marks 86 continuous days of over 500 delayed transfers of care in our hospitals. For the first four months of this year, almost 50% of those waiting to leave hospital were waiting for a nursing home place. What is the response to this crisis?

I thank Deputy Sherlock, who is quite right to highlight delayed transfer of care, DTOC. As she said, it has been well over 500 variously for the last period, which is essentially a hospital. This is why the use of every bed is so very important. Deputy Sherlock is correct to identify nursing home beds, community nursing units and all of the appropriate step-down facilities that are, can and should be in the system to make sure we do not have people staying in acute hospitals longer than is necessary.

In this context, the national service plan commits to the delivery of 352 community beds in residential settings for older people in this period. The community nursing unit capital programme is ongoing and will have 90 public community nursing units and community hospital beds refurbished or replaced so they meet all of the regulatory requirements. It was a big problem for us that we had beds that were closed because of HIQA standards. This is correct because we have to bring them up to standard but it is a body of work to do this. The public-private partnership project will deliver 528 residential care beds on seven sites in 2026. The programme for Government commits to building more public nursing home beds, including dementia-specific provision, which is a huge issue in the delayed transfer of care.

We are developing a new long-term residential care additional capacity plan, which will be published in the later part of this year. There is a complexity to many of the DTOCs. There is an increase in complexity, particularly on the dementia side. There are other cases where there is a clear pathway out of hospital. I have highlighted the south west a number of times because of my frustration with the use and non-use of Mallow. There are patients in hospital today who could be discharged to virtual beds that are not being used. I do not need to conflate these different issues but it speaks to efficiency and the management of every bed and seeing every bed as being so very important.

The average waiting time in DTOC is 24.8 days across all acute hospitals and in the midlands and north-east Dublin it is more than 30 days. This is a huge cause for alarm in terms of risk to the patients themselves and their prospects of recovery but also the cost to the hospital. We know that nursing home demand is the biggest driver of this, with more than 1,500 people waiting for a nursing home space, but I have to ask about the urgency with regard to the Government's response. In 2022, ESRI research identified that we would need somewhere between 54,000 and 60,000 nursing home beds. We had 33,000 beds back in 2022. We have gone backwards and in 2025 we had fewer beds at 32,408. We are not even running to stand still. I am glad to hear a capacity expansion plan will be put in place but, like the acute hospital expansion plan, it has been sitting there for a number of years and I am not hearing urgency with regard to this problem.

Going back a couple of days, on 6 July there were 526 delayed transfers of care. Of these, 68 involved legal complexity, 35 involved basic housing needs, 90 involved very complex clinical needs, 61 were about access to rehab facilities of various kinds, home support packages were involved in 42 cases, residential care in 217 cases and non-compliance in 13 cases. It is not just about nursing home support; it is also about support at home. For example, it is important to mention the expansion of the enhanced community care teams, which are the multidisciplinary teams supporting earlier discharge from hospital closer to home. There is also extended service availability in the evenings and at weekends, including discharge planning, community supports and decision makers addressing avoidable non-clinical delays to discharge where it is possible.

I have mentioned the virtual wards. I do not suggest that everybody would move onto a virtual ward but there are people for whom it is clinically appropriate to do so. Crucially, the SAFER patient flow bundle and the plan for every patient are now in place across most sites, supported by seven-day and 14-day length-of-stay reviews.

Obviously, there are a whole range of issues as to why people do not leave hospital. Almost 70% of the cases relate to a need for residential care or complex care such as dementia. The big issue is the cost. We know the HSE is running a significant deficit at the moment. It will not even make the savings it is supposed to make at the end of this year. We know the cost of an acute daybed is about €1,300, which is almost five times the cost of a community nursing unit bed. This has a very real financial implication for hospitals. The question being asked of me is about the tolerance and particularly the very long average waiting times across our acute hospitals. We need to see a much greater urgency with regard to a nursing home capacity plan, which would be a public nursing home capacity plan.

I agree with Deputy Sherlock. I recall speaking with one of the hospital managers where this is a most acute issue with regard to what is going on, what the experience is and what conversations are happening. Again, there is a question of dementia and advanced decision-making. Some of these issues are very complex and that is its own bundle. As Deputy Sherlock said, there is also the need to access nursing homes and public nursing home support. Within this, it is important to say we will not be able to facilitate every request for every patient to be in the exact location they need to be. There are some questions. I do not wish to overstate it or amplify it but I am saying we will be able to provide supports but we will not be able to provide the perfect support for every person either. A measure of flexibility will have to come into that too.

There are also cases, and again it is hospital managers describing this to me, where families do not want to have a particular outcome and the hospital needs to move the patient, who is no longer an acute model 4 hospital patient but requires a different type of care.

It is important that everybody understands that model 4 beds are for the most acutely unwell and people cannot stay.