I want to ask about delayed transfers of care. As the Minister knows, there is an enormous number across the acute hospitals at the moment. On 23 consecutive days between March and April-----

I am sorry. I have this question as "not submitted".

Is this question not related to delayed transfers of care?

It is Question No. 116.

I do not have a Priority Question from the Deputy. I will try to get an answer for her, but we have this question as "not submitted".

I believed I had resubmitted a Priority Question but, clearly, there was an issue with regard to it appearing on the Questions Paper.

To be clear, the question is on the Questions Paper.

I will do my best to answer.

On 23 consecutive days between March and April, the number of delayed transfers of care exceeded 500 across our acute hospitals, and again over the last six days. This has a major impact, not only on the people who are caught in hospitals who should no longer be there, but also on admissions. We saw that 129 people were waiting over 24 hours on Sunday night for admission to our emergency departments, 16 of them over the age of 75. It also has an impact on hospital activity, particularly with regard to the staggering reliance on surge capacity at the moment. What is being done with regard to step-down facilities across the health system at this point in time? There is a strong focus on the trolley numbers but, to my mind, insufficient focus on the step-down facilities.

My apologies for the mix-up, whatever the source. I will get the Deputy a full and more official answer. Nevertheless, I will speak from my own experience.

The focus on delayed transfers of care is an integral part of the focus on trolleys - the whole thing goes together. What we are really talking about is patient flow. Hospitals that experience ongoing delayed transfer of care, DTOC, problems include Letterkenny University Hospital, for example, where the number was in the 40s, but is now down in the 30s and moving towards 25. Directly across the road, there is a 100-bed community nursing unit that will open in 2026 and take some of the pressure off.

It is also about the management of this. For example, in Galway, we have gone through a deliberate reset. This speaks to the Deputy's example. The last week in Galway hospital was not good. It lost some of its private capacity for egress or transferring out of the hospital, and because that happened, the trolley numbers built up, and it has had seven very poor days. In the previous 25 days, it had only two red days, 22 green days and one amber day. In the 25 days before that, that was essentially inverted, and it was all red and maybe one green. Patient flow matters, and it matters all the time. It matters because of the impact on people in emergency departments, but it also matters to the hospital's ability to bring in inpatient day cases. As the Deputy highlighted, the use of surge means hospitals cannot do endoscopy investigations and so on. They cannot bring in non-time-critical electives. Of course, they bring in time-critical electives like cancer surgery, but not non-time-critical electives.

That is why the focus on urgent and emergency care, UEC, is important. It is a complete piece. There is no point in focusing on UEC without making sure they have a full awareness of what is available in the nursing homes. University Hospital Waterford does that particularly well. It has visibility in its patient control room of all of the passages out of the hospital. There are others that could do it dramatically better, such as Letterkenny University Hospital, and many of those have a DTOC problem, except for St. James's Hospital, which is a weird one that I will come back to.

The Minister referred to beds and management. When I talk to a number of the hospitals that are experiencing some of the worst problems with transferring those patients, there is a huge absence of neurorehabilitation beds and dementia-specific beds. In particular, we know that in Cherry Orchard, two wards have been closed for almost the past two years, supposedly for fire remediation works. The Killarney Community Nursing Unit was ready a year and a half ago, but has yet to be opened. We know that at South Infirmary, there are beds closed that should be open. We know that at a facility that is due to open in Blarney, as I understand it, the governance is due to lie with the Mercy Hospital, which has no neuro responsibilities because they are with Cork University Hospital.

The question concerns the decision-making and the management. It makes no sense to me that the sole responsibility for this lies with the hospital itself. What is the community element? In particular, what is the IHA doing to try to address these issues?

The Deputy is 100% right. It does not necessarily lie with the hospital management. For example, in Cork, with the IHA managers, there is no governance element to this. They are not CUH beds or Mercy Hospital beds, and nobody had better tell me that they think they are. They are beds for the south west, and they have to be managed from a single centre, which happens to be in CUH at the moment, but we will see about that. They have to have visibility over what is the situation in Blarney, Bantry, Mallow, South Infirmary and other places. It is their whole responsibility to be able to move people through.

As for the hospital managers' responsibility, I do not want to hear from consultants who say they cannot move X patient because they need to be in CUH instead of the very good care in Mallow. There needs to be an understanding that every hospital sits within a region, and patient flow works in that way. That is the only way this can possibly work. I am glad to hear the Deputy highlight that because it is the sort of reinforcement I need, particularly in the south west, to make sure that the patient flow experience is fully understood and that every bed is opened.

As regards the Killarney unit, I am told that will be in the next couple of weeks. There was a HIQA registration problem and there is engagement with the union but, frankly, it is not good enough that those beds and other beds have not been opened. Mallow's 24 beds were supposed to be opened in quarter 1. It will now be very shortly but it should have been done.

I understand. For example, I visited a facility very like that. Please forgive me; I do not have the name in front of me but it is in the north of Dublin, an acquired brain injury-----

An Saol.

That is exactly it. Forgive me. It is looking to build the facility adjacent to the primary care centre.

It is residential there.

Exactly. What we can do is work with an approved housing body, AHB, to build that residential. The HSE is for delivery of healthcare and we try to make it work as well as we can but here are the things we are not: we are not a transport company and we do not build homes. What we can do is partner with AHBs to make sure we are developing long-term residential that is adjacent and appropriate for needs of that kind.

On that site in particular, what we are looking at is what capacity we can have for people who need to come to that facility and that form of residential. We are trying to work with the sites we have adjacent to a primary care centre. I used that example because I happened to be there so recently.

The Deputy is right about acquired brain injury and dementia but the HSE has to focus on healthcare and partner with bodies like approved housing bodies that are experts in building housing.

There is HSE money going to nursing homes. They are residential facilities.

I would rather it did not.