We know that 33,000 fewer patients went through accident and emergency units in 2003 than in 1998. Last week in response to a question in the Dáil the Taoiseach admitted that accident and emergency facilities were, in his words, "not up to scratch". What is a crisis in the rest of the country, and what has driven nurses the length and breadth of the country to protest outside hospitals during lunch time, is simply "not up to scratch" in the eyes of the Taoiseach.

This morning we learned that the situation is much worse. The independent report of the Health and Safety Authority has criticised the level of congestion in accident and emergency units around the country. It says this increases the risk of injury, infection and violence from frustrated patients. There are reports of trolleys, chairs and medical equipment being stored in fire protected corridors. Some eight of the hospitals inspected since March have been reported to fire officers because exit doors and corridors have been blocked. Yesterday 283 patients were on trolleys in accident and emergency departments and there are serious reports of deep frustration and of anger verging on violence among some patients in some units.

The Government's response to this has been to fly a kite about the availability of a hospital at St. Bricin's, which will not happen now. There are complaints from nurses of being intimidated by management when highlighting the impossible conditions in which they are expected to work. The Tánaiste has said that the nursing home charges issue is putting patients off moving out of hospitals.

The Taoiseach has been, or is supposed to have been, in charge for the past eight years. This situation in the fourth richest country in the world is unacceptable. Conditions in accident and emergency hospitals in some places around the country are appalling. What does the Taoiseach intend to do about this——

The Deputy's two minutes have concluded.

——instead of talking about plans and his vision for the future? He has been eight years at the job and we are still talking about plans. When is he going to take action?

I will not go through the numbers. I have already explained how many people go through our accident and emergency units. I am glad Deputy Kenny has distinguished between ones that are overcrowded and those that work extremely well. That is the position.

As I said previously, the action is that this year alone we have put a substantial part of both the capital and revenue budgets into providing extra facilities. Those facilities range from better cleaning to better complex tasks such as MRI scans——

There is no change on the ground.

Allow the Taoiseach without interruption. This is Deputy Kenny's question.

There have been eight years of waffle.

——in Beaumont as part of this year's plan. We are providing acute medical units in Tallaght, Beaumont and St. Vincent's Hospitals. This will mean that people who go to hospital with problems and medical conditions such as respiratory illness or diabetes can be assessed and observed without waiting for long periods in accident and emergency units. Other hospitals around the country have found that these units work well. Comhairle na nOspidéal has also pointed this out.

Has the Taoiseach ever visited the accident and emergency unit in the Mater Hospital?

In reply to Deputy Kenny, these acute medical units have begun. They are positive actions.

I ask the Taoiseach to give way for a second.

I do not mind, a Ceann Comhairle. This is the disruption we get every Wednesday.

This is Deputy Kenny's question. He is the only Member entitled to submit the question. The Taoiseach is entitled to the courtesy of silence to reply.

If the Deputy does not behave the Chair will take appropriate action. Allow the Taoiseach continue without interruption.

If the Taoiseach waffles, the patients are the people who suffer.

We are buying beds from the private sector for step-down care for hundreds of patients this year who no longer need to stay in hospital. I assure Deputy Kenny that this is working and has been happening over the past few weeks. People are moving from acute beds into private nursing homes. This is a costly way of dealing with it, but the Government is doing it. We are contracting for long-term nursing care beds for many people who need higher level care than would be available in the community. We are providing special home care packages for 500 people currently awaiting discharge from acute hospitals. This will help families and older people in their homes and communities and free up beds. We are ensuring we will be able to get access to general practitioners outside of normal working hours so that people do not have to go to accident and emergency units with normal problems.

Is that the doctor-on-call service?

All of these are not long-term actions but are under way now. Deputy Kenny raised the issue of the Health and Safety Authority's report which is out today. The authority has completed its programme of inspections in 11 accident and emergency departments. It has acknowledged that the hospitals are fully engaged in the process of addressing health and safety in accident and emergency units. The report also says there should be management changes. There should be changes in bed practices within hospitals. The CEO of the HSA met the chief executive of the HSE yesterday.

We need new management in the Taoiseach's office.

The HSA has indicated that it is satisfied that the HSE is committed to addressing the areas of concern, that it will prioritise the management of health and safety issues and——

This is more management waffle and jargon.

——that it will highlight in its actions the recommendations of the inspectors. The HSA has secured the commitment of the HSE to examine the health system in the wider sense. This follows a meeting that took place yesterday.

Willie beat the Tánaiste in the punch up——

The Taoiseach's reply shows the scale of the appalling lack of competency of this Government over the past eight years. That it takes a HSA report——

Nobody likes a smart ass.

I ask Deputies Rabbitte and O'Dea to desist from interrupting.

If I am a smart ass, the Minister is illiterate.

That is why the Deputy is taken nowhere.

I am aware the Minister for Defence was flying a phantom last night with St. Bricin's Hospital, which is not available.

That is not true. The Deputy should correct himself.

I ask Deputy O'Dea to allow Deputy Kenny to continue without interruption.

Wee Willie Winkle should go back and place his order.

The Taoiseach's response sets out the scale of incompetence and devastation. After eight years, it has taken an independent report by the Health and Safety Authority to trigger the measures to which he referred. If a major hotel had blocked fire escapes and trolleys in its corridors, there would be calls by Members to close the facility.

Will the Taoiseach give an assurance that patients attending hospitals in the coming period will not be in danger given the violence, frustration and carry on mentioned in the report? God forbid but if there was a serious accident following the Luas derailment earlier, could hospitals have coped and implemented the major accident and emergency plan?

My final three questions relate to the Tánaiste and Minister for Health and Children's ten-point plan. When will the minor injuries units be developed and expanded? Where are they? When will they open? When will the Government provide the MRI scanner at Beaumont Hospital? Will it be this year or next year? Will the Taoiseach, for God's sake, see to it that scandalous conditions in toilet units in hospitals are cleaned up once for all?

The Deputy's time is concluded.

I was interrupted.

The Deputy had plenty of injury time.

I have evidence from people who are normally responsible who say they would be ashamed to have anything to do with the level of filth and dirt in some toilet units in some hospitals.

The second MRI scanner will be provided in Beaumont Hospital this year. The resources have been made available for the medical units. I cannot be certain about when the work will be finished on them but the money has been provided this year. Hopefully, they will be ready as soon as possible. The major accident and emergency plan is in place and, thankfully, it has always served us well. It creates disruption for others in hospital when it is invoked but it works well and it is upgraded all the time.

All these initiatives are under way but they are additional to ongoing work. Issues such as cleaning and so on should not arise because costly contracts are in place but I accept this report has highlighted some of these issues.

Contracts are the problem.

It also highlights management issues in the hospital, which also must be taken into account.

Too much management and not enough workers.

Perhaps there is too much management but we have to try to deal with the situation as it is. We are trying to provide the best services.

We are looking for solutions.

Everybody accepts that once one gets through accident and emergency, hospital services are excellent. There is a problem in accident and emergency and we are trying to deal with that. We have put huge resources into staff, equipment and the physical infrastructure to address this issue and we are committed to continuing to do what we can to get them all up to the same standard.

Where is the Cabinet programme?

The Deputy did not do a whole pile when he was in charge of the Department of Health.

The Minister was my junior Minister. He barely ever turned up. He was too busy knocking on doors in Limerick.

I could not get anything with the Deputy. He blocked everything. He was in the Department all the time doing nothing.

Only for Máire Geoghegan-Quinn, nothing would have happened.

The Government parties are eight years in office and they have made a hames of the health service.

I call Deputy Rabbitte. I ask Deputy O'Dea to remain silent and allow Deputy Rabbitte to ask his questions.

I was provoked.

It is easy to do so.