Last week some 300 people protested outside the gates of Cavan General Hospital in the pouring rain in solidarity with the Irish Nurses' Organisation's campaign entitled "Enough is Enough", and with citizens and patients who continue to suffer daily in accident and emergency units throughout the country. They were joined in Cavan and elsewhere by elected representatives of all opinion, including from Fianna Fáil. Is the Taoiseach not aware that citizens are absolutely outraged that this crisis in accident and emergency units continues despite all the promises and commitments that have been made and the money that has undisputedly been spent on the health services? It happens despite all the pledges by the Tánaiste and Minister for Health and Children, Deputy Harney, when she took up her position more than six months ago.

The honeymoon period is long over, and it is now time for the Minister to be accountable, not only to this House, but to the citizens. I ask the Taoiseach to forget the text that he used in his response to Deputy Kenny. Instead, I ask him to stand here today and, in his own words, tell the House what he and Deputy Harney intend to do today to address the situation. It is outrageous that eight hospitals have been reported to fire officers because exit doors and corridors are blocked. That means not only that citizens are suffering on trolleys in accident and emergency units but that they are also at risk from fire and such other potential hazards and emergencies that might arise.

The Deputy's time is concluded.

Will the Taoiseach and the Tánaiste meet the Health Service Executive and call on it not to go ahead with its plan for 2005, which entails a cut of some 600 jobs at the coalface of health care delivery and which the INO itself has said will result in bed closures and make the situation in accident and emergency even worse?

I ask the Deputy to conclude.

Where are the additional 2,250 acute hospital beds, the 4,000 elderly care beds and the 60 primary care units promised in the Government's health strategy? This is a very serious issue, and the Taoiseach's textbook reply will simply——

I ask the Deputy to give way to the Taoiseach.

——not suffice. We want to know what the Taoiseach intends to do today.

I have already answered this. The Deputy asked me to explain matters in my own words, something I did for Deputy Kenny. He wanted to know what actions were currently being taken, and I gave him those. They are under way now, in addition to what has already been put in place. I will give those points again. Those actions are significant.

Why is there a problem in accident and emergency? Many people argue there is not a problem in that department but with beds elsewhere. That is why we have added 500 beds. Step-down places are being provided in the private sector so that people in acute hospitals can move to suitable and excellent care facilities not in such hospitals, thus freeing the beds so that people can move through accident and emergency more quickly. That is the issue.

As I said, everyone accepts that, whether with cancer, cardiac or other services, when people are in hospital, they receive good treatment, operations and aftercare. However, with accident and emergency, because of people staying a long time in beds — far longer than was traditionally the case — one needs more beds. That is why we have the step-down beds. We already have 200 extra public beds this year, as well as out-of-hours GP services. People do not stop getting sick at 5 o'clock in the evening. Where there are no such services in communities, people go to the accident and emergency department, and that exerts further pressure.

When people are blind drunk or drugged and start to fight or become involved in public order disturbances, they often end up in accident and emergency departments, which puts further pressure on such services. A significant proportion of the €11.5 billion allocated each year to the health service, which has 100,000 staff, is spent by the Government on measures to improve the accident and emergency service. The Government is confident that such measures will help to alleviate some of the difficulties we have encountered in recent years. The Deputy is aware that the Government is also investing in a substantial capital programme that will bring new hospitals and services on stream.

The Government has not announced it yet.

Some of them are finished. We do not have to announce things that are finished.

When will we see the 2005 programme?

St. Vincent's Hospital has almost been finished. Tullamore General Hospital has been finished. The hospital in Blanchardstown has also been finished.

Phase 2 of the Blanchardstown hospital project has not even started.

The hospitals I have mentioned are open. The Deputy should acknowledge that.

The Taoiseach knows a little about Blanchardstown.

I am waiting for the Deputy to acknowledge completion of the excellent phase 1.

It took seven years for the Government to finish phase 1.

It is open.

Nothing was done when Deputy Burton's party was in government.

Phase 2 has not——

I ask the Deputy to allow the Taoiseach to conclude.

The excellent facilities——

I ask the Taoiseach to correct the record of the House.

The Labour Party cannot have the three Leaders' Questions.

Phase 2 of the Blanchardstown project has not started.

This is Deputy Ó Caoláin's question.

Deputy Burton has failed to acknowledge that there are excellent facilities in her constituency.

The Taoiseach has given a false impression of the state of Blanchardstown hospital.

I ask the Deputy to allow the Taoiseach to speak without interruption.

I have answered Deputy Ó Caoláin's question.

A Cheann Comhairle, may I ask——

I ask the Deputy to resume her seat.

——the Taoiseach to make a correction?

There is no provision for anybody to interrupt during Leaders' Questions.

Phase 2 has not started.

If the Deputy does not resume her seat, she will have to leave the House.

The Taoiseach did not answer my questions in his response. The electorate will not be convinced that the Taoiseach has addressed the serious matters raised by Deputy Kenny and me in a satisfactory manner. How does the Taoiseach respond to the pathetic excuse offered by the Minister for Health and Children last Monday? She said that the issue of nursing home charges was to blame for her failure to deliver on the ten-point plan she has proposed for dealing with the crisis in accident and emergency departments. Is the Taoiseach aware that the fire service in Dublin has indicated that the crisis in accident and emergency units is affecting its ability to respond to emergencies because fire brigade crews have to queue with patients after being called to attend to various problems? If fire fighters are stuck in long queues, they will not be available to respond to other emergencies which arise. What is the Taoiseach doing to address this very serious matter?

What does the Taoiseach have to say to nurses who have pointed out that the employment ceilings imposed on the health services are preventing the recruitment of additional staff to ease the crisis in our accident and emergency departments? Is it true that the moneys which are being allocated to implement the Tánaiste's ten-point plan are being taken from the original financial allocation made to each hospital? The redistribution of such moneys will result in other cutbacks in 2005. It is time for the Taoiseach to respond.

I remind Deputy Ó Caoláin that the provision of an additional €1 billion can hardly be described as a cutback. I hope the resources being invested in the health system will solve all the problems in that sector.

The Deputy made a point about beds and facilities. He said that people should be able to access step-down places. Nobody has said that the controversy about nursing home charges has caused the problems mentioned by the Deputy. The Tánaiste made the point, which I had made previously, that hospitals have argued that people are now less inclined to leave acute hospitals to go to nursing homes. That phenomenon has been reported by nurses — I presume they have also mentioned it to Deputy Ó Caoláin. I assure the Deputy, if he is interested in what we are doing rather than me giving anything else, that people are starting to receive the special home care packages to enable them to leave hospitals. Some 500 step-down places are being provided by the private sector and nursing home places for long-term stays will soon be contracted.

The Government has cut the home help service in half.

Out-of-hours services are being improved. As I said, access to MRI and CT scans has been increased.

Will the Taoiseach meet representatives of the Health Service Executive about——

I ask Deputy Ó Caoláin to allow the Taoiseach to conclude. There is no provision for a second supplementary question.

There have been no cutbacks.

There have been cutbacks in home help.

Of course there have been cutbacks.

The Health Service Executive——

The Government has cut the home help service.

The Taoiseach, without interruption.

Is the Taoiseach an ostrich?

The Deputy will leave the House if he does not behave himself.

He should take his head out of the sand.

If the Deputy interrupts once more, I will have to ask him to leave the House.

God forbid.

When one spends an extra €1 billion, one cannot refer to it as a cutback. It is obvious that the Deputy's mathematics are slightly different from mine.

The Government has cut home help in half.

The Health Service Executive is putting in place a permanent system of audit and inspection for cleanliness in acute hospitals. The system is already working. The Government has provided money for the acute medical units and an MRI scanner will be acquired for Beaumont Hospital this year. An eminent physician in this city said recently that the new accident and emergency unit in Blanchardstown, which has just been opened, is the best such unit he has seen anywhere in the world. Deputy Ó Caoláin should acknowledge the improvements which have been made.

Did the Taoiseach check the number of trolleys in Blanchardstown?

For the information of the House, we have gone over time by 12 minutes on Leaders' Questions this morning.

The Ceann Comhairle is losing control.