I make no apology for returning to the crisis in accident and emergency units, especially given the inadequacy of the Taoiseach's response yesterday. Surely the Taoiseach appreciates that for an elderly woman retained five days and five nights on a trolley in the Mater Hospital it is very little comfort when he rhymes off to the House his version of statistics about hospitals where he claims only a small number of patients are on trolleys. He stated that in the case of Monaghan General Hospital, nobody was retained on a trolley until Deputy Ó Caoláin informed him there is no accident and emergency department in that hospital.

Does the Taoiseach think the nurses who are members of the INO, SIPTU and other trade unions, are out protesting during their lunch hour behind picket boards because there is no problem? Does he accept that the crisis is acute in hospitals such as Tallaght, Beaumont, the Mater, St. Vincent's, Wexford, Galway and others? Does he agree that in a country where so much money has been raised in taxes, elderly people who have paid their taxes all their lives are entitled to be accommodated in hospital care with a minimum of dignity and this is being denied them? Fianna Fáil backbenchers have already started to mutter behind her back about the Tánaiste's competence. This is fine coming from a party whose super-clean hero has escaped leaving a legacy of €2 billion behind him and more health strategies and reports than the fiction department of Eason's.

The Deputy's two minutes is concluded.

What will the Taoiseach do in response to the INO request for his intervention, given what it calls a national emergency in accident and emergency departments in several hospitals up and down the country, details of which I am sure the Taoiseach has received, as I have, in my e-mail traffic since I raised this matter yesterday?

Since this matter was raised yesterday, approximately 3,300 people have been through the accident and emergency facilities. Thankfully, 90% of those people did not require trolleys but unfortunately 10% did. I regret that some people are spending several days on trolleys. It shows the system is not as perfect as we would like as we would like it to be 100%. I outlined to the House yesterday the hospitals where this problem is particularly acute and where long delays occur. I also pointed out that facilities have been improved in many areas. New facilities in Cork University Hospital opened last week which are two and a half times the size of the existing accident and emergency department. I opened facilities at Roscommon County Hospital earlier this year and facilities have been opened at Naas General Hospital. The new facilities at James Connolly Memorial Hospital have been described as one of the best accident and emergency departments in Europe.

There is a protest there at the moment.

I ask Deputy Burton to allow the Taoiseach without interruption.

The Labour Party provided the pickets.

We provided money to build it. The Government has failed.

This is Leaders' Questions. The Taoiseach is entitled to the same courtesy for his reply as Deputy Rabbitte was afforded.

Facilities at St. James's Hospital and at St. Vincent's Hospital will open shortly. The Mater Hospital is an acute hospital and will commence building a new hospital shortly even though it has taken the hospital some years to commence building. The Government has provided the resources.

Naas hospital is open with no staff.

I informed the House yesterday of all the improvement initiatives being undertaken this year by the Government rather than waiting for the longer term.

There are no results now.

Allow the Taoiseach without interruption, please.

Home care packages are being provided to support an additional 500 older people and which will free up beds. Step-down care beds are being purchased in the private sector for those in acute hospitals who are suitable for such care which will make beds available. Last December the Minister for Finance announced funding of €70 million. It is to be hoped the hospitals will get on with those projects because they were all announced last December.

The home help service has been cut in half and there are no disabled person's grants.

In reply to Deputy Howlin's question yesterday the capital programme will be finalised in the next few weeks.

It is very late because the session is nearly over.

The Government is endeavouring to deal with the acute problems in hospitals as speedily as possible. In answer to Deputy Rabbitte's question I do not believe the nurses are protesting other than that they believe there is a problem. Approximately 1,000 nurses work in accident and emergency departments and they deal with the daily problems. The Government needs their goodwill in order to extend rosters and examine the situation during the busy periods. Consultant and others must be encouraged to work more. People do not get sick at particular hours but rather at all hours. These issues must be examined.

If the Taoiseach knows this, why does he not take action?

These are industrial relations issues and hopefully the nurses and others will help us. Work cannot stop at 6 p.m. because people do not stop being sick after that time.

I wonder who is in charge.

Blame the nurses.

I do not think the Taoiseach appreciates the number of people who are suffering in distress and being treated in very undignified circumstances and the number of staff working in impossible circumstances. No category of staff other than frontline nurses and doctors would give the type of commitment that is being given in the conditions in some of these hospitals.

The Taoiseach talks about initiatives. For example, the former Minister for Health and Children, Deputy Martin, announced €170 million for the provision of 800 community beds in July 2002. However, not one of them was ever provided and the Irish Examiner, the Minister’s local newspaper, confirms they are cancelled today. The Taoiseach has also spoken about the home care initiative. I will read the relevant paragraph from a reply to an applicant for the scheme:

I wish to inform you that the allocated funding for this scheme is now fully committed and no additional payments can be made at this time. Accordingly, you have now been placed on a waiting list for consideration.

This is typical of the answer applicants receive to inquiries about the so-called initiative announced by the Tánaiste.

Applicants are being asked to wait 12 more months.

Where is the capital programme and where are the step-down beds? Where is the ten-point plan announced by the Tánaiste in terms of its efficacy in these circumstances? The Government parties have been in office for eight years but people are still expected to work in circumstances akin to Third World hospital care facilities. People in pain are kept overnight on trolleys in many hospitals while the Taoiseach continues to rhyme off statistics about what the Government has done in an economy that for more than 12 years has been expanding at a rate unprecedented in the history of this State.

On a point of order, I wish to clarify for the record that we are treating accident and emergency patients in Monaghan Hospital, albeit in a treatment room. Some 11,000 patients are treated annually. This morning we had to cancel operations for want of beds in the hospital.

There can be no point of order on Leaders' Questions except by the leader asking the question. I ask Deputy Connolly to resume his seat or he must leave the House.

We can talk about many issues but I am concerned with areas in which practical help can be given. I will not leave one point go.

The Taoiseach must bring the situation to an end.

From the time this issue was raised yesterday, approximately 3,300 people have used our accident and emergency facilities. Some 90% of them did not have to be accommodated on trolleys.

It is senior citizens who are being left on trolleys.

Deputy Broughan should allow the Taoiseach to continue without interruption.

It is regrettable that it was necessary to accommodate 10% of accident and emergency patients on trolleys.

These people have worked their entire lives. Some of them are the Taoiseach's own constituents.

Deputy Broughan will be removed from the House if he continues to interrupt the Taoiseach.

This is why we are investing excellent resources to try and improve the situation. In many hospitals, including Cork University Hospital, Roscommon Hospital, Naas General Hospital, James Connolly Memorial Hospital, St. Vincent's Hospital and the new building in the Mater Hospital, we are constantly trying to improve facilities.

Has the Taoiseach been in the Mater Hospital lately?

The home care package is there to suit the needs of patients in order to facilitate their move from hospital care.

We need a hands-on approach.

In total, this initiative will provide support for an additional 500 older people this year. People are already being moved from acute beds into top-class nursing homes, private facilities in most cases. The Government will continue to work in this regard. We are buying beds from the private sector for step-down care. Provision is being made now rather than next month or the month after for hundreds of patients who no longer need to stay in hospital but require some intermediate care for up to six weeks before going home. This process is well under way.

We regret that there are people still on trolleys but we are actively working to improve facilities and the standard of care available.

What will the Taoiseach do to improve the situation this evening?

I said yesterday that proposals are being finalised in regard to improvements in acute medical units for non-surgical patients in Tallaght, St. Vincent's and Beaumont Hospitals. Hopefully the hospital management teams will work to best use the money given to them by the Minister for Finance for the initiatives announced by the Tánaiste.

We have also tried to improve access to GP services, an area of considerable importance. Unfortunately, no GP services are available after 6 p.m. in some parts of Dublin city. This has begun to change, however, and we are providing assistance in this regard.

Patients must pay €65 for an evening call from a doctor in central and west Dublin.

The Taoiseach should be allowed to conclude without interruption.

The package we have put forward, including the provision of MRI facilities for diagnostic tests and the screening facilities in Beaumont Hospital, represent practical actions. We are trying to take action that will help the situation rather than holding a protest.

We should put some of the Government spin doctors on night duty in hospitals. There is no shortage of such persons.

Some Deputies seem to be able to spin themselves off the front bench.

We should put the spin doctors on duty after 6 p.m.

I have called Deputy Joe Higgins and he should be allowed to speak without interruption. Deputy Ring is not the leader of the Technical Group.