The Health Service Executive is to withhold payments due to nurses and midwives under the Sustaining Progress agreement and under benchmarking, which fall due on 1 June. What is the Minister's view of what I can only describe as very provocative action? Is he aware that this threatened action by the HSE has evoked a very strong response from the Irish Nurses Organisation, that is, to consider industrial action? Will the Government intervene to encourage the HSE to withdraw immediately its threat to withhold these payments as of 1 June? Will he further encourage the HSE to re-engage with the INO in its ongoing negotiations on health care assistant training programmes and the other outstanding matters? Much has been resolved, although some matters remain to be addressed. Will the Government intervene with the HSE to avert the situation, which is already at crisis point in accident and emergency units, from deteriorating further, with all the serious consequences of industrial action in our hospital services throughout the State?

Will the Minister join me in commending the INO on its campaign, Enough is Enough, which is bringing greater public attention and awareness to the ongoing crisis in our accident and emergency units? Is the Minister aware that as of yesterday, there were 181 people on trolleys in accident and emergency units in various hospitals throughout the country? Can the Minister advise us whether the Tánaiste's so-called solution or part solution to this problem, that is, making further beds available in the already difficult ward situations in hospitals, has made any contribution to alleviating the current crisis? What information can he share with the House regarding that proposition from the Minister for Health and Children?

On the first matter, I understand that is an industrial relations issue that is being dealt with through the usual industrial relations machinery. I hope, as has been the case in the past, that might provide a means by which those issues can be resolved peaceably in an industrial relations sense.

Regarding accident and emergency services, over 1,240,000 attendances are recorded at the accident and emergency services for 2004. That is, on average, 3,300 people per day. As the Tánaiste said, we are committed to improving the experience of patients through sensible and achievable measures. It is not simply a resource issue, although it is so in some cases. As I said here previously when asked about this matter, there is need for co-operation in terms of internal reorganisation of the provisional delivery of services in our acute hospital system if we are to deal with that issue.

They need more beds.

It is not simply a question of beds because more beds have been provided. There is far more throughput of day cases now than was the case in the past.

There is a shortage of beds.

Order.

The Tánaiste indicated in her ten-point plan the short-term measures she wishes to take to deal with those aspects of the service causing greatest difficulties. It is her intention that they will make a difference. She is in the process of getting on with that with the HSE, hospital management, staff and unions to ensure that happens successfully. However, there is a whole range of issues that are inter-dependent in terms of the proper delivery of our health services. It is clear that the availability of general practitioners at all times for primary care services is critical, as is the need to internally reorganise the way we deliver those services within the acute hospital sector. If we can provide the necessary environment and co-operation for that to happen, we can and will see real improvements because the resources have been improved and will be further improved in the future.

The Minister must recognise that it is Government's responsibility and duty to help avert a deterioration of the situation in our accident and emergency units throughout the country and across the range of hospital services, which industrial action would undoubtedly precipitate. Is it enough to say this is a matter of industrial relations? The Health Service Executive and the Government must be aware and acknowledge that the INO has engaged in a very focused and determined way to overcome all the difficulties relating to the health care assistant training programme and related matters. As I said in my initial questioning, it has made significant progress. There are matters outstanding, but against the backdrop of the threatened withholding of payment to nurses and midwives from 1 June, there is now a poisoned atmosphere. This is not a climate that will be conducive to realising the necessary focused engagement between the HSE and the INO.

Does the Minister not recognise that this issue requires intervention at this point, not post the debacle visiting each and every one of us? Will he not also, in recognition of the major contribution nurses, midwives and the INO body make to the overall delivery of health care services in this State, accept it is the duty of Government to take cognisance of their expressed concerns and act accordingly? I do not believe the HSE can depend on Government as a crutch for any and every move it chooses to take. There is a responsibility on Government and on all voices in this House to ensure the crisis of such proportion that threatens is averted. I appeal to the Government to intervene to ensure this matter is addressed positively and sincerely so that the ongoing engagement will be under way and payments will not be withheld on 1 June.

As I said in a previous reply, the question of ministerial intervention as the solution to the problems being spoken about does not comprehensively deal with the issue. Full co-operation from everybody is needed to deal with the issue that has arisen recently in respect of accident and emergency services. The industrial relations machinery should be utilised by everybody for the purpose of finding solutions to these problems. I reiterate, however, that these problems will not be solved on the basis of status quo plus. They will continue to revisit the service if we do not overhaul and reorganise the way we deliver the services in the acute hospital system and how that relates to the availability of primary care, and ensure that people who present to accident and emergency units require the services in those units.

I saw a statistic recently which indicated that four out of five people who present to accident and emergency units are not admitted to hospital. We must ensure that the accident and emergency services that are required by the people who need them are available. We must ensure also that other parts of the service outside the acute hospital sector meet their responsibilities in dealing with patients who do not require accident and emergency treatment or hospital admission. Hospitals are for acute admissions.

We must ensure also that where problems arise in accident and emergency services, hospital management gives priority to reducing elective admissions so that the immediate short-term problem can be dealt with. We need co-operation on the part of everyone to ensure that those who require accident and emergency services get them. It must be said that those experiencing genuine emergencies are dealt with in the health service but we must ensure also that where service pressures arise, elective admissions are reduced to allow those emergencies to be dealt with. That is the way to deal with this issue sensibly, but it requires the co-operation of everybody.