Following our day of double apology I wish to return to the situation in accident and emergency units around the country. After nine years in power with access to unprecedented funding the Government has failed miserably to provide the most basic frontline health services for people.

The Taoiseach is fond of quoting statistics, but he will be disappointed to hear that yesterday 314 people were on trolleys and chairs in accident and emergency units around the country. What is the status of the ten-point plan introduced by the Tánaiste, which was intended to deliver real improvements in accident and emergency units by last November? Last weekend Professor Drumm, chief executive of the Health Service Executive, said it would be at least two years before the problem could be resolved and that the situation now is worse than it was three and four years ago.

The Government has spent almost €60 billion on health services, a tripling of expenditure, but the service in accident and emergency units appears to be going backwards. Given that the same number of people are attending accident and emergency units as in 1998, can the Taoiseach offer any credible explanation for the behaviour in those units?

What is the Taoiseach's response to the shocking findings of a recent survey of accident and emergency units, including that in nine hospitals there were 900 assaults on staff, patients and visitors in these units? These attacks occurred when staff tried to break up fights, and when they were assaulted by patients high on drugs or intoxicated with alcohol. In one case a nurse was held at knife-point, in another a patient was stabbed in a cubicle and in a third a nurse was kicked in the abdomen.

The frontline staff in accident and emergency units must bear the brunt of the failure of the Government's commitment and promises to provide the safety and services that the people should expect. They deserve better than this. What measures will the Taoiseach take to see that this situation improves? Does he accept Professor Drumm's explanation that nothing will happen to bring about any real improvement for the next two years? Are these appalling and shocking stories to continue day after day, of people sitting in plastic chairs as closely packed as the seats in this Chamber, inaccessible to the comfort of seeing their relations, friends or families? Surely in 2006 we should be able to do better in accident and emergency units.

I will make a couple of brief points first. Deputy Kenny is correct in saying we have provided significant resources for the health services.

The taxpayer has provided them.

That is surprising.

We are still short.

I managed to complete one sentence without interruption. The Opposition should stop interrupting and let me speak. We have put in the resources and the staff. There have been significant improvements throughout the health service, in the level of cancer care, in paediatric medicine and in most of the difficult specialties there have been major and growing improvements.

I accept the accident and emergency units have not been as successful but in many of these units there has been success. The newly-built units are very good. I will not go into the figures for the number of patients on trolleys.

Of course the Taoiseach will not go into those.

My figure is not the Opposition's figure. I get a different figure.

We need 500 new beds.

That row goes on every day.

That's the problem.

The figure I received for yesterday was 190. Deputy Kenny asked what we are doing about this.

Nothing.

It is important that we make steady and substantial progress for patients. It is not acceptable to, or accepted by, Government that people, particularly older people, must wait a long time on trolleys before admission.

Why are so many beds closed?

This affects their dignity and other issues arise. The ten-point plan, which involves a focussed implementation of actions, is under way. We are helping older people move out of hospitals when they are medically fit to leave. The home care package and the enhanced nursing home subventions——

There cannot be a home care package.

There is no home care package.

Allow the Taoiseach to speak without interruption.

A total of 530 people have already received the new supports.

It is only 20 minutes a day.

Many more will do so in the months ahead. We are working with the HSE to provide more home support to help people avoid admission to hospital.

Where?

There are no home supports.

We are also supporting the HSE's comprehensive flu vaccination campaign. We are providing step-down facilities for immediate care. To date 562 people have moved out of hospitals. The HSE provides 48 high-dependency long-term beds for the more severely ill. We are also putting in place an out-of-hours GP service and as I said previously, we have opened a new accident and emergency unit in St. Vincent's Hospital, the accident and emergency development and extension to St. James's Hospital is almost complete and a new accident and emergency admissions unit opened at the Mater Hospital in December, a 33-bed overflow unit. It closed last week because of the winter vomiting bug but has now re-opened.

I have had lengthy meetings on this issue with HSE personnel. They tell me that in Dublin hospitals, admissions to accident and emergency units have increased by about 20%, admissions of older people have increased substantially and twice as many people presented with influenza in the past six weeks compared to this time last year, because of the colder weather. Winter vomiting has been a feature every year.

Why?

The HSE has got clearance for another 250 private beds which will take long-term public acute patients. That is in addition to the 250 beds provided in November. The HSE informs me that it gets a benefit of about three months when the patients are removed. Older people then fill those beds and the difficulty recurs.

Deputy Kenny's last point is valid and the HSE is prioritising it. The HSE is trying to deal with the issue of comfort and dignity and sanitary requirements. Hospitals have made a number of proposals which the HSE is trying to deal with under the capital programme for this year, which should help. Some work has been done in the area but there is work to be done in hospitals in Letterkenny, Wexford, Tallaght, the Mater and Beaumont in terms of increasing bed numbers. I hope this will be helpful over the course of this year. It is not a matter of resources, which are available in all these cases. It is a matter of moving on and completing the plans.

Over the past few months I have visited, as no doubt the Taoiseach has, quite a number of accident and emergency units throughout the country. The Government seems to miss the point that older people filling hospital beds are not there by choice. If the health system was properly planned and was in a position to deal with their requirements it would provide better facilities for them to be at home, where they want to be, so they would be in hospital only for the shortest possible time. I do not know if the Taoiseach and his Ministers appreciate the level of fear people have about going to hospital in the first place — fear of infection, of picking up some ailment other than what they are going to have attended to in hospital. That is a genuine fear among the general population.

What has happened to the three special injury units which were to be provided in 2005 and to the nine 50-bed convalescent units which were to be provided as step-down facilities? There should surely be some joined-up thinking between the Department of Health and Children and the Department of Justice, Equality and Law Reform. It is intolerable that as a consequence of the new social phenomenon of total abuse of alcohol and drugs, accident and emergency units in almost every hospital are visited at weekends by drunks and their hangers-on, who go there to cause intimidation and assault on front-line staff, who must bear the brunt of the Government's failure in this regard. Is it time that assaulting a member of staff in an accident and emergency unit was classed as a particular offence? Is it time for us to have special rooms, wet rooms as Deputy Twomey calls them, where people can be allowed the privilege of sleeping off their intoxication and be charged handsomely for that privilege? Their friends and hangers-on who cause assault, fear and intimidation of staff and patients must be removed from accident and emergency units. Is it time we realised the current situation is worse than it was nine years ago? How can the Taoiseach say the situation is improving when we know that the number of people attending accident and emergency units is the same as it was years ago, and that people are now attending in situations of far greater chaos, and with a greater sense of fear and intimidation? I raise this issue because front-line staff in all those units are bearing the brunt of public frustration at the Government's failure to plan properly for health situations and provide facilities and a service for people when they need them most. People deserve better.

There are more than 1 million inpatient hospital visits annually and thankfully, every bit of research shows that people in hospital in this country find the services and resources provided very satisfactory. There is a very high regard for all areas of the health services. People fear hospitals as they fear dentists and doctors but they are not fearful in the manner expressed by Deputy Kenny. We have a very good inpatient and day patient service. The accident and emergency area has always been a problem. It is not today or yesterday that drunks began to come to accident and emergency units, though it is only in the past 20 years that we have seen drug users attending them. It is true we now have a violent element, and gardaí are almost permanently based in the city hospital accident and emergency units. Security personnel have been there for many years.

In December 2004 we provided money for the acute medical units at Tallaght, Beaumont and St. Vincent's hospitals. The HSE then set up a mapping report for these rather than building them straight away, but they are building them now. I am sure there were good reasons for the delay, but they were not clear to us at the outset.

With regard to step-down places for immediate care, so far there are facilities for 562 people to move out of hospital into private care. I understand there is plenty of capacity in the private sector. The HSE told me yesterday it is now taking another 250 patients out of the acute public beds and putting them into longer-stay private beds. There is a cost element to that and Deputy Kenny is aware as I am that the old system whereby people came out on subvention, which existed up to the Supreme Court decision, has almost ceased. They are not moving, but waiting until they get the private facility. That is a fact of life and we must deal with it.

It is all to do with big business.

Deputy Kenny also made a point about older people wanting to move out of hospital when they are medically fit and raised the issue of home supports. In the last budget we provided large resources to the HSE in an attempt to help people stay at home and have more comprehensive facilities there.

The Government is fooling only itself.

We have provided such facilities. The senior official in charge of this process at the HSE has set up a task force which includes accident and emergency consultants, respiratory consultants and geriatricians — front-line staff who know the area well. They are also bringing forward proposals on the dignity issue. It is unacceptable and unnecessary that there are sanitary problems with regard to chairs and trolleys. In the past few years, some of the hospitals put forward proposals which were dealt with. In the hospital I know best, the Mater, a very good new accident and emergency unit opened in December, with 33 beds. There was chaos there last week because of the vomiting bug and the unit closed, so the burden fell back entirely on the old accident and emergency unit, which was designed for a different century. The new hospital at the Mater should have started at Christmas but because of the paediatric issue it has not yet started. Hopefully it will start when it is decided where to locate the paediatric unit. That is not the fault of the Government as we provided the money two or three years ago.

In Letterkenny an 11 bed unit will open this month, later in the year a 30 bed unit will open, in Wexford 19 beds will be opened this year and in Tallaght a 41 bed unit will be opened. In regard to capacity expansion the HSE is looking across the health service where there are other difficulties. I have mentioned the areas where there are problems. In all the other hospitals, for example, in the new unit in Cork, St. Vincent's Hospital, and Blanchardstown, huge progress has been made and there have been few complaints. Obviously that changes when the figures for flu and the vomiting bug increase.

Deputy Kenny asked what is the difference between now and a number of years ago. There is one difference between now and a number of years ago. The number of people of an older generation presenting at accident and emergency units is increasing. Obviously we have to deal with that. It is unsatisfactory that we do not have a general practitioner service after 5.30 p.m. That is forcing people——

The Government is delaying it.

We are not delaying it. The Government is quite prepared to——

Deputy McManus, this is a Fine Gael question and not a Labour Party question.

——pay people to work after 6 p.m. and is prepared to pay for the general practitioner service. We have to get people to work. I hope we will get co-operation in the talks that are taking place. It is a fact of life, and I do not say this in a cynical way, that people do not stop getting sick at 5 p.m. or 1 p.m. on a Saturday. What we need in the negotiations is the co-operation of front line people to work those hours. They are not being asked to do that for nothing but for payment.