We meet on a day of national emergency. The matter of accident and emergency units has been raised on at least two dozen occasions in the past two years by the leaders of the Opposition parties and by other Members on this side of the House. I wish to ask the Taoiseach and the Tánaiste the question that is on everybody's lips about this matter. When did the penny drop with the Government? Was it the doctors, nurses, patients, their relatives, the constant radio phone-ins or Brendan Gleeson? It was none of these people. The realisation of the accident and emergency problem has come about because for 17 opinion polls in a row, the Taoiseach's party has been languishing in the mid-30s. This national emergency is driven by a sense of political desperation. The Minister for the Environment, Heritage and Local Government, Deputy Roche, can smirk all he likes——

I was thinking of Deputy Kenny's 30 years in the Dáil.

Deputy Kenny, without interruption, please.

——with his unbridled arrogance, but it is no joke for the——

I am laughing at Deputy Kenny's smugness.

——384 people lying on trolleys today.

Deputy Kenny is the only joke here. Thirty years with nothing to show for it.

The Minister should allow Deputy Kenny to speak without interruption.

The Minister for the Environment, Heritage and Local Government and his lot have sat around the Cabinet table for nine years and it was only yesterday that this became a national emergency in the eyes of the Tánaiste. On 12 October 2004, I asked the Tánaiste, Deputy Harney, what would be her political priorities upon taking office as Minister for Health and Children and she said:

One of the priority areas is accident and emergency units. It is unacceptable that people have to spend upwards of 12 hours on a trolley.

In 2006 this becomes a national emergency, the penny has dropped. The realisation is clear around the Cabinet table——

The Deputy's time has concluded.

——that the people have had enough and do not want any more of this Government, which has proven itself to be completely incompetent in dealing with this matter. Is the Taoiseach prepared to apply to his Government, the targets that the Tánaiste——

A return to the days of Deputy Noonan.

I ask the Minister to allow Deputy Kenny to conclude.

The Minister for chewing gum is at it again. His conceit and arrogance are unbridled in the history of Fianna Fáil Governments. Without interruption from the Wicklow hills, when can we expect to see real improvements in the accident and emergency units? Will it take one month or six months, or is this another false dawn like all the other false dawns we have had from the Government in the past three years? In the poorest countries in the world, for instance in Peru, people bring their own drugs to hospital. In a country that is knee-deep in financial wealth it appears that people here need to bring a bed or chair to a hospital. While the Minister for the Environment, Heritage and Local Government, Deputy Roche, might not like that, it is almost a fact of life.

Last Wednesday, Deputy Kenny asked if we could give a greater sense of urgency to the implementation of the ten-point plan and to dealing with the excessive number of people who, unfortunately, are wrongly waiting in some of our accident and emergency units. More than 1 million people a year use accident and emergency units, which is approximately 3,500 people a day. In spite of the enormous resources and huge improvements in many of the hospitals — the new accident and emergency units in St. Vincent's hospital, in Cork and Blanchardstown, and stand-down beds in many other locations — there are still problems in some areas.

Last week I told Deputy Kenny that the Tánaiste was about to set up a task force of some of the key specialists involved to try to complete the implementation of the ten-point plan in the areas that are not yet done and to try to get better co-ordination and co-operation across the medical and nursing sectors to resolve the difficulties. We have put in the resources, as I indicated last week. In the areas where there are still difficulties, the Government has made clear we are prepared to put in extra resources. I pointed out that many of the key hospitals have put forward short-term, medium-term and long-term plans. Many of the short-term plans are complete, like the one I mentioned last week in the Mater, and other units have opened up. Some medium-term plans have been implemented and others are being implemented — the issues are resolved in the areas where they have been implemented. There are some long-term ones that are still required. I pointed out that in many of the hospitals, this year will see additional beds.

I made the fair and valid point as to why we are still having difficulties despite having put in so many resources. As I said last week, the admissions in the early months of this year have been up by more than 20%. We have an older population, who, in the obvious sense, require better services. In the early weeks of this year, we also had the flu difficulties and the winter vomiting bug which affected and closed down units in some areas.

We have that every year.

There is overcrowding in the hospitals.

We have had nine years of Fianna Fáil and Progressive Democrats Governments.

There are a number of old people in beds who need to be taken out of the hospitals. They are not able to go home.

They are sick.

They are medically cleared to go home by their physicians, but they are not, for one reason or another, able to go back. We need to provide alternative accommodation for these.

Why does the Government not provide that accommodation?

Allow the Taoiseach to speak without interruption, please.

We provided 250 beds in the autumn and we provided another 250 beds.

It is not enough.

As the Tánaiste made quite clear yesterday, in our various home care packages and health packages, we will continue to do that.

We have heard most of this before. The Government has decided and agreed——

Is the Taoiseach saying——

Allow Deputy Kenny to speak without interruption, please.

Deputy Burton should stop interrupting Deputy Kenny.

The Government has decided and agreed, and accepted the repeated observations by parties on this side of the House, that there is a national emergency in so far as accident and emergency units are concerned. We have heard nothing from the Taoiseach on behalf of the Government as to the Government's plan to deal with capacity. What is the target for capacity? There seems to be confusion about the number of beds which are required. Why has the Government not dealt with the acute medical units which were supposed to be put in place under the Tánaiste's ten-point plan or the after-hours GP service, both of which would relieve stress on accident and emergency units? There is no reference to such matters in the plans to deal with this national emergency, which requires a national response.

It is interesting to note that the Tánaiste said in an interview yesterday that there were 500 people on trolleys in hospitals three weeks ago. She rightly said that it was completely unacceptable. Given that the figure she cited had been issued by the Irish Nurses Organisation, can we take it that yesterday's figure of 384 is also correct? Is the phoney war between the HSE and the Department of Health and Children, on the one hand, and the INO, on the other hand, now at an end? Does the Tánaiste accept that the figures issued by the INO are correct?

The Tánaiste's statement that the problems in accident and emergency units constitute a national emergency represent a complete reversal of the Taoiseach's claim that there is no crisis in the health service. We found out yesterday that the HSE is happy to accept that there should be a waiting period of 24 hours, rather than 12 hours, in accident and emergency units. This is completely unacceptable. The Tánaiste, who has been Minister for Health and Children for 18 months, said when she took office that accident and emergency departments were her first priority. The ten-point plan she set out at that time has since been abandoned, clearly as a result of a difference of opinion about hospital capacity figures. Responsibility for matters of this nature is being deliberately hived off to the Health Service Executive.

Hear, hear.

No questions are being answered in this House and nobody is accepting political responsibility for the problems about which we are speaking. It has suddenly dawned on the Government after nine years that this is a national emergency. The Tánaiste's statement yesterday was not driven by political sympathy for patients who are lying on trolleys today and every day, but by political desperation. The Government knows that the people are waiting for the members of its parties when they next seek their support. It has failed to use this country's unprecedented wealth and resources to provide proper services for the people. As they say in the medical profession, the Government is "TATT"— tired all the time.

Deputy Kenny knows I will not rise to any of his political charges, but I will give some of the facts.

The Minister, Deputy Roche, would rise to them.

The Taoiseach will rise to them when he meets the people on the streets.

We have moved health——

Backwards.

——in recent years. We have increased the health service budget from €3 billion to €12 billion. The fact that we did not realise that it required——

We never doubted the Government's ability to spend money.

If I am allowed to answer Deputy Kenny's questions, I will be happy to do so.

The Taoiseach should answer the real questions. We know the Government is able to spend.

Deputy English is here today.

It is nice to see him earning the few shillings today.

I will still be here next year.

I ask the Ministers to allow the Taoiseach to answer without interruption. Deputy English, please——

I have to answer the Ministers.

You do not have to answer them. You have to keep quiet and allow the Taoiseach to answer. Your own leader went four minutes over his time.

The Minister, Deputy Roche, went two minutes over time as well.

The Taoiseach is entitled to be heard without interruption and the Chair will insist on it.

The Government can spend the taxpayers' money, but what else can it do?

I remind Deputy Kenny that the Government has recognised since it took office that additional resources are required. That is why the health service budget has been increased from €3 billion to €12 billion. This year's health service capital programme is worth €500 million, as it has been every year in recent years. We have finished many units. St. Vincent's hospital is almost a new hospital. Similar investment has been made in hospitals in Cork, Galway and other places throughout the country. An additional 35,000 staff have been employed in the health service. Some 3,000 people who would not have been helped previously will benefit from the home care packages this year.

What about home help hours?

Deputy Kenny has spoken about the number of people on trolleys, but I am sure he knows the reality is that 411 people have been medically discharged from the main hospitals in this city — they have finished their entire treatment in this city's acute medical hospitals — but they cannot go home for a variety of reasons.

Why?

That is the responsibility of the Government, which did nothing——

The Taoiseach, without interruption, please. The Deputy will have an opportunity.

The Government cut home help hours.

The problems are the direct result of the Government's actions.

This is the Fine Gael question and the Deputy is not a member of that party.

He might as well be.

He is getting closer.

Why do we not talk about Deputy Stagg's actions?

We have provided private beds for the patients in question. We provided 250 beds before Christmas and we are providing a further 250 beds now. We have had to buy private accommodation in which these people can be located. That is the only way to free beds in accident and emergency departments so that people can move through the system. I will outline what the Tánaiste has been doing for the past 18 months——

She has been making up for the ineffectiveness of her predecessor, Deputy Martin.

——and what the Government has been doing in recent years. We have been trying to improve bed capacity, employ more consultants in accident and emergency units and increase the extent to which nursing and other services are provided in such units. As the Tánaiste said yesterday, we need the co-operation of the medical services in other areas, such as diagnostic services, so that people do not have to wait several hours for a fairly simple x-ray or other procedures. We should ensure that enough staff members are available at weekends to provide diagnostic services and improve patient flow.

The Government should do something about it.

We cannot do such practical things without the co-operation of the paramedical, nursing and medical staff.

The Government has been in office for nine years.

There is no difficulty with paying such people, but it can be difficult to get their co-operation in helping us.

It is everybody else's fault.

The Taoiseach is blaming the staff.

As I said last week——

He is blaming the nurses.

Nine wasted years.

Allow the Taoiseach to conclude, please.

He is blaming the nurses.

He could blame the Labour Party Members.

Nobody is blaming anybody. The Opposition Members want to make political points, but we are trying to solve problems.

Hear, hear.

Come on now.

Why not blame the patients?

The only——

Who will the Government blame when it is facing the electorate?

Allow the Taoiseach to continue without interruption.

Ask Mr. Fitzpatrick.

The only fear the Opposition has is that we might resolve this issue. What we want to do is solve the issue and we will continue to do that.

There is no fear of that. The Government will not solve it in this century.

I call Deputy Rabbitte.

Ask Mr. Fitzpatrick. He wants to close all the hospitals.

The Government will not——

Deputy Ryan should allow his leader to speak without interruption.

Half of the beds in Monaghan General Hospital have been closed.

Mr. Fitzpatrick wants to close them.

Whatever the Taoiseach says——

The Minister, Deputy Roche, should concentrate on polishing his rusting ballot boxes.

What about the Deputy's valuable contribution on the health board?

Deputy Rabbitte, without interruption.

The Deputy's party will not allow anybody else to talk.

On a point of order, I ask my colleagues to allow Deputy Rabbitte to speak, but I ask Deputy Rabbitte to ask his colleagues to allow me to speak.

Hear, hear.

They find me less provocative.

Nobody is being provocative. You have campaigned that every time I speak, your colleagues——

Rubbish.

I can do the same.

Deputy Rabbitte should not underestimate himself.

I will ask my colleagues to stay quiet for Deputy Rabbitte, as they should, but he should ask his colleagues to stay quiet for me.

Why can the Minister not stay quiet?

He is acting like a bullyboy.

It is a simple matter.

Deputy Rabbitte should not underestimate himself.

Let him speak.

The Taoiseach has rhymed off a number of statistics and practical things which he claims the Government is doing. Is it not the bottom line that whatever the Taoiseach thinks the Government is doing is not working? Is that not why the Tánaiste and Minister for Health and Children has declared a national emergency, nine years after the Government took responsibility for the health services? The last national emergency related to an outbreak of foot and mouth disease. It is not plain why the national emergency in the accident and emergency services has been declared at this time, after nine years in which there were two Ministers for Health and Children from Fianna Fáil and one from the Progressive Democrats Party.

Can it be the case that they have realised that the people are dissatisfied with the health services, just as Mr. Haughey discovered when he went on the election trail in 1989? We have been telling the Government for a number of years that the people are not happy with the health services. The ten-point plan that was announced by the Tánaiste in November 2004 has not worked — the situation has got worse. According to the Irish Nurses Organisation, there were 384 patients on trolleys yesterday. That is the position. Why has the Government now recognised that there is a national emergency in this area? Does it relate to the imminence of the next general election?

Yes.

The situation in accident and emergency departments is worse than it was when the Government took office. Will the Taoiseach tell the House whether there is agreement or consensus among the stakeholders about the diagnosis of this problem? Specifically, has the Government, particularly the Minister for Health and Children, reached agreement with Professor Drumm about the solutions to the problem? The rest of us who are able to keep up with the debate hear conflicting analyses and recommendations.

Hear, hear.

Professor Drumm says one thing, Deputy Harney says another. The Tánaiste is beginning to take on the bewildered bystander persona, so affected by the Taoiseach. She was on television last night to say this was something which we cannot put up with, as if she had not responsibility for it or as if somebody on this side of the House was responsible. Who has been in Government all those years? We have now moved from a Minister for Health and Children who does not read his brief to one who cannot handle her brief. We have reached the stage where the Taoiseach's backbenchers are sniggering at the fact that the two PD Ministers are up to their arms in trouble everywhere they look. The backbenchers are beginning to enjoy it. Meanwhile, unfortunate patients, including the aged, are kept in the most inhumane undignified circumstances in hospital corridors, in accident and emergency units all around the country. There were 384 of them yesterday, and the Taoiseach rhymes off statistics about what it is he thinks he is doing. Whatever he is doing is not working. If this national emergency plan makes an assault on this serious problem, it has our full support. However, why should this plan be successful when all of the others failed? We had the ten-point plan in November 2004 and it did not work. Why should this one work?

I reiterate what I have said a number of times. We are talking about the problems in the accident and emergency service. It is internationally recognised that this country's health service is very good. Because of it people are living longer and getting hospital treatment faster.

The Taoiseach is full of excuses.

They are getting to see far more specialists. They are working in much healthier workplaces and we are dealing with disabilities and a range of other services far more effectively. Across the cancer, cardiac and paediatric services there are enormous improvements of which the staff involved and the country should be hugely proud. There are well over 1 million inpatients, over 500,000 day patients with more than 1 million going through accident and emergency units. The point is that one important facet, namely accident and emergency, which has traditionally been a difficult area for the health service, is not up to standard we want in all the regions and hospitals. It has been Government policy to deal with that issue. Over a number of years, in different ways, we have dealt with a whole range of issues, for example increasing the number of consultants. This was not formerly the situation. There was only a handful of them in the country in 1997, while now there are dozens in our hospitals. We have not yet got them to work after 6.30 p.m., but these are issues we are trying to deal with. There are additional nurses and in all we have given 35,000 additional staff to the health service, a large proportion of whom have been allocated to accident and emergency departments. We have provided 1,500 beds for respite care to deal with these issues.

However, the population of the country is getting older. Many general practitioners do not want to work after 5.30 p.m. If no GP services are available after 5.30 p.m.and there are no consultants in accident and emergency departments after that time, one can see why there are problems. We are trying to deal with those problems. I have never said there is not a problem in accident and emergency. I have defended the health service and we are trying to put in the resources, staffing and free-flow arrangements in an attempt to improve those areas which still face difficulties. In St. Vincent's Hospital and in hospitals in Blanchardstown, and in Cork and Galway where the excellent facilities have been built, we might not have solved all the problems, but we have seen improvements.

Deputy Rabbitte knows as well as I do that life, time and circumstances are changing. There was a time when families and everyone concerned wanted to get people home from hospital. There are other pressures nowadays, and that is how it is. This means we now have to deal with matters differently. We are doing our utmost and asking people to co-operate with us. We did not realise this today or yesterday. I realised it when I worked in the Mater Hospital 30 years ago, and I am trying to do something about it now.

Hear, hear.

The difficulty is that the Taoiseach is out of touch. He probably genuinely believes what he is asserting. However, he is completely out of touch with what is happening on the ground and in the wards. He should know better than most that 3,000 beds were taken out of the system in 1987-89 by his predecessor, Charles Haughey. How can he make an argument to me about the population increasing since then, people living longer etc., while not acknowledging that the nub of the problem is that those 3,000 beds were taken out of the system in 1989? He seemed to acknowledge it in the Ballymascanlon strategy when the previous Minister for Health and Children pledged the restoration of those beds and a €7.7 billion programme. That was scrapped as soon as the Taoiseach appointed his new Minister for Health and Children. I cannot figure out whether the view is that we do not need any beds. That is what I appear to be hearing from Professor Drumm, who seems to be making policy as well as being responsible operationally. The Tánaiste seems to concur with that except that she will provide tax incentives for investors to build beds on the campuses of public hospitals.

What is the net Government position on the critical question of bed capacity? How can one deal with a population that has increased by more than 500,000, where people are living longer, medicine has become more advanced, and where we have fewer beds? Is that not the net issue? What is the response to that? Will the Taoiseach say what exactly is in this national emergency plan that is different? When the Tánaiste says that she is going to target resources at the HSE for improvements to be made, does that mean there will be a Supplementary Estimate for health? How much money exactly will be targeted for the elimination of the accident and emergency crisis? What in particular is the Tánaiste offering that is different from what she offered in November 2004?

The Deputy's time has concluded.

After three Ministers and nine years, the best this Government can do to alleviate the accident and emergency crisis is to declare a national emergency. I am merely asking the Taoiseach the elements that are different in this plan as compared to its predecessors.

Deputy Rabbitte asked me a number of questions. There are 1,000 more beds in the public system in the last three years alone. I do not have the figures back to 1997. Some 500,000 patients are being dealt with effectively and efficiently by the medical services on a daycare basis. It was a fraction of that ten years ago. Thankfully, the same acute highly sophisticated hospital beds are no longer needed, as in the past, since the system has been modernised. That is the point Professor Drumm is making. We have the ability to take people in as day cases. Hernia operations are now performed on a one-night basis. They took ten days when I worked in the health service. Cardiac surgery could have taken six weeks and now people are being moved out after five or six days. These are major improvements in the service. The Deputy referred to the problems of 1989. There were problems with the entire health service because it was under-resourced. That it why we raised the health service budget from €3 billion to €12 billion. It was under-staffed and that is why we put over 35,000 more people into it.

On the beds issue, I again ask Members to please listen to the point I am making. The figures were higher when the winter vomiting bug was at its height and with the 'flu epidemic in January and February, because I watch the statistics every day. Today, 411 patients in this city are being medically discharged. Traditionally, such patients would have gone home, but they cannot do that. That is why we have been using——

——for a range of issues——

We know that.

The Taoiseach should be allowed to speak without interruption.

A total of 3,000 home care packages will be provided this year alone. That is why we are using a good number of the 2,500 private beds that are available. In total there are 16,000 beds in the health service — 13,500 public beds and 2,500 private beds. I do not like using the medical term that is applied to people who are in beds in that situation.

They have nowhere to go.

I am answering. The Deputy knows what is the difficulty.

The Taoiseach is not answering.

Some 411 people have to be put in——

The Taoiseach should be allowed to speak without interruption.

I announced last week that we have provided an additional 250 beds on top of the 250 provided at Christmas time for those particular patients.

That is not enough.

Deputy Rabbitte asked me what is different about what we are doing now. We have put in place a range of activities and measures, including the provision of high-dependency beds — which the Tánaiste has announced — intermediate care beds in private nursing homes, additional beds in public nursing homes, 3,000 home care packages and enhanced subventions. This has already facilitated 1,500 patients to leave acute hospitals.

How many public beds have been provided in the nine years?

Does Deputy Ryan want to know?

How many?

One thousand.

The Taoiseach should be allowed to speak without interruption.

The only change is that people are now queuing for the trolleys.

The Taoiseach should be allowed to speak without interruption.

I am trying to answer the questions Deputy Rabbitte put to me. The last question he asked was about what additional issues we are addressing. In response to what he said and just in case there is any confusion, we have not abandoned any of the remaining points of the ten-point plan. The purpose of the new task force which the Tánaiste has announced is to bring together those people who have expertise in co-operation and who have proved in their own hospitals how one can get a better flow of patients to wards, better discharging practices and better time in discharge which are all relevant to this problem and how we can deal with it.

I should not be answering for Professor Drumm and the HSE but the point he has made is that pro rata, the ratio of the number of acute beds in this country per thousand of population and the number of staff compared with the age profile of the population is far higher here than it is in the UK or in most other countries.

Hear, hear.

It is a total failure. We will be sending them to Angola next.

The Deputy is waffling again.