The "Prime Time Investigates" programme exposed once again what is probably the greatest scandal of modern Ireland, that is, the growing numbers of people who have to brush with death rather than go into accident and emergency units. As one of the wealthiest countries in the world, we have failed to provide even basic health care for our people, especially the old and vulnerable. Eileen Reilly said she would sooner die than go back into an accident and emergency department. The late Jimmy Kerry asked his family why he was on a trolley when he would be better off at home where he had a bed. Marie Kilkenny said she wished she would never have to go near an accident and emergency department again and the late Robert Hamilton, as the Tánaiste will know, refused to go into an accident and emergency department. This time, this hard-working man kept his dignity and was staying at home.

The fact is these people worked all their lives to build up this economy but their experience, stories and, in some cases, deaths prove how the Government has failed to use the wealth they created and generated to deliver a proper accident and emergency service to look after them. Some €60 billion has been spent to deliver a lack of privacy, sensitive information discussed in overcrowded conditions, intimate procedures carried out in full view of patients and their visitors, and dangerously overcrowded conditions which have turned our hospitals from sources of healing to sources of infection.

The real scandal is that this is not a new crisis because four years ago the Government did an analysis on what was needed to fix the then crisis so. There can be no shock-horror now. After nine years in power and three different Ministers for Health and Children, a Tánaiste and €60 billion later, the Government has failed to deliver, look after our most vulnerable, invest in the beds we need and invest in developing proper primary care which is the key to a good health service. Last night's "Prime Time Investigates" programme sums up the Government's story so far: plenty of promises, no delivery, quick to blame and slow to shame. When the Taoiseach saw that programme, as Head of Government, Taoiseach of Ireland and Leader of the Government for nine years, was he not ashamed this could happen in this country in 2006?

No shame.

As I said earlier on Question Time, last night's programme showed the distress of patients and their families and the conditions and waiting times in some of our accident and emergency departments. That is an issue I have addressed in the House several times over the winter. We understand the distress. That is why the Health Service Executive is determined to reduce unacceptably long waiting times for patients and all the other issues to which I referred earlier. No stone is left unturned to address problems where they occur. All the necessary funding is being made available. Deputy Kenny is correct in that over a number of years we have put in the resources which effectively have been for extra staff. The HSE is bringing management attention to this as never before. The accident and emergency action group has been working since the HSE was formed early last year and will support the commitment of doctors, nurses and other staff to continually improve patient care. It ensures that in many of our hospitals those departments are working well. We have 53 acute hospitals, with 35 accident and emergency units, of which about 13 are recognised to have a problem. The other two thirds are working effectively and well. There are many such examples across the country. The task is to bring the remainder into line.

The "Prime Time Investigates" programme also carried an interview with Sir George Alberti about the accident and emergency area reforms in Britain, reforms which we have been carrying out for several years. He said it is important there is faster access to senior decision makers and consultants for extended periods of the day, a vital reform I have spelt out in the Dáil many times. It is not that individual consultants in accident and emergency and elsewhere do not work long hours, but the problem is they are not scheduled to be routinely available to patients at all times when needed. That is the issue that arises. The accident and emergency task force has identified practical actions being implemented to get faster access to patients by consultants. Such actions have been suggested by consultants themselves on the task force, and we are working with the individuals to move that forward.

Many other issues are involved. Some 3 million people use our 53 hospitals annually on an inpatient and outpatient basis. Some 1.3 million people — 3,000 per day — use the accident and emergency services annually. That figure has risen substantially, by 10% during the past year alone, so people are using the accident and emergency services in increasing numbers. That increase of 10% is the biggest for a number of years, so it is a myth that people are not using the services.

Many other issues have been highlighted. The two programmes shown last night, "Prime Time" and "Questions and Answers" must be considered together. Nothing was said in them which I have not said several times before, such as how we avoid hospital admissions, enhanced out-of-hours GP services, greater GP access to diagnostics, rapid access to clinics, increased community intervention time, primary care teams, the chronic illness management programmes and home care packages.

We need action on the ground.

A lot of excuses and nothing done.

Deputy Kenny is entitled to hear the answer to his question.

I am not sure how Opposition Deputies call a move from €4 billion to €12 billion a cutback. That is extremely good mathematics.

The Taoiseach is great at such pronouncements.

We have tackled reducing hospital stays, appropriate use of capabilities, beds and facilities, proactive admission and discharge planning, the diagnostics available over extended working days, the consultants providing daily and routine rounds for all patients, the provision of more consultants and working teams and hospital out-reach services.

Were we watching the same programme?

We have heard it all before.

Nevertheless, that is how we will get on top of it. There are more than 2,000 consultants, 4,000 non-consultant hospital doctors, 7,000 extra nurses and 7,000 extra paramedics, all working to get on top of the one aspect of the health services which we must deal with.

There are many closed beds.

The problem is that we did hear it all before. When Professor Drumm addressed the Fine Gael parliamentary party in Portlaoise last year he said that of the 140,000 people who had worked in the health boards, at least 3,500 did not know what their jobs were or where they fitted into the service.

We have heard this all before and the Taoiseach has put the taxpayer to considerable expense producing another consultants' report to identify problems which he knew existed for the past nine years. While the Taoiseach sits here beside the Tánaiste, he has done nothing about after-hours GP care, step-down facilities or getting value for money. The State and the system cannot cope with elderly and vulnerable people who need emergency care. They are not deemed to be a priority and that is the scandal.

When, on 12 October last, I asked the Tánaiste to identify her main target during her Ministry in 2004, her response was accident and emergency care because, as she rightly said, it is unacceptable that people have to spend up to 12 hours on a trolley. Before the report was published, hours before the "Prime Time Investigates" programme was shown, the Tánaiste said that the latest consultants' report on accident and emergency services showed there was no crisis in that area. It seemed to be a case of lurching from a national crisis to a national emergency to no crisis at all, simply because the taxpayer was put to the expense of having another consultants' report to show the same problems that have existed for the past nine years, with which the Government has not dealt.

There is no point blaming nurses, doctors and consultants. This is a problem of Government. The Taoiseach said the spend has gone from €4 billion to €12 billion, but while the extra money is being spent, patients are not seeing the value. The Government has failed to deal with step-down beds, GP out-of-hours care and the provision of acute emergency care as a priority for elderly people when they arrive in accident and emergency units. As we are told, the chaos in such units costs lives — someone's husband, wife or child.

Tomorrow is the fourth anniversary of the last election. The Government has been in office for nine years, with three Ministers for Health and Children and a Tánaiste in charge of that Department and, while, as the Taoiseach rightly pointed out, the spend has been increased to €60 billion, the issues of out-of-hours GP services, step-down beds and medical priority for vulnerable, elderly people in particular who need emergency care are not being dealt with. The Taoiseach is responsible for that and, as head of Government, was he not ashamed to see the carry-on involving elderly and vulnerable people in some of our accident and emergency units around the country? The television programme showed that what happens in a number of our hospitals is disgusting. The Government has failed to deal with this problem, which it has known has existed for the past nine years.

As Deputy Kenny knows, the GP out-of-hours service is excellent in many parts of the country. Until recently, we were not able to resolve the service in a large part of Dublin, covering about half a million patients. Thankfully, those negotiating that issue have now concluded an agreement which will become operational from 1 September. That has been publicly announced. That coverage is very important because up to now, as I regularly pointed out, people without the out-of-hours service had no alternative but to attend accident and emergency units in three or four of the hospitals out of the 13 where there was a difficulty.

Deputy Kenny is not correct on the step-down facilities. Last year, more than 500 beds were used from private nursing homes for step-down beds and already this year over 300 have been provided. About 50 people per week finish their acute treatment in hospitals and they are the people who require step-down facilities.

The Government is required to step down.

This is a serious issue which we are all trying to resolve. The Deputy should not be so silly.

It is a damn bad effort.

The step-down facilities provide continuing care. With regard to the report mentioned by Deputy Kenny, no report like that was done before. This was a detailed report on ten individual hospitals. Until now they were always classified in statistics that were grouped together and did not look at the individual requirements. This is the first time a report has examined the individual difficulties on the ground by talking to the staff who deal with the problems. The report shows that there are different problems and issues. The issues are not all the same in different areas.

The HSE has looked at the recommendations. They deal with the issues of beds, step-down beds, general practitioner out-of-hours service and the ability of general practitioners to access diagnostic services, whether those services are in public hospitals or private operations. It is a huge benefit for general practitioners to be able to get quick diagnostic turnaround. It means patients do not have to go to accident and emergency departments and those departments can be used for their real purpose. Community intervention teams have been established by the HSE which are hugely helpful in dealing with people in their homes and communities. Primary care teams have been set up and the HSE has worked on the chronic illness management programmes.

Many of these programmes are not new. In the past few years, we have examined the best practice we have seen in hospitals such as St. Luke's Hospital in Kilkenny, where there is very good community access. I spoke about this previously. We are trying to take that best practice into other hospitals.