Every winter we read headlines about the number of people spending many hours, or even days, on trolleys in the accident and emergency departments of our public hospitals. There is a myth that this is only a winter problem. Is the Taoiseach aware that the figures released yesterday by the Irish Nurses' Organisation show that some 202 people were on trolleys in A&E departments on the previous night throughout the State's hospital network? All of those 202 people were someone's child, brother or sister, parent or grandparent. The agony for all is obvious.

On 5 July 2005, this day 12 months ago, there were 232 people on trolleys according to the figures then applying. That is an improvement of 30 places but it is hardly something to trumpet given the fanfare that accompanied the announcement of the Tánaiste and Minister for Health and Children's ten-point plan to ensure an end to the accident and emergency crisis. What will the situation be like when it really becomes a crisis time of the year? If over 200 people are on trolleys today, what will it be like in November? Are we going to see record numbers of 500 plus on trolleys? What is the Taoiseach doing to address the problem now, rather than waiting until it becomes absolute bedlam?

The new treatment room that was established in Monaghan General Hospital remains closed and unresourced. Given the figures the Taoiseach mentioned earlier concerning a significantly greater tax take, why are we still waiting for the Department of Health and Children to resource this essential facility? That hospital has faced much turmoil and trauma in recent years.

The Deputy's time has concluded.

Where stands Fianna Fáil's promise, in its manifesto prior to the 2002 general election, to end the two-tier system within our acute hospital services? What about the commitment in the programme for Government to improve A&E services by significantly reducing waiting times and having senior doctors available at all times, including all appropriate consultants? I ask the Taoiseach to consider a final point. Is he aware, as I am, that we have a serious shortfall concerning the number——

The Deputy's time has concluded.

——of consultant radiologists within our hospital system? People are being unnecessarily detained overnight in hospital because there are insufficient consultant radiologists to read the scans in order to inform the clinicians of how best either to continue the management of patients or to decide on their discharge. Clearly, this places a huge cost on the families concerned——

The Deputy's time has concluded.

——on the health system and — I will finish on this point — on the statistics concerning the bed crisis. Does the Taoiseach not agree that, unquestionably, we need the additional 3,000 beds promised? In addition, however, there must be a holistic approach to the crisis identifying the areas that have to be addressed. People should not be unnecessarily detained because clinicians have not received the report of scans.

I ask the Deputy to give way to the Taoiseach.

I ask the Taoiseach to advise us what steps he is taking to address this real crisis.

Deputy Ó Caoláin will be aware that the largest share of expenditure of additional revenues this year was given to health — over €1 billion into health resources and €500 million into the capital programme for health. That has been the case every year, with expenditure on health increasing from approximately €3 billion to €12 billion. Therefore, the resources are being provided. Most of that expenditure is reflected in staff, with approximately 35,000 more people, mainly medical and nursing staff, working to deal with these issues.

Most of the Deputy's questions were about accident and emergency units. He is right that this is the time of year to work on plans for the autumn. That is precisely what Ministers have been doing. Those of us who are on the Cabinet committee on health have regular meetings with the Department of Health and Children officials and the HSE with a view to improving the areas that need to be improved, dealing with problems where they exist and building on the successes. The key objectives are to try to tackle the problems in accident and emergency units in those hospitals where there are problems — I stress that is in a limited number, about 14 out of almost 60 hospitals — deal with the numbers of patients in accident and emergency units awaiting admission to an acute bed, the time those patients have to wait and the turnaround time for those patients who are treated without being admitted. They are the key objectives.

The number awaiting admission in June was 109, a reduction of 39% in the average numbers nationally between June 2005 and June 2006. I am not sure from where the Deputy got his figure. There was a 49% decrease in the average numbers waiting in the east and a 24% decrease in the average numbers waiting outside the east. The reduction can be attributed to a number of factors, particularly the impact of the private nursing home initiative for delayed discharges and increased management focus on accident and emergency units of hospitals. In recent months the seasonal factor has had an impact on the figures.

The Deputy asked about our plans. We will continue with the ten point plan and the short-term objectives that no patients will have to wait longer than 24 hours to be admitted to an acute bed. There will always be people on trolleys. Obviously when people come to accident and emergency departments they will be on a trolley. The elimination of trolleys in accident and emergency units is not the issue but rather that patients do not spend an excessive period there. No accident and emergency department is to have more than ten patients awaiting admission. The privacy and dignity of patients awaiting admission is to be preserved. The long-term objective is to ensure no patient will wait longer than six hours to be admitted after a clinical decision to admit has been made.

During June, 14 of the 18 targeted hospitals achieved their targets. The exceptions were Beaumont, Tallaght, Cork University Hospital and Drogheda hospitals. During the past two weeks eight of the 18 hospitals had patients waiting longer than 24 hours for admission. All this is being monitored closely.

The Deputy asked if I would say what is happening. The development-expansion of the minor injuries units, chest pain clinics and respiratory clinics is moving well with provision for these units in Connolly Hospital in Blanchardstown, Cork University Hospital, St. Vincent's Hospital and St. James's Hospital. Outside Dublin we have provided for the expansion of minor injuries units in St. John's Hospital Limerick and Waterford Regional Hospital. These units are fully operational. In regard to the second MRI at Beaumont, the interim arrangements with a provider are in place. The second MRI is due to be commissioned later this year.

What about——

Provision for acute medical units for non-surgical patients is being made as well as the transfer of 100 high dependency beds, 38 of which have been dealt with. All of these initiatives are being monitored carefully. We are providing admissions units and other facilities to alleviate pressure in accident and emergency departments in Cavan, Wexford, the Mercy Hospital in Cork and Our Lady of Lourdes Hospital, Drogheda. In Tallaght Hospital an admissions unit is being provided close to the accident and emergency department which is expected to be operational in September for 40 patients. St. James's Hospital has another low dependency unit as has Naas General Hospital. All these reforms are taking place, resources are being provided and construction work is under way during the summer.

The Deputy referred to the service provided by pathologists and radiologists. He has a point. As part of the social partnership talks I particularly asked the staff associations, both professional and non-professional, to work with the negotiators in the Department of Health and Children. The old concept that a hospital can work for seven hours a day while many of its main units have machinery and equipment that costs a huge amount is a system from the past. The Deputy is correct in saying that is part of the problem. It does not work if people finish at 4 p.m., 5 p.m. or 5.30 p.m. We have asked the unions to engage with us during the summer in real negotiations with a view to extending the hours. We know this will cost money.

In the private hospitals the units start at 6.30 a.m. and work until 8 p.m. or 9 p.m. Last night a friend of mind had a procedure at 8.30 p.m. This happens all the time. This will have to be done in the public hospitals also and we will have to pay our staff accordingly and, perhaps, buy out old agreements. One cannot run a hospital around the clock when some of the main units only work six or seven hours per day and where equipment costs the taxpayer millions of euro. We want to engage with the staff.

The Taoiseach's time has concluded.

Sorry, a Cheann Comhairle, it is important. We want to engage with the staff and come to agreements where the length of the working day or the shift system will work so we can read the pathology lists and other lists and deal with these issues. However, we need the co-operation of the staff and staff associations to do that. I made a particular point of this in the negotiations. Also we want to make progress with the doctors and the common contract. I understand the consultants are anxious to help us improve the health service. Hopefully, during the summer they will make the necessary moves to help us. We cannot do it without them. They can, of course, take a belligerent view and not help us but that would not help the patient. We are also making progress with general practitioners. I hope we can continue with these reforms but we cannot do it on our own; we need the staff associations to work with us.

On that point where stands the renegotiation of the consultants' contract? Is the Taoiseach pursuing that with the necessary vigour to ensure consultants are appointed who will work solely within the public system? I welcome the fact the Taoiseach's friend has obviously had access to a procedure and I wish the person well. The 202 people on trolleys also have families. They are waiting within our public health system and it is their need and interest I wish to see addressed here. The Taoiseach can trundle out his responses on the amount of money thrown into the system but where is it being directed to when there is a new treatment room at Monaghan General Hospital that is unresourced for months, not open and not serving the community? That is unacceptable when we have a dearth of consultant radiologists to read scans while people are being left for days waiting and worrying about results, apart from the fact that but for the delay they may have been able to be discharged, saving them an expensive overnight stay in our hospital system and the system itself which must subsidise that presence.

Nothing in what the Taoiseach has said tells me that, given the past nine years of the horrendous state of our health service, over which he has presided, he has any answers to address the problems at the core of the health crisis. He has less than nine months to address the problem and convince the people and no amount of Houdini like tactics will fool them or cod them when it comes to the general election. People have memories. No matter what the Taoiseach does in the intervening period, unless he demonstrates he is serious about addressing this crisis in the interests of all our citizens, he will deservedly pay a very dear price.

I could go through all the procedures in every hospital under the capital programme. The Health Service Executive is putting €500 million this year alone into the hospitals. That is a huge amount of money. The biggest problem is making sure they will all spend it.

Will they be staffed?

Please, Deputy Ó Caoláin——

Bricks and mortar.

We are staffing them.

No. They are not being staffed.

The Deputy wants to ask questions. When I am replying he wants to ask more. Will he please listen?

Will the Taoiseach answer the question?

I will answer the question. Every single hospital is receiving assistance. There is not a crisis throughout the health service.

We are delighted to hear that view expressed.

The Deputy had his opportunity to speak.

We have a difficulty in A&E units in some hospitals. However, daily throughout the country successful operations and procedures are carried out and people get medical and surgical treatment to help them back to full health. The picture the Deputy is trying to paint of 1 million people failing to get excellent care is wrong. It is sad that he paints that picture. At this very hour, people are being treated in hospitals throughout the country.

The Deputy should take into account that hospitals such as in Kilkenny and Waterford, which have fewer staff than the hospitals referred to by him, carry out the services more efficiently.

Blame the staff.

Deputy Ó Caoláin is right about reform. I praise the excellent staff who carry out their duties, but some hospitals with more staff than those hospitals have problems. That is the reason reform is essential. We need reform such as a change in the length of the working day. The Deputy pointed out that sometimes people who come into hospital on a Monday do not get treatment until a Wednesday because the staff in the unit finish work at 4.30 p.m. This would not happen in any other area. How would industry work efficiently if people operating expensive equipment finished at 4.30 p.m.?

Doctors cannot operate in a hospital if operating theatres are closed.

I ask Deputy Ó Caoláin to allow the Taoiseach.

The Deputy should listen to the point he made. His point was that people are in beds too long because facilities are not available. My response is that the reason for that is that the work practice for years has been that the services close at 4 p.m. or 4.30 p.m. The Government has been trying to change this so the units can remain open till 8 p.m. or 9 p.m. We will pay the staff and work with them to come to an agreement so patients do not have to remain in beds.

We have advanced the situation over nine years and whereas we had very few day cases, we now have hundreds of thousands of day cases and these people do not have the trauma of staying in hospital overnight. We brought in more consultants and hundreds of doctors to do this, but essential reforms are still needed.

The Deputy asked about the common contract for consultants. This issue is moving at a snail's pace, not because of the actions of the Department of Health and Children, the Government or the HSE, but because the consultants have a very good position. We want them to move through meaningful negotiation and do not want to take money from them. We know they are well paid, good and experienced people and do not want to take money from them. We only want to bring in necessary reforms to make the system work better. That is all we want to do. We want to engage with them. The Deputy asked me about the letter they sent back saying they would not engage with us. We just want to deal with them, as we would with any association or trade union so we can make progress with the patients the Deputy and others are concerned about.

The Government has had nine years to do that.

We have made huge progress in that period. I will not remind Deputy Jim O'Keeffe about what happened with some of the contracts during the years some of his colleagues were involved.

The Government has had nine years to bring about reform and has had tucks of money to do it.

We are engaged in the process and will continue our engagement. We have brought our health service to a stage where it is well resourced. We have a doctor and staff ratio higher than in most countries.

The Taoiseach should come to Mallow some time.

We are spending resources. We want to make the necessary reforms and will work with the HSE to do that. Deputy Ó Caoláin knows that in the hospital he mentioned it is in this area that some of the difficulties have arisen, and we are engaged in trying to solve them.

The only thing sadder than the Taoiseach is the reality of the hospital we must support and sustain.