The Taoiseach seemed to reject Deputy Kenny's factual assertion that the accident and emergency figures are being deliberately massaged. One of the ways that is happening is that elective surgical procedures are being cancelled. The Taoiseach admits this is happening and suggests that it is normal. He is suggesting it is normal for the elective appointments of cardiac and cancer patients to be cancelled.

At the last minute.

The Taoiseach is saying that in Ireland in 2007 it is normal for patients suffering from cancer and cardiac problems to have their appointments cancelled. I have a letter from a woman from the former Southern Health Board area dated 23 January. She has cardiac problems and on instructions from her GP was rushed to Cork University Hospital. She has now received a letter stating that her appointment for an x-ray examination would be on Wednesday, 5 December 2007 at 10 a.m. She received a second letter on the same day, stating that her appointment for an x-ray examination would be on Friday, 7 December 2007 at 11 a.m. Two letters were sent to the same woman suffering from a heart condition advising her of an x-ray on two different dates in December — she is expected to wait for a year. How can that be justified?

The cancer strategy has already been derailed. The cystic fibrosis area is in crisis and money is unspent. The negotiations on the common contract for consultants are logjammed. The doctor-only medical cards have not been taken up. Now we have the problems in St. James's Hospital.

The Deputy's time has concluded.

It is arguably the best run hospital in this city and unprecedentedly it now states it cannot cope. The Taoiseach has come in and quoted statistics. Is it not the case that this is about capacity, beds and the relevant staff? When will the Government address any of these issues? Given the shortage of nurses in this city, what is the Taoiseach saying to the INO, which now feels the necessity to threaten industrial action because of grievances it has? What is the Government's official position on the INO dispute? What advice will he give to nurses who will be interested in what he has to say on the way forward?

I wish to correct Deputy Rabbitte, who was obviously preparing his notes and did not listen to the final reply I gave to Deputy Kenny — which I can understand. I said "elective operations". I did not categorise any elective operations. I said that when there is pressure on a hospital through its accident and emergency unit, it holds back on elective admissions.

I agree.

That is a regular occurrence. The Deputy said that I said cancer services. I did not say that.

It includes cancer patients.

The Deputy should allow the Taoiseach to speak without interruption. It is Deputy Rabbitte's question and he is entitled to hear the answer.

He is waffling again.

I got five seconds into it anyway. We have spent large resources successfully to ensure that more than 40,000 inpatients with cancer are treated and there are 55,000 more day cases. We have created more than 110 consultant posts in the cancer area and more than 300 new cancer specialist posts. We are building cancer services through the cancer control strategy, which has been welcomed by everybody involved. We have extended BreastCheck. We are investing in new cancer treatment. We have guaranteed capital funding, including more than €400 million for the new radiotherapy network. The HSE will implement this as quickly as possible. I do not accept some of the recent claims that it could not be done by 2011. We have seen what a private operation in Waterford could do in two years. The resources have been provided. It is carrying out the task and putting far more people through the system. It is the same with cardiac procedures. We have effectively eliminated cardiac lists. We used only to have cardiac surgery in Crumlin for children.

What is the Taoiseach talking about?

I ask the Deputy to let me answer her leader.

It is just not true.

It is true.

Patients must wait a year to get an X-ray.

Allow the Taoiseach to speak without interruption.

In reply to Deputy Rabbitte, who mentioned cancer and cardiac procedures, we now have practically no waiting lists for cardiac services because of the facilities in Cork——

That is just not true.

The Deputy will need to find another way to raise the matter.

——in Galway and in St. James's Hospital.

Not in St. James's Hospital.

Yes, we have it in St. James's Hospital.

No. That is not true.

As her party's health spokesperson, I do not know why the Deputy is so badly informed.

I will tell the Taoiseach. Should I show him the patient?

The Deputy is not the leader of the Labour Party.

Not yet.

I ask her to allow the Taoiseach to speak without interruption.

In reply to Deputy Rabbitte, I have met representatives of the INO directly. They pointed out to me the difficulties they have and that they believed other categories of staff were allowed in under the previous agreement where they were not. They have suggested to me mechanisms they believe should be used in dealing with that case. They have made their point of view clearly known through the normal industrial relations channels and we will try to assist them in that regard.

I know what the INO case is, but I do not know what the Government's response is, which is what interests me. What is the Taoiseach saying his Government will do in response to the INO position? That is the question.

If the Taoiseach agrees that elective operations are being cancelled, I suggest he asks his backbenchers whether any cardiac or cancer cases are included. They know they are because they are knocking at people's doors stating that it is the fault of the Minister, Deputy Harney, while the Taoiseach stills tolerates in Cabinet the man who bequeathed this disastrous legacy to her. At the launch of the latest health strategy in 2004, the Taoiseach sat with his Minister for Finance and pledged solemnly to the people that nobody would wait for longer than three months. People are still waiting for longer than 12 months.

In a recent reply to a question from Deputy McManus about the number of care beds in the country, the HSE stated on 6 December that "information on intensive care beds and day beds is not currently available". In his capacity as chairman of the Oireachtas Joint Committee on Health and Children, Deputy Moloney got a letter from the Intensive Care Society of Ireland, drawing his attention to the fact that precisely what has happened in St. James's Hospital this morning would happen.

The Deputy's time has concluded.

The letter went on to point out:

The Society would like to draw the attention of the Committee to this policy of closure of adult ICU beds at a time when the population is expanding. DOHC has stated that the ratio of adult ICU beds to acute hospital beds is 2.2%. This is incorrect. The ratio is in fact1.6%, amongst the lowest in EU.

It goes on to point out to Deputy Moloney the crisis that this would inevitably precipitate. Is it not a fact that the problem is capacity and expert staff, neither of which is being addressed? The commitments into which the Ministers for Health and Children have entered since Deputy Cowen held that office have been neither honoured nor implemented. As a result, in our relatively affluent economy, people cannot receive health services of a quality they have a right to expect. People are acutely distressed as a result of their interaction, or that of their relatives, with the health services.

To repeat myself, the Health Service Executive contracted with the private nursing home sector for 1,050 extra beds last year. These have been put into the areas of greatest need, particularly Dublin. The plan is to provide 360 extra beds this year, the large running costs for which have been provided. The Health Service Executive proposes to expand public capacity by 446 beds this year and a further 414 next year, the resources and staff for which have been made available.

Every year for the past ten years there has been a significant increase in consultants, specialists, nurses and related staff. At times there is a difficulty in recruiting for those posts and in retaining nurses, particularly those who are recently qualified and wish to travel for a period. Many come back here but not all do. There would be fewer problems if none of them went but that is life. There is no restriction on them which creates some pressure. Many non-Irish staff work in the health service because of that shortage. We have increased the capacity in paramedical, medical and nursing schools in recent years and provided resources.

In recent years 800 new staff have been appointed in the cardiac services under the cardiac health strategy. These include 19 consultants, 81 cardiac specialist technicians, chest pain clinics, fast tracking of patients through accident and emergency units and specialist cardiac services which have been either opened or greatly expanded in Cork, Galway and Dublin hospitals. Cardiac diagnostic tests have increased by 40%, coronary artery interventions by 153%, cardiac rehabilitation is provided in 29 hospitals compared with 12 six years ago. It is no longer the case that 75% of people awaiting cardiac surgery wait for a year or more. That figure now is under 20%. Most children had to wait a long time but now the waiting list is short. Those are the facts.

So there is no problem in the health service. Everything is grand.

I did not say there is no problem. There will always be pressure and demand for improving the services and issues such as that which arose in St. James's Hospital today. This is not new and will not go away. Although we increased the bed capacity for intensive care unit beds from nine to 14 the hospital will at times run into difficulties. One serious road traffic accident, or operation, or one infection, can at any time create that difficulty. Although we continually increase the capacity I will not stand up here and say there will be some simple solution such that increasing capacity by another one or two will change the situation.

That has not happened.

Let us stop trying to offer simple solutions to every little headline that comes out of every hospital.

It is not happening yet anyway.

The Taoiseach has been in power for ten years. He should give us a break.

There have been major improvements over the past ten years. As Deputy Finian McGrath knows, because he knows the health service better than anybody, it has improved rapidly and dramatically. He is a good beneficiary of that improvement, as is right. We will continue to improve which is good for the health service. We will continue to provide more beds. I have given the figures for that provision.

I wish to remind the Taoiseach that this debate is not about newspaper headlines. It is about public patients suffering acutely on hospital waiting lists and in our hospitals because of a simple failure by his Government. He has gone all over the place with figures so I will keep the focus of my question narrow. Later tonight an excellent motion on cancer care tabled by the Independent Deputies and me will allow a much wider discussion on this and wider aspects of the health service. It is very simple to see why planned surgeries in St. James's Hospital have been cancelled over the past week because the Taoiseach, the Tánaiste, Deputy McDowell, and the Minister for Health and Children, Deputy Harney, individually and jointly have blatantly and cynically failed to meet the commitment the Taoiseach made five years ago to restore 3,000 extra beds to the public hospital system.

That is the story. That is the real world.

These are the 3,000 beds that the Government parties ripped out ruthlessly in the 1980s when they aimed at the old, the sick and the handicapped. If the Government rips out thousands of beds, naturally it will have an acute difficulty. If in the meantime the population increases by three quarters of a million people it will have a full-blown crisis. That is as simple as A,B,C.

The Government deliberately obfuscates the problem because instead of providing those beds in a straightforward way, by extending the capacity of existing hospitals which have plenty of land for such development, and maybe building some new hospitals where they are required, it delays. It then gives its political friends, beef barons, speculators and developers, lots of tax breaks and public land to make a killing on people's health. In the meantime public patients are suffering grievously because of this agenda.

When will the full complement of the 3,000 beds be provided? Does the Taoiseach have an accurate figure for the extra beds needed by virtue of the increase in population by three-quarters of a million people? When will they be provided? Then we will have no more of this.

In answer to the Deputy's last question the Health Service Executive and some statisticians are examining bed capacity for the country. I do not know the figure. We must wait for that. To date we have provided approximately 1,500 beds and there are approximately 1,000 in the co-location initiative, which invites private investment and is designed to free up 1,000 beds in public hospitals for public patients. I know the Deputy does not approve of that initiative but it will add to overall capacity. I have already given the figures for this year and next year. That is the status of the bed numbers.

I have not quoted the wrong figures. For the winter months so far the reduction in accident and emergency units, which were a significant problem needing to be tackled, was as follows — October, -34%, November, -32%, December,-53% and January, -57%. Those are the real figures. The hospitals have worked extremely hard with the Health Service Executive and the accident and emergency unit initiative to provide services more efficiently not just by moving patients around——

It was moving them around.

This was achieved by providing out-of-hours services, the winter initiative, the rapid access clinics where the services have commenced and to which people have been referred from accident and emergency departments and are receiving efficient services and use of the National Treatment Purchase Fund. These initiatives were designed to help people. There are pressures at certain times of the year in hospitals. At other times, when there is less pressure they can take more people off the waiting lists for elective surgery. It is not always so easy to do this. While there are some staff difficulties they are not too great, as I understand it, from the Health Service Executive.