Over four years into this Government's term of office, we still have no proper roll-out of universal access to general practitioners, GPs. This was a stated Government policy. We learned as late as yesterday that a reported 50% of GPs have signed up for the under sixes contract. The figure is as low as 8% in County Tipperary. It stands at 32% in parts of Cork city and county. The figures for counties Clare and Louth are 29% and 22%, respectively. Large tracts of the country are to be left without access to GP services for under sixes under the new contract. While we did not oppose the Bill that made provision for the under sixes contract, we made the point from an early stage that primary care was simply being under-resourced and starved of funds and services. GP services are now beginning to fold across the country, which is an unsustainable position. At the same time, the Government is continuing to pretend that its stated primary care strategy, which involves investing in GP services, is the way forward in terms of maintaining people in the community and keeping them out of the acute hospital system. It may have escaped the notice of the Tánaiste that a couple of weeks ago, a 102 year old woman who had received a blood transfusion had to lie on a trolley in a corridor at the emergency department in Tallaght for over 24 hours.

It was outrageous.

The same type of circumstance was repeated in Limerick in recent weeks. Given that we are talking about investing in primary care and keeping chronic illness and disease in the primary care setting, will the Tánaiste not accept that the Government's policy of rolling out universal access to GPs is in rag order?

It is shambolic.

It is certainly shambolic from the point of view that four years have passed since the Government started to roll out this programme, but less than half of the GPs in the country are getting involved in it and just half of the people of this country will have access to GP services in the next few weeks and months. There is huge uncertainty out there. Could we have some clarity? Will the Minister for Health and his colleagues re-engage with the doctors who are not signing these contracts? Will they engage with the National Association of General Practitioners, which represents many of the GPs who are not taking up these contracts? Will they give the parents of children under the age of six an assurance that this service will be available to them as stated by the end of next month?

Every hospital management has to be alerted to the issue of elderly patients being on trolleys for unacceptably long periods of time, which was mentioned by the Deputy. I know the Minister is absolutely determined to ensure such cases should not actually occur. I want to sympathise with those affected by the recent cases, including their families. As the Deputy knows, €5 million is being spent on finalising a new emergency department in Tallaght. As his party's health spokesperson, he will also be aware that the very successful urgent assessment units are now used quite widely. They have been in use in my local hospital in Blanchardstown for most of this year. Older people, particularly those over the age of 70 who often have chronic conditions, can go to those assessment units and be looked after extremely well. This takes them out of the emergency department situation very quickly. This system works very well. I understand that Tallaght is in the process of developing an urgent care approach to very elderly patients who come in. This is happening alongside the work in the emergency department. On the issue of GP cards and GP care for under sixes, I have to say I am very pleased at the level of response so far, which is just over 50% of the eligible doctors.

There are very few in County Tipperary.

These decisions are made for medical and business reasons by the doctors' practices and the many medical companies that are involved in this sector nowadays. Very good progress has been made with this initiative, which has been discussed in this country over a long period of time. The number of GPs signing up has actually been very good in my constituency and in most of the suburbs on the north and west sides of Dublin. That is important for the families of the children involved. As Deputy Kelleher is aware, parents will very shortly be able to apply online to register their under sixes to receive GP services from local medical practitioners. I understand there are specific problems in some areas of the country. While the figures have been extremely high in places like County Donegal and the west and north sides of Dublin, they are rather disappointingly lower at the moment in places like County Tipperary. The Deputy mentioned that there are problems in Cork. I believe all of these problems can be addressed over time. Obviously, medical practitioners have to make these decisions. I believe the under sixes GP card is good for the health of all children under the age of six. We will be rolling out the provisions for people over the age of 70 the following month. We have ambitions to extend this initiative further in line with the programme I agreed with the Taoiseach when I was appointed as Tánaiste. It is intended to roll it out to other primary school children and ultimately to all children under the age of 18.

If the 50% rate mentioned by the Tánaiste is in line with the Government's aspiration, it is a very poor effort. The provision of universal access to GPs for everybody is a stated policy in the programme for Government that was formulated in March 2011, which said that everybody in the country would have access to GP care free of charge. We were told there would be universality across the board. We are now over four years in and we have a situation where just half of GPs have signed up to the first effort to roll out this strategy. This means that large tranches of the population will be discommoded. These people will not have access to their family GPs. The Government had four years to negotiate this. We are now at the 11th hour and families are unsure of what services will be available to them in the coming weeks when they try to access their family doctors.

The broader issue is that it is simply not good enough to apologise to the 102 year old who had to lie on a trolley for 24 hours. Apologies will not change the policies being pursued by the Government. The under-resourcing of primary care, which is under huge pressure, is driving people into hospitals. GPs are referring people to hospitals because they cannot cope with chronic illness and disease. Even though the Government has a stated policy of keeping people out of hospitals, everything it is doing is facilitating the reverse. I hate to inform the Tánaiste that her constituency colleague, the Minister for Health, was doing his usual grand tour of radio stations this morning and waxing lyrical while making observations about health. He seems to forget he is the person who is ultimately in charge and responsible for the health service.

He is not a journalist.

He has been entrusted with making some effort to address the problems being faced in the health service on a daily basis.

It is getting progressively worse. Over 400,000 people are waiting to see a consultant. The Taoiseach promised in 2011 to reduce the number of trolleys but there is a crisis every day in the emergency departments. The Government accepts that to have 350 or 400 people lying on trolleys is fine. It is not the case that it is all fine.

The Minister for Health tells us that the budget presented to the Dáil last year was realistic but he can tell Shane Coleman today that he needs more beds, money and resources. At the heart of this is a lot of disingenuous talk, nonsense and spin. Our health services are now in rag order. Patients are suffering day in, day out. I should not have to raise it here. The Tánaiste should know that. She only has to look at the trolley figures for Beaumont, Tallaght and many other hospitals around the country. The Government’s stated policy was to reduce trolley numbers in our emergency departments and give free access to everybody by the end of this year, but none of that has been achieved. It is a shameful, sad indictment. In the context of general practitioner services, will the Government commit to giving additional resources to primary care to address the problems people face in having to go to acute hospitals because they cannot access treatment in their communities?

The task force on overcrowding and trolleys in hospitals and emergency departments has been allocated an additional €74 million to ease the difficulties. It is not acceptable to have somebody of an advanced age on a trolley for anything longer than a number of hours. This is something that hospital management must address. Anybody who has experience of waiting with an elderly person in the small hours knows that is a difficult and worrying place to be. The additional resources for and development of the urgent assessment units and special access for older people are working really well in several hospitals around the country. The ideal would be that somebody of an advanced age, with a complex medical history, should not have to go through the normal emergency section but should be able to go to the urgent assessment units.

I agree with the Deputy that primary care will be the best basis for the health service in this and every other country in years to come because it achieves the objective of helping to keep people out of hospitals. Very fine primary health care centres are being built around the country. In my constituency, one opened recently on the Navan Road. It is a fine three-storey building with diverse primary medical care facilities. In Corduff where, when Fianna Fáil was in government it had been promised for more than a decade during the best period of the boom, it was an empty site with grass growing on it.

The Tánaiste should not talk about promises. She is on weak ground.

I invite the Deputy as a health spokesperson to go and see the building, which is more than 50% complete.

Does the Government have staff for it? It is an empty shell.

That is what will deliver primary health care around the country.

There will be a primary health care centre in every Minister’s constituency.

The Tánaiste is looking after her own constituency.

The Tánaiste is rolling them out in her own constituency.

Does the money follow the patient or the Minister, Deputy Reilly?

Furthermore, for all those parents of the 270,000 children who are going to benefit from the general practitioner medical card, it will ensure that those children, from birth to six years of age, will have a very good primary health care service through GPs.

They cannot get a tablet in a chemist.

The Deputy has a difficulty because it has taken time. During his party’s period in charge of the Health Service Executive, which his party leader helped to create, notwithstanding the funding that was available-----

The Tánaiste’s Government promised to get rid of it but it is still there.

-----and throwing money at the problem, the outcomes were much less than those now being achieved.

That is not true.

If the Deputy goes back over the history of mother and child health care in this country, to the period of Dr. Noël Browne, it has always been necessary and appropriate to negotiate with GPs.

Go around the house and mind the dresser.

When will the Government abolish it?

My message to GPs around the country is to engage with the HSE and to give the 270,000 children-----

What about their patients?

-----and their parents who would benefit from a GP medical card the opportunity to improve their health not just from nought to six years, but because those years are so vital for the rest of their childhood and their adult life.

Will the Tánaiste arrange a visit for me to Balbriggan where I can see the health centre?