We now move on to the Topical Issue Debate.

We are taking Leaders' Questions now.

My apologies.

I can assure the Ceann Comhairle the issues raised will be topical.

Leaders' Questions would be postponed too, if it were possible.

The situation in our accident and emergency departments is chaotic and out of control. All of us in this House will have been shocked at the contents of a letter written by an emergency department consultant at Tallaght hospital to his chief executive officer, which was copied to the Minister for Health and referenced by me to the Taoiseach yesterday. It outlines how a couple in their 90s, married for 59 years, found themselves waiting for long periods in an emergency department. The man, who has advanced Parkinson's disease, was left a on trolley in a conduit between the psychiatric rooms and some cubicles for over 29 hours.

The consultant refers in his letter to there being 79 patients in the emergency department at 10.40 p.m., 19 of whom were waiting for beds and two of whom had been waiting in the emergency department for longer than two days. In regard to the man with Parkinson's disease, the consultant stated, "This man, like the others in non-designated patient conduits, had no privacy, no dignity, was subject to constant noise torture, constant light torture, resulting in major sleep deprivation and pressure effects causing pain as a result of lying for an advanced period on a trolley not designated for same, as well as boarding conditions that constitute an infection control hazard." He further stated, "Nobody of any age should be subjected to this inhumanity." He then spoke about gross governance failure evidenced by two patients who were boarded and deemed to be requiring isolation, a patient festering two days and 11 hours and a dedicated pressure control isolation room that currently lies idle in the expanded new emergency department, along with eight cubicles lying idle since June of this year. Chillingly, the letter concludes, "It's only a matter of time before we disclose our next crowding related death at Tallaght hospital while crowding is tolerated."

The INMO has now balloted for industrial action, citing record numbers on trolleys in our hospital emergency departments, the total figure for which amounted to 80,000 over the past ten months, which is an all-time high since the introduction of trolley watch. There were 8,000 people on hospital trolleys in the month of October alone. Two years ago, the Taoiseach announced to this House that he was taking personal charge of health services. This letter speaks to an absence of decency and dignity. The situation has worsened over the past two years. Can the Taoiseach explain the reason for this to the House?

The Minister for Health, Deputy Varadkar, is asleep on the job.

Is the Taoiseach not ashamed of this damning indictment of his stewardship?

It is a scandal. Where is the Minister for Health?

Please give the Taoiseach a chance to reply.

I agree with the consultant concerned-----

The shine has gone off this Government.

-----that this is a shocking example of dysfunctionality in the system. One does not need legislation to know that a 91 year old should not be left on a trolley for lengthy periods.

Hear, hear.

The same applies in respect of the man's wife. One does not need legislation to understand that.

We need beds.

I would like to know who is responsible for that 91 year old man being left on a trolley for 29 hours.

The Taoiseach is responsible.

I know that there are serious changes being implemented in many of our hospitals.

There are no beds available.

Sorry, would you stay quiet please?

Some of these changes are being resisted, as they always have been resisted.

We need more full-time staff.

It is important to understand, from any sense of humanity, that a 91 year old man should not be left on a trolley in the first instance, if that can be at all prevented and, if not, certainly not for that length of time.

Deputy Kenny is the Taoiseach.

As pointed out by the consultant, this indignity, lack of privacy and noise and light interference in this man's senior years is unacceptable.

It is a fire hazard.

Emergency department overcrowding remains a serious challenge. We were told earlier on this year that the provision of additional funding for the fair deal scheme would help to bring down waiting times under that scheme from 15 weeks to a more normal level and that this would end this particular problem. That funding was provided. It is now four weeks on and it did not deal with the problem as envisaged.

An extra €117 million has been allocated this year to free up hospital beds, to create additional beds and to hire more staff. I did not hear the hospital manager, or the bed manager, from Tallaght hospital speak on this particular incident. I do not have all of the details, other than the letter Deputy Martin has referred to from the consultant, with whose view I agree.

It is happening every day.

The task force set up by the Minister in respect of emergency departments meets on a regular basis. There are more beds. Delayed discharges have been reducing steadily since the start of the year. Beds in the community - for instance, in Mount Carmel - have been opened and 300 additional hospital beds are to open shortly, as already announced and in respect of which money is in place. A series of campaigns are going on to attract front-line staff. Since January of this year, there are 500 more nurses in the health service. Since September 2011, almost 300 additional consultants have been appointed, including 57 more this year. The number of NCHDs employed has increased by over 250 since last year.

I do not understand how what happened to this 91 year old man was allowed to happen. It is up to everybody in the health service to play their part, accept their responsibilities and to work to ensure that the plan works. All Members will be aware, in terms of hospitals they may have had to visit, that somebody has to make a decision about the extent of medical priority such that no 91 year old is left on a trolley for 29 hours. The facilities are being provided. The extra staff are also being provided, as is the money, but it is still not making the impact that it should. I am sure that over the next number of weeks other shocking cases will be brought to light.

Maybe the Minister would wake up and do something.

Please stay quiet.

This is a challenge for everybody. The Minister has provided the money through the budget. Extra staff have been appointed and yet these kinds of cases continue to arise.

The Government is responsible for the closure of wards.

I would like to hear the response from the hospital. I am not passing the buck-----

That is exactly what the Taoiseach is doing.

-----but the point is that anybody in an accident and emergency department who has to make choices knows that-----

The Government took 500 beds out of the system.

-----a 91 year old person should not be left on a trolley for 29 hours.

Staff should not be forced to make those kinds of decisions.

I agree with this consultant in his views.

This Government gave tax cuts to the rich instead of increasing hospital beds, which is an absolute disgrace.

Deputy Finian McGrath should-----

It is outrageous that a 91 year old man would be left on a trolley for 29 hours.

It is happening every single day.

Will the Deputy sit down? Do not be putting on a show for television and I ask the Deputy to resume his seat.

I make no apology for raising this issue.

The Deputy did not raise anything.

I will not resume my seat.

The Deputy will leave the Chamber.

It is outrageous. This is about beds. We need beds.

Leave the Chamber.

That is what we need.

I told the Deputy to leave the Chamber.

I have just raised this on behalf of my constituents. What we need is a solution.

Leave the Chamber. Does the Deputy want to be named? Leave the Chamber.

Shane Ross is missing.

This is Leaders' Questions and no Deputy is entitled to interfere in Leaders' Questions to make a show.

Last February we were all shocked that a 100 year old woman spent 24 hours on a trolley and the Taoiseach said the same thing last February.

Yes.

Last January the Minister, Deputy Varadkar, produced his 25 priorities when he published a budget, which provided for reducing accident and emergency department waiting times for the number of people waiting for longer than nine hours to more than one third. The Taoiseach has come in here today and said that he would love to know why this is happening, after he said two years ago that he would take personal charge and after the Minister establishing a task force, the co-chairman of which has said it has not made a dent on the problem. Then the Taoiseach says people are resisting change. That is an appalling assertion against the staff in our emergency departments.

The Deputy set up the HSE when he was Minister.

If the Taoiseach listened to the staff he would know that they are absolutely at the end of their tether in terms of the stress and strain in emergency departments. I saw a series on accident and emergency services on RTE last Monday week and the staff said it was appalling, from their perspective, to watch patients in such distressing conditions and under such stress and strain.

Will the Deputy put his question?

The Deputy opposite created the HSE.

It is not good enough for the Taoiseach to say that the staff are resisting change or that people by resisting change are slowing down progress, or for him to wonder aloud-----

Will the Deputy please put his question?

-----why this is happening. It is his job. He must accept responsibility and the Minister must accept responsibility. It is not about saying the staff must accept responsibility. The staff are accepting it. It is really the Taoiseach's job to accept it and he should be explaining it to me.

Will the Deputy put his question?

I did not get an answer to the first question I asked the Taoiseach. The first question I put to him was------

Remember a former Secretary General-----

-----why has the situation got worse in the past two years.

Thank you, Deputy.

I would like to know why that has happened because if we could find that out, then the Taoiseach might have some chance or people might believe there is a prospect of him getting to grips with what is a chaotic situation.

The Deputy created that chaotic situation; he created the HSE.

They called it Angola.

The Deputy opposite cannot remember that.

Has the Deputy taken over the role of the Taoiseach?

I am sorry, a Cheann Comhairle.

We would need the Army then.

I have listened to Deputy Martin on this matter on many occasions. He asked what has happened since then and why the situation is worse. I have already pointed out to him that the delayed discharges are reducing steadily since the start of the year freeing up beds, with beds in the community, such as for example, Mount Carmel which has opened and 300 more are due to open very shortly, as announced, and money is in place.

Bring back calamity James.

With an ageing population and those of senior years increasing in number and living longer, thanks be to God, obviously people are required and have occasion to go to hospital on a very regular basis.

So it is the people's fault.

They are living too long.

Given that statistic alone, we need further opportunities to treat people.

October just gone was the worst month on record.

I want to make it perfectly clear that the people who work on the front-line in our hospitals, and I have seen them do so, work under stressful conditions, under pressure at all times-----

Created by the Government.

-----and they do a marvellous job, but we get these cases on a pretty regular basis. We have had them in a number of other hospitals around the country recently and they are pointed out for whatever reason. Some hospitals are not able to be as efficient as others.

In 25 out of the 29 there have been increased numbers.

The chief executive of the HSE has visited 19 hospitals in the last number of weeks where the pressure in this kind of situation was more acute and more obvious than in other cases. I am not saying that staff are resisting change. Change is always difficult to implement but the Government, in response to queries last February and March, put more money into the system to reduce the delayed discharges to provide for the availability of the fair deal scheme and the waiting period was reduced from 18 weeks to four. That was supposed to deal with the problem; it did not deal with it. We now have an extra 300 beds coming onstream and extra money in the system.

Thank you.

If the facilities are there and the money is there, is this a management problem, or is it just being exacerbated because of a situation that can apply in any locality-----

It is a Government problem.

----- where more people have to go to hospital?

The Taoiseach is in government. He is the manager.

Who manages the manager?

Cubicles are lying idle in accident and emergency departments.

Where is Leo?

We try to provide the resources and the facilities to deal with the problems but in any line-up in any accident and emergency unit if the choice is to leave a 91 year old on a trolley for 29 hours, I do not accept that should be the case.

Hear, hear.

It should not be the case.

The Taoiseach should tell that to his Minister.

I agree with the consultant who wrote his letter and sent it in publicly. Obviously there is a clinical review in this particular case taking place in Tallaght hospital-----

Tell Leo to wake up.

-----and I would like to hear from the person in charge as to the situation that actually applied in this case.

I gave that to the Taoiseach yesterday.