Last Wednesday evening I visited University Hospital Galway where I was briefed comprehensively by representatives of the Saolta group and authorities in the hospital on the enormous challenges facing staff and the pressures under which they were operating and, in particular, the situation in the emergency department. After the briefing they brought me to see the emergency department at first hand. The conditions for patients and staff and the circumstances in which they worked made for an appalling vista.

Did the Deputy apologise?

More than 250 people a day, on average, attend the emergency department which works out at approximately 62,000 a year, but it was built to cater for 100 a day. The situation in the paediatric department was shocking. There were two bays in the corner of a room, children were on the ground crying, parents cramped together and there was no capacity to deal with infection control. I met the nurses the following day in Galway, those working in the emergency department and those working in the community and elsewhere. They articulated their fears about patient safety in the emergency department at University Hospital Galway and how the interventions to date had failed.

Did the Deputy tell them that he had commissioned a report when he was Minister?

The hospital has a solution to this problem which it has put to the Government. Fundamentally, it has stated to the Government that it has sought approval to progress to design stage for a replacement emergency department and shell accommodation to replace the existing maternity unit, a 1950s building, but incredibly the Government has not included the project in its health capital programme. It has rebuffed the proposition from the hospital, sent back the proposal to it and told it to scale it down and engage in another cost benefit analysis. The Taoiseach has set up task forces.

The Deputy set up a few himself.

Particularly since it is now the tertiary hospital for the west and north west, as the Taoiseach knows, and the numbers are increasing on an ongoing basis-----

Produce a report on it.

-----the very minimum required is a commitment to replace the emergency department.

I ask the Deputy to, please, put his question.

All of the projects so far in the health sector have been in Dublin. There is very little being provided outside Dublin in the rest of the country in the health arena.

You have been in power for five years, lads and lassies.

The Taoiseach is to reopen Roscommon County Hospital.

As those opposite have been in power for five years, they should get over it.

It is only the first five years.

Will Deputies, please, take a pill and allow the Taoiseach to reply?

A Cheann Comhairle, I am being heckled by Government backbenchers.

The emergency department at University College Galway is not fit for purpose in this day and age.

Will Deputies, please, stay quiet, as we cannot hear the Taoiseach?

We cannot hear him anyway.

The staff in the hospital are working under extraordinary conditions. It is one of the most inadequate facilities in the country and needs to be replaced. I am not privy to the details of the stage it has reached in its design or architectural planning. The HSE has to send its service plan to the Minister for Health in the next week or ten days.

Where is Leo?

Silence, please. What is the Taoiseach saying?

It is very necessary that this piece of infrastructure be provided. As the Deputy is well aware and as he has seen at first hand, University Hospital Galway is a centre of excellence which has an enormous reach in terms of the different medical facilities provided. I assume the Deputy saw the new building that is under construction and which has been awaited for a very long time. He is also aware that the capital programme provides for a mid-term review. I cannot say what stage the design of the replacement unit for the emergency department is at, but I will find out. I was in the hospital recently, not in the emergency department but to visit a patient. Clearly, it is a major university teaching hospital, but it is a facility that has served its time and in which staff are working under extraordinary pressure. I accept that the emergency department has to be replaced.

Like James Reilly.

I accept that it requires approval, design and planning, all of the processes that must be gone through, at the end of which a very substantial sum will be invested to replace it. I do not object to the point made by Deputy MIcheál Martin. The facility needs to be replaced, but we cannot replace it over night. As the Deputy is well aware from his own experience in this field, such major pieces of infrastructure need to be planned for the future. The planning regulations, the design of such facilities and the building regulations that apply to the construction of a very modern unit have utterly changed from what they were five or ten years ago. I do not know at what stage the design is at, but I will make it my business to see that the HSE is informed about the matter. I would like to think we could progress the project for people from all over the west who use the facilities of University College Hospital Galway, but as the Deputy is well aware, it is not the only piece of infrastructure that needs to be replaced. If we had had a stronger economy when the Deputy's crowd was firing money left, right and centre, we might now be in a better position, but we have to deal with this challenge also.

Back to the future again.

The bottom line is that the Taoiseach has said he has been to the hospital and that its emergency department is not fit for purpose.

The Deputy did the same in 2002 when he was Minister for Health. We need to hear again the speech he made to the INMO. He promised the development of an accident and emergency department.

Will the Deputy, please, stay quiet?

The bottom line is that the Taoiseach knows and has said the emergency department is not fit for purpose. He has been to the hospital recently, yet the project has not been included in the health capital plan. He knows that if provision for the project is not made in the capital plan for the next five years, it will be a further five years beyond that before any start will be made on it. While the hospital has other priorities, it is stating the replacement of its emergency department is number one on its list of priorities. It has been stating that to the Government for quite some time.

This is like a Christmas card.

The policy makes it clear that everybody on the western seaboard must go to University Hospital Galway.

A question, please.

The community nurses I met said people in the community were begging them not to send them to the emergency department in University Hospital Galway because of the conditions there. It escapes me how the project was not included in the health capital plan. The Taoiseach has said he does not know at what stage the project is at. He should know if it is at design stage. He should know what is going on in the major tertiary hospital for the west.

Contact Leo.

Of course, the Taoiseach should know.

The Deputy should have known when he was in office.

The bottom line is that the project has not been included in the health capital plan and nothing can happen if it is not included in it.

There is no point saying to the hospital, "Scale it down, we want a lesser plan"-----

The Government said that about Beaumont Hospital.

-----because the Taoiseach knows what is proposed is essential and should be included in the plan.

Sorry, the Deputy is over time.

Will he now commit to its inclusion in the capital plan in respect of health? What I said earlier is correct. If he looks through the national capital plan-----

The Deputy should come on. We are over time.

-----there is a distinct discrimination against the regions in terms of the allocation of funding for those projects.

Deputy Adams might make the Deputy Minister for Health yet.

There are precious few health projects for the western seaboard, including the north west and south west. The Taoiseach should look at this; he will be surprised by it.

Deputy Adams will make the Deputy Minister for Health.

When the Deputy had responsibility for this, he said back in 2003 that the crisis was not his responsibility. I recall it well.

I invested heavily in Galway.

When the Deputy comes to the House, why does he not ask me if I know what the design status is for Our Lady of Lourdes Hospital or any other hospital around the country?

The Taoiseach used to be a Deputy for Mayo.

I am well aware of the problem in so far as the accident and emergency department in University Hospital Galway is concerned.

The Taoiseach should get the Minister for Health on the phone.

Would the Deputy ever stay quiet?

It needs to be replaced and it cannot, and will not, be replaced overnight. There is a process to be gone through - planning, design, regulations and permission.

Start the process.

The Government is not even allowing it to go to design.

When the Deputy comes to the House, he never mentions the 75-bed unit under construction at the moment. Did he see that?

That is not the accident and emergency department.

Maybe they have to go to the accident and emergency department first.

Patients are left standing in the chemotherapy department.

Perhaps Deputy Martin did not want to see it or comment on it. He did not comment on the fact that 30 beds are being provided in the old physiotherapy unit, which will be opened in spring 2016.

We know that. There is no problem there.

Deputy Martin did not mention the fact that 14 additional beds are being provided in Merlin Park hospital. All of these go to ease the pressure on the emergency department in UHG.

The Taoiseach is there to solve problems, not to clap himself on the back for the things that are going okay.

Would Members mind staying quiet and listening to the reply?

Believe me-----

We cannot believe the Taoiseach after Roscommon.

-----the Health Service Executive has a responsibility to send its service plan to the Minister for Health.

The Taoiseach closed Roscommon hospital so people have to go into Galway, which cannot cope.

The Taoiseach made a solemn promise.

I assume that if this project were to be shovel ready or ready to go, it would have been included.

All they want is to go to design stage and the Taoiseach has refused.

It will never be shovel ready the way the Government is going on.

When Deputy Martin met the nurses and every other member of the medical personnel there, did they explain to him what stage of the design programme this is?

Yes.

So it was ready to go?

They said they sent the design proposal to the Government, which sent it back. How many more times do I have to say it?

The Deputy should resume his seat. We are now three and a half minutes over time on this question. Please respect the Chair.

That is awful. The Taoiseach is clapping himself on the back for a few beds that he opened in the physiotherapy ward.

In that case, the Deputy should follow his own logic. He visited Castlebar last week and he was welcome. He attended the Sacred Heart Home. His representatives there are saying it will never proceed, despite the fact there is €14 million on the table.

Will the Taoiseach please resume his seat? I call Deputy Adams.

It is a disgrace from a west of Ireland Taoiseach.

Will Members please show some respect to the person asking the question and the person replying, no matter what party he or she is in, or none?

They do not want to hear the reply.

I spoke this morning with Daniel Long who is the father of Orlaith, a little six-week old baby girl who was forced to wait 11 hours in the accident and emergency department of Cork University Hospital for a bed. Orlaith, with her father and mother, Debbie Looney, was referred to hospital as she was unable to hold her bottle down. She kept getting sick and she showed signs of dehydration. She was admitted to the accident and emergency department at 11.20 p.m. on Sunday, 22 November but she only got a bed at 10.30 a.m. the following day. Is it not an indictment of the Government's stewardship of our health service that a six-week old child and her parents were put through such an ordeal? Is it not particularly so because such unfairness to citizens like Orlaith is no longer unusual on the Taoiseach's watch? It is the norm.

He promised to reform our health service, to end the scandal of patients on trolleys and to end the two-tier system of unequal access to health care. He also promised free GP care for all, an end to prescription charges and the abolition of the HSE but he has delivered none of this. In fairness, he never promised universal health care because he is opposed to it and that is why Orlaith ended up on a trolley, why 25 out of 29 accident and emergency departments have seen increased overcrowding and why there are delayed discharges, a shortage of home care packages and a lack of nursing home beds. The Government is responsible for a health service in complete chaos. Is Orlaith's disturbing case not further evidence that the Government has no intention of adequately resourcing the health service and bringing in universal health care?

The Deputy is wrong again. The Government concluded the Supplementary Estimate for health this morning, which is a serious increase on what was there for the past number of years. That is all aimed, within the prudent management of the economy, at attempting to provide the best level of service we can for patients. The Government remains committed to universal health care and the provision of a single tier system. We introduced free GP care for all those under six and over 70. The next part of that strategy is to provide free GP care for the children of all working families. I do not accept the Deputy's assertions at all.

The point the Deputy made about the little baby is real and I empathise completely with the parents in the case whose child was sent to the hospital by the general practitioner because she was dehydrated. What can one say about the fears, anxieties and concerns of parents, particularly in respect of a young baby? CUH is carrying out an investigation into why this child was on a trolley for 11 hours. I am glad to note little baby Orlaith is recovering well at home and making good progress. That is something everyone will appreciate. I do not know the reasons the little child was left on a trolley for that length of time. The hospital management has asked the question and an investigation is being carried out in that regard.

In general, accident and emergency departments are a priority in dealing with the question of overcrowding, which happens for a variety of reasons, as the Deputy will be well aware. A total of 450 additional beds are being opened to relieve that pressure. These are either new beds or ones that were previously closed, with 200 having opened to date and the remainder due to open in the next few weeks before the end of the year. It is imperative in that regard that all relevant parts of the health service, including acute, community and primary care, make the best use the resources at their disposal in respect of dealing with this particular problem.

In respect of the question the Deputy raised initially, I am glad the little child is recovering well and I am sorry that she was on a trolley for those hours. I expect that the management of the hospital will respond to the Minister and the HSE as to why that happened.

I have no doubt the Taoiseach is sorry but that is not good enough. He is five years in that seat as the Taoiseach of a Government which made all these promises. This morning, I also spoke to Denise Tuohy who has been told that she has to pay €75 a day for being on a trolley in Our Lady of Lourdes Hospital, Drogheda. Denise spent four days in hospital. To make matters worse, her son, Jake, has a rare genetic condition and he does not have a medical card. He is five years old but he only has a GP visit card.

What about the free care for those under six?

Denise now owes €700 in medical bills. She told me that the nurses were fabulous but the system is letting patients down and she is right.

A question, please.

I will not be long.

I thank the Deputy.

She says she feels degraded. She has worked all her life and she has paid taxes. She says this is not about her; it is about older people and youngsters like her son, Jake. She is being released from hospital this afternoon and then she has to bring her son to the doctor.

A question, please. We are over time.

If she has to bring him to the hospital, she will have to pay again and the Taoiseach is responsible for this. He is responsible for a health service in chaos and there is no point in him saying he is sorry. The fact is he is in charge and the reality is that the Government, led by Fine Gael and supported by the Labour Party-----

Will the Deputy put his question?

-----will not adequately resource our hospitals because they do not believe in a public health model. Is this not why accident and emergency department overcrowding is getting worse?

Is this not why citizens, including Denise, her son Jake and a little baby like Orlaith, are treated like second class citizens in the Taoiseach's two-tier health service?

If the Deputy had said sorry himself a few times in the past, it might have helped matters as well. Of course, Deputy Adams does not use the Irish public health service in the first place. The case that the Deputy mentioned, of the good lady-----

How does the Taoiseach know that? How does he know it?

We all know that.

Cheap shots rather than dealing with the issues.

The Taoiseach can answer the question himself.

Does the health service get any funding in America?

It is $500 a plate for dinner.

The good lady who was admitted to the hospital and was on a trolley in the emergency department was then-----

This is from a Fine Gael Deputy

I cannot hear the Taoiseach. He should speak up, please.

Please stay quiet until we hear the reply.

I do not take directions from Deputy Adams, but if he gets his people to hold their silence, he might hear.

I cannot hear the Taoiseach.

Deputy Adams, it was your own Deputy in the back making noise.

The Taoiseach was mumbling.

The Taoiseach is not mumbling at all.

Would you please stay quiet? Thank you.

The Taoiseach is not mumbling and he does not take directions from the leader of Sinn Féin.

Will the Taoiseach say that again?

If Deputy Adams cannot hear, he should please ask his Deputies behind him to hold their silence.

Will the Taoiseach do the same?

The good lady-----

Will the Taoiseach answer the question?

Would you please stay quiet?

The good lady who was admitted to hospital on a trolley in the emergency Department was later removed to a ward and she was on a trolley in that ward. The hospital has waived the charge against that period. I do not know the circumstances of her son, Jake, but there is a very flexible system for application for medical cards where difficulties are encountered by any person-----

God help us.

-----whether they are a child or not. I expect that can be reflected in -----

A flexible system? It is flexible in refusing.

-----the system that applies there. If Deputy Adams thinks it is not appropriate to say sorry in these cases, then I disagree with him.

The Taoiseach has to say more than sorry; he has to fix it.

Perhaps if he had said it himself a few times in the past it might have helped us.

I call on Deputy Fitzmaurice. There is a telephone interfering somewhere.

Media reports this morning-----

Ming is coming home for Christmas

Media reports this morning-----

Okay, Deputy.

Media reports this morning are saying that €300 million in additional tax revenue will be announced this evening, which is welcome. The Taoiseach and the Minister for Jobs, Enterprise and Innovation have travelled around the country announcing the number of jobs that will be created over the coming years. They have gone to eight regions. One region, which includes the second biggest county in Ireland, the third biggest county, which is the Taoiseach's home county, and Roscommon, have sadly, in the period between 2013 and 2015, lost 4,000 jobs. Last week in the High Court, a High Court judge said that mental health services in Roscommon were in disarray. In 2011, the Government took the TEN-T funding from the west, when it was reallocated to Foynes and Cork. Two months ago, the Minister announced on RTE "Six One News" that a few towns in the west would have broadband by Christmas, but that is another broken promise.

Last week, the Minister for the Environment, Community and Local Government announced that rates would be dropped for utilities companies, yet SMEs will get no break. What has gone wrong? Will the Taoiseach set up a task force or get his Ministers to concentrate on the counties in the west that are in difficulty at the moment? The Taoiseach might have forgotten, but he is from the west.

That comment is beneath the Deputy as a fellow west of Ireland man.

The Taoiseach is well able to give it.

If that is the extent of Deputy Fitzmaurice's vision, I do not share his view on the range of questions he has asked. It is an indication of the credit that must go to the Irish people - north, south, east and west - for the way they have accepted the challenges of the mess that we inherited.

The Taoiseach was going to get the Army in.

The fact that the Minister for Finance is in a position to report income of €3 billion before the end of November from corporate taxes and VAT, which is more than was projected for the entire year, speaks for itself. In that regard, the opportunity to further reduce the national debt is in the Deputy's interest and is everybody's interest.

I want to make it clear that simply because we happen to be heading towards the end of the lifetime of this Government and that an election will take place in the spring, the Government will continue-----

I thought we were going to have it in November.

-----to deliberately manage the financial affairs of this country in a prudent and competent fashion. Simply because an election is on the way does not mean that there will be a rash of endless promises that cannot be-----

The Taoiseach cannot make any more promises.

-----met. Deputy Fitzmaurice will note that the Chairman of the Revenue Commissioners has indicated that just €300 million of that €3 billion needs to be considered separately and that the remainder is sustainable and will continue for the future.

The Deputy has referred to various important matters, such as TEN-T funding, broadband and rates. The Government changed the legislation to allow for the ESB to partner with a service supplier, Vodafone, the company called Siro, which is now in direct competition with Eir, formerly Eircom, to provide broadband throughout the country. The tender for procurement for servicing the area in which the State will have to intervene should be issued by the end of 2015 or very early in 2016. As the Deputy knows, one can check on any of the maps for indications of when broadband will be available.

Deputy Fitzmaurice is also aware that Apple is investing €1 billion in the Athenry area for data content storage. I can confirm that the splicing has taken place on the last link of the cable from Shirley, New York, to the west coast of Ireland. That will improve the broadband capacity immensely in the time ahead. I pointed out that in the far flung west, €100 million is being invested in a new wood burning power plant which will provide another opportunity for farmers with marginal land to increase their income through the growing of appropriate timber.

It is not true to say that SMEs are getting no breaks. I have just come from a meeting in Newbridge this morning which over 200 people from the business sector attended. They pointed out various inadequacies in the structure of SMEs in terms of micro loans, access to credit, facilities for training, upskilling and new employment, the JobBridge scheme and the JobsPlus scheme, all of which were discussed by people working in the sector.

Deputy Fitzmaurice will also note the increase in private and commercial vehicles. The Government has listened carefully and the 20 rates of tax for commercial vehicles will be reduced to five on 1 January 2016. Hauliers, in particular, appreciate the reduction from over €5,000 to a maximum of €900 in tax for major trucks. These apply in the west, from where the Deputy comes but perhaps he has not noticed.

These apply in the west but they also apply in every other part of Ireland. The Central Statistics Office has released its figures, which I have no reason to doubt and which show that there are 4,000 fewer people working in the three counties to which I referred than there was in 2013.

The Taoiseach talks about farmers. We should have someone on an aeroplane to meet the agriculture Minister for in England. Yesterday, the beef barons of Ireland and England announced that cattle exported from Ireland to England would take €1 per kilogram less. This has effectively stopped our exports to England. We should have someone addressing that.

The fact is that the TEN-T funding for major infrastructural projects, such as Knock Airport in the Taoiseach's county, the ring road in Galway, and a main road from Dublin to Castlebar, which is needed, was stopped by this Government in 2011.

The Deputy should ask a question.

The facts are that electricity suppliers have gotten the break on the rates.

Small businesses which pay the rates in each county are struggling but there is nothing there for them. The Taoiseach himself has said that Galway hospital is in chaos.

Come on Deputy. You are over time.

A High Court judge has said the mental health services in Roscommon are in chaos. We know-----

They are not in chaos.

We know the numbers of unemployed. We know what has happened in the west. Is the Taoiseach prepared-----

It is not in chaos. Go down and have a look at it. I was there myself last week. You should not talk about Roscommon hospital. It is open for business and better than ever.

Is the Taoiseach prepared to tackle these head on for the benefit of people?

Go into Roscommon and have a look at the hospital. You should sit down. You are a fool.

Sit down you. Your day is over.

You are a fool.

Deputy Feighan, sit down.

It is beneath a Member to call someone a fool.

You are a fool.

Your day is over.

Stay quiet Deputy Feighan or I will ask you to leave the Chamber.

I am sorry, a Cheann Comhairle. I just get a bit upset when I hear that kind of talk.

A Cheann Comhairle, Deputy Feighan called Deputy Fitzmaurice a fool.

Is it not beneath a Member to call someone a fool across the floor of the House?

There is too much grandstanding. Members are not impressing anybody. We are all long enough around here.

There must be an election in the offing.

Deputy Fitzmaurice comes from County Galway. The Central Statistics Office figures he quoted also point out that the numbers on the live register in Galway have reduced from 25,389 to 15,677, a drop of 40% since 2010, the lowest in seven years. Maybe Deputy Fitzmaurice has not noticed-----

Is the Taoiseach telling me that there are fewer people working?

Stay quiet Deputy. You have had your say.

Maybe Deputy Fitzmaurice-----

I am telling the Taoiseach the facts.

Deputy Fitzmaurice had his chance to speak.

Frankie, get up again.

Deputy Fitzmaurice, would you ever stay quiet and listen to the answer?

I only want to give him the facts.

Will you stay quiet? You had your say.

I will repeat the facts for Deputy Fitzmaurice. At the end of October, the numbers on the live register in Galway were 15,677, down from 25,389, a drop of 40% in seven years.

What about the statistics of 181,000, down from 185,000?

Maybe he has not noticed the €600 million investment in the motorway from Gort to Tuam.

What about Roscommon and Mayo? They are in the west as well.

Maybe he has not noticed the capital programme which includes several major infrastructure projects for his native county and the west. The Government has made its decisions in respect of broadband. We expect those companies to measure up and provide proper broadband services for the entire country, not just for the west.

I also point out to Deputy Fitzmaurice that for the first time, the Government ring-fenced moneys for mental health services. As Deputy Feighan pointed out, the situation is nothing like Deputy Fitzmaurice described.

The High Court judge is wrong then.