I want to raise the important issue of health and the urgent need for action in this country. Yesterday, we had 522 people on hospital trolleys. Beaumont Hospital in my constituency had 44 people on trolleys. These are our people, our senior citizens and our sick on trolleys. We have a crisis in this country. Does the Taoiseach accept we have a crisis when it comes to the health system, particularly in accident and emergency departments?

What is the Taoiseach's vision and plan for the health service? I also strongly challenge the Taoiseach on the gross misrepresentation of the beds issue. Between 300 and 350 people have died as a direct result of overcrowding in our accident and emergency departments. There is a desperate situation and crisis in our health service. That is twice the number of people who die on the roads each year. The Government spin comes out with claims that it is not about beds but that it is a more complex issue than that. Dr. Fergal Hickey, an emergency medicine consultant at Sligo General Hospital, recently said:

Undoubtedly we need a sustained programme to develop additional bed capacity both in acute hospitals but also in community facilities. More suitable facilities for those with chronic medical conditions and a greater capacity to better care for those elderly patients who need more acute, though not necessarily hospital care, are also urgently required.

It is about beds.

Six months ago, I walked the accident and emergency department at Beaumont Hospital with a group of doctors and nurses. They were looking for between 80 and 100 beds. The Minister for Health last week was bragging on radio and television that he was going to give Beaumont Hospital 30 beds. That will not even take the 44 people off the trolleys there. What is the Taoiseach going to do about the health service and, in particular, the people on trolleys in our hospitals?

Overcrowding in emergency departments is always a serious issue. Over the past short period, the Government has focused on addressing this issue by making extra capacity and facilities available. It is not just a beds issue.

The Taoiseach is wrong. Medical professionals are telling me the Taoiseach and the Minister for Health are wrong.

The Deputy can come back in with a supplementary question.

Some 1,000 beds were taken out of the system. These have to be put back in. This requires investment in facilities, nurses, doctors and other staff. That means one needs an economy that can actually drive that.

An extra €117 million has been put in to this area, along with extra staffing put in place. There is a three-pronged approach to addressing the problem. These include measures to reduce numbers of people coming into hospitals, the expansion of the community intervention teams to deliver services outside of hospitals and in communities, as well as the use of community hospitals, such as Mount Carmel, a new facility to assist in that regard. There are also measures to expand capacity to change work practices in different hospitals. As of 14 January, 111 beds were opened out of 154 which had been closed. Some 200 out of 326 new beds have now been opened with the remainder to open this month and in early February. A further 750 additional nurses in the health service were employed more than a year ago. Since September 2011, more than 300 additional consultants have been appointed to acute hospitals, including 78 appointments made last year. There has been real investment in the fair deal scheme, bringing the waiting time down for a nursing home place from 16 weeks to between two weeks, which is satisfactory. Other measures include reducing the level of delayed discharges in our hospitals, freeing up a further 300 beds; the opening of 170 community beds all over the country; 1,200 additional home care packages which apply where people want to stay at home, and rightly so.

There have been some improvements since mid-November in the number of patients on trolleys in emergency departments. An analysis performance through a 30-day moving average shows a 10% improvement in the overall numbers. Although it is not as satisfactory as one would wish, it is heading in the right direction. It is important to note that on average 3,000 patients present to emergency departments every day, a 7% increase on last year, with some 200 patients presenting at larger emergency departments every day. Up to 83% of those patients are typically discharged or admitted within nine hours of registration, which includes patient assessment, acquired diagnostics and treatment. It is an ongoing challenge and extra resources are being provided, as well as extra personnel.

Deputy Finian McGrath will be aware that the Minister for Health introduced the escalation policy if numbers increase above a certain level in emergency departments. That was the subject of intense discussions between management and the Irish Nurses and Midwives Organisation, INMO, recently. I hope that is proving of benefit in emergency departments where it applies.

I am very disappointed with the Taoiseach's answer; he has again come out with the usual response that it is a more complicated problem. I have three questions for the Taoiseach. Does he consider it is acceptable that people over the age of 80 are languishing on trolleys for 24 to 48 hours and suffering in severe pain? These are our senior citizens who paid their taxes all their lives. Can I bury the myth in regard to the response he spun a while ago about primary care? I will quote a senior consultant. He said, "Those calling for investment in primary care as a purported solution to emergency department [overcrowding] ... miss the point that the current difficulty is caused by the warehousing of admitted hospital inpatients in [emergency departments] ... not the patients who could be more appropriately treated in [a] primary care [group] ... who certainly do not end up languishing on trolleys". The Taoiseach needs to listen to the front-line workers. Again, he and his Government seem to be totally out of touch.

A question, please, Deputy.

Will the Taoiseach for once and for all listen to the nurses and the doctors but also accept the reality that in order to deal with the accident and emergency crisis we need to increase bed capacity? Thirty beds in Beaumont Hospital is not enough, 80 are needed, and that is the reality. If the Taoiseach was to go around the country and visit Deputy Halligan's constituency in Waterford, he would find that is also the reality there and in other hospitals. We need to increase bed capacity and ensure that the necessary resources are put in place. We need to take the tough decisions and not give tax cuts to wealthy people while we have people dying on trolleys. Some 300 to 350 of our citizens die every year because of the current crisis. People need to wake up to that reality.

Where is the Deputy's health policy document?

Sorry.

Extra resources are being pumped into the health system-----

Where is the Deputy's health policy?

How is that relevant? Three hundred people are dying on trolleys.

Deputies, please desist.

-----and extra staff are being appointed, including 750 extra nurses and 300 consultants. With 1,000 beds having been taken out of the system bed capacity is an issue, which brings me back to the central point that with our economy recovering, we need to be able to keep that in focus in order that investment can take place to provide for these very facilities that people need.

I do not agree or say it is acceptable that persons of senior years should have to wait for very long periods on trolleys in hospitals. Much of the focus is on ensuring that does not happen. It was the focus of intense discussions between the Irish Nurses and Midwives Organisation, INMO, and management in hospitals in the recent past. An agreement was reached on that and I hope that management will be able to put in place the changes for the facilities within those hospitals that staff need and that staff have complained about in the sense of not being able to look after their patients to the level to which they have been trained.

Primary care is a central feature of Government policy on health and the more people who can be treated in the community and at primary care centres and not have a requirement to go hospital in the first place, the less pressure there will be on accident and emergency departments. It is a part of a three-pronged approach to provide facilities as close to people as possible within the primary care system and, within a recovering economy, to be able to invest where possible. That includes bed capacity and staff and personnel who are trained to deal with these matters. It is always a challenge, as the Deputy is well aware.