I raise the very serious issue of overcrowding at South Tipperary General Hospital. It is sad that today HIQA has published a report which is very critical. It is not a problem with the staff or management who are overworked and totally overstretched. According to Trolley Watch, emergency department trolley statistics at South Tipperary General Hospital show that it has suffered the most because of the cuts of recent years. Figures from the Irish Nurses and Midwives Organisation show that in March there had been a 100% increase in the number of trolleys and the level of overcrowding nationally compared to the figures in March 2008, when only 4,700 patients were on trolleys. We need to bear in mind constantly that these statistics represent an old person, a sick child or a person with disabilities who are on trolleys in unsuitable surroundings. They are human beings and we must always treat them as such. The medical staff do their best for them. It is, therefore, truly disturbing to have it confirmed that the total number of patients on trolleys in South Tipperary General Hospital this year has increased to 552, 319 more than this time last year. It just gets worse.

Clearly, the establishment of the emergency department task force has done nothing to alleviate the problem. It is a high-powered task force and promises were made about what it would do, but things have got worse. I am glad that the Minister for Health is present. I ask him to look into this matter to see what the task force established by his predecessor is doing. People are being advised to visit their GPs, but GPs are overwhelmed, particularly since the introduction of the free scheme for those aged under six years. They cannot cope. They are on the front line and many of them are operating on 40 year old contracts which are not fit for purpose.

Despite the promises made three years ago that stepdown beds would be provided in Cashel, with almost €20 million spent, they are lying idle. Never mind beds, they do not have pillows or blankets to put on them. The facility could be used to alleviate the immediate problem and the standard of refurbishment is exceptional. When will this happen? The former Minister of State, Mr. Tom Hayes, announced that it would and I am sure he did not make it up himself. Three years ago he was told by the HSE that it would happen, but nothing has. This cannot go on.

We can thank the former Minister of State, Ms Kathleen Lynch, for the closure of St. Michael's, a psychiatric institution of long-standing, which provided an excellent service in Clonmel on the same campus as the hospital. People must now travel to Kilkenny, and all the patients now present in the emergency department. The former Minister of State was warned about this and we were told other stepdown facilities and crisis accommodation would be provided, which we clearly do not have.

A Vision for Change is not working. I therefore ask the Tánaiste what she will do because the HIQA report is very damning, especially regarding patient safety. I ask the Tánaiste and the Minister beside her what action will be taken immediately.

I have read the summary of the HIQA report and I agree with the Deputy that some of the findings regarding South Tipperary General Hospital are extremely disturbing. I noted, however, that when the HIQA inspectors returned six weeks later they had found considerable improvement in some of the issues that had been identified when they first visited on an emergency basis. The Deputy is right, however, that there are serious infrastructure and capacity issues regarding demand at South Tipperary General Hospital. The important point is that we are entering a new era now of further investment in the health service, as evidenced by the extra €500 million that has been allocated to the Department of Health and to the Minister, Deputy Harris. There are improvements overall in the trolley situation but still a lot of work to be done. There is clearly more investment in the area of general practitioners and investment in primary care and it is important that this continues. It will deal to some degree with the infrastructural issues. New initiatives and new funding have gone into the fair deal scheme, which has meant that patients now only have to wait a very short period of two to four weeks for a bed, reduced from 14 weeks just over a year ago.

Improvements are therefore being made, but the Minister has indicated that he intends to address the general issues that the Deputy raises about infrastructure. Clearly, however, there are also management and accountability issues, as evidenced by the HIQA report, that need to be taken up at a local level. I note, for example, that some of the issues that were identified concerned the risks relating to infection prevention and hygiene, with very poor cleansing of equipment around some patient areas and stained, dusty and rusty rubbish bins in some of the surgical wards, and the paediatric ward was not clean. Some of these issues can be dealt with via proper management and accountability from hospital groups. The Deputy makes the point about investment and infrastructure in the hospital. The Minister has said he plans to focus on the issue of capital investment in hospitals that need infrastructural development and he now has the resources to begin to do that. There will be a capital review, as the Deputy knows, in the near future, and the issues he raises can be considered then.

I hope the Minister will address the matter. The money was promised as part of the talks for the programme for Government. I look forward to the roll-out of this. Nobody will condone or accept bad practices and unclean places, especially in a hospital. HIQA has accused South Tipperary General Hospital of putting patients at risk because of unacceptable practices such as lack of access to oxygen, lack of space - which I see any time I am there, and I am called in there regularly - trolley overcrowding and similar issues. There is no physical space. The staff are at their wits' end and the nurses are under enormous pressure. They are no longer in the reception area because they have been moved into wards, of which there are fewer and fewer. The hospital only has a certain number of beds. It is an old hospital and has done Trojan work. We need infrastructural investment and we need it now, and we need support for the management and staff there. As I said, nobody will condone any poor trolley practices. Sick patients cannot be nursed on long corridors out into the foyer and such places, with no dignity and no privacy. I see this happening every week.

I also note, as the Deputy says, the capacity issues, and the Minister accepts that there are legitimate capacity issues in the hospital. It has in fact been experiencing high occupancy rates since January. It is a question of reinvestment and the fact that our hospitals need further capital investment. Thankfully, because of the changes in our economy, we are now in a position to do that, and I am sure that South Tipperary General Hospital will be one of the hospitals that will benefit from the improved economic situation and the reinvestment in our health service.