Enda Kenny (Mayo, Fine Gael)
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I am glad to welcome the Taoiseach and his motley crew back into this arena. No matter what way the Taoiseach looks at it, the health service is in crisis and the Government still does not appear to understand what it should do to sort that out. Every day, on average, 250 people lie on trolleys in hospital corridors while 29,000 are waiting to see consultants and 40,000 operations have been cancelled. Earlier, St. James's Hospital, which is one of the best and busiest in the country, had to cancel operations again because there are not sufficient intensive care beds and patients who are sick are being cared for in high dependency beds following the cancellation of serious operations. After ten years of this carry on from the Government parties who have always talked about their plans, two words sum them up — wasting and waiting. They have wasted the people's money and when they are sick, they make them wait even longer. For some, unfortunately, that is the last thing they do.

The Government's response is absolute silence while the HSE's response is to ask hospital management to explain why these difficulties have resurfaced at this time. When one talks to somebody who has prepared for a serious operation and who finds it has been postponed, one can understand the depth of feeling and anger. The fundamental issue, which has not been addressed by the Government parties over the past ten years, is bed capacity. In 2001, 3,000 additional beds were promised together with an end to waiting lists by 2004. These were false promises and these commitments have not been, and will not be, honoured. What would the Taoiseach like to say to the 20 people whose operations were cancelled earlier or the 29,000 people who are waiting to see consultants or the 40,000 whose operations have been cancelled? What will the Government do about this?

Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Kenny asked me three questions. Our figures differ a little. On his first question regarding patient waiting times, the HSE, which has responsibility for all 50 hospitals, continues to report significant improvements in the numbers of patients awaiting admission compared to the same period in previous years. The average number of patients awaiting admission during the December to January period was more than 50% lower than the equivalent period 12 months ago. I would have thought that was worthy of acknowledgement. Obviously, the lower it gets, the better, but we would like to acknowledge the efforts being made by the HSE. The average number awaiting admission in January up to last night was 111, whereas the average number for admission during the same period last year was 259. January's 57% reduction follows October at minus 34%, November at minus 32% and December at minus 53%. The HSE also hopes to reduce the over 24-hours category, which is now down to 4% of patients, to 12 hours over the next few months. I think that is important.

The second point Deputy Kenny made was that 40,000 operations were cancelled. I do not think any operations were cancelled, although some were postponed.

Olwyn Enright (Laois-Offaly, Fine Gael)
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Either way, they did not take place.

Bertie Ahern (Dublin Central, Fianna Fail)
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Figures released by the HSE show that in the first six months of last year, 10,368 operations were postponed, not cancelled. That figure represents 2% of the total number of 527,000 patients who were treated in acute hospitals in the first six months of last year. While it always regrettable to postpone operations, they are postponed for a variety of reasons, including emergency cases resulting from road traffic accidents and other priorities being taken over elective cases, infection control and the availability of medical and nursing personnel. Operations are also postponed for medical and social reasons at the request of patients.

The third question raised by Deputy Kenny referred to St. James's Hospital. The bed numbers in St. James's have increased significantly by a total of 140 beds under the bed capacity initiative in new units developed over the past few years. The HSE informs me that it is aware of the pressure on the intensive care unit capacity in St. James's and it has entered discussions with management on that issue to help rather than, as Deputy Kenny said, to hinder. The HSE has offered its full support in terms of assisting fast-track post-acute patients in other settings in order to free up intensive care unit beds. It has also begun discussions with the hospital with a view to increasing high dependency capacity and advises that intensive care unit capacity has been increased from nine to 14 beds over the past few years. A national bed capacity review is currently being conducted, which will include the assessment of critical care beds. The critical carers society will be an important participant in that exercise.

Enda Kenny (Mayo, Fine Gael)
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I do not agree with the Taoiseach and am not inclined to give great credence to his statements about reductions in waiting times in accident and emergency units. He is well aware that a deliberate massaging of the figures is taking place. People are being moved from accident and emergency units to elective beds in which people were supposed to be recovering from operations. However, their operations have been cancelled. The Government and the Taoiseach made more than one promise that 29,000 patients would be removed from waiting lists by 2004. What happened to those broken promises?

Dublin hospitals operate at between 1% and 4% spare capacity, even though the best operational standards recommend 15% spare capacity. That means a hospital such as Beaumont has between six and 18 beds available if a crisis occurs. Last night, I visited a number of patients in that hospital. What this Government has permitted to happen in Beaumont and other hospitals is incredible. With between 1% and 4% spare capacity, Dublin hospitals are literally operating on a knife edge.

What happened to the promise to end the waiting lists by 2004? Does the Taoiseach accept that the figures are being deliberately massaged to make the HSE and the Minister for Health and Children look good in terms of numbers on waiting lists and in accident and emergency units? Why does there appear to be no responsibility or accountability within the HSE? Surely, somebody should have asked every person working in that organisation to outline his or her job responsibilities but nobody seems to be able to determine that.

This is traditionally the night on which people leave out a piece of white cloth so that St. Brigid, if she is around, would keep sickness away. Maybe it is the case that the Government should turn that into a white flag and give up because it has failed abjectly and utterly on health and the people of this country will not forget that when they get their chance to vote within the next 20 weeks.

Deputies:

Hear, hear.

Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Kenny will continue to make those points but we are spending a lot of money in this country.

Paul Connaughton Snr (Galway East, Fine Gael)
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The Government is wasting money.

Bertie Ahern (Dublin Central, Fianna Fail)
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We are paying 140,000 people in our health service to work hard and they are working hard. Deputy Kenny is correct in that the spare capacity in most acute areas of the health service is very tight. That always has been the case and I would say it will continue to do so. As we increased bed numbers by 1,500 and used the National Treatment Purchase Fund——

Jerry Cowley (Mayo, Independent)
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The Government took away 3,000 beds and never put them back.

Bertie Ahern (Dublin Central, Fianna Fail)
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I am answering Deputy Kenny. We have used the National Treatment Purchase Fund to treat many of the people on waiting lists. Opposition Deputies should not try to paint the picture that the people who were on the waiting list five years ago are still waiting. There will always be people on waiting lists.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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They cannot get onto the list.

Bertie Ahern (Dublin Central, Fianna Fail)
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As long as people——

Paul Connaughton Snr (Galway East, Fine Gael)
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As long as the Government is in power.

Bertie Ahern (Dublin Central, Fianna Fail)
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——are ill, people will be on waiting lists, so do not paint the picture that it is always the same people. A person may be in for an operation today and somebody else will be on the list tomorrow.

Paul Connaughton Snr (Galway East, Fine Gael)
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More will be on the list.

Bertie Ahern (Dublin Central, Fianna Fail)
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I am replying to the Deputy's leader. We have increased capacity in practically every hospital in the country. Last year, the HSE contracted from the private and nursing home sector more than 1,000 beds, concentrated particularly but not only in the Dublin area. This year, it plans to contract 360 beds with the private sector, more than 220 of which will be in Dublin, and it proposes to extend public capacity by 446 this year by building on what it did last year. Of course, it is already planning beds for next year. That will provide a total of nearly 800 long-stay beds during the course of this year, comprising 350 private and 446 public beds. Significant resources are being put into that and they are being used well. This comes in addition to projects such as the rapid access clinic, which is a new initiative and is now up and running to treat a large number of elderly people, the hospital in the home service, which is being used by teaching hospitals including Connolly and is a very good service, and the out-of-hours system, including the Dublin north doctor on call service in particular, for which the HSE deserves great credit. For almost a quarter of a century, there was no out-of-hours service by GPs in the Dublin area. I acknowledge the work done by GPs and we now have centres in Ashtown Gate, Coolock, Ballymun and North Strand which offer excellent services every night and on Saturdays and Sundays by the best qualified GPs. GP diagnostics and community intervention schemes have also been established and work is ongoing by the accident and emergency task force.

Deputy Kenny knows that the improvement of 57% in January is an enormous figure. I do not like to see anybody waiting for anything but it is impossible to reach a situation like that. However, they are working hard to reach it, which means at times that elective cases are not taken because if there is huge pressure on accident and emergency units and no free beds, hospitals will not admit elective patients. It is not perfect but that is the position.

Jerry Cowley (Mayo, Independent)
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It happens all the time.

Bertie Ahern (Dublin Central, Fianna Fail)
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I am answering Deputy Kenny. The Deputy can raise it the next day the Minister for Health and Children is taking questions. That is what they are doing, but they are still seeing more patients on an inpatient basis, more on an outpatient basis and more under the National Treatment Purchase Fund. I know it is a rising population, but they are getting more resources to do this and people need to acknowledge it.

Richard Bruton (Dublin North Central, Fine Gael)
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There are fewer.

Bertie Ahern (Dublin Central, Fianna Fail)
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No, there are more.

Richard Bruton (Dublin North Central, Fine Gael)
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The Taoiseach should look at the figures.

Bertie Ahern (Dublin Central, Fianna Fail)
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The Deputy is very good at figures. Normally if something is 30,000——

Richard Bruton (Dublin North Central, Fine Gael)
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The Taoiseach should look at the figures for the Mater and Beaumont.

Bertie Ahern (Dublin Central, Fianna Fail)
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If something is normally 30,000 and it is now 34,000, how does the Deputy make out it is fewer?

Richard Bruton (Dublin North Central, Fine Gael)
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There are fewer inpatients in Beaumont and the Mater than there were five years ago.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach to conclude.

Bertie Ahern (Dublin Central, Fianna Fail)
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There are not. The number of inpatients, outpatients and patients being dealt with in our hospitals has gone up every year. Deputy Bruton knows that — he is excellent at figures.

Enda Kenny (Mayo, Fine Gael)
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All cataract operations are being dealt with through the NTPF in the Royal Victoria Eye and Ear Hospital.

Bertie Ahern (Dublin Central, Fianna Fail)
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The National Treatment Purchase Fund is being used effectively to take people off lists——

Enda Kenny (Mayo, Fine Gael)
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They are now in the Royal Victoria Eye and Ear Hospital.

Bertie Ahern (Dublin Central, Fianna Fail)
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——such as that for cataracts and to deal with them. That represents a massive improvement in the service.

Pat Rabbitte (Dublin South West, Labour)
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The Taoiseach seemed to reject Deputy Kenny's factual assertion that the accident and emergency figures are being deliberately massaged. One of the ways that is happening is that elective surgical procedures are being cancelled. The Taoiseach admits this is happening and suggests that it is normal. He is suggesting it is normal for the elective appointments of cardiac and cancer patients to be cancelled.

Ruairi Quinn (Dublin South East, Labour)
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At the last minute.

Pat Rabbitte (Dublin South West, Labour)
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The Taoiseach is saying that in Ireland in 2007 it is normal for patients suffering from cancer and cardiac problems to have their appointments cancelled. I have a letter from a woman from the former Southern Health Board area dated 23 January. She has cardiac problems and on instructions from her GP was rushed to Cork University Hospital. She has now received a letter stating that her appointment for an x-ray examination would be on Wednesday, 5 December 2007 at 10 a.m. She received a second letter on the same day, stating that her appointment for an x-ray examination would be on Friday, 7 December 2007 at 11 a.m. Two letters were sent to the same woman suffering from a heart condition advising her of an x-ray on two different dates in December — she is expected to wait for a year. How can that be justified?

The cancer strategy has already been derailed. The cystic fibrosis area is in crisis and money is unspent. The negotiations on the common contract for consultants are logjammed. The doctor-only medical cards have not been taken up. Now we have the problems in St. James's Hospital.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's time has concluded.

Pat Rabbitte (Dublin South West, Labour)
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It is arguably the best run hospital in this city and unprecedentedly it now states it cannot cope. The Taoiseach has come in and quoted statistics. Is it not the case that this is about capacity, beds and the relevant staff? When will the Government address any of these issues? Given the shortage of nurses in this city, what is the Taoiseach saying to the INO, which now feels the necessity to threaten industrial action because of grievances it has? What is the Government's official position on the INO dispute? What advice will he give to nurses who will be interested in what he has to say on the way forward?

Bertie Ahern (Dublin Central, Fianna Fail)
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I wish to correct Deputy Rabbitte, who was obviously preparing his notes and did not listen to the final reply I gave to Deputy Kenny — which I can understand. I said "elective operations". I did not categorise any elective operations. I said that when there is pressure on a hospital through its accident and emergency unit, it holds back on elective admissions.

Pat Rabbitte (Dublin South West, Labour)
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I agree.

Bertie Ahern (Dublin Central, Fianna Fail)
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That is a regular occurrence. The Deputy said that I said cancer services. I did not say that.

Liz McManus (Wicklow, Labour)
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It includes cancer patients.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy should allow the Taoiseach to speak without interruption. It is Deputy Rabbitte's question and he is entitled to hear the answer.

Deputies:

He is waffling again.

Bertie Ahern (Dublin Central, Fianna Fail)
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I got five seconds into it anyway. We have spent large resources successfully to ensure that more than 40,000 inpatients with cancer are treated and there are 55,000 more day cases. We have created more than 110 consultant posts in the cancer area and more than 300 new cancer specialist posts. We are building cancer services through the cancer control strategy, which has been welcomed by everybody involved. We have extended BreastCheck. We are investing in new cancer treatment. We have guaranteed capital funding, including more than €400 million for the new radiotherapy network. The HSE will implement this as quickly as possible. I do not accept some of the recent claims that it could not be done by 2011. We have seen what a private operation in Waterford could do in two years. The resources have been provided. It is carrying out the task and putting far more people through the system. It is the same with cardiac procedures. We have effectively eliminated cardiac lists. We used only to have cardiac surgery in Crumlin for children.

Liz McManus (Wicklow, Labour)
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What is the Taoiseach talking about?

Bertie Ahern (Dublin Central, Fianna Fail)
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I ask the Deputy to let me answer her leader.

Liz McManus (Wicklow, Labour)
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It is just not true.

Bertie Ahern (Dublin Central, Fianna Fail)
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It is true.

Joan Burton (Dublin West, Labour)
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Patients must wait a year to get an X-ray.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Allow the Taoiseach to speak without interruption.

Bertie Ahern (Dublin Central, Fianna Fail)
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In reply to Deputy Rabbitte, who mentioned cancer and cardiac procedures, we now have practically no waiting lists for cardiac services because of the facilities in Cork——

Liz McManus (Wicklow, Labour)
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That is just not true.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy will need to find another way to raise the matter.

Bertie Ahern (Dublin Central, Fianna Fail)
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——in Galway and in St. James's Hospital.

Liz McManus (Wicklow, Labour)
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Not in St. James's Hospital.

Bertie Ahern (Dublin Central, Fianna Fail)
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Yes, we have it in St. James's Hospital.

Liz McManus (Wicklow, Labour)
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No. That is not true.

Bertie Ahern (Dublin Central, Fianna Fail)
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As her party's health spokesperson, I do not know why the Deputy is so badly informed.

Liz McManus (Wicklow, Labour)
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I will tell the Taoiseach. Should I show him the patient?

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy is not the leader of the Labour Party.

Deputies:

Not yet.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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I ask her to allow the Taoiseach to speak without interruption.

Bertie Ahern (Dublin Central, Fianna Fail)
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In reply to Deputy Rabbitte, I have met representatives of the INO directly. They pointed out to me the difficulties they have and that they believed other categories of staff were allowed in under the previous agreement where they were not. They have suggested to me mechanisms they believe should be used in dealing with that case. They have made their point of view clearly known through the normal industrial relations channels and we will try to assist them in that regard.

Pat Rabbitte (Dublin South West, Labour)
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I know what the INO case is, but I do not know what the Government's response is, which is what interests me. What is the Taoiseach saying his Government will do in response to the INO position? That is the question.

If the Taoiseach agrees that elective operations are being cancelled, I suggest he asks his backbenchers whether any cardiac or cancer cases are included. They know they are because they are knocking at people's doors stating that it is the fault of the Minister, Deputy Harney, while the Taoiseach stills tolerates in Cabinet the man who bequeathed this disastrous legacy to her. At the launch of the latest health strategy in 2004, the Taoiseach sat with his Minister for Finance and pledged solemnly to the people that nobody would wait for longer than three months. People are still waiting for longer than 12 months.

In a recent reply to a question from Deputy McManus about the number of care beds in the country, the HSE stated on 6 December that "information on intensive care beds and day beds is not currently available". In his capacity as chairman of the Oireachtas Joint Committee on Health and Children, Deputy Moloney got a letter from the Intensive Care Society of Ireland, drawing his attention to the fact that precisely what has happened in St. James's Hospital this morning would happen.

Rory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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The Deputy's time has concluded.

Pat Rabbitte (Dublin South West, Labour)
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The letter went on to point out:

The Society would like to draw the attention of the Committee to this policy of closure of adult ICU beds at a time when the population is expanding. DOHC has stated that the ratio of adult ICU beds to acute hospital beds is 2.2%. This is incorrect. The ratio is in fact1.6%, amongst the lowest in EU.

It goes on to point out to Deputy Moloney the crisis that this would inevitably precipitate. Is it not a fact that the problem is capacity and expert staff, neither of which is being addressed? The commitments into which the Ministers for Health and Children have entered since Deputy Cowen held that office have been neither honoured nor implemented. As a result, in our relatively affluent economy, people cannot receive health services of a quality they have a right to expect. People are acutely distressed as a result of their interaction, or that of their relatives, with the health services.

Bertie Ahern (Dublin Central, Fianna Fail)
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To repeat myself, the Health Service Executive contracted with the private nursing home sector for 1,050 extra beds last year. These have been put into the areas of greatest need, particularly Dublin. The plan is to provide 360 extra beds this year, the large running costs for which have been provided. The Health Service Executive proposes to expand public capacity by 446 beds this year and a further 414 next year, the resources and staff for which have been made available.

Every year for the past ten years there has been a significant increase in consultants, specialists, nurses and related staff. At times there is a difficulty in recruiting for those posts and in retaining nurses, particularly those who are recently qualified and wish to travel for a period. Many come back here but not all do. There would be fewer problems if none of them went but that is life. There is no restriction on them which creates some pressure. Many non-Irish staff work in the health service because of that shortage. We have increased the capacity in paramedical, medical and nursing schools in recent years and provided resources.

In recent years 800 new staff have been appointed in the cardiac services under the cardiac health strategy. These include 19 consultants, 81 cardiac specialist technicians, chest pain clinics, fast tracking of patients through accident and emergency units and specialist cardiac services which have been either opened or greatly expanded in Cork, Galway and Dublin hospitals. Cardiac diagnostic tests have increased by 40%, coronary artery interventions by 153%, cardiac rehabilitation is provided in 29 hospitals compared with 12 six years ago. It is no longer the case that 75% of people awaiting cardiac surgery wait for a year or more. That figure now is under 20%. Most children had to wait a long time but now the waiting list is short. Those are the facts.

Michael Ring (Mayo, Fine Gael)
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So there is no problem in the health service. Everything is grand.

Bertie Ahern (Dublin Central, Fianna Fail)
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I did not say there is no problem. There will always be pressure and demand for improving the services and issues such as that which arose in St. James's Hospital today. This is not new and will not go away. Although we increased the bed capacity for intensive care unit beds from nine to 14 the hospital will at times run into difficulties. One serious road traffic accident, or operation, or one infection, can at any time create that difficulty. Although we continually increase the capacity I will not stand up here and say there will be some simple solution such that increasing capacity by another one or two will change the situation.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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That has not happened.

Bertie Ahern (Dublin Central, Fianna Fail)
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Let us stop trying to offer simple solutions to every little headline that comes out of every hospital.

Paul Connaughton Snr (Galway East, Fine Gael)
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It is not happening yet anyway.

Finian McGrath (Dublin North Central, Independent)
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The Taoiseach has been in power for ten years. He should give us a break.

Bertie Ahern (Dublin Central, Fianna Fail)
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There have been major improvements over the past ten years. As Deputy Finian McGrath knows, because he knows the health service better than anybody, it has improved rapidly and dramatically. He is a good beneficiary of that improvement, as is right. We will continue to improve which is good for the health service. We will continue to provide more beds. I have given the figures for that provision.

Joe Higgins (Dublin West, Socialist Party)
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I wish to remind the Taoiseach that this debate is not about newspaper headlines. It is about public patients suffering acutely on hospital waiting lists and in our hospitals because of a simple failure by his Government. He has gone all over the place with figures so I will keep the focus of my question narrow. Later tonight an excellent motion on cancer care tabled by the Independent Deputies and me will allow a much wider discussion on this and wider aspects of the health service. It is very simple to see why planned surgeries in St. James's Hospital have been cancelled over the past week because the Taoiseach, the Tánaiste, Deputy McDowell, and the Minister for Health and Children, Deputy Harney, individually and jointly have blatantly and cynically failed to meet the commitment the Taoiseach made five years ago to restore 3,000 extra beds to the public hospital system.

Finian McGrath (Dublin North Central, Independent)
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That is the story. That is the real world.

Joe Higgins (Dublin West, Socialist Party)
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These are the 3,000 beds that the Government parties ripped out ruthlessly in the 1980s when they aimed at the old, the sick and the handicapped. If the Government rips out thousands of beds, naturally it will have an acute difficulty. If in the meantime the population increases by three quarters of a million people it will have a full-blown crisis. That is as simple as A,B,C.

The Government deliberately obfuscates the problem because instead of providing those beds in a straightforward way, by extending the capacity of existing hospitals which have plenty of land for such development, and maybe building some new hospitals where they are required, it delays. It then gives its political friends, beef barons, speculators and developers, lots of tax breaks and public land to make a killing on people's health. In the meantime public patients are suffering grievously because of this agenda.

When will the full complement of the 3,000 beds be provided? Does the Taoiseach have an accurate figure for the extra beds needed by virtue of the increase in population by three-quarters of a million people? When will they be provided? Then we will have no more of this.

Bertie Ahern (Dublin Central, Fianna Fail)
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In answer to the Deputy's last question the Health Service Executive and some statisticians are examining bed capacity for the country. I do not know the figure. We must wait for that. To date we have provided approximately 1,500 beds and there are approximately 1,000 in the co-location initiative, which invites private investment and is designed to free up 1,000 beds in public hospitals for public patients. I know the Deputy does not approve of that initiative but it will add to overall capacity. I have already given the figures for this year and next year. That is the status of the bed numbers.

I have not quoted the wrong figures. For the winter months so far the reduction in accident and emergency units, which were a significant problem needing to be tackled, was as follows — October, -34%, November, -32%, December,-53% and January, -57%. Those are the real figures. The hospitals have worked extremely hard with the Health Service Executive and the accident and emergency unit initiative to provide services more efficiently not just by moving patients around——

Paul Connaughton Snr (Galway East, Fine Gael)
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It was moving them around.

Bertie Ahern (Dublin Central, Fianna Fail)
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This was achieved by providing out-of-hours services, the winter initiative, the rapid access clinics where the services have commenced and to which people have been referred from accident and emergency departments and are receiving efficient services and use of the National Treatment Purchase Fund. These initiatives were designed to help people. There are pressures at certain times of the year in hospitals. At other times, when there is less pressure they can take more people off the waiting lists for elective surgery. It is not always so easy to do this. While there are some staff difficulties they are not too great, as I understand it, from the Health Service Executive.

Joe Higgins (Dublin West, Socialist Party)
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The reality is that the Government stands over a two-tier health system which it sponsors and nurtures. That is having a grievous impact on the plight of public patients including those who are very ill. For the most part private hospitals do not cater for the very ill. They cherrypick the profitable procedures and the very sick and those requiring high maintenance are directed back into the public health system.

In recent weeks, everyone became familiar with the gut-wrenching case of a Kilkenny mother who was obliged to wait eight months for her colon to be examined. That delay will cost the woman in question her life. This is the reality faced by people who are not wealthy and who are dependent on a proper public health system.

Did it ever occur to the Taoiseach that there is a good reason that the section of consultants who want to operate in the private health system cannot take the Minister for Health and Children seriously when she lectures them on the need for a public-only contract? Such lectures on her part ring hollow because she is doing everything in her power to shift an increasing level of resources into the private hospitals where these consultants wish to operate at the same time as having contracts to work in public hospitals. The metaphor of the fox lecturing the members of the pack for casting their eyes over the henhouse comes to mind, particularly in light of the fact that the Minister has already directed the fattest chickens in that direction. Now she is telling consultants that they cannot move in this direction because she wants them to remain in the public sector. It is important to note — this is sometimes overlooked — that doctors are committed to public-only health care.

The problem does not relate to the quality of health care or the dedication of those who work in the service, but to access and capacity. The Taoiseach did not indicate the date on which the full complement of 3,000 beds will be provided and I want him to do so. Is it not pathetic, when it is clear that the population is burgeoning, that the HSE is only now discussing carrying out of a survey? Have the HSE and the Government been asleep for the past several years? When will that survey take place and when will an accurate number of additional beds required by our increasing population be provided?

Bertie Ahern (Dublin Central, Fianna Fail)
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I stated earlier that the overall survey relating to a population of 4.25 million and rising is under way. The HSE will present its report on the survey when it is completed. I also indicated that 1,500 have already been provided and that approximately 350 private beds and 446 public beds will be provided this year. Arrangements have been made to provide approximately 400 additional beds next year. I also referred earlier to the 5,000 private beds in public hospitals.

This matter is not as simple as the Deputy thinks. The length of stay by patients in all our hospitals has been dramatically reduced. In the past, people were obliged to remain in hospital for between 14 to 16 days in respect of quite minor procedures. An enormous level of day surgeries are being carried out at present and the figures have risen by hundreds of thousands. The old system — even that which obtained five years ago — does not necessarily apply. That point has been made by medical and nursing organisations. It is because of the efficiency and skill of the members of these organisations that the number of day patients being treated has increased while the length of stay has decreased.

Jerry Cowley (Mayo, Independent)
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Why then did the Taoiseach state that an additional 3,000 beds are needed?

Bertie Ahern (Dublin Central, Fianna Fail)
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I am aware the Deputy is an expert on medicine. We can discuss the matter later. Day and inpatients are being dealt with in much shorter periods. The relevant staff have, therefore, maximised the return from our acute hospitals.

Deputy Joe Higgins is correct that because of the standard of services on offer in our public hospitals, the huge numbers of staff that have been committed and the deployment of modern equipment, people who are seriously ill are far better off in public hospitals than they would be in their private counterparts.

Joan Burton (Dublin West, Labour)
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Why are public hospitals so dirty?

Bertie Ahern (Dublin Central, Fianna Fail)
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Deputy Joe Higgins is correct that the standards on offer in and the capacity of our public hospitals are of a level of which we should all be proud. We should continue to put resources——

Joe Higgins (Dublin West, Socialist Party)
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I did not say that.

Bertie Ahern (Dublin Central, Fianna Fail)
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That is what I heard the Deputy saying. He stated that, because of the standards on offer and the resources available, one would be far better off in a public acute hospital than in a private hospital and he is correct in that regard.

Joe Higgins (Dublin West, Socialist Party)
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The Taoiseach is rewriting the script.

Pat Rabbitte (Dublin South West, Labour)
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Is that why the Government is intent on building more private hospitals?

Bertie Ahern (Dublin Central, Fianna Fail)
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That is not to take from the fact that hundreds of thousands of people opt to pay health insurance to various companies so that they can access private care. There is nothing wrong with that.

Some 1.3 million people have medical cards and 60,000 people have doctor-only cards. I congratulate the parties opposite for at last seeing the wisdom behind our decision to introduce doctor-only cards. The Opposition berated me last year and stated that such cards are worse than useless.

Emmet Stagg (Kildare North, Labour)
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The Government did not issue any of them.

Bertie Ahern (Dublin Central, Fianna Fail)
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We issued 60,000. I would have issued one to the Deputy if he had been under the limit.

Emmet Stagg (Kildare North, Labour)
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A total of 200,000 were supposed to be issued. There is a shortfall of 140,000.

Bertie Ahern (Dublin Central, Fianna Fail)
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I will ask the Minister to increase the limit in order to take account of that fact. This development has been of major assistance to the service.