There were rowdy scenes in the Dáil amid heated exchanges between Tánaiste Joan Burton and Sinn Féin deputy leader Mary Lou McDonald.

Ms Burton rejected Ms McDonald's claims that a two-tier health system was still in place and the Government had made it worse.

There was repeated heckling during leaders’ questions as Sinn Féin TDs reacted to Ms Burton and she hit out at Donegal TD Pádraig Mac Lochlainn, describing him as a “barroom brawler”.

Ms McDonald listed health service shortcomings including 4,000 fewer nurses, 68,000 people waiting for inpatient treatment, 400,000 waiting for out-patient appointments and a service plan imposed on the HSE that is €150 million short of what was needed.

She claimed the Government had failed despite promises to provide a fair and proper health service.

But the Tánaiste replied that Sinn Féin’s new health service policy document had no costing and hit out at Ms McDonald for “reading from your carefully scripted speech”.

Ms Burton said it "lacked any sense of conviction" as TDs across the House intervened and started heckling. Mr Mac Lochlann engaged in angry exchanges with Fine Gael's Dinny McGinley.

As leas Cheann Comhairle Micheál Kitt repeatedly called for order, Ms Burton sharply criticised Mr Mac Lochlainn, calling him a “barroom brawler”.