Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

All my contributions have been limited and with the passage of time have become even more limited. As the Chairman knows, I am a very simple country boy and have simplistic solutions to everything, including some of the complicated issues raised by Deputy Kelleher.

I see two issues. First, there is overcrowding in accident and emergency departments. This has occurred every year for the past ten years with no change. The same applies to waiting lists for elective surgery despite the corrective measures. I welcome all the measures that have taken place and the extra funding made available in the current year over last year and the proposals for the future.

Regarding overcrowding in accident and emergency departments, what research has gone into the reason for the persons being there in the first place? Have they come of their own volition? Have they come following referral from their GPs or have they come as a result of being on a waiting list for elective surgery for a period of two or three years, or whatever the case may be? I would like precise answers to those questions because I believe I know the answers to them.

When a patient first presents for elective surgery, to what extent has an examination been done as to whether at any given time there is sufficient capacity in the system to deal with the volume? It is simple mathematics. I know people will tell me it is not possible to interrelate mathematics and medicine, but there is a certain merit in it.

We appear to be closing down step-down beds in the public sector. This has happened gradually over the past 15 years on the basis of health and safety and so forth. I know the institutions concerned. I was on the visiting committee of some such institutions previously. I cannot understand why that is happening. It surely would be of huge benefit at this time to try to make available the maximum number of those beds at a time when beds are at a premium in the public hospital system.

Why was it not possible to identify the extent of the urgency of the particular scoliosis cases without having to wait for an investigative programme by RTE? Surely it was known to everybody along the line that there were a number of patients in the system. Their individual suffering is not recognised by everybody because we do not all know where it is happening. However, somebody knew what was happening and decided to put them on a waiting list. As the Chairman will know, this arises all the time with hip replacements. It is not unusual to find a person hobbling along with one crutch, having suffered in silence for a long period of time, eventually being told, "Sorry, there's a problem; we had a bed for you yesterday but we won't have one again for two months."

There is an examination of capacity. What is the optimum required to address the accident and emergency department problems, from where the patients are coming and the hospital problems in terms of waiting lists? Is it due to a lack of surgical facilities, such as theatres and theatre staff? For example, in the past 24 hours I have dealt with a case where a serious operation was scheduled to take place, but had to be postponed because of a lack of theatre staff. It was an urgent procedure involving a child. Parents and patients of whatever age are vulnerable. That should identify the scale of what is required to provide the services for the next three years.

We should not have a shortfall the following year. We should address the issue, identify the core problem and deal with it. That may mean increasing the services dramatically to cater for our population. When people tell me we have an ageing population I feel sensitive about it and look in the mirror. There is also a very young population contributing tax to the system. I would like a comment on that.

It is very obvious that if a person discovers a particular drug can have a dramatic impact on his or her condition, he or she will want to have it. That the person is in his or her little world and reaching out for something to alleviate the pain is a natural reaction. I know the Minister and the HSE have done some work on this recently but we live in a single market. If the drugs are approved, available and paid for in Milan, Berlin or other places, they should be available here too at the same cost. The European market is 500 million people. It is more lucrative for a drug company to deal with that number than to deal with three or seven million. How much time and energy do we devote to ensuring we get the benefits of being part of the 500 million?

Why was it not possible to identify the full extent of the waiting lists in our hospitals? We have asked that question several times. RTE was able to discover it in a couple of hours or that is how it looks to me. The information does not seem to filter down to the area that matters, and if it does not, there is a problem. It cannot and will not be dealt with until that happens.

Everybody thought it was a good idea to centralise the services. I never believed it was a good idea. This is not a criticism of the HSE but I never believed it was the appropriate body to deliver services nationwide and it is not. The people working in the medical card section are decent people and work very hard where there is a huge demand. I cannot understand how a cancer patient may have to wait while bank details and other documents are submitted and the patient's condition is deteriorating. Nobody seems to think about that. It would be quite simple to issue the medical card in the first instance. Safeguarding the patient should be the priority.

I could go on and on. If we can get the answers to some of my questions and to those my colleagues have put, we will solve health service problems we have been trying to deal with over the past ten to 15 years.