Seán Crowe (Dublin South West, Sinn Fein) | Oireachtas source

I have a couple of comments myself. At the start of the meeting we heard that there were 592 people on trolley beds yesterday with an average of 560 a day. There are huge challenges there. It was asked why people turn up at emergency departments. The reason people turn up is that they are not well and are looking for medical assistance. In a lot of cases the first port of call is the pharmacy. We talked about this before around minor injuries and so on. Maybe at some stage the Minister could come back to us on what he proposes to do in in that regard. It is an important element in medical care and medical support for people in the community. The next step is usually the GP. This depends on where people are living but based on anecdotal evidence from colleagues and so on people are waiting about a week to get a GP appointment. People probably turn up at accident and emergency departments because they cannot get an appointment. We know there are huge challenges there with GPs. The health system is many moving parts and if one of them is blocked or not working that creates a challenge. The Minister mentioned that there are more GPs in training. We have had plenty of nurses going through the system but not staying. That is the key. If we are training more medical staff and more GPs, the important thing is that there are jobs there for them and that they actually stay in Ireland

Deputy Gino Kenny asked what the Minister had seen in accident and emergency departments. I am aware that he was not always a Minister. He has probably been in accident and emergency when he was not the Minister for Health and what he saw was probably completely different as a person coming into accident and emergency for themselves or a loved one or whatever else. My experience has been that there is good and bad. I have been in a number of hospitals. Some were the difference between night and day because of where they are located and some of the challenges the staff in those hospitals are facing. I have been in some where the toilets or the hand-wash basins were not working. I have been in ones where there were people taking drugs outside, there were people selling drugs and there was drug-dealing going on. I am just giving a picture of the huge challenges. That is outside the place, before you go in. In those emergency departments, particularly at weekends, there can be an air of violence because of that. I am saying all this because I accept all the challenges staff are facing.

Years ago there was talk of separating those presenting at accident and emergency departments with drug, alcohol mental or health issues. Deputy Kenny asked about the images the Ministers had seen. I have an image of someone. I was in an accident and emergency department visiting a friend of mine and there was an elderly woman there dying. I always remember this day. All her family were around here and they were praying. She was in a corridor with the family standing around her. Just beside her, there was a guy who was handcuffed who was clearly out of his head on drugs. He must have been out of prison and he was shouting abuse and expletives and so on. I still have that memory in my head of what happened to that family. It was awful. What a way to say goodbye to your mother. I am just using that as an example.

We need to consider the issue of people with addiction who clearly have alcohol and drugs taken, particularly at weekends. We need to examine the hospital system and the dangers within it. People who have mental health issues or are suicidal turn up there, but the accident and emergency department is not suitable for them. We need to see if we can come up with a different approach.

The Minister referred to additional beds for those in the system. It would be fantastic if we could get those 1,500 beds, but where they will be located is key. The beds could be in particular areas, but we need to put them where they are required. The Minister has mentioned many times that there are areas where blockages in emergency departments are down to a lack of beds in the system, and we know that there are hospitals that have submitted applications and where planning permission and climate concerns are not problems. The committee has asked the Minister multiple times for the 1,500 beds to be fast-tracked. Will he revert to us at some point on the matter?

Regarding rehab, why do people stay in hospital for so long? Is rehab one of the areas where there will be additional beds?

I have probably gone way over my time, so I apologise to members who are looking to contribute. I have asked a number of questions. The system is not working. The Minister described primary care centres and community care. The system is fantastic where it works, but I know of many areas where we do not have a one-stop-shop or other facilities. The Minister is describing the ideal model. Unfortunately, though, we know it is not in place. There are major challenges in the community. We are getting older because people are living longer. Housing adaptation grants, community supports and so forth form part of the package of supports that keep people out of hospital and are clearly necessary. If there are no supports in an area, it causes a major problem.

I have gone on for too long. Those were comments, but there were also questions among them.