Joe Costello (Dublin Central, Labour)

I am not reading. It is an inauspicious beginning that we should in a short period put through important legislation of this nature. It seems that every important issue we debate is dealt with as an emergency and must be rushed through without the real issues being dealt with. I have had it up to the teeth with the Minister for Justice, Equality and Law Reform in this regard when it comes to his brief. It is wrong that we should rush through this legislation when it is supposed to redress all the grievances of the past seven years.

I compliment the Patients Together group on coming out on the streets to highlight the crisis in accident and emergency departments. The Byrne family, when their mother was left lying on a trolley, had the courage to go public on the issue when many others would not have had the confidence to do so. However, the Byrne family had the courage to do so and to organise a campaign. I have no doubt this is part of the reason for the sudden alacrity now being displayed by the Minister for Health and Children and the Government in seeking to get the legislation through at this early stage.

The health service and the accident and emergency departments have been in crisis for the past seven years and steps of any kind were not taken to deal with the situation. In the Mater Hospital there are still 20 to 35 people lying on trolleys at any given time. The Minister could go to see them. It would be a very useful exercise for her to pass through the accident and emergency unit where there is no separation or distinction between someone arriving after an accident perhaps related to alcohol or drug overdose, and a little old lady who has had a stroke or a heart attack. Such people lie cheek by jowl there, side by side. That is not good enough in this day and age. Every accident and emergency unit should have separate admission sections so that people would not be mixed like that for long periods of time, especially when they must lie on trolleys for days.

The accident and emergency unit in the Mater Hospital is short of four nurses and needs more medical staff. The hospital currently has 60 vacancies for nurses. Patients who could be catered for in a recovery unit if there were such a unit, occupy more than 70 beds. According to the staff, 100 new beds are also urgently needed. There are 4,000 people waiting for serious operations and treatment. That is the level of the problem facing the Minister in one hospital. That is how far the situation has deteriorated there.

The hospital consultants said that 3,000 beds have been lost to the system. There is no point in denying that. In my constituency the Jervis Street and Richmond Street hospitals have closed. Looking immediately across the Liffey I can see the closure of Sir Patrick Dun's, Mercer's and the Meath Hospitals. These have all closed in the heart of the city and the beds have not been replaced. Some 3,000 beds were lost to the system by 1990 and with an increased population we expect a service to be provided. It cannot be provided. We urgently need more beds. We also have hospitals and units where beds or wards are closed down, or units which have not been opened due to lack of funding. We are promised funding for these in the Estimates but we must wait to see if it will arrive.

I have always wondered why the Minister could not do something with the old nurses' home in the Mater, which after about five years still lies idle. Could the Minister knock down a few walls and provide either a step-down or accident and emergency facility there? We do not know when it will be demolished, nor when the plans for the new Mater and Temple Street hospitals will be drawn up. There is an unused facility there which could provide much-needed space in terms of hospital beds either for accident and emergency purposes or for normal admission and treatment.

The Estimates allow approximately €11 billion for spending on the hospitals this year. The Minister goes to great lengths to explain what a fine job he is doing in that area, with an increased spend of €950 million on last year, an increase of 9%. Approximately 40% of the total of the extra money being spent in the Estimates this year is going on hospitals. That is a great deal of money. The Minister tells us that since 1997 there has been a spending increase of 205%. Yet here we are in the Dáil again discussing the crisis in the hospitals.

The Minister said it was wonderful that 80% of those on waiting lists do not now have to wait more than a year. Waiting a year for an urgent operation is not wonderful by any means. The waiting lists remain very long. The changes and improvements have not taken place. As far as I know, accident and emergency waiting times have not improved at all and there is no mechanism to ensure that someone who has been admitted to hospital, who has perhaps spent a couple of days on a trolley and perhaps has then had an operation, can be moved on.

I will give an example that might be useful to the Minister. I visit a friend of mine in the Mater Hospital every week. Following a stroke, he arrived in the hospital in August. He is in pretty good shape, though he needs physical therapy. Mentally he has suffered no detrimental effect. He is receiving physical therapy in the hospital but could just as easily receive it at home. However, he cannot go home. He has no medical card. That was a problem we had to sort out. He also needed a ramp at his home. The local authority installed the ramp but it was the wrong size and has not yet been adjusted. This man then needed downstairs facilities in his home because he could not go upstairs. Those facilities have to be installed but there will be no sign of them in the near future.

This man has been occupying a hospital bed since August. Being in fine mental shape, he would love to be out of the hospital but cannot leave. There is no step-down facility. If the old nurses' home in the Mater were available as a step-down facility he could spend recovery time out of the main hospital. If the link with the local authority and the community services were strong enough he could be dealt with there too.

I share the concern expressed by Deputy Kelleher and others in the House about accountability and transparency. If we cannot ask the Minister parliamentary questions in the House we are handing over the responsibility which should be conferred on this House to an agency to be established, which is not right or proper. We should not allow that to happen. Whatever mechanism is put in place, it must ensure that this House is paramount and that on behalf of our constituents we can get answers directly from the Minister.

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