John Gormley (Dublin South East, Green Party)

I thank the Independent Deputies for tabling this important motion. Nothing better reveals the true face of modern Ireland or the PD-Fianna Fáil coalition than the crisis in accident and emergency wards-units where there is now a safety problem. I do not say that to make political capital. It is a fact that was categorically and repeatedly stated on 12 January by Dr. Aidan Gleeson on "Morning Ireland" who said that the accident and emergency units were "unsafe". He put forward a proposal to move accident and emergency patients into wards, an idea that did not find favour with the nurses' unions, which believe it simply transfers the problem. Dr. Patrick Plunkett also made a similar proposal and was lambasted for it.

The proposals Dr. Gleeson put forward were interesting, as was his analysis. He said that it will take several years to deal with this problem. The world-class health system the Tánaiste promised this House must wait because she is not dealing with the problem properly. The Tánaiste put forward a ten point plan in the autumn, stating that the accident and emergency crisis is unacceptable, yet it continues.

On the same edition of "Morning Ireland", Mr. Pat McLaughlin of the Health Service Executive was questioned at length about the implementation of the ten point plan. It was clear that it is not being implemented properly and is being left in abeyance. The Government promised 3,000 beds in its health strategy but part of the ten point plan was to give us 300 beds. Where are they? Pat McLaughlin tells us they will be available by the end of 2005. Does the Tánaiste think that is acceptable? Does she really believe that is the way to tackle the crisis in accident and emergency units, to let it go on and on? Why can we not just deliver the beds? I have always said that this is a problem of capacity. It is interesting that much of the ten point plan reflects the content of a Green Party document published two years ago on the accident and emergency crisis.

Extra capacity and minor injury clinics are both contained in the plan, but where are they? Mr. McLaughlin was not specific on that when asked. I will be fair because the man has been in the job only a short time. A number of new MRI units and acute medical units were said to be in the pipeline and were being examined in detail, along with the transfer of high dependency patients. He said that tenders have gone out and it was all about to happen, but none of it has happened. Deputy McDaid has experience of this and knows this is the same old story and that we are not tackling the problem. If it is not tackled, it will continue.

I advise the Tánaiste to start investing. The €70 million for the accident and emergency initiative is a drop in the ocean. Funding must go much further. This is a significant part of the problem because the PDs are not prepared to invest or, as the Minister, Deputy Martin said, to raise taxes if necessary to deal with the health crisis.

It was said that while the crisis was taking place, the Tánaiste was on holiday. I would hate to think of her lying on a beach while others where lying on trolleys and sitting in chairs in the most terrible conditions. If the Tánaiste was a Fianna Fáil Minister, it would have been splashed all over the papers. The Tánaiste, however, enjoys a charmed existence with the media. To be on holiday while this took place is unacceptable.

The Green Party believes that the crisis within accident and emergency services reflects the crisis in the wider health system. Any attempt to address the problems in accident and emergency services must therefore be part of a strategic programme in and restructuring of the health services. New investment in health must be targeted at key areas, primary care in particular. The primary care strategy is just not happening.

The low tax, low spend economic policies of Fianna Fáil and the PDs have limited the options available to the Government to respond to the growing crisis. The Government's self-serving rhetoric about the need for greater efficiency and accountability in the health system is an attempt to distract from the fact that it is not prepared to invest in the sort of health services that are available in other EU member states.

The health care available in a society reflects its values. In the USA the provision of health care is not seen as the obligation of society but as a voluntary consumer purchase. It is up to individuals to ensure they receive health care in an environment where social solidarity plays second fiddle to economic forces. One in five Americans is under-insured or has no health insurance and their access to health care is severely curtailed. In comparison, health care systems in the majority of EU states are based on the concept of social solidarity. Ireland's two-tier health care system reveals values closer to Boston than Berlin, in line with the views the Tánaiste has always expressed. Good quality health care does not come cheap. In the United Kingdom, there is a growing realisation that if health care spending is to rise, people must be convinced to pay for it. An Irish Government that intends to deliver equitable and high-quality health care has to convince the electorate to pay for it — that is the bottom line.

The Green Party believes that many of the difficulties encountered in accident and emergency departments can be primarily attributed to this country's lack of a comprehensive and properly funded primary health care system. There are other problems, however. Almost half of all GPs are engaged in solo practice and two thirds of GPs do not employ a nurse. High referral rates to specialists often reflect the isolation and uncertainty of GPs. A modernised GP service would relieve the pressure on the inpatient and outpatient hospitals sector. Accident and emergency services are serving as a catch-all for patients, many of whom should be treated elsewhere. There is a shortfall in the bed capacity of major hospitals, particularly in the eastern regions. Deputies are aware that patients who are assessed in accident and emergency units often have to wait on trolleys for up to 48 hours.

I would like to discuss step-down facilities before I finish. I will give an example that highlights the crisis we face. I spoke recently to two people whose parents, aged 80 and 84, are in hospital. They were told six weeks ago that they could be discharged, as long as they moved back home. The middle-aged children wanted to look after their parents. This is an example of beds being taken by people who should not be in hospital. Proper facilities should be put in place, appropriate equipment should be provided in people's homes and people should be paid to look after their parents. Such a system would be much cheaper than keeping such people in hospital, where they take up space and exacerbate the crisis in accident and emergency departments. I urge the Tánaiste to examine this matter. I will table a parliamentary question on the issue and I will write to the Tánaiste about it.

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