Liam Twomey (Wexford, Fine Gael)

I am delighted the Tánaiste and the Minister of State, Deputy Brian Lenihan, are present. Deputy Gormley of the Green Party said earlier that the Tánaiste seems to have a charmed relationship with the media in terms of the coverage she gets on what is happening in the Department of Health and Children. All Ministers seem to have a charmed relationship with the media. Perhaps it is something to do with the amount of money being spent by the Government on public relations and spin doctors. It is increasingly my belief that many Members of this House are expected to get information from the media after it has been properly sanitised by the public relations people.

Regardless of what the Tánaiste said in regard to her budget estimates, up to this point we have had no great idea about what she was planning to do to address the accident and emergency crisis. I went to the trouble of reading an extensive one page article on the Tánaiste in the Irish Examiner on Monday to glean more insight into what she was thinking of doing to address the crisis in health care, but I did not get any more knowledge on that. This shows that the spin is much better than the substance of what the Government often says inside and outside this House which does not stand up to critical scrutiny.

In the article to which I referred, the Tánaiste pointed out that the Hanly report has more or less been permanently put to bed. In explaining why this was the case, she said that the problem with Hanly was that it was presented to the public or maybe pursued by certain vested interests which led to a lot of unnecessary fear. I do not know what she meant by "a lot of unnecessary fear" when the essence of her speech and that of the Minister of State, Deputy Brian Lenihan, focused completely on the accident and emergency services in Dublin and across the country. The essence of what Hanly stood for was the closing of accident and emergency departments and providing such facilities in regional centres. The Tánaiste is conceding that she does not agree with over-centralising the health services. She is now talking about regionalising services. Does that mean that the radiotherapy report, which was published, is also more or less finding its way to the bin and that radiotherapy units will be provided, as we would have expected given that such units constitute appropriate medical care, in Cork, Dublin, Galway, Limerick and Waterford, or is that something that will be announced next year?

I was disappointed when I heard the Tánaiste say that for her the standard of accident and emergency departments form a litmus test in respect of the health services generally. The crisis in accident and emergency departments is a sign of the botched job that has been done to the health service for the past seven years and of a crisis that has got progressively worse during that time. For the Ministers to merely point out all the measures they will take and which we are expected to believe will make the delivery of the service excellent, is rubbish. The accident and emergency crisis should have been sorted out five years ago. The Government has shown no great dedication to addressing problems in the health services. The health strategy in 2002 was deceitfully published, given that the people expected that additional investment would be made in the health services from 2002 onwards. The Minister of State might say that extra money has been invested in the health services but that is not the same as extra investment. Most of the money that has been put into the health services is to cover the cost of benchmarking pay awards. Little has been put into the system, certainly in the past two, if not four, years, to improve the level of services.

The Minister of State said a significant report was published in October 2002 by Comhairle na nOspidéal on accident and emergency services. It is more than two years since that significant report was published. It has now cropped up in the Chamber as if it was something new and unique when it is not.

The Capita report identified system-wide problems as affecting bed and patient management in acute facilities. A group of experts got together and wrote that report in which they identified a shortage of acute beds, a high rate of bed occupancy, acute beds being blocked by patients who were ready for discharge and capacity problems in relation to long-term care. We have known that since 1997 when the Government parties came into office. Presenting that information as if the Government only found this out last week and will now do something about it shows that in some respects the Government had no interest in what was happening in the health services.

I noticed an interesting point which I probably should not raise here. The Tánaiste said she has appointed Prospectus to examine a way of mixing public and private investment in the health services. I received a request recently from a student for Fine Gael's views on its health policy and what it considered was the way forward in regard to health services. I am always willing to help any student to become more educated on the health services and I would even help the Minister if she needed help, which seems to be the case. The only reason I did not reply to that student was that the email address I was given was @prospectus.ie. Perhaps we should cut out the middlemen and work together on this one.

It seems the Government has no idea what it wants to do with the health service as highlighted by developments in the past 12 months. What about the treatment of pensioners? The Minister should read the scripts from the High Court and Supreme Court in regard to the Government's treatment of them. It has been stated in this House that those who are sick in hospital beds will be the ones to pay if the Government has to pay back this money.

Mr. Justice McCarthy asked a senior counsel whether it was appropriate to raise the appalling vista scenario regarding the cost of meeting potential claims. The senior counsel stated those alive should get their money back. No facts regarding those alive, dead or over 70 years of age were presented to the Supreme Court. The Minister knows the legislation to which I refer, that dealing with nursing home charges. Counsel even pointed out that they were not impressed with the speed of the passage of the legislation through the House.

As the Minister is aware, when the legislation was being debated in the House, many problems in the Department of Health and Children, including the waste of time and money, were highlighted. For example, a meeting was held in the Gresham Hotel in December 2003 but the minutes of that meeting seem to have been totally ignored. This led to the crisis in which legislation had to be rushed through the House in the last sitting days before last Christmas. Now we are expected to believe the ten point plan the Minister has presented will cure all ills in accident and emergency departments and other health services.

The Government will achieve little because it does not recognise the problems. The Minister should state why an MRI scanner in Beaumont Hospital is so important to solving the accident and emergency crisis. Why does it get precedence over the operation of 24 hour CAT scanning machines in all other hospitals? Beaumont Hospital needs an MRI scanner because patients with significant head injuries in many hospitals outside Dublin must be transferred to be scanned. Many of the patients who travel there for a scan are then sent back in an ambulance to the hospital from which they originally came. In some respects, much of this debate points up that the Government responds more to the media than to a medical crisis. The Minister should seek to make CAT scanners available on a 24 hour basis in regional hospitals in order that patients can be treated there. She should not focus on delivering an MRI scanner to Beaumont Hospital and think this will make everything wonderful.

The medical admissions units are another interesting issue. A report was drawn up by Comhairle na nOspidéal well over a year ago. However, it was not until the Tánaiste was appointed to the Department of Health and Children and some regard was paid to the crisis in accident and emergency units that the report was even published. Now the Minister is diving headlong into the setting up of such units. Does she agree with me that there should be a consultant in charge of them? If so, are we just making them into a medical form of an accident and emergency unit? Does the Minister believe consultants should not be in charge? Does she believe the units should be the responsibility of all consultant physicians in order that they have ownership of them and that, therefore, it would be in their own interests to ensure they empty at 7 p.m. or 8 p.m.? Does she believe it is in the interests of consultants to free up acute beds within hospitals and, therefore, have the progression we expect such units to deliver?

Medical admissions units on their own will not solve the crisis. A ten bed medical admissions unit may be opened in the coming days but such units which operate efficiently and effectively in Kilkenny and Wexford have stopped working at the same success rate as they are full of patients who cannot get a bed in a ward because trolleys are backed up in accident and emergency units and are now backing up in the medical admissions units.

The problem is that the focus is on quickly putting beds into hospitals. The people have been told that some 500 beds are being provided in private nursing homes. Why did the Government wait so long for this? Why was this not done three years ago when the problems were as acute as they are now? Why did the Government not bother in the past three years to investigate the issue of patients waiting on trolleys? Why did it wait until the crisis is such that patients are more or less dying on trolleys in hospitals?

No matter what is said in the House, much of it is too little too late. It is based on the attempt by the Government to bail itself out of the mess it has made of the health service in the past seven years. It has done a botched job and caused this crisis. It would be better off facing up to its responsibilities and admitting it was wrong. It should invest properly in the health service. It has no intention of delivering on its commitments on primary care because it has already stated it will not make a significant investment until 2007.

All the Government is trying to achieve is to tidy up matters for the next general election in order that it can walk back in on the premise that it somehow improved the health service. However, the people are copping on to this and to the fact that pouring money into the service does not equate with better health services. This is where the Government has failed.

See this speech in context