John Moloney (Laois-Offaly, Fianna Fail)

I welcome the fact that on entering office, and at the publication of the Estimates, the Tánaiste identified the delivery of accident and emergency services as a priority for attention. Policy is continually evolving and, although there has been huge investment in the health services, there are still areas that require further attention. I would like to examine the action that has been taken in recent months to recognise the problems in accident and emergency services and the time set aside by the Tánaiste and the Government to deal with the relevant issues.

The Tánaiste acted promptly in November 2004 by writing to the CEOs of the ERHA and in December 2004 by reiterating her plan of action for the other CEOs. It is hoped that the proposed actions will reduce waiting times, particularly for patients waiting for trolleys, facilitate the movement of patients from accident and emergency departments to more suitable parts of hospitals and improve the working conditions of accident and emergency staff. Such aspirations were included in a statement made at the launch of the Book of Estimates and are part of the Government's overall policy.

The Tánaiste has asked all hospitals to prioritise accident and emergency services and to identify key actions that will improve the flow of accident and emergency patients. It is clear to those of us who have served on health boards that some hospitals can remain within budget while offering a superior level of service. Other hospitals in certain health board areas do not seem able to offer the same level of initiative or delivery. The Tánaiste has made it clear to hospitals that they should demonstrate clearly how they intend to prioritise and improve their accident and emergency delivery policies before they look for further funding for various initiatives.

The relevant health authorities have been instructed to begin discussions on the core issues with the CEOs of the relevant hospitals immediately. Such issues include analysis of patient flows, reorganisation of work practices and rostering of accident and emergency staff. Regular ward rounds should be undertaken by consultants and registrars. It might seem that such matters were in place for a long time, but it is clear that they need to be resurrected. The old ways need to be improved on.

Other bodies have been asked to assist in prioritising accident and emergency services. The national treatment purchase fund has been asked to scale back its activities in public acute hospitals, thereby freeing up bed capacity.

The members of the Joint Committee on Health and Children, of which I am Chairman, recognise the difficulties that are faced by accident and emergency units as a consequence of the abuse of alcohol. It is clear that a great deal of staff time is spent treating problems which result from the high level of such abuse. People who are intoxicated or under the influence of drugs take up many spaces in accident and emergency units. The joint committee produced a comprehensive report on alcohol misuse and abuse last year. The report stated that the misuse of accident and emergency services by people who are drunk or in a serious condition has to be clearly recognised if we are to improve such services. We have to tackle the problems caused by those who should not be presenting themselves at accident and emergency units. The measures to be introduced will help accident and emergency patients, particularly older people, and their families.

I read with interest a recent letter in The Irish Times, which showed the positive side of accident and emergency services. The letter writer praised the excellent treatment he received in the accident and emergency unit of the Mater Hospital. Accident and emergency departments throughout the regions can be praised in a similar manner because they are providing improved services. Staff have extra confidence in the improvements in the system because they know the Government's policies will improve accident and emergency services.

I welcome the allocation of funding of €16.8 million to the ERHA, which will result in 1,600 patients being discharged to more appropriate settings. Improved and expanded accident and emergency departments are being provided throughout the State, for example at Cork University Hospital, James Connolly Memorial Hospital and Naas, Clonmel and Roscommon hospitals.

I recognise the initiatives taken by the Tánaiste and the Government and the increases in health service funding. I dispute the suggestion that there have been cutbacks in the health sector. The level of funding made available to the health system has been increasing since 1997. The capital programmes have increased throughout the State. There has been massive investment in most county hospitals. It is clear that the regionalisation of health services is to be welcomed. Tackling the problems in accident and emergency services is the final piece of the jigsaw if we are to provide a First World health service. The Tánaiste is going the right way about it. I give her my full support.

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