Liz McManus (Wicklow, Labour)

I welcome this motion. That the Health and Safety Authority has had to step into the breach and seek a full inspection of accident and emergency services is the greatest expression of Government failure to tackle the crisis in our health services. The Minister for Health and Children puts on a brave face and welcomes this move when she should be hanging her head in shame. She talks about €23 billion being spent on the health service in 2004-05 as if someone else were responsible for the mess.

The issue is the small return from that money. Why is it that, far from getting better services for acutely ill and emergency cases, the service is getting worse to the point that people are being put at risk merely by being within a hospital? The Minister has given commitments to patients that accident and emergency departments will at least be clean. Patients Together sent me an email today following the Minister's remarks yesterday:

In light of the ongoing A&E crisis, yesterday 'Patients Together' called to A&E to meet with a family. The first thing we noticed on our arrival was blood-splattered steps. In passing a comment to another member of Patients Together a very embarrassed young woman had overheard and told us it was actually her brother's blood which he had coughed up. This woman proceeded to tell us her brother had TB and had been a patient in Peamount for over a year. This woman also told us she herself had just been checked for TB. The patient at this stage had also already been there two hours. This also means the blood was there for two hours.

We visited with the Minister 11 weeks ago and the only definite assurance we came away from that meeting with, was her promise to implement a 24-7 hygiene programme. On our last visit we found a used syringe on the ground at the public entrance.

Patients Together taped the Minister, with her permission, at a meeting where she said:

... on the house keeping side. All hospitals have contract cleaners and are paying top dollar to them, there are no excuses for hospitals having hygiene problems, we live in a country that is pretty prosperous, so there are no excuses for the lack of cleanliness.

Almost three months later the Minister continues to only talk the talk. The ten-point plan that she repeated last night in this debate was announced over two months ago. While a global figure is attached to it, there is no breakdown of how the funding is to be allocated. Each point requires money. The first relates to new minor injury units, chest pain clinics and respiratory clinics but no progress appears to have been made on these since mid-November. It is interesting that the Minister failed to tell us about any progress.

The second point is the provision of an MRI scanner for Beaumont hospital but the Minister does not say that there were two scanners there, one fixed and one mobile. The mobile one was taken out because it was deemed to be too expensive. Now, presumably, Beaumont is getting this scanner back. While this is good for patients it is hardly breaking new ground in dealing with the accident and emergency crisis.

She also said that acute medical units are being promoted but they will take up to 12 months or longer to get staff and equipment in place. Although there is spare capacity in the private nursing home sector, to which inappropriately placed patients could be moved to free up acute beds, there has been no change in that regard. Nothing has actually changed even though much could have been done as far back as November.

Many patients in private nursing home beds, who receive health board subventions, forfeit their entire pension because of the increased cost and the ceiling on subventions. In some cases the charges are rising and the patients are in serious difficulties. They do not even have the cushion of €30 per week pocket money which characterised the experience of public nursing home patients and which is now the subject of a Supreme Court action.

This group of patients is being pauperised because it has no safeguard. As there are no longer contract beds, and because of the Minister's policy, this group will continue to grow. Some protection must be provided for these people.

The Minister refers to home care packages. People with disabilities, or coming out of hospital, experience severe difficulty, for example in getting a shower fitted, due to cutbacks in the home-help services and the disabled persons' grants. In one case, Lidl has built a supermarket in a shorter space of time than it has taken to complete a shower room for a severely disabled woman in the same town.

The Minister talks about out-of-hours general practitioner services yet she has allocated only a pittance to the primary care strategy. This strategy has become a joke among medical professionals who regard it as another broken promise from a discredited Government.

The Minister does not even understand what is happening to general practitioner services. General practitioners are already scarce and will quickly become more so. The fact is that 1.9 million cases go to the acute services in a year yet 16 million are treated at primary care level. Primary care is the key to sorting out the accident and emergency crisis, yet there has been a very small increase in trainee places and no effort has been made in realistic terms to deal with the issues around undergraduates training for general practice. We are one of the richest countries in the world but we have one of the most incompetent Governments in the world when it comes to health care.

Fianna Fáil and the PDs are the parties which gave wealthy over 70 year olds a medical card and paid GPs four times more for caring for these wealthy patients than they are paid for caring for their poor patients. The Government squandered millions in this cynical bid to win votes and both Government parties are responsible for that. These are the parties that promised to deliver 200,000 medical cards and then removed approximately 200,000 medical cards from people on low incomes. The Minister for Health and Children promised yellow pack cards to provide cheap GP care last November but to date all these unfortunate people have seen is a massive increase of €10 in the cost of a visit to an accident and emergency department. Not one of the yellow pack cards has materialised. We are still awaiting legislation in this regard, but with effect from 1 January accident and emergency department charges rocketed.

The PDs and Fianna Fáil have presided over the worst level of crisis in accident and emergency services ever experienced. For the first time relatives of patients waiting for treatment at the Mater Hospital went so far as to stage a public demonstration to highlight the appalling plight of their loved ones. They spoke to the media and their stories were litanies of pain and suffering. The organisation Patients Together grew out of those outpourings. Its members eventually met the Minister, Deputy Harney, on 5 November. They raised issues about cleanliness. Their statement reads:

We demand today a target time of a maximum four hours for any trolley stay and insist that this be less for those left in chairs.

We have found from our experience that hygiene and safety standards are being compromised and request that an independent health and safety audit be immediately carried out in all our A&E departments around the country and its findings be made public.

Could [the Minister] please take the time to visit the ... Mater Hospital.

They requested that she meet people in the A&E department, and pointed out that:

At present when a family member is left lying for days in A&E it takes a horrendous toll on all family members, as most must do a 24 hour vigil resulting in vomiting bugs, work commitments suffering [as well as] ... children and basic home life disrupted...

We question what would happen today if we suffered a major disaster when our A&E departments are already working to full capacity.

Accident and emergency is by its very nature an emergency and needs immediate attention.

We feel that [this is an important point that we should remember] the privacy and dignity of patients in A&E is being violated.

At that point when those patients and their families spoke to the Minister, Deputy Harney, she could and should have responded to the request for a health and safety audit. She chose silence instead. Only now that she has been forced into supporting the Health and Safety Authority's requirement is she welcoming this development.

One development, to which she has not referred, is the deferral of planned surgery which is inevitable when there is pressure on accident and emergency services and which was the subject of discussion of LRC meetings on the crisis. The Minister praised the national treatment purchase fund but did not mention the angrywords said by one consultant in emergency medicine:

What I think is completely obscene is public hospitals have set aside beds for NTPF work. So you can have varicose veins, be on a waiting list for six months and one day you ring up the NTPF and they'll roll out the carpet for you to go to a public hospital and have your job done essentially as a private patient but at the same time you've got an 85 year old lady with pneumonia from Coolock who has worked hard all her life, paid her taxes and she's left on a trolley in the middle of an overcrowded emergency department for three days.

The health service responds when the money follows the patient and often regardless of need. That is the simple fact the Minister needs to learn. This fact is creating a negative impact on the accident and emergency crisis, as Dr. Gleeson stated. It is also evident in the high level of disregard of the 20% limit on private beds in public hospitals across the country. There are many public hospitals treating well over that ratio, some have well over 30% and some have even 40% patients for elective surgery and day care.

It is interesting to note from the recent blunderbuss approach to imposing fines on certain hospitals while rewarding others that no account is given to rewarding hospitals that stayed within the 20% limit and thereby cared for the patients who tend to be more in need such as an 85 year old lady from Coolock to whom Dr. Gleeson referred. The South Infirmary Hospital in Cork had 38% private patients, yet it received a whopping €517,000 reward while a hospital like St. Mary's Orthopaedic Hospital which stayed well below the limit and treated only 6% private patients was penalised by losing a massive €388,000. James Connolly Memorial Hospital and St. Colmcille's Hospital in Loughlinstown were hammered with the loss of €1.3 million and €1 million, respectively. These hospitals are far removed from having the requested percentage of private patients, comply with regulations and meet the greatest need, but that is clearly a bad policy for a hospital to pursue if it wants to keep afloat. The Minister for Health and Children loves the idea of private health care, but what is happening is plainly wrong and is making the situation in accident and emergency services even worse.

Reading the Minister, Deputy Harney's, approach to the health service and her over-reliance on and naive expectations of the private sector to deliver her from the crisis is dismaying. I ask her to consider clearly what she is doing when she sets about relying on the private sector to deliver in terms of protecting her from the rage of the electorate when it comes to the health service. If she continues to promote this idea of over-reliance on the private sector she will deepen inequality, increase costs, decrease the value for money secured and ensure that the public sector is not able to provide in an effective and efficient way the services needed by the people.

The Labour Party has argued for a long time that what we need is care based on need not on ability to pay. We know the system responds when people are insured because I am sure we have all experienced that. The vast majority of Members are covered by health insurance. It comes down to the issue of money following the patient. What we want to ensure and what needs to happen is that each patient must have the protection of insurance so that the system will respond appropriately and be rewarded appropriately for doing so. Currently, acute hospitals are penalised if they care for too many public patients while they are rewarded for caring for private patients. That does not lead to any efficiency; that approach is grossly inefficient. Often the person who has health insurance and is receiving care is far less ill than, as Dr. Gleeson pointed out, a woman with pneumonia from Coolock. If we want to target need and ensure the system is efficient, we must have a different basis on which people access care, namely, equality and ensuring there is universal cover regardless of income.

The Minister, in her approach, is deepening inequality. She is making the risks between private and public health care more acute. As a result of that, she is doing a grave disservice to elderly, sick people who are currently, as has been repeated in this debate, lying on trolleys in hospitals in Beaumont, Letterkenny, Wexford, St. Colmcille's Hospital in Loughlinstown, the Mater, Tallaght and St. James's. These are issues that need to be addressed by a clear policy based on ensuring the service is genuinely patient centred. Everybody uses the term "patient centred" as if its mere use will produce the magic that will deliver good quality care. If we are to have a genuine patient-centred service, the relationship between the patient and the service must be changed with regard to public patients to ensure the money follows them when they come into the system. It must be an integrated service and, most important, it must be delivered at the appropriate level. Far too many people end up in hospital who would not need to be there if they could get care at an earlier stage. Primary care is the key but the Government has turned off the tap in regard to it.

I am carrying out a survey which seeks to find from the various boards of the Health Service Executive how many front-line services have vacancies aside from administration vacancies. The results are startling. For example, in one of the smallest health board areas, that of the Mid-Western Health Board, there are 50 vacancies in the key areas of psychology, speech therapy, occupational therapy and the range that provides services at local level, so that patients can be cared for at home rather than in hospital.

We know that the numbers of general practitioners will not grow to meet demand, a matter which must be addressed. We would have been heartened if the Minister had yesterday talked of providing for more doctors and increasing the number of places in our medical schools for EU citizens and, in particular, Irish people. If this is not done now, the problems will be exacerbated in the future because it takes years to produce a doctor. In particular, the Minister needs to concentrate on the position in regard to GPs because they will not be there. She can lambast them and talk about out of hours services not being available but doctors will not be there unless she ensures this issue is addressed.

Most people would prefer not to end up in hospital in any case. Community spirit is strong and families are good at looking after their relatives. This was highlighted when Patients Together was formed because its members felt so strongly about their individual family members. Our community has that strength and it contains experts in terms of community services and general practice. However, if we do not invest in this area, we will end up investing more money at the wrong level, namely, the secondary level.

Since 2000, there has been a 7% increase in population but only a 2% increase in inpatient activity. This must tell us something. It is a real indicator that we have not been able to ensure that additional investment is delivering a service. We need more beds but we also need to ensure they are not inappropriately occupied. Most of all, we need to ensure that, at primary care level, there is a consciousness of the importance of delivering services at local level, within the family context as far as possible, to ensure that people are cared for well when they need it, rather than ending up on trolleys or, worse, on a chair without a pillow in an accident and emergency department.

See this speech in context