Paudge Connolly (Cavan-Monaghan, Independent)

The crisis appears to be an ongoing saga. Depending on the day of week, there may be between 200 and 400 people on hospital trolleys. Given that most of these hospitals are designed to cater for approximately four people in cubicles, this gives one some idea of the crisis. In the past this was a winter crisis or a Monday morning phenomenon and the position would be sorted out within a given period.

During the past 15 years the population has increased by 25% and our response as a nation has been to reduce bed capacity by 25%. It is obvious there will be major difficulties. If people cannot get beds they will create problems in accident and emergency departments. Our response in the Cavan-Monaghan area has been to run advertisements on the Shannonside-Northern Sound Radio asking people not to go to accident and emergency departments. Many people in the country will sit there with a pain in their chest and hope the pain will go away because they have been told on radio not to go to the accident and emergency department. We all know the best medical outcome occurs following the earliest possible intervention. These problems will not go away. There will be illness and death and we have to learn how to sort out the accident and emergency problem.

We have had a number of initiatives in the past such as strikes. We have had promises of 2,000 extra beds and a ten-point plan to address the accident and emergency crisis. It is a crisis that will be sorted out over a period of years and I doubt if the ten-point plan as announced will do anything to relieve the position.

More recently, we have had an act of desperation. The consultants in accident and emergency departments invited the Health and Safety Authority to address issues in accident and emergency departments. If one has to ask an outside statutory body to sort out accident and emergency difficulties one is at the end of the line. It is a cry for help. Any member of the public can call in the Health and Safety Authority and it can look in every nook and cranny in the accident and emergency department, but how much expertise can it bring in? The Health and Safety Authority can issue a seven day improvement notice and come back after the expiration of those seven days to see whether the position has improved. I doubt if it will have improved in most cases. If the position has not been addressed or improved it can issue a notice to close the accident and emergency department. That will cure the problem but it will go elsewhere. This is not the way forward.

The Health and Safety Authority will say every employer should have a safe place of work and safe work practices and systems. I wonder whether this can happen or if the Health and Safety Authority will improve the position. I would like the Health and Safety Authority to involve itself in the MRSA difficulties and ask for the appointment of somebody to be responsible for the control of MRSA in hospitals. Perhaps the Health and Safety Authority can point the way forward to deal with the crisis in accident and emergency departments.

Another problem is inter-personal difficulties. Consultants in accident and emergency departments have had a falling out with the unions on how to improve the position. Staff are falling out with staff. That does not create the best type of work environment. A key element of the problem is that staff are not pulling together and working as a team. That is an issue that should be looked at. Other countries have had this type of crisis, including England which suffered a similar crisis. We must look at what was done there. In 2000 the target was to treat 90% of people in a four hour period; now it treats 96% of people in the four hour period following their arrival at accident and emergency departments.

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