Liz McManus (Wicklow, Labour)

I wish to share my time with Deputy Howlin. I have a sense of déjÀ vu about this debate. The accident and emergency crisis was debated in this House on a number of occasions. What is different now is that we have just come through the worst crisis and the worst winter in terms of the situation in our accident and emergency departments. There are also other differences. When the Minister for Health and Children initially referred to her plan, she suggested that by March-April this year we would see a significant improvement. She later changed it to autumn. She stated tonight that it would be winter before we would see improvements. This does not auger terribly well.

One aspect of this motion deals with an extreme facet of the accident and emergency crisis, namely, the drunkenness that is apparent therein, particularly at weekends. This is the cause of intimidation, violence and fear and must be recognised as a real problem. It is a pity the various measures being proposed are not considered a little more thoughtfully by the Minister. It may be that some are workable and some less workable but it is important that they be treated seriously. It is not easy to address the problem of drunkenness because there are people who are ill who appear to be drunk, drunk people who are also ill, and people who are only drunk. It is very difficult to diagnose such people unless they go through the normal procedures that obtain in accident and emergency units. When they can be identified, separation makes sense. It is important that efforts be made in this regard.

One proposal on charges does not stand up to scrutiny. At present, €3.7 million is owed per annum because people are not paying charges, mainly for accident and emergency services but also for other services. Doubling the charge will not make a considerable difference. However, the principles are important and, if acted upon, may alleviate a desperate situation.

It is interesting that the Minister acts as if she has just stumbled upon the accident and emergency crisis and as if she has not been Tánaiste for the past seven or eight years. During this time, chronic circumstances have got worse rather than better. There has been a steady deterioration. While the Government put more money into the health service, the accident and emergency crisis got worse. Over the years during which our population grew by 25%, we lost 25% of our overall bed capacity. This has not been fully addressed but needs to be. I felt the shade of the former Minister, Deputy Martin, reappearing while the Minister, Deputy Harney, was speaking. She talked about reviews, reports and action plans. This does not fill one with confidence.

I took the opportunity before this debate to look back over my records and noted a study was carried out on accident and emergency services in 2000 by Geraldine Regan, a senior nurse manager. She made many sensible proposals which, unfortunately, were not taken on board in the way they should have been. The proposals concerned bed management and staffing. In 2000 the problem was still manageable and waiting times were not nearly as severe as they are now. However, the Government did not heed Ms Regan's recommendations enough to make a difference.

The problem became more serious and in 2002 the Labour Party tabled a Private Members' motion thereon. The Government amendment to that motion was remarkably similar to the amendment it has tabled tonight. It is characterised by the same kind of self-congratulation. However, the only changes in accident and emergency services in the past two years have been for the worse.

In 2002 the former Minister for Health and Children announced 709 new beds, which were to be delivered within 12 months. They were not delivered within 12 months and were part of the 3,000 beds to be delivered by 2011. I would be very interested to hear if the Government is still honouring that commitment. Subsequent to the former Minister's announcement, we discovered that not all of the beds referred to were actual beds — some were trolleys and chairs.

The former Minister set up the accident and emergency forum, about which we have all forgotten. A nurse to whom I spoke when my colleagues and I were out supporting the nurses on the picket line in recent weeks described the forum as "worse than useless". This indicates where such fancy notions lead.

In early January 2003, elective procedures were being cancelled. A shock-horror story in a newspaper referred to a patient who had been waiting on a trolley for 17 hours. Nowadays there are patients who would probably be grateful if they had to wait for only 17 hours. In 2003, at which time the current Minister for Health and Children was Tánaiste, the Government commissioned the Capita report to inquire into bed management, bed capacity, community facilities, community nursing beds etc. The review was produced with great fanfare and of course we were told everything would improve and that we did not have to worry.

In early January 2004, 200 people were waiting for beds on accident and emergency trolleys. This figure is now lower than the norm considering the high numbers of people who had to wait on trolleys this winter. In February 2004, a headline stated there were 42 patients on trolleys in Tallaght Hospital. In February 2005, at which time Deputy Harney had become Minister for Health and Children, there were 63 patients on trolleys in the hospital. One unfortunate man stated in an interview on the radio that he had been in his bed in a hospital ward, gone out to the toilet and discovered on his return that his bed had been taken by somebody else. He ended up back in the accident and emergency unit. There has been a steady deterioration in conditions in accident and emergency units under the Government. Let us not pretend otherwise.

It is fairer to call the ten-point plan a nine-point plan because the MRI scanner is only to replace the one which should never have been taken away in the first place. I do not know why the replacement is taking so long. Why has it not been replaced?

We were promised that the various initiatives being taken by the Minister under the plan would deliver 1,000 step-down beds for home care and nursing home care. The figures speak for themselves. At most, we have 90 beds as a result of the nursing home initiative and 51 home care packages. Two weeks ago, 65% of all the beds in Beaumont Hospital were being used by people who were located inappropriately therein.

It is important that we get real about this issue instead of pretending there have been improvements. There have been none. It seems there may be none in the future on the basis of a statement by the very experienced accident and emergency consultant Dr. Aidan Gleeson:

I personally see very little light at the end of the tunnel. We are in for a very rough ride and ultimately, patients will suffer. I can work a 10-hour day in casualty, and it is stressful, but I can go home to my family at the end of the day. An 85-year old lady waiting on a trolley in A&E cannot do that. These patients are given no dignity or privacy, emergency departments are congested and can be violent and aggressive places at times.

I believe things will get worse as I am not convinced that the real problems relating to A&E are being tackled.

That is from the horse's mouth and nobody can disregard what a very experienced person working at a very senior level at the coalface has to say.

One of Dr. Gleeson's concerns is that there is insufficient funding to implement the ten-point plan. He is correct. I do not know how one could deliver the kinds of changes required on such a low budget. I did not know the HSE itself is being underfunded. This disturbs me greatly. There is a shortfall of almost €200 million and Kevin Kelly has admitted this to an Oireachtas committee. This is very serious.

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