Beverley Flynn (Mayo, Independent)

The motion is very well intentioned. However, it is slightly narrow in its focus, while recognising that drunkenness in accident and emergency departments is a very serious problem. I have consulted with accident and emergency units in my area, and it is true that many young people arrive in accident and emergency units who are drunk and simply need to sleep it off. They are not able to look after themselves and there is nobody to look after them. Many drunken individuals who arrive in accident and emergency departments have a serious injury, perhaps as a result of a fight, and need treatment. Some people, often older people, who are admitted to accident and emergency departments are habitual drinkers and need to be admitted to hospital to detox and receive treatment. While many drunk people are admitted to accident and emergency units, they are not all disorderly and violent. Unfortunately, even if a very small percentage of them are, they cause mayhem for staff. From that perspective, I understand Deputy Twomey's perspective.

I wish to focus on a more general issue in accident and emergency services, particularly the ten-point plan and how it relates to a general hospital in my constituency. My concern with regard to many of the proposals put forward tonight and in the ten-point plan is that they are very focused on cities. Even when the Health Service Executive gives us a progress report on the ten-point plan, it tends to focus on the eastern region and new facilities for Dublin hospitals. I have visited the accident and emergency department in Mayo General Hospital on at least five occasions since Christmas and there are up to 18 people on trolleys on a regular basis, particularly at weekends. When the Health Service Executive came before the Oireachtas Joint Committee on Health and Children, it told me that there have been an average of nine patients on trolleys since Christmas. That may be the case but on any given week, there are up to 18 people on trolleys on one or two nights at the hospital. There are people who have to spend up to two nights on a trolley, getting no sleep and sometimes in the company of very drunk individuals, which is of huge concern. Having spoken to the staff and consultants about what they see as the solution, I do not see much mention of it within the ten-point plan. The main solution to the crisis in accident and emergency departments is more beds. We have a growing population and improved medical practices and technology but the number of inpatient beds has not kept pace with this. Deputy Mícheál Martin when he was Minister for Health and Children did a very good job in substantially increasing the number of accident and emergency consultants. However, there was no corresponding increase in the number of inpatient beds. While there are additional consultants, they can only work with the facilities that are available to them.

Another very important issue that must be addressed as soon as possible is changing the consultants' contract. When a consultant only works 33 hours per week and his or her hours are sometime between 9 a.m. and 5 p.m., there is no senior clinician in many accident and emergency units in the early hours of the morning when many of these problems occur. One of the recommendations of the Health and Safety Authority's report was that a senior clinician should be in charge of accident and emergency services. Accident and emergency consultants have plenty of experience in dealing with crises, in assessing a person and discharging him or her if appropriate. However, junior doctors attending to patients commonly err on the side of caution and admit rather than discharge people for fear of making the wrong decision. If a person of sufficient medical seniority were in the accident and emergency departments, they would be more effective in managing the activities and making better use of available resources. Dealing with this critical issue must be a priority.

I ask the Minister of State to bring to the attention of the Tánaiste an issue relating to the ten-point plan, that is, nursing home places for high dependency patients and step-down beds for intermediate care. I asked what facilities were being put in place in the west, in particular in Mayo, and was told this is a nationwide programme. However, not one County Mayo nursing home has tendered for beds because they were told when they contacted the HSE that they must have a minimum of ten beds available. In a 30-bed or 40-bed unit there will not be ten beds available at any given time to contract out to the HSE. Nursing homes were also given a short period of time in which to put their tenders in place. If no one has tendered, how can this be an effective mechanism to deal with the accident and emergency crisis?

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