Liam Twomey (Wexford, Fine Gael)

I move amendment No. 3:

To delete all words after "Dáil Éireann" and substitute the following:

"—asks the Taoiseach, Tánaiste and Minister for Health and Children and former Minister for Health and Children, Micheál Martin, to apologise to the people of Ireland for their failure to ensure appropriate emergency medical services in hospital accident and emergency departments, despite being in Government for nine years;

—condemns the Government for its failure to deliver the following services as promised in the National Health Strategy and Primary Care Strategy 2001:

—3,000 promised acute hospital beds;

—200,000 full medical cards to families on low incomes;

—the 5,600 community nursing unit, community care, community support, extended care beds (800 promised each year over a seven-year period from 2001);

—40-60 primary care teams by the end of 2005;

—condemns the Government's further failure to deal with the accident and emergency crisis despite numerous public relations attempts such as the Tánaiste and Minister for Health and Children's accident and emergency ten-point plan; and

—demands that:

—the Government's commitment to deliver a "world class health service" as announced by the Taoiseach in 2001 is fulfilled;

—the Tánaiste and Minister for Health and Children take appropriate measures to reduce the suffering of patients both young and the elderly who are regularly forced to endure unnecessary hardship when seeking medical attention due to the failures of the Fianna Fáil-Progressive Democrats Government; and

—the Tánaiste and Minister for Health and Children clearly outline the measures she intends to take to improve all aspects of acute hospital care that will allow patients to be treated in a dignified and respected manner."

The Government parties have not that much to show after nine years in office in regard to improvements in the health services but it would be no harm to go back over the recent history of our health services to examine why we have arrived at the current crisis. In October 2001, the Government held a special Cabinet meeting, attended by the Tánaiste, in Ballymascanlon, County Louth, the purpose of which was to discuss only the health services. The then Minister for Health and Children, Deputy Martin, was confident that his day of publishing reports and doing little else was about to change as he was about to announce the health strategy, Quality and Fairness — A Health System for You. As he left that meeting, the ghost of former times, Mr. Charlie McCreevy, stated: "Putting money into the health services is like pouring money down a black hole." On the same day the Taoiseach informed us the health services were well resourced and further stated we had a world class health service.

I am not sure what the Tánaiste's views were at the time but, since she was at the Cabinet table and would have read these comments in the media reports and given that she did not announce a ten-point plan at the time, I assume she was in the Taoiseach's corner and that she also thought the health services were well resourced and world class. However, what happened next was the greatest fraud ever perpetrated against the people of Ireland. The health strategy and the primary care strategy, which was published two months later, were announced as Government policy and they both found their way into the Fianna Fáil and Progressive Democrats manifestos for the 2002 general election. The Taoiseach, the Tánaiste and Mr. McCreevy never intended to fund these reports to the extent they proclaimed prior to the general election and that contributed greatly to the position we are in today.

At the same time, it is unbelievable that the Government parties have doubled health spending since their re-election but they have also managed to double the number of patients on trolleys waiting for an acute bed in our hospitals over the past 18 months. The Progressive Democrats members consider themselves accountable and providers of value of money as they look after the taxpayer's money but they should ask themselves where all the money has gone over the past four years. When €150 million went down the Swanee during the PPARS debacle, the Tánaiste informed the Oireachtas Joint Committee on Health and Children that maybe that was where all the money had gone. However, the taxpayer should receive improved accountability for what has gone wrong with the health service, given the amount invested.

Why was the accident and emergency department problem allowed to go so much out of control that at first it became a crisis and then was finally declared a national emergency by the Tánaiste last month? In October 2004 she stated it was unacceptable for people to spend up to 12 hours on a trolley while last month she stated it was unacceptable that the waiting period in accident and emergency departments had increased to 24 hours. She announced a six-hour waiting list earlier. This was an announcement for consumption by people who do not pay much attention and it sounded like spin. However, the position has deteriorated over the past four years, no matter which way one looks at it, and the Government should be more accountable.

The public will tolerate the arrogance of a number of Ministers but not when it is mixed with the incompetence and complacency we are witnessing. I have sympathy for the Tánaiste because she is trying to put a Band-Aid on a gaping wound in our health services so that the Progressive Democrats can limp past the post following the next general election. However, while I agree many of the problems she faces were developed by her predecessor, she bears collective responsibility as a Cabinet member for what has gone wrong in our health services.

During her 18 months in the portfolio, she has suffered a dose of "Micheálitis" as she publishes one report after another without making great improvements to the health services. She has taken to publishing reports with the same gusto as her predecessor, Deputy Martin. The Health Service Executive commissioned a report on acute hospitals.

The report on Wexford General Hospital was exactly the same as one commissioned by the hospital in 2001. The problems highlighted in both reports were the same, even though they were published five years apart. Both reports acknowledged that the accident and emergency department was too small to cater for the numbers attending, was not fit to provide modern day emergency health care, was cramped and offered little patient comfort, privacy or dignity. The same report on Wexford Hospital could apply to many other hospitals because it states the hospital has fewer beds and staff per capita than many other acute hospitals. However, I would like the Tánaiste to pay particular attention to the following statement in the report: "That hospital's medical admissions unit, which opened 18 months ago, is experiencing difficulties moving patients on to wards due to the lack of beds". She is attempting to portray the medical admissions unit concept as the solution to the accident and emergency department problem but it is only part of the solution.

The Tánaiste referred to the accident and emergency departments in Kilkenny and Waterford hospitals as success stories. The reason the medical admissions unit in Kilkenny is successful is that consultants work well together and have equal responsibility for the unit. In addition, in 1997 a number of acute beds were opened in the hospital which allowed management to move patients ready for admission from the medical admissions unit to the hospital proper.

When Professor Drumm appeared before the Oireachtas joint committee, he stated Waterford Regional Hospital was a success story in terms of patients not waiting on trolleys. However, the reason for the success story is the accident and emergency department is located near the ENT ward, which holds 30 beds. Many patients who attend for ear, nose and throat procedures are told their appointments have been cancelled because accident and emergency department patients have taken their beds. ENT consultants are therefore attending the hospital with no work to do. The Tánaiste should be honest with the public. Waterford Regional Hospital has not resolved its accident and emergency department crisis because it is penalising ear, nose and throat patients.

Kilkenny hospital has succeeded because management secured additional acute beds while consultants are working well together. Wexford General Hospital is falling down in this regard. Accident and emergency departments represent a bottleneck in the system. Patients must queue to gain access to an acute bed in a hospital. The solution to this crisis is the proper delivery of acute beds. Many of the other solutions mentioned will have a varying impact on the crisis but the only solution that will make a difference is an increase in the number of acute beds. The Tánaiste is moving too slowly in this regard. The Government parties have only delivered 380 new inpatient beds since the previous general election, even though they published a report prior to it in which they stated they would deliver 3,000 new acute hospital beds. At that time, she did not describe them as day beds, acute beds, recliners or couches. She said that there would be new beds in the hospital system, but she has not delivered on that. That is why the crisis exists at the moment.

Fine Gael has put forward some solutions to the accident and emergency crisis. The solutions will not in themselves solve the problem, but they will help. To solve the hygiene problems, there is little point in auditing hospitals by informing them that they will be checked once or twice a year. Some form of flying squad must be set up that can arrive at these hospitals unannounced. In her speech, the Tánaiste spoke about making someone responsible for accident and emergency departments, but she must do the same for hygiene. Patients should be able to contact someone to report that bathrooms or wards are filthy. That is the only way to improve standards. Security, alcohol abuse and the behaviour of drunks in accident and emergency departments has also been made a top priority by Fine Gael. It is not acceptable that staff and patients, particularly the young and the elderly, should put up with the behaviour that goes on in accident and emergency departments on weekend nights.

The Tánaiste again paid lip service to this problem. The Minister for Justice, Equality and Law Reform is trying to legislate for it, but we must ensure people's experience of hospitals is more acceptable. People are afraid to enter hospitals as patients or visitors because they are afraid they will pick up something. That is a disgraceful standard for a country that has seen the best of times in the past nine years, but we have had the worst of Governments when it comes to delivering an acceptable health service.

We must examine the kind of patients that enter accident and emergency departments. Many of these patients could easily be treated in primary care by their general practitioners. Others have problems that could be dealt with by GPs, but they need access to diagnostic services, which are not being delivered. However, the real problem in accident and emergency departments is the number of patients lying on trolleys that need to be admitted to a bed. These are the most vulnerable.

There has been much commentary about what Derek Davis said at the IMO conference in Killarney. He is right in many respects. His comments may have been too general, but that can often be the case. There is a manpower crisis in general practice. GPs have done their best to cope with the pressures on them. There were about 50 practice nurses in Ireland 15 years ago, but now there are more than 800. GPs have invested in primary care centres, mainly because the Government has done nothing about it. The Government has provided tax concessions to build private hospitals, but there are no tax concessions for primary care. If a problem exists whereby patients cannot access general practice services, it is because such services are shrinking due to the lack of Government involvement in primary care. I fear for the future of general practice and primary care.

I know the patients who will be worst affected by the fact that the Government is doing nothing. The patients that are worst affected are those to whom the Government has most responsibility, that is, those who have medical cards. They will be squeezed out of the system because the Tánaiste is not taking control of the situation. GPs will provide the service and it is insulting that the Tánaiste can state that there is no GP service out of hours. Does she know how much her Department pays out every year for out-of-hours services in this country? Either someone is carrying out massive fraud in the health service, or an out-of-hours service is being provided. North County Dublin is the one area over which she had control in terms of out-of-hours service, but she and the HSE did not seem to be committed to its delivery. It could have been easily provided over a year ago.

It has been stated that the lack of an out-of-hours service has contributed to the rise in numbers attending accident and emergency departments. I will be working in such a service next weekend in County Wexford, but 41% of patients will still go to accident and emergency departments. In some respects, it is the choice of the patient. Tourists, immigrants, young people who do not have a GP and others who do not understand how the system works will often attend the local accident and emergency department. They do not do this because they cannot access a GP service or because they think it is expensive. If one attends a GP out of hours and then attends an accident and emergency department with a letter from the GP, one will not be charged in the accident and emergency department. That should be highlighted a little more.

I do not accept the solutions proposed by the Tánaiste. Derek Davis stated that if his GP provided blood results and x-rays to patients on site, more patients would go to primary care, but I do not think that is true. There is only one place in which patients can receive a consultation, get a blood test and an x-ray carried out and have results given on site, that is the VHI Swiftcare clinic in Dundrum, opened by the Tánaiste. Not many patients in the country would pay the €200 demanded for such a service if we offered it to them. Only a small percentage of the population can pay such an amount of money for such a service. A service which involves access to diagnostics and blood tests must be provided in the public system. I am not interested in her comments about people making more money. People who are earning good incomes in this country do not have that kind of money to pay out on health care costs. That money is there to pay high mortgages and for a range of stealth taxes that have been brought in under this Government. Just because they have high incomes does not mean that they have the disposable income the Tánaiste imagines. We should still be providing these health services to people in the public system like before. The Tánaiste is privatising the health services and it is unacceptable.

People often pay these high costs in places like Dundrum out of fear, especially for their young children. That is why I am a strong advocate of providing medical cards for children under five years of age. People come to the doctor out of fear for their babies and young children. My wife and I are both doctors and we have often been concerned about our own children at that age. The Tánaiste is disconnected from what is happening to the public. Many issues raised in her speech constitute a list of failures in the delivery of health services.

The role of consultants in the health service is very important. Some of the consultants feel hard done by as a result of some of the comments we have made. I have been critical of a number of consultants and the Lourdes report has confirmed many of the things about which I have spoken. The criticisms only relate to a small cohort of consultants. It is disappointing to see how little importance the Tánaiste put on the recommendations of Judge Harding Clark and that she is not moving on the issues that need to be addressed urgently. We only need to worry about a very small percentage of consultants in our health care service. The vast majority of them are doing a good job.

There are major industrial relations issues in the acute hospital sector, yet the Tánaiste talks about expanding the availability of diagnostic services for longer periods of time. She has been talking about this since the day she entered office and the Government is now nine years in power. Instead of talking about it, she should be telling us how she overcame these problems. It is an absolute disgrace that these diagnostic services are not available for longer periods of time in our acute hospitals. If one suffers a stroke in Carlow, Kilkenny, Waterford, Wexford or south Wicklow, one must go to Waterford to get a CT scan. The other acute hospitals in the south east go off-call at 5 p.m. That is a disgraceful use of an extremely valuable service.

Even CT scans are not considered as high-tech as before. There is now a whole range of diagnostic services such as MRIs and PET scanners. The fact that our CT scanners are not working 24 hours a day shows that Government has been paying lip service to the problems in our acute hospital sector.

Accident and emergency departments are in crisis but that is just the tip of the iceberg. They are problems patients do not understand and to which people do not pay much attention because they have not yet become crises. Problems are building in the HSE and in general practice. The day will soon come when GPs are not available and the crisis in accident and emergency units will become worse. Regardless of the spin put on cancelled elective procedures and patients who must wait forever for operations, patients have lost hope. These problems will become worse over the coming years, yet we will be able to do little about them because the Government has allowed them to build up over the past nine years.

See this speech in context