Liz McManus (Wicklow, Labour)

The second anniversary is approaching of the publication by the Tánaiste and Minister for Health and Children of her ten point plan to resolve the accident and emergency crisis. She promised real and measurable improvements within months, stating:

Accident and emergency is a litmus test for me, for the government and for the people of our country. By focussing our analysis, our funding and our energy on this area I believe we will achieve tangible improvements this year.

The year she referred to was 2005. We are now in the second quarter of 2006 and are still waiting for the colour of the litmus paper to change. There are no signs of the promised real and measurable improvements. This year, the situation has worsened and there is no relief for patients. When it comes to the Tánaiste's solutions for the accident and emergency crisis, I am reminded of Estragon's line in "Waiting for Godot": "Nothing happens, nobody comes, nobody goes, it's awful."

Recently in the Coroners Court, a case was highlighted of a woman who died on a trolley in the nurses' tea station after waiting four hours to see a doctor. The doctor giving evidence said: "it is inexcusable what happened". A doctor in Letterkenny explained how hospital staff move heaven and earth to find beds for terminally ill patients on trolleys so that they can have a chance to die with dignity but noted: "the tragedy is we are not always successful...it's awful, awful, awful."

Yesterday, 198 patients were on trolleys in our accident and emergency departments. The winter is over, the seasonal pressures are off and there is no flu epidemic, yet 198 people were waiting, nothing happened and it was awful. Not as awful as last month, when the number of patients on trolleys nearly topped 500. In Wexford hospital, where 40 patients were waiting, staff ran out of trolleys and had to go as far as Tipperary to find more.

The ten point plan has been shelved alongside all the other plans to tackle the accident and emergency crisis. The ten point plan bears a close resemblance to plans that the former Minister for Health and Children, Deputy Martin, used to serve to us on a regular basis. The minor injury units and chest pain and respiratory clinics have not materialized. Unbelievably, the promised MRI scanner for Beaumont hospital still has not been provided. The word is now that it will not be in place until October or even April of next year. The acute medical units are still awaited and the promised provision of GP out of hours cover for north Dublin has become a farce. Less than 10% of our hospitals have proper hygiene standards and, every day, members of staff are put at risk because of insufficient security.

The record of the Tánaiste with regard to keeping her word is abysmal. She staked her reputation on the successful delivery of her ten point plan. The reality is she has performed so dismally that it is even beyond her to provide diagnostic equipment to Beaumont hospital to relieve the pressure. It seems the central task of taking responsibility for the health service is also getting beyond her. Increasingly, she is off-loading her burden on to the HSE and, in particular, Professor Drumm. We no longer receive answers to parliamentary questions from the Tánaiste but referral letters to Professor Drumm, who then refers us to the parliamentary unit in the HSE. Then, like patients waiting for an appointment to see a specialist or for a bed in a hospital ward, we are left waiting weeks and sometimes months for a reply.

Meanwhile, the Tánaiste gives lectures to everyone else in the health service about how they should be more efficient and harder working. It is particularly risible that the Tánaiste ticked off doctors for not working 24 hours a day like her old GP, given that she was on a lengthy break from the Dáil herself. The hallmark of this Government is the extraordinarily low number of parliamentary working days it delegates to itself.

The Taoiseach does not lecture in the way his Tánaiste does but depends on plain old verbal abuse. When referring to the relatives of patients on trolleys he merely said:

People say "so what about Joe and Mary down in A and E; they shouldn't be on a waiting list". Now, I think it's a pity that people are so unintelligent, really.

This Government considered us fools when we complained about patients on trolleys, until the actor Brendan Gleeson articulated on the "Late Late Show" the deep and widespread anger and dismay about what is happening in our hospitals. That caused the Tánaiste to snap to attention and declare an emergency in accident and emergency services. A declaration of national emergency demands rapid and significant action but, in this case, the Minister declared an emergency and disappeared to Limerick to address the party faithful. Nothing happened. Not one additional resource was provided or action taken as a result of her announcement. The task force in which she lays such store is not markedly different from what was previously in place and what should always be in place if the HSE is ever going to live up to its ambition to deliver a streamlined administration.

The single most important response to the emergency has been a one day debate around a smug, self-congratulatory and delusional motion which only proves to the public that this Government has lost touch with the people and is quickly losing its grasp on reality. That is why I proposed on behalf of the Labour Party an amendment which not only sets out the problem but outlines the solution.

On 1 November 2004, when the Tánaiste took over as Minister for Health and Children, 166 patients were on trolleys. On 8 March 2006, 495 patients were left on trolleys. The deterioration in the service has been real and measurable. This was foreseen by doctors working in accident and emergency departments but their concerns were ignored. If a declaration of emergency is to have any meaning, the necessary changes must be fast and funded but that has not happened. We need a clear programme of capacity building and the provision of more beds must be central to that programme.

In 1980, 33% of acute bed capacity was removed from the system, yet our population has increased by almost that amount. Of the patients admitted through accident and emergency departments, 71% are elderly people. By 2026, our elderly population will have doubled and the Government's own health strategy determined that 3,000 new acute beds are needed, yet all we have from the Government are muddled thinking and mixed messages. Professor Drumm does not agree to new beds, so the Government flip-flops on the issue. Yesterday, the Taoiseach said we do not need any new beds, yet three days earlier, the Minister for State at the Department of Health and Children, Deputy Seán Power informed the IMO conference that the Government planned to provide 450 beds over the next six years. That figure falls far short of what is required but does answer questions about the content of Government policy. We hear various declarations from Ministers and it is difficult to ascertain the proposals coming from the Government. It is clear, however, that the great capacity building project promised in the health strategy has stalled. The 900 beds the Minister of Health and Children has promised are too few, too late and hundreds of them are chairs and trolleys rather than beds. At least the Minister of State, Deputy Seán Power, had the grace to turn up. His senior Minister was too busy talking to the party faithful and Professor Brendan Drumm, the CEO of the HSE, made the extraordinarily shortsighted choice to attend the PD conference instead of meeting the organisation that represents 6,000 doctors. At a time of emergency, officers usually talk to the troops on the ground and by showing them leadership build up their morale, which needs to be done considering the state of the health service. In this emergency the officers absented themselves and went to Limerick instead of to the front line. Is it any wonder health professionals feel let down? This lack of leadership is at the core of the problem. Health professionals and their patients need strong and clear direction from the Taoiseach and the Tánaiste. They are not getting it and they will have to wait for a new Government before it happens.

Professor Drumm has argued for more beds for the elderly in the community and I agree with him. At least 1,500 new community long-stay beds must be provided by 2010, but he and the Minister are disingenuous when they talk about this issue. This week for the first time I was able to publish the truth of what is happening with community beds. Figures in the latest Labour policy document that we launched this week record that the number of such beds is falling, not rising. The information was extracted from the Minister as if it were a State secret. I put in a parliamentary question on 29 November 2005 and did not receive a reply until 29 March 2006, and even then some of the data was blank. It is clear the Minister and the Government have presided over a significant reduction in the number of long-stay community beds for the elderly since taking office in 1997.

In Dublin south city there are 80 fewer beds for the elderly now than in 1996. In Limerick there are 60 fewer beds, in north Tipperary 43, in Meath 25, in Westmeath 28 and in Longford 16. Many of these are areas where the elderly population is higher than the national average. All her rhetoric about elder care is contradicted by the facts. Far from investing in new beds in the community, Deputy Harney and the HSE have closed beds and denied elderly people the chance of a bed in a community nursing environment close to their homes.

To solve the accident and emergency crisis a radical shift towards primary and community care is required. Labour will tackle the issue effectively and comprehensively by its commitment to the following proposals: to provide acute hospital beds to meet current and future needs; to ensure accident and emergency departments are dealing with accidents and emergencies and that direct referral by GPs of patients is facilitated and encouraged; to increase the percentage of those on medical cards to 40% of the population; to ensure high-class management of chronic illness in general practice; to implement a primary care preventative strategy; to increase the numbers of GP training places to approximately 160 annually and double undergraduate places for Irish and EU citizens; to integrate primary health care services at community level; to integrate primary and secondary care; to expand and support GP out of hours service, with particular encouragement of GP co-ops; to encourage GP-based audit and research and have universal patient registration and robust data collection systems; to ensure there is comprehensive legislation to allow for compulsory peer review by the Medical Council for standards of care; to ensure accountability by making the Minister for Health and Children answerable to parliamentary questions; to aim to have a hospice in every former health board area with a palliative care team in the local hospital or primary care centre; to increase the numbers of home care hours and ensure proper contracts; to expand community support services for elderly people to enable them to live independent lives as far as possible; to build at least 1,500 additional community beds by 2010 to meet current and future needs; and to ensure a comprehensive, integrated and well-funded range of mental health services at primary care level.

When the public began to protest at the way elderly and frail people were being marooned on trolleys in corridors without dignity or comfort they were insulted by the Taoiseach and lectured by the Minister. People are entitled to a well planned, fair, well resourced and efficient health service to meet their needs. Like the patients on trolleys in accident and emergency the people are being forced to wait for this by an incompetent and bloated Government. Fortunately we live in a democracy and the people will have an opportunity to choose not just a new and different Government, but a better one.

When one speaks in a debate such as this there are many cases of people who are having difficulty accessing care one wants to bring forward. When we concentrate only on the accident and emergency department we do not give the full picture of people who are sick and suffering. I know a man who has an extreme case of psoriasis and who needs treatment to relieve the pain and suffering it causes. He wants to have that treatment in Hume Street hospital and will have to wait until December. I was contacted in the last few days by another patient who requires treatment for a dermatological condition but has been told she will not see a specialist for three years. That is the experience. These people are paying taxes and are entitled to expect a decent service in return. One of the reasons there are so many pressures on our accident and emergency departments is that the services and capacity are not there to meet people's needs earlier. A condition becomes an emergency and people present at accident and emergency departments. Accident and emergency departments must deal with crisis cases while other people are admitted to hospitals via alternative routes to hospital care such as a GP's referral or other means we see in a few isolated cases where hospitals such as St. Luke's in Kilkenny operate different systems of admission. That must be developed but it requires capacity.

It is disingenuous on the part of the Minister and Professor Drumm to say we will not need extra capacity in our acute hospitals. Our population is growing rapidly and aging and we will have to provide the acute hospital beds to meet its needs. There is no other way to do it. Beds are not the sole solution but are part of it. When doctors complain and make that point we must listen to them. While the Minister says she wants to hear from consultants, she wants to hear only what she wants to hear. She does not absorb the message she is being given. The most startling event in recent times has been the public statement by neurosurgeons on the demands that they cannot meet. The fact that they, as professionals, are concerned about standards of care that are not being met for their patients, could be exposed to litigation and have been driven to the extreme measure of going public is telling. Hospital consultants are not known for their radicalism. If one was seeking an example of a non-radical group, hospital consultants would fit the bill. Yet, increasingly, when they are not being muzzled — I know of cases where attempts have been made — it is those like hospital consultants or nurses who are on the front line speaking out on behalf of patients. The Government is not listening. The motion shows that it is disconnected from the reality of the health needs of our population. It is time for a complete change in the mindset that dominates a Government that is either incompetent, incapable or unwilling to meet the challenges that exist in the community and which desperately need to be addressed.

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