Paudge Connolly (Cavan-Monaghan, Independent)

I too welcome the opportunity to speak in today's debate. Problems regarding accident and emergency services have been aired daily for the past three years and I see no sign of debate having improved the situation. We should acknowledge that staff work very hard in what are often quite cramped conditions in accident and emergency departments. It is not a secure working environment and health and safety could be described as non-existent in what should be a rather safe place to be. That could lead to mistakes and it is not a safe environment for a patient.

Before today's debate, I spoke to several staff in accident and emergency wards, asking for their opinions and assessment of the situation. It is very important to listen to what staff have to say. On several occasions, one of the first comments made has been that accident and emergency departments should be used for just that. Among problems described were admitted patients remaining in the department, which should not happen. A patient who has been admitted will receive no further active treatment there per se.

We should consider Nenagh, where GPs regularly contact accident and emergency admissions officers and will only send the patient when they know that a bed has become available. That might mean holding the patient for an extra night at home, and GPs are often prepared to do that to offer the patient a service. GPs generally like to offer the best service, involving, for example, their sending the patient to hospital for a test. It is also wise for the patient to remain in the accident and emergency department for the result of the test.

If the GPs had the same access to diagnostic reporting as the hospital or could get it at the same speed, it would mean that the patient could go back under his or her care. Effectively, the patient is there waiting for the result of a test, and I have cited the example of a venogram. The patient would have to be treated for deep vein thrombosis for a period until a negative result was forthcoming. That is part of the problem.

Accident and emergency departments have been used by gardaí under section 12 as a place of safety for children. That too is inappropriate and unhelpful. Staff also cited the absence of social workers as a major problem, particularly when no social worker is available for young children or people who might need such a service. There is no weekend service and when it comes to 4 p.m. on a Friday, staff find that there is no social worker available, although many social problems present themselves at accident and emergency departments. Those are the matters that we should resource in the community and we should ensure that people are sent there.

Old people are sometimes sent to hospital despite the fact that appropriate treatment could be provided for them in a nursing home. Effectively, they find themselves there while they wait for a nursing home bed, again putting additional strain on hospital resources. The idea of a patient having to be seen by five people before admission is not safe. One goes to a GP and then has a sequence of people to see in the accident and emergency department, which is not the best use of resources. We should not second-guess GPs, who should know when someone requires elective admission to hospital. That person should be sent straight to a hospital bed.

In recent years, while problems have grown in accident and emergency departments, we have planned to close them in smaller hospitals. There were plans to close the surgical accident and emergency service in Monaghan General Hospital, as well as threats regarding Nenagh and Ennis. By now, we must have seen enough to shelve those plans and state publicly that such small hospitals play a major role in delivering accident and emergency care where allowed to do so. We have all sorts of ten-point plans, but I would like to see people listen to staff on the ground. I found that they had much to contribute, with many useful ideas.

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