Barry Andrews (Dún Laoghaire, Fianna Fail)

I am pleased to be able to speak on this important issue. In my area a number of important changes have taken place recently, particularly in St. Vincent's, into which St. Michael's has been subsumed. This has given extra specialties to St. Michael's and it has become a first-class hospital. Its accident and emergency department operates between 8 a.m. and 8 p.m. and it has been successful. There are waiting lists, but that is inevitable. It has developed specialties and on visits I have noticed a pride among the staff in the work they do and the specialties they have undertaken. It is an example for the centralisation of certain specialist deliveries, which should be continued to be rolled out nationwide.

I claim no great expertise in this area, and my one observation is a shortage of senior clinical decision makers in hospitals. No matter how good the primary care service, if the person with a headache visits a GP, and the GP cannot definitively say the person is okay, he or she will try to set up an appointment with a consultant. Because the consultants are unavailable and the patient must wait 14 or 16 months for an appointment, a visit to an accident and emergency department is his or her only recourse. The junior hospital doctor in the accident and emergency department is unwilling to take a clinical decision because there is somebody above him or her and services, such as a scan, are unavailable. The patient must therefore wait until either a consultant or a scan is available. If the patient goes to the accident and emergency department on a Friday or a Saturday he or she could wait two or three days for a decision. The patient may or may not have a serious illness.

More senior clinical decision makers are needed in the system and without this we will face a continuing logjam. As the Tánaiste pointed out to the Committee on Health and Children, accident and emergency is a symptom of other problems in the health service. There was an illuminating letter in today's The Irish Times which contained in one long and farcical sentence all the problems identified in a debate of three or four hours here.

All of those problems exist, but the most grave and serious symptom is of course the trolley problem. It is clear that problem is more significant during the winter months. At the time, the Irish Nurses Organisation opposed the HSE proposal in regard to moving accident and emergency patients into hospital wards to relieve congestion.

My next point concerns the industrial relations problems being experienced as the attempt is made to roll out this massive health reform strategy. Deputy Crawford referred to the individual problems in regard to the HSE. If 12 hours home care is available in Donegal and only two hours is available in Monaghan, that is an inevitable consequence of the fact that there were 11 health boards in the Eastern Regional Health Authority. When the system is centralised, the anomalies will be revealed. It will take some time for that to be——

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