Joe Costello (Dublin Central, Labour)

It appears that Tallaght is cloud cuckooland also because Deputy Andrews shares territory with the Tánaiste.

Three years ago the situation in the accident and emergency unit of the Mater hospital had reached such a pass that the Labour Party decided to mount a protest outside the hospital from 1 p.m. to 2 p.m. on occasional Saturdays. It was only then that the full appalling state of affairs became known to us from regularly visiting the accident and emergency unit and speaking to patients and relatives who were visiting the hospital. Consequently, we decided to mount the protest on a weekly basis and have done so for almost three years.

At the time, 20 to 35 people were lying on trolleys at any one time. The accident and emergency department was short four nurses and needed more medical staff. There were 60 nurse vacancies in the hospital, over 70 beds were occupied by patients who could be catered for in a recovery unit, if there was a recovery unit, 100 new beds were desperately needed and the waiting list for serious operations and treatment was a massive 4,000. That was the position in the Mater hospital in 2003. That situation was replicated in all major hospitals throughout the country at the time. Hospital consultants said there were 3,000 fewer beds than in 1990. Three years on, the situation is worse. There are clearly now chairs as well as trolleys in overcrowded accident and emergency departments. A new hyrdo-tilt chair has been installed in the Mater Hospital within the last few weeks, and the hospital authorities clearly do not expect major changes in the foreseeable future.

The Tánaiste became Minister for Health and Children in September 2004 and immediately launched a ten-point plan to eliminate the accident and emergency crisis once and for all. Major improvements were promised within a few months. She said the Government's credibility would depend on its delivery. Now, 18 months later, she has declared a national emergency. She clearly does not have a clue what to do, and the ten-point plan is in tatters.

The Labour Party published a policy document entitled Healthcare — A New Direction Towards Primary Care. It spells out a long-term strategic approach to delivering community-based health care that has the funds and resources to treat the many patients clogging up accident and emergency departments and that can acquire the confidence of the patient. In the short term, however, there is a need for urgent action to address the national emergency.

First, we must separate accident and emergency reception areas to divide ill people who are elderly and frail from the noisy and boisterous who have overdosed on illegal drugs or are drunk and disorderly. Second, existing wards and hospitals closed for years should be opened and staffed immediately. Third, a formal link should be established between each local authority and the bed management section of the local hospital. Remedial work required on the home of someone in hospital recovering from a serious illness such as a stroke or heart attack should be able to bypass the usual bureaucracy and queue and be carried out without delay, dovetailing with the patient's readiness to return to his or her home and community.

Fourth, there is a need to enforce strict hygiene standards for all staff and overhaul the system of contract cleaners, who clean the hospitals at certain times of the day rather than according to need, thus cutting the appalling level of MRSA to which vulnerable patients are prone. It damages their health no end and extends their stays in hospital. Fifth, there is a great need to sort out the industrial relations procedures to which Deputy Andrews referred. Those result in virtually no GP service after hours or at weekends on the north side of Dublin. Finally, there is a need for a recovery unit or step-down bed facility on the grounds of every hospital or adjacent thereto.

None of those measures is rocket science. They are simple, logical procedures that do not cost an arm and a leg, if the Minister will pardon the pun. They can be introduced quickly and prevent untold suffering on the part of old and ill citizens at their most fearful and vulnerable.

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