Jimmy Devins (Sligo-Leitrim, Fianna Fail)

I state quite categorically that there are serious problems with accident and emergency services in certain hospitals. Approximately 35 of them provide such services in the country, and I understand that research undertaken by the HSE shows that approximately 15 such units have specific issues.

It is important to stress that the level of service provided by each accident and emergency unit depends on the specific service commitment of the individual hospital. As a result, the number of patients presenting themselves at accident and emergency departments depends on the hospital's location, the service that it offers, and other factors such as the level of GP cover available in the hospital catchment area. A hospital serving a large population base will generally have more attendees at its accident and emergency department.

As a non-consultant hospital doctor many years ago, I engaged in a training programme for general practice. As part of that programme, I spent six months as a casualty officer in one of the main Dublin hospitals, part of the city's on-call ambulance rota. That six months' training was very rewarding on a personal level and very informative on a professional level. It gave me great insight into the enormous pressure cooker an accident and emergency unit is and how stressful it is for all the staff who work in it. It is only right and proper that I pay tribute to all the staff, whether nurses, doctors, paramedics or support staff, who work day and night in all the accident and emergency units. I know many of the staff in the accident and emergency unit in Sligo General Hospital and there is no doubt in my mind that there are very few jobs anywhere which are as stressful as the jobs they undertake. It is a rewarding job but it is also exceptionally stressful. In all the debate about accident and emergency, it is frequently forgotten that these vital units would not function without these dedicated people.

Accident and emergency units are simply that — units which deal with accidents and emergencies. One of the issues which contributes to some of the overcrowding in accident and emergency units is inappropriate attendances at such units. Patients may chose to go to accident and emergency units inappropriately for a variety of reasons but frequent educational programmes throughout the media can better inform the public what cases are best dealt with in accident and emergency units and what can be best dealt with elsewhere. In that regard, we in the Republic can take a lesson from the NHS and our friends across the water in the United Kingdom who frequently show well prepared, informative advertisements on television informing the public on what accident and emergency units are specifically equipped to dealt with.

Much comment has been made of the trolley count and the difference between the figures produced by the Health Service Executive and the Irish Nurses Organisation. This is a side argument. It is obvious the number of people in accident and emergency units can vary depending on the time of day and the day of the week. There are certain times of the year when admission rates to hospital rise and this can put more pressure on accident and emergency units.

In the limited time available to me, it is not possible to discuss in detail the many causes contributing to the problems experienced in some accident and emergency units. Let us not beat about the bush. There are severe problems in some accident and emergency units. I am delighted the HSE set up a dedicated accident and emergency team last month to deal with the problems in these hospitals. The HSE has made dealing with the accident and emergency situation its number one priority this year. I welcome the commitment by the Tánaiste and the HSE that no person should have to stay overnight on a trolley. We want the best service for all who attend accident and emergency units and it is intolerable that anybody should be required to stay overnight or longer on a trolley.

I say this in full cognisance of the enormous range and complexity of medical and surgical problems which can present at accident and emergency units. Emergencies by their very nature must be dealt with immediately, whether a potential stroke, heart attack or whatever. Many of them will need immediate treatment followed by further and continuing assessment with admission the end result in many cases. At the same time, all accidents must be dealt with, whether severe ones from road traffic accidents or minor accidents. Recognising the complexity of these problems and the need for immediate treatment in many of them, the commitment by the HSE to end the practice of overnight stays on trolleys is most welcome.

While the cause of overcrowding in accident and emergency units is multifactorial, there is little doubt that the unavailability in certain areas of suitable beds for discharge patients has resulted in some of the problems. I welcome the fact the HSE is sourcing an additional 250 beds to accommodate some of these discharge patients. It has been frequently reported to me that patients are kept in acute hospitals after their due discharge dates because of the unavailability of a suitable bed elsewhere, whether for short or long-term care.

In my area of Sligo-north Leitrim, there are geriatric hospitals such as St. John's, long-stay facilities such as Nazareth House and many excellent nursing homes available to accommodate people who are ready for discharge from Sligo General Hospital but not ready to go straight home. I urge the Tánaiste to ensure full use is made of all these excellent facilities whenever they are required. Using such facilities will ensure that the acute beds in Sligo General Hospital are occupied by people who need the full range of investigative and therapeutic services a hospital such as Sligo can give them.

In that regard, I have asked before, and I do so again today, that approval be given for the establishment of an acute medical assessment unit in Sligo General Hospital. Such units have worked exceptionally well in other hospitals and have resulted in accident and emergency units in such hospitals not experiencing the overcrowding that exists elsewhere. There is no doubt that such units are a vital component in the smooth running of accident and emergency units. Sligo General Hospital submitted detailed planning of such a unit to the HSE some time ago. I have spoken to the Tánaiste and Professor Drumm of the HSE about the urgent need for such a unit. I again ask that immediate approval be given for the establishment of such a unit in Sligo.

The patients who attend accident and emergency in Sligo need and fully deserve an acute medical assessment unit immediately. Its establishment will result in a much better service for patients. The patients of the north west want this unit and I again ask the Tánaiste to use her influence with the HSE to ensure this unit is established as soon as possible.

I refer briefly to Trolley Watch, as published by the INO. On 5 April last a record number of patients were recorded as being on trolleys in accident and emergency units — in excess of 360. Since then the figures nationally have shown a very welcome decrease to a low of 186 last Friday. While there was a slight rise yesterday, I note the figures for Sligo General Hospital have been among the lowest nationally and I say well done to all concerned. However, we need that acute medical assessment unit to keep up the high standards in the hospital. I fully support the Tánaiste in her work to date to deal with this very difficult problem. I support the motion.

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