John Moloney (Laois-Offaly, Fianna Fail)

Rather than spending the few minutes I have talking about the financial statistics, it is important to note that there certainly has been no cutback by way of financial allocations. Neither have there been any cutbacks in the level of services. To be critical of the fact that the Government has neglected the health service does not take into account what has been done over the years.

I heard criticism a few minutes ago of the various Ministers of the Department over the years. When one recalls the mid-1990s, there were very few capital programmes being disbursed throughout the main towns and counties. It is fair to suggest that much of the health endeavour in those years was aimed at putting hospitals in place in most of the main towns in every county. We now have state-of-the-art hospitals. In the Laois-Offaly and Longford-Westmeath area over recent years, three modern hospitals have been built in Portlaoise, Tullamore and Mullingar. I make those points not to be parochial or to say that we have three hospitals so what about the rest, but to show that while the reality is that the health policy has not worked in every region, it has worked in some.

The points made a few minutes ago by Deputy Cooper-Flynn must be borne in mind as well. I do not believe for a minute that patients would be treated so shabbily in the midlands region. I certainly do not see or recognise any difficulty.

I presented as a patient at my own accident and emergency department in Portlaoise shortly before Christmas, thankfully for a short time. Nevertheless, I saw the activity levels, the turnaround in patients and the level of patient care. More recently I had to call to the Mater Hospital on a private matter and was in the accident and emergency unit at 8 p.m. There I saw at first hand the enormous pressure on the nursing staff. When I asked whether it was normally like that, I was told it was very quiet at that time and that the real pressure would be felt at around midnight.

Rather than indulge in general practitioner bashing, and I read the reports of the Irish Medical Organisation conference, it nevertheless must be taken into account, as the Tánaiste cited, that 75% of those who present at accident and emergency departments are discharged the same day. In other words, they do not require acute beds. An issue exists which needs to be dealt with by means of better services at primary care level. That is neither a cop out nor us neglecting our responsibilities in Government. The reality is that with a spiralling population and the enormous demands on the health service, a radical response is needed. I recognise the dramatic impact on the health service over the years wrought by changing population patterns.

I also recognise, however, that this Administration and its predecessor went out of the way to try to regionalise services. It has not happened in some places. Where it has, there is very little difficulty with either trolleys or accident and emergency units. Obviously the level of services is being delivered in those regions where change has been accepted. I again refer to my area, the former Midland Health Board. The cancer service based at Tullamore, the orthopaedic service, etc. has lessened the strain on hospitals in the capital. As long as this policy continues, I believe we can get to where we want to go.

It is important for Members to read the presentation Professor Drumm made some time ago to the Joint Committee on Health and Children in which he acknowledged the difficulties in accident and emergency departments. At the same time he recognised that some hospitals were working to a degree whereby there was no complaint. We must home in on that. The committee has invited people from the so-called successful hospitals to come before it to explain the procedures and processes involved which ensure that there are no complaints. On the other hand, we want to invite consultants and other staff from those hospitals which have not performed to the best hoped-for levels. Rather than penalise them by way of financial penalty, the Minister and the Department should identify initiatives that will recognise best practice and, most importantly, best outcomes. Until that time comes, there will be problems in certain hospitals.

The Minister and Professor Drumm have come before the committee, listened to concerns and outlined their responses to the problems, specifically as regards accident and emergency departments and the rising numbers. I have heard it said that the Government is closing its eyes to criticism. It is fair to point out that the Joint Committee on Health and Children has the facility to pursue specific issues and look for policy change. That is where we will see the responses, whereby the HSE and the Minister come before the committee, respond to various criticisms and come back on a three-monthly basis to resolve or at least explain problems.

I have always believed there is no quck-fix solution to problems in many accident and emergency units. Many of the problems are complex. A wide variety of actions will be required to address them, whether through a combination of reform, resource management to improve efficiency in such a way that suits the individual hospitals concerned or whatever. It is important to suit the individual hospitals concerned. Obviously the demands on a rural general hospital will be different from those on an urban central hospital complex. Therein lies the solution. It is not enough to have solutions at the same level for every hospital in the country. There should be some means of assessing the efficiency of hospital facilities to see if the systems in place are successful and, if so, to work from there.

I do not believe everything is as it should be. However, outlandish as it might sound, some years ago all the parties in the House came to recognise that the only way to sort out all the problems in the North was through a combined unified effort. If the Opposition believes we have a crisis on our hands——

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