James Reilly (Dublin North, Fine Gael)

I will answer the easiest question as to whether I have ever experienced Saturday nights in emergency departments. I have experienced them numerous times because I worked in them. However, that is not to make light of the situation where people feel threatened - both staff and the people lying there ill and distressed. The drunken and violent behaviour of some of our citizens is not acceptable. The real issue is a health service that has not been functioning and has not been joined up.

In order to answer the question in a comprehensive fashion, it is very clear that we need to reduce the inflows into emergency departments by having more prevention and more chronic illness care in the community along with more early diagnosis and treatment. Family doctors should have access to X-ray, ultrasound and blood testing to diagnose and treat patients so that they do not end up in the emergency department. When they end up there and once a decision is made to admit, there ought to be a bed in the hospital to which that patient can go. We are looking for ways to achieve that because not only do we have the beds that have been closed, as Deputy Kelleher has pointed out, but we also have a host of other beds unavailable because of delayed discharge, where people are awaiting placement in the community. I have a team examining the issue to determine how we can alleviate the problem particularly in urban areas where the problem is most acute. Furthermore, downstream we also need to have more rehabilitation in the community. We are going out into the field to get quotes for those services from nursing homes so that we can expedite the passage of patients through the system.

As I mentioned earlier, the medical care programmes are considering how to discharge patients earlier and the mechanisms of how hospitals work. These are basic time and motion studies to help move patients through quickly. People do not want to be in hospitals any longer than they need to be as we all know.

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