Kathleen Lynch (Cork North Central, Labour)

I thank the Deputy for raising this issue. There is a slight flaw emerging in the topical issues debate format. The Deputy is speaking about something of which we are all aware. Perhaps we should be concentrating on plans to resolve the issues involved. That is what Members would really like to see, but that is not what we get. I am about to repeat virtually everything the Deputy said, although I must correct one of his figures. The throughput at Galway University Hospital's accident and emergency unit last year was 68,000 as opposed to 66,000.

We all know the reason for bottlenecks in acute hospitals is the lack of step-down facilities for people who should not be in hospital but are not able to go home. Primary care will be part of the solution to the bottlenecks in acute hospitals. For instance, the leg injury of the constituent to whom the Deputy referred could have been dealt with in an upskilled minor injuries clinic or a proper primary care unit. If such facilities were in place, the only people being assessed in accident and emergency departments would be those whom general practitioners considered to be in need of an assessment by a consultant or admission to hospital. We need to address the ancillary services required around acute hospitals rather than focusing solely on acute hospitals. The Minister of State, Deputy Shortall, is battling to have primary care units and multidisciplinary teams established in the community setting. These units and teams will also form part of mental health services, for which I am responsible, and care of the elderly. The social care needs of older people, persons with a disability and those with mental health issues are identical, and there is no reason this aspect of their care cannot be delivered in the community.

If we do not start thinking outside the box the chaos we have inherited, including in Galway University Hospital, will continue. The special delivery unit is gathering all the information we need to allow us to put in place mechanisms to ensure we can avoid the type of problems Deputy Nolan has observed in overflow wards and accident and emergency departments. The Deputy's most poignant comment concerned a 75 year old man who found himself facing the indignity of being placed on a trolley. While the rest of us may have a degree of dexterity and mobility, it must be disturbing for anyone of that age profile to find himself or herself in such a position.

Before coming to the House, I attended a meeting of the Cabinet sub-committee on health at which we discussed how we would address the issues Deputy Nolan raised. We must act urgently because a long-term response would be of little benefit to the 75 year old gentleman to whom the Deputy referred. I concur with the Deputy on this issue. The Government is working very hard to resolve the problem.

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