Paul Connaughton (Galway East, Fine Gael) | Oireachtas source

I welcome the opportunity to contribute to the debate on this extremely serious issue, which has been topical both in the past two weeks and for the past 15 years or so. I have no wish to present myself as an expert in identifying solutions to all the problems that exist. From what has been said during the past fortnight, it appears that no two experts have the same answer to this problem. People seem to list four or five different priorities in the context of how they feel it should be solved. One of the reasons this problem has continued for so many years is that although many people have identified certain parts of the health system as being the cause of difficulties, we have never actually brought everyone together in the interests of finding an overall resolution.

I would certainly not be doing my job as a public representative if I did not highlight some of the issues that arose for my constituents in the past couple of weeks. I refer, for example, to a very frail 84-year-old gentleman who underwent heart surgery last April and who was brought by ambulance to the accident and emergency department of Portiuncula Hospital in Ballinasloe at 5.30 p.m. on Friday, 2 January last. He was not seen until 4 a.m. on 3 January, at which point he was X-rayed twice. He had become quite weak by that point and was placed in a wheelchair. One Monday 5 January last, he was discharged from the hospital with pneumonia. I was contacted by his son on the Friday night and I rang the hospital immediately after to discover the position. I immediately recognised the level of stress and concern in the voice of the nurse with whom I was dealing, who clearly outlined the pressure under which the staff were operating. She informed me that they were being obliged to categorise those presenting at the accident and emergency department on the basis of the seriousness of their medical conditions. Anyone whose loved one is obliged to visit an accident and emergency department will be of the view that his or her condition is serious. Hospital staff operate under a great deal of pressure and it is simply not acceptable that only one doctor was on duty on the night of Friday, 2 January at the accident and emergency department of Portiuncula Hospital. This is, perhaps, a resource issue to which we must give proper consideration.

I was obliged to attend the accident and emergency department in Portiuncula Hospital on two occasions in the past year, once on my own behalf and once with my daughter during the summer. It was only by pure chance that we were seen immediately on both occasions. It is almost a question of good luck and timing as to how long it will take to be seen. On occasion, one can walk into an accident and emergency department and there will be very few people present. My daughter and I attended Portiuncula Hospital during the summer months, which is probably the time when fewest people present in accident and emergency departments. Overcrowding in such departments always occurs in December and January, not just here but also in Northern Ireland and across the UK.

What are the solutions in this regard? It is very easy to identify what is wrong and to recount anecdotal evidence. However, we must try to identify long-term solutions to the problem that exists. I welcome the changes the Minister has made and also the additional funding that has been allocated in respect of delayed discharges. The latter will certainly be of assistance in some, but not all, hospitals. It is important that the task force he has established should put forward some really sustainable solutions that can be implemented. In the past, reports were compiled, problems were identified and solutions were recommended, but absolutely no action was taken. We cannot allow that to be the case on this occasion. I am of the view that the Minister will, within the budgetary constraints that exist, implement the recommendations the task force puts forward in order that 12 months from now there will not be a recurrence of what happened in recent weeks.

I acknowledge we are not even out of the woods in respect of the current problem and that it may spike in a couple of weeks.

A possible solution, mentioned by the Minister, involves the role of general practitioners and primary care. We realise we need to have more primary care units rolled out and built and give more resources to general practitioners. I am convinced that a percentage of people arriving in accident and emergency units do not need to be there and are simply taking up space. While the percentage may be small, reducing it, by any amount, can only do good. That is a long-term solution but we also need short-term ones. I acknowledge the trends are in the right direction but, as Minister of State Deputy Kathleen Lynch said yesterday on the radio, one person waiting more than nine hours is one too many. We must get this under control. The one phenomenon we do not want is fear on the part of people who legitimately need to attend an accident and emergency department.

We have an issue with our ambulances. This has been highlighted, particularly from a rural perspective. Ambulances arriving at accident and emergency departments simply cannot get patients in quickly enough, thereby causing concern and upset.

When researching this matter this evening, I came across a media article that very clearly spells out the current problems. It states:

It hasn’t gone away you know. Turn on any radio or TV news programme, or open up any newspaper last week and ‘accident and emergency trolley crisis’ headlines were in your face...

Whatever the Government might say about the huge amount of funding invested in the health service in recent years, the fact remains that there is underinvestment in key areas, such as in adequate community facilities for the elderly once they have completed their acute care, and in adequate numbers of acute beds to carry out non-emergency work. There is also a need for investment in the expansion of primary care to allow it to take on more work that is currently carried out in hospital...

So the 'accident and emergency crisis' is not simply a matter of how many patients are crowded into accident departments at any given time; it is largely a crisis relating to the capacity our healthcare system has to meet patient demands. It remains to be seen whether Mary Harney’s new action plan will address the capacity problem, particularly as she has said there will be little additional funding provided for the health service next year. A short-term action plan can only achieve so much; there is also a need for structural and attitudinal change.

This was written in October 2004 and it is now 2015. At times when we had a lot of money to spend, this was not addressed, or addressed correctly. It is time for people to put their heads together and finally find a solution to this problem.

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