Maureen O'Sullivan (Dublin Central, Independent) | Oireachtas source

We can all agree that health care should be based on need. With the health care budget we have, which is massive, we should have a state-of-the-art health service. We have excellent care for people once they get into the system, but getting in is the problem. That is the thrust of the motion. Tá sé uafásach éisteacht leis na fadhbanna atá ag daoine, go háirithe seandaoine, le déanaí. Cad ba cheart dúinn a dhéanamh?

I acknowledge the work of the doctors in local areas who are doing their best to keep people out of emergency departments. We must remember that they are just for accidents and emergencies. These doctors, with additional equipment and facilities, could stay open much later and prevent more people going to emergency departments when they could go to their local doctor. We need to look at emergency departments in terms of the demands on the service. Those presenting with addiction issues need a separate facility which should not to be imposed on the general population, because that is not fair to either group.

To break the cycle of addiction, we need staff who are trained in addiction and we need a service where those who present drunk or drugged in accident and emergency have an opportunity to sleep it off, get the medical care they need but, more importantly, be linked in to detox, community programmes or whatever because at present the emergency department is a revolving door for those in addiction. According to the statistics from the HSE for August 2015, some 8,000 plus were returning attendees. I wonder if there is a breakdown of those and how many of them were presenting in addiction.

Another group who have significant difficulties at accident and emergency departments are those who present with mental health issues, autism and Asperger's syndrome. Accident and emergency is a nightmare for them. Designated intellectual disability nurses would ease that situation for such people. I ask that the Minister look at a separation of services.

Regarding the waiting time for knee and hip replacements, I thought patients were making progress in this area but the calls are coming in again. I am hearing of delays with hip and knee replacements. If the replacements were done speedily, these patients would not have to give up their jobs, which is what they tell me they have to do. It is worth considering that they could be back in work paying their taxes rather than in a situation where they are a cost to the State. There is a role here for the treatment abroad scheme. It would be interesting to conduct a cost-benefit analysis on what it costs the State to have someone out of work as opposed to utilising the treatment abroad scheme. If the private health care system can be run efficiently and promptly, why can that not be replicated in the public health service?

Great work is being done by our doctors and nurses, and they are in demand abroad. While the salaries that those abroad would get here might bring them back, one aspect they will not come back for is the working conditions here because they have better working conditions abroad.

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