Dara Calleary (Mayo, Fianna Fail) | Oireachtas source

To follow Deputy Ó Cuív's theme, the frustrating aspect of this debate is that we are here again. Debates on trolleys and accident and emergency departments are like Christmas in that they come around every year, although this year the debate is earlier. Anybody with a busy constituency clinic would have been able to pick up early in the summer that there were difficulties in the health service that would not normally be seen in June and July. There were delays, with operations being cancelled wholesale. If we could see it, it is beyond me why management in the HSE could not see it as well and start planning for it then, as opposed to adapting the normal winter plan, which apparently only comes into effect in mid-November. We have had the various incidents that have been highlighted in the past number of weeks in Tallaght and every other hospital, to be frank. The same management is comfortable putting out a tender for trolleys for Tallaght hospital without dealing with what is causing the use of trolleys in the first place.

When listening to Deputy Ó Cuív, I was reminded of a Dublin media personality visiting my home town, when his spouse got an ear infection. Their first question was to ask where was the nearest accident and emergency department and when I told them it was an hour away, they nearly got a bigger infection. If we have a properly resourced primary care system, it should be able to take much pressure from the accident and emergency departments. A properly resourced system would work seven days a week, with GPs rewarded for offering services rather than penalised, so we would not drive GPs to Canada because of a lack of resources. We should not be going around begging to get doctors into rural areas because every rural vacancy is treated differently when it comes to the rural practice allowance. A proper system would work with district hospitals operating on an effective step-down basis.

On examining waiting lists, I noticed the waiting list numbers for Mayo General Hospital have fallen. That is not due to anybody in the constituency but rather an effective system of step-down working in Ballina, Belmullet and Swinford, using the older people's and community nursing homes as step-down facilities. People are being moved from Mayo General Hospital when they do not need to be there. We get them out at that end and stop them coming into the accident and emergency department when there is a properly resourced system of primary care around the county. In a county with such expansive geography, that is a necessity.

Our district hospitals should be able to do X-rays seven days a week rather than five days a week between 9 a.m. and 5 p.m. That way of thinking and doing business must change, and surely with any kind of reform that must be considered. I am not convinced about these hospital groups. They have nice flashy logos - it is Saolta in our case - but do those groups involve the district hospitals, or is it a case, for example, that Mayo General Hospital needs to work with them? What have the hospital groups brought to the equation in dealing with this problem? If we look at the size of the problem in mid-November, it is far more serious than it has been for some years. Much work must be done around those hospital groups.

We are supposed to have had much public service reform in the past few years. I know it took much work to get to an 8 a.m. to 8 p.m. working day but we must examine the possibility of a seven-day service, putting extra positions in place to do that. It is ridiculous that operating theatres are empty through the night and X-ray machines are switched off at weekends unless there is an emergency appointment. It is ridiculous that services that can be done and which do not take long must be done between 9 a.m. and 5 p.m. It is absolutely ridiculous, particularly when people must travel long distances, that everybody gets the same appointment at 9 a.m., meaning that in many cases hundreds of people will turn up for that appointment, leaving some people to be seen only at 3 p.m., 4 p.m. or 5 p.m. Such practice still goes on. Until patients are treated with dignity and respect, with resources provided to back this up, there will be more cases like we saw in Tallaght, with accident and emergency services backed up.

I am not convinced that the current management of the HSE understands this but if it does, it is not interested in change or putting patients at the front and centre of the system. With the kind of money being spent on health, we should be able to resolve these problems. We do not necessarily have to think outside the box; with a bit of cop-on we could resolve these problems. If somebody experienced the journey of a patient from Erris or Ballina into Galway, he or she would know it involves driving through the city of Galway in peak traffic to try to get to the regional hospital, when there are hundreds of acres in Merlin Park that could offer many services without forcing people through the city. That would require somebody to think about the patient in his or her home and what it takes to get to the hospital. We are pushing people into these super-hospitals but it seems nobody in the HSE management is thinking of the patient's journey. As long as this continues, we will have accident and emergency department problems every year. We will see tenders for trolleys each year and we will hear of cases where people were on those trolleys for 97 hours every week from November to March. That is simply not good enough.

We can wring our hands in the Chamber, give out and vote but we will go home again at 9.30 p.m. The problems will continue at 9.30 p.m. this evening, at 9.30 a.m. tomorrow and 9.30 p.m. tomorrow evening. The people who should be accountable are not here in the Chamber and the people running the health service are not here. It is time they walked in the shoes of the people they are supposed to serve; if they did, we would have a different kind of health service.

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