Dáil debates

Wednesday, 26 January 2005

Private Members' Business.

Accident and Emergency Services: Motion.

7:00 pm

Tony Gregory (Dublin Central, Independent)
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I move:

That Dáil Éireann,


—that the Tánaiste and Minister for Health and Children is now more than 100 days in office;

—with deep concern, the request from the Health and Safety Authority seeking an urgent safety inspection and comprehensive risk assessment of every hospital accident and emergency unit in the State with immediate steps to address any deficiencies;

—that the Health and Safety Authority request follows a statement by the Irish Hospital Consultants Association last week that overcrowding of accident and emergency units is posing a "serious risk" to patients;

—that there are as many as 400 patients on trolleys in accident and emergency departments awaiting beds at various times according to statistics from the Irish Nurses Organisation;

—that the situation is worst in a number of Dublin hospitals with 46 patients on trolleys at Tallaght Hospital, 28 at St. Vincent's Hospital and 27 at the Mater Hospital;

—that the Health and Safety Authority requires the hospitals to report back by 25 February 2005 along with confirmation that steps are being taken to tackle the problems identified;

—the necessity for the action of the Health and Safety Authority in requiring an urgent safety inspection of every accident and emergency unit in the State;

—the failure of the Tánaiste and Minister for Health and Children to make any impact on the crisis situation in the accident and emergency departments of our hospitals;

demands that the Tánaiste and Minister for Health and Children:

—take immediate action to address the ongoing and continuous crisis in the accident and emergency units of our hospitals;

—outline a timescale within which this action will be taken;

—immediately address the growing sense of frustration among staff in accident and emergency units;

—make urgent provision for sufficient new beds to end the crisis; and assist the hospitals immediately to meet all their needs arising from the safety audit and risk assessment as required by the Health and Safety Authority.

I propose to share my time with Deputies Cowley, McHugh, James Breen, Gormley and Ó Caoláin. I acknowledge it was the action of the Patients Together group which primarily focused national attention on the scandal of the suffering of so many of our people, left on trolleys for days and nights in accident and emergency units, which has led to this motion. I pay tribute to the group for its efforts to expose this scandal and am confident it will continue until this outrage is ended.

The situation is all the more scandalous and unacceptable because Ireland is now one of the wealthiest countries in the world and apparently the second most affluent state in Europe. In this context, it is particularly shameful that the crisis in the accident and emergency service is allowed to continue. It is a blot on the good name of this country.

As long as there is a two-tier health service, with medical care readily available for those who can afford to pay and long waiting lists for the rest, there will be the misery of trolleys in accident and emergency units for hundreds of unfortunate people. This inequality is at the heart of the matter. Ironically, it is the policies of the Government that have made Ireland one of the most unequal societies in the developed world. The crisis in accident and emergency units is merely one of many symptoms of that social injustice.

Jerry Cowley (Mayo, Independent)
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Somebody must be responsible for this situation. There are more trolleys in our hospitals than at any time in the past. In view of my experience as a practising GP for 27 years and a casualty officer in UCHG, I am in a good position to comment. The situation I have witnessed in recent times is extraordinary. In Mayo General Hospital last night, some patients were treated in ambulances outside the accident and emergency unit because no trolleys were available.

This is entirely unacceptable and somebody must take responsibility. The Tánaiste has been in office for 100 days as Minister for Health and Children but there have been no improvements. She has said the service will improve by next March. That is an easy claim to make because we are currently in the height of the winter crisis. The problem is that the winter crisis is worse than ever and is effectively a year-long crisis. I am not hopeful the problem will be resolved by March. The Government is now paying for its own sins of omission, neglect and failure to the people. It is not possible to put a pint of water into a half-pint glass, which is what is happening. The Government took 3,000 beds out of the system for financial reasons to save money. There must be a consequence to this decision, which is the present crisis. Until those beds are restored the crisis will not end. It does not make sense to try to empty a casualty department when no beds are available upstairs.

While the health strategy promised 3,000 more beds, we have seen nothing like that number so far, nor do I believe we will see it. Promises are made all the time. We were recently promised 38 beds in Mayo. However, those beds have been announced and promised before on more than one occasion. Those beds are used up mainly for orthopaedics, with a few for overflow from accident and emergency departments. The beds are already in use. The 38 beds offered by the Tánaiste and Minister for Health and Children are useless. They are phantom beds for phantom patients. We have enough patients without having phantom patients.

Operation freeflow was established to help the traffic in Dublin. It is time to get freeflow out for the accident and emergency departments. Casualty consultants suggest getting rid of the trolleys and putting them elsewhere — out of sight, out of mind. With respect to my colleagues who are casualty consultants, to put the trolleys elsewhere will not solve the problem. With the trolleys where they are now, at least people can see them.

Some people have been on waiting lists for up to ten years and the 100,000 still waiting to get on the official waiting list are the people who are presenting at accident and emergency departments. We have an inordinate number of emergencies because of those people. If they are left on a waiting list for five or ten years, what can we expect? They will get seriously ill and block up accident and emergency departments.

West Mayo has no ambulance base. A patient has to wait an hour for an ambulance at the end of Achill, which is 50 miles away, and then wait another hour to get to emergency hospital services. If it was not an emergency when the ambulance was called it would certainly be one by the time the patient reached the hospital.

Paddy McHugh (Galway East, Independent)
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I am glad to have the opportunity to speak on this very timely motion, which mainly concerns itself with the Health and Safety Authority's call for a safety audit of all accident and emergency departments. For the Health and Safety Authority to make such a call shows great concern on its part about the shortcomings of accident and emergency departments.

It is a timely motion from another point of view. The Tánaiste visited the accident and emergency department in UCHG on Monday and again yesterday. She applied herself to some other issues, which have been of concern to my constituents for some time. I was amazed to hear that she encountered only 14 people in the accident and emergency department in UCHG during her visit, which is rarely the case. To get the real picture the Tánaiste should visit the hospital on a weekend night when she would see multiples of 14, some of whom should not be there but should be accommodated in more suitable accommodation and supervised by appropriate staff members.

I was disappointed that the Tánaiste did not take the opportunity to approve an application to the Department of Health and Children for a medical assessment unit which the medical staff state would provide a system-wide solution to the issues experienced in the accident and emergency department in Galway at the moment. I would encourage the Tánaiste to approve that proposal as a matter of urgency.

On a positive note, I warmly welcome the announcement that the new radiotherapy centre at UCHG will be opened in March. This will go some way towards addressing the totally unacceptable situation whereby patients had to undertake a journey from one side of the country to the other to receive a few minutes treatment per day. Some of those patients were barely well enough to undergo such a gruelling ordeal.

It was disappointing that the Tánaiste did not deal conclusively with the Tuam hospital issue on her visit to Galway. I was alarmed to hear that she is awaiting yet another report on the matter. All the relevant information has been sitting in the Department of Health and Children since 8 October 2002, a long time before the Tánaiste became Minister for Health and Children. That relevant information comprises a 150-page planning brief prepared by the Western Health Board for the Tuam health campus and identifies the need for a community hospital for Tuam, comprising 60 beds, dementia day-care, mental health day-care, a primary care unit, an ambulance base, regional family and child care, and a training unit. We also know that the Western Health Board has established that while the existing building is not suitable for the hospital and medical portion of the development, it can be used for ancillary accommodation.

The need has been established and the assessment has been done. The model has been created, a photograph of which adorns a notice board on the site, proclaiming that the site has been purchased by the Western Health Board for the development of a Tuam health campus, incorporating a community hospital.

Separately in specific isolated studies, the Western Health Board identified Tuam as the appropriate location for an ambulance base to serve north Galway, south Mayo and on to the Roscommon border. This ambulance base is critical for the population in the region. Under a pilot scheme announced by the former Minister for Health and Children for the delivery of primary health care, Tuam was identified as a priority area for a primary care unit. The West Regional Authority published a document, Regional Planning Guidelines for the West Region, which identified the need for the provision of health care services in Tuam.

Tuam has been designated as a hub town under the national spatial strategy. As the Tánaiste will be aware, one of the characteristics of a hub town is that it should have a regional or community hospital. The studies have been done, the needs established and the relevant bodies all support the case. Now all we need is for the Tánaiste to approve the planning brief for Tuam health campus.

James Breen (Clare, Independent)
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Our hospitals are slowly suffocating to death due to neglect and lack of investment, as is the case with Ennis General Hospital, where staff have been working under protest since 8 a.m. on Thursday, 20 January 2005. This protest was fuelled by the failure of senior management to respond to the issues of poor staffing levels. Ennis General Hospital is one of the busiest in the regions, with increased activity in the area. Workers will continue to work under protest until the shortages have been addressed.

We would all welcome a holistic health model that would meet all our aspirations in terms of what we expect from a health service and which is also cost effective. Why is so much emphasis put on expenditure and financial limits when at all the affected hospitals we should be prioritising this problem and introducing positive initiatives to ease the discomfort of patients and the excessive workload on nursing and other frontline staff? The Government and hospital management must take primary responsibility for the reality that the problem is getting worse. We should seek to minimise the extent of overcrowding and acknowledge the discomfort and distress experienced by patients in the nights and mornings when they find themselves spending extended periods on trolleys. Further investment should be made to increase bed capacity with the employment of additional nursing and other support staff to deal with the extra workload.

We have a national crisis and the experience of recent days confirms this. Much more can be done at hospital level to alleviate the suffering of hundreds of patients and the intolerable workload on nursing staff with as many as 400 patients on trolleys in accident and emergency departments awaiting beds at various times. The recurring problem of overcrowding in accident and emergency units is posing a serious risk to patients. The problem is much worse in a number of Dublin hospitals, with 46 patients on trolleys at Tallaght Hospital, 28 at St. Vincent's Hospital and a further 28 at the Mater Hospital.

Our health service is fragmented, disparate and disjointed. Accountability for the service is dissipated. Information is either non-existent or difficult to access. The Government hoards money for this mishmash while allowing the underlying problems to fester, leaving a service that is coming apart at the seams and screaming for reform.

As a result of a better health service we will live longer but there will be higher maintenance costs associated with keeping sick people alive and optimising their well-being. There must be a system to ensure that we know exactly where the money is needed and how it should be spent. Too much has been wasted in the health service because of a lack of basic information — the underestimation of the extension of the medical card to those over 70 by millions of euro is one such example. Our health service cannot afford these mistakes. There is an urgent need for significant investment in information technology.

Patients need the comfort, certainty and reassurance of being able to see a doctor. People living in urban, suburban and rural communities need to be reassured that the distance they live from a hospital will not influence the reaction in an emergency. To avoid these problems we should have the things we were promised — better equipment, more ambulances and fully trained staff. People want a form of medical cover on a 24 hour basis, and it is not beyond the ingenuity of the Government to provide it.

The hundreds of millions of euro for upgrading general hospitals and their services have not been matched by spending on long-term care centres or community services which are vitally needed. Even with subvention, private nursing home care is not an option for many people. The publicly funded long-term care we offer these people is often distant from their homes and families, which can cause great distress for patients and relatives at a difficult time.

The public is becoming more aware about the health system; it is continually under the microscope and health will be a priority in the next election. The Minister must ensure that the immediate needs of the thousands awaiting treatment and the shortage of staff are addressed. When will the €20 million promised four years ago by the then Minister for Health and Children, Deputy Martin, be spent on upgrading Ennis General Hospital?

I am deeply concerned about the failure of the Tánaiste and Minister for Health and Children to make any impact on the ongoing crisis in the accident and emergency departments of our hospitals. I demand that she should address this problem, outline a time-scale for action to tackle the growing sense of frustration among staff in accident and emergency units, make urgent provision for sufficient new beds and assist the hospitals to meet all the needs arising from the risk assessment by the Health and Safety Authority.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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I thank the Independent Deputies for tabling this important motion. Nothing better reveals the true face of modern Ireland or the PD-Fianna Fáil coalition than the crisis in accident and emergency wards-units where there is now a safety problem. I do not say that to make political capital. It is a fact that was categorically and repeatedly stated on 12 January by Dr. Aidan Gleeson on "Morning Ireland" who said that the accident and emergency units were "unsafe". He put forward a proposal to move accident and emergency patients into wards, an idea that did not find favour with the nurses' unions, which believe it simply transfers the problem. Dr. Patrick Plunkett also made a similar proposal and was lambasted for it.

The proposals Dr. Gleeson put forward were interesting, as was his analysis. He said that it will take several years to deal with this problem. The world-class health system the Tánaiste promised this House must wait because she is not dealing with the problem properly. The Tánaiste put forward a ten point plan in the autumn, stating that the accident and emergency crisis is unacceptable, yet it continues.

On the same edition of "Morning Ireland", Mr. Pat McLaughlin of the Health Service Executive was questioned at length about the implementation of the ten point plan. It was clear that it is not being implemented properly and is being left in abeyance. The Government promised 3,000 beds in its health strategy but part of the ten point plan was to give us 300 beds. Where are they? Pat McLaughlin tells us they will be available by the end of 2005. Does the Tánaiste think that is acceptable? Does she really believe that is the way to tackle the crisis in accident and emergency units, to let it go on and on? Why can we not just deliver the beds? I have always said that this is a problem of capacity. It is interesting that much of the ten point plan reflects the content of a Green Party document published two years ago on the accident and emergency crisis.

Extra capacity and minor injury clinics are both contained in the plan, but where are they? Mr. McLaughlin was not specific on that when asked. I will be fair because the man has been in the job only a short time. A number of new MRI units and acute medical units were said to be in the pipeline and were being examined in detail, along with the transfer of high dependency patients. He said that tenders have gone out and it was all about to happen, but none of it has happened. Deputy McDaid has experience of this and knows this is the same old story and that we are not tackling the problem. If it is not tackled, it will continue.

I advise the Tánaiste to start investing. The €70 million for the accident and emergency initiative is a drop in the ocean. Funding must go much further. This is a significant part of the problem because the PDs are not prepared to invest or, as the Minister, Deputy Martin said, to raise taxes if necessary to deal with the health crisis.

It was said that while the crisis was taking place, the Tánaiste was on holiday. I would hate to think of her lying on a beach while others where lying on trolleys and sitting in chairs in the most terrible conditions. If the Tánaiste was a Fianna Fáil Minister, it would have been splashed all over the papers. The Tánaiste, however, enjoys a charmed existence with the media. To be on holiday while this took place is unacceptable.

The Green Party believes that the crisis within accident and emergency services reflects the crisis in the wider health system. Any attempt to address the problems in accident and emergency services must therefore be part of a strategic programme in and restructuring of the health services. New investment in health must be targeted at key areas, primary care in particular. The primary care strategy is just not happening.

The low tax, low spend economic policies of Fianna Fáil and the PDs have limited the options available to the Government to respond to the growing crisis. The Government's self-serving rhetoric about the need for greater efficiency and accountability in the health system is an attempt to distract from the fact that it is not prepared to invest in the sort of health services that are available in other EU member states.

The health care available in a society reflects its values. In the USA the provision of health care is not seen as the obligation of society but as a voluntary consumer purchase. It is up to individuals to ensure they receive health care in an environment where social solidarity plays second fiddle to economic forces. One in five Americans is under-insured or has no health insurance and their access to health care is severely curtailed. In comparison, health care systems in the majority of EU states are based on the concept of social solidarity. Ireland's two-tier health care system reveals values closer to Boston than Berlin, in line with the views the Tánaiste has always expressed. Good quality health care does not come cheap. In the United Kingdom, there is a growing realisation that if health care spending is to rise, people must be convinced to pay for it. An Irish Government that intends to deliver equitable and high-quality health care has to convince the electorate to pay for it — that is the bottom line.

The Green Party believes that many of the difficulties encountered in accident and emergency departments can be primarily attributed to this country's lack of a comprehensive and properly funded primary health care system. There are other problems, however. Almost half of all GPs are engaged in solo practice and two thirds of GPs do not employ a nurse. High referral rates to specialists often reflect the isolation and uncertainty of GPs. A modernised GP service would relieve the pressure on the inpatient and outpatient hospitals sector. Accident and emergency services are serving as a catch-all for patients, many of whom should be treated elsewhere. There is a shortfall in the bed capacity of major hospitals, particularly in the eastern regions. Deputies are aware that patients who are assessed in accident and emergency units often have to wait on trolleys for up to 48 hours.

I would like to discuss step-down facilities before I finish. I will give an example that highlights the crisis we face. I spoke recently to two people whose parents, aged 80 and 84, are in hospital. They were told six weeks ago that they could be discharged, as long as they moved back home. The middle-aged children wanted to look after their parents. This is an example of beds being taken by people who should not be in hospital. Proper facilities should be put in place, appropriate equipment should be provided in people's homes and people should be paid to look after their parents. Such a system would be much cheaper than keeping such people in hospital, where they take up space and exacerbate the crisis in accident and emergency departments. I urge the Tánaiste to examine this matter. I will table a parliamentary question on the issue and I will write to the Tánaiste about it.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Ar son Sinn Féin, ba mhaith liom tacú leis an rún seo in aimneacha na dTeachtaí Neamhspleácha. On behalf of the Sinn Féin Members, I wish to record my support for the motion that has been proposed in the names of the Independent Deputies. This is a timely motion, sadly. I say "sadly" because the winter crisis in our hospitals' accident and emergency units is an annual event. It is as predictable as Christmas and totally preventable.

Many of the remedies to these problems are outlined in the Government's health strategy, which the Minister for Health and Children, like her predecessors, has failed to implement. I refer to promises that more acute beds will be provided in our hospitals and the additional nurses who are required will be recruited. The strategy states that the primary care centres that have been promised will be rolled out to help to relieve the pressure on our hospitals. It also promises the conclusion of negotiations with hospital consultants about a new contract. It provides for exclusive working by new consultants in the public system. It recommends the restoration of accident and emergency services in local hospitals where they have been cut.

It is scandalous that the number of people on trolleys and chairs in accident and emergency units reached an all-time high earlier this month. The Minister spoke about bringing in a new broom, but it has certainly not yet shown itself to be capable of sweeping clean. I hope it does not yet prove to have been threadbare. I wonder what we can expect from the Tánaiste in her new role as Minister for Health and Children. On 9 December last, she made a statement in the House that was remarkable for a Minister who is responsible for health. It did not receive much attention at the time or since then, but it deserves to be highlighted. I ask the Tánaiste to elaborate on her comment:

I believe in a minimalist role for the State in all our lives, including health care. All but two of the hospitals in this city are voluntary, private, independent organisations.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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That is true.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I will now argue that it is not true.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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It is true.

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Tánaiste's comments, which are an example of pure Progressive Democrats ideology, have been reflected in several pronouncements made by her and her colleagues, indicating a growing trend towards the privatisation of the health service. As I have said, her statement is built on a falsehood. She spoke of Dublin's hospitals as if they are private institutions funded and run independently of the State. The taxpayer pays the hospitals' capital funding, running costs and staff remuneration. It is pure deception to pretend that is not the case.

The Government is trying to have it both ways. It is attempting to claim credit for significant and essential increases in Government spending on the health services over recent years while at the same time absolving itself in a Macbeth-like fashion of any responsibility for the delivery of such services. Those who pay tax are entitled to expect that their basic health care needs will be met by the State, as are those whose incomes are too low to pay tax, including people earning low fixed incomes. People who have been paying tax and social insurance for many years have entered into a social contract. Does the Tánaiste and her colleagues propose to renege on that contract?

I will discuss a specific case with which I am familiar. Accident and emergency services have been axed at Monaghan General Hospital, like other local hospitals. The Minister's predecessors in this portfolio, Deputies Cowen and Martin, claimed repeatedly that they could not intervene to prevent the axing of services. Monaghan General Hospital lost maternity and paediatric services before accident and emergency services were axed. I give credit to the remaining staff of the hospital for the fact that the services we have today can survive.

It appears that the Tánaiste as Minister for Health and Children can intervene directly and swiftly when it suits her to do so. I have asked her a number of questions on this matter and I have written to her about it. I await a response and an explanation. The Tánaiste made an unexplained intervention in the case of two suspended consultant surgeons at Cavan General Hospital. She has yet to explain why she lifted the suspensions. Many people consider that she took such a step to prevent legal action, which she had been advised would go against the State. There are all sorts of possibilities within the wider equation in all of that issue, but I think it represents blatant double standards. Intervention has been ruled out as not being possible, but it seems that an intervention can be made where there is a particular agenda or need. It does not balance out. I demand once again the restoration of the accident and emergency and maternity units at Monaghan General Hospital. I ask the Minister to address the difficult situation that maintains in surgical services at Cavan General Hospital.

The Department of Health and Children released figures last week showing that hospital budgets have been cut by €7.5 million under the punitive system that involves the budgets of so-called "inefficient" hospitals being cut and allocated to other hospitals. The north-east region, in which I live, has suffered more than any other region, proportionately. Hospitals in Monaghan, Cavan, Navan and Drogheda have suffered budget cuts of more than €1 million. When the extra funding for Louth General Hospital in Dundalk was taken into account, the net loss to the hospital services in the north-east region was over €650,000. The Minister is effectively punishing patients for the alleged inefficiency of hospitals and plunging struggling hospitals into further trouble. The north-east region is suffering more than any other region in proportion to its population. Monaghan General Hospital has seen service after service taken away from it and its budget has now been cut by a staggering €368,606 because the Minister has deemed it inefficient, yet she and her colleagues have presided over the removal of all those services, thus creating the crisis in which the staff of that hospital must try to operate and provide the limited services that are on offer today.

The funding of Cavan General Hospital, which has had to cope with the displaced Monaghan patients after the closure of Monaghan maternity, paediatric and accident and emergency units, is also to be cut by a staggering €346,384. Two of the hospital's consultant surgeons were suspended over a period. The Minister has recently lifted that suspension but neither of the surgeons has been allowed to resume his duties. There are so many questions to be asked and so much yet to be exposed.

The staff working in both Monaghan General Hospital and Cavan General Hospital have been heroic in their efforts to cope with the health care needs of the region in the face of Government neglect. This has included cuts in services as well as the State-wide shortage of nurses, the underprovision of acute beds and the ongoing problems associated with the deployment of consultants.

Is it fair and in the interest of patients for the Minister to deem certain hospitals inefficient, cut their budgets and award the funding to other hospitals? If one considers the beneficiaries of this funding, one will note that they are, by and large, larger hospitals throughout the State. Such a system is more akin to that under which bonuses are awarded to and penalties imposed against production managers in factories and other employment locations than to a health system. This is another indication of the much-favoured approach of the Minister and her party colleagues. This approach to health care and hospitals must stop and should be scrapped. Hospitals and patients should not suffer because of the inability and inefficiency of Government and the Department in terms of allowing for the provision of key and critical services. I appeal to the Minister to scrap that particular annoyance.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"commends the Government for the level of additional investment that has now been provided to improve the delivery of accident and emergency services, supports the implementation of the new ten-point plan for accident and emergency services and supports the Tánaiste and Minister for Health and Children in her commitment to improve patients' experience of health care and particularly of the accident and emergency service."

I wish to share time with Deputy Brian Lenihan.

Photo of Rory O'HanlonRory O'Hanlon (Cavan-Monaghan, Ceann Comhairle)
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Is that agreed? Agreed.

Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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The Deputies opposite should note that on 31 December 2005, we will have spent €23 billion from the public purse on the provision of health care in this country of 4 million people since 1 January 2004. Deputies should reflect on that because much of the comment was to the effect that there was no investment or that there were cuts in spending. Some €23 billion is a lot of money and I suspect that if some of the Members opposite were in power they would not be able to raise such a sum for the health services.

I am pleased to have the opportunity to set out for the House the steps the Government is taking to improve people's experience of accident and emergency services. It is a fact that people judge our health services by their experience of accident and emergency units. While it is not a complete measure of health services, it is understandable that people consider accident and emergency services in this way. There are 1.2 million attendances at accident and emergency units annually, amounting to nearly 3,300 per day. People from every background, suffering from nearly all medical conditions, use accident and emergency services. The extent and quality of services at accident and emergency departments are affected by factors and issues right across health services, from long-term care for older people to GP services, diagnostic facilities, clinical and hospital management and investment programmes.

People will judge our health services by accident and emergency services. The Government will also judge our health reform programme by whether it makes measurable improvements in patients' health care experience, including their experience of accident and emergency services. I have stated that long waiting times at accident and emergency departments are not acceptable to me or the Government. I have also stated that there is no magic wand that I or anybody else can wave to provide an instant solution.

Additional beds must be staffed and we have to recruit nurses, doctors and other personnel.

Photo of John GormleyJohn Gormley (Dublin South East, Green Party)
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Photo of Mary HarneyMary Harney (Dublin Mid West, Progressive Democrats)
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This takes time and that is why we have given top priority at the Cabinet committee on health to improving accident and emergency services. This is why I have brought forward a fully-funded ten-point plan for accident and emergency services for this year. There is €70 million in current funding and €10 million in capital funding allocated for it. This plan builds on the wider investment in health that has been made since 1997.

We are bringing the greatest focus possible to improving accident and emergency services. Each factor that has caused delays in accident and emergency units is being addressed and each action is being implemented. With the single Health Service Executive now in place, the lines of reporting and accountability are clear. I have asked for and I am receiving frequent and detailed reports on the implementation of each action. We will continue to focus on accident and emergency services throughout the year. We will monitor actions and results and if further decisions and actions are required, we will take them also.

I am sure Deputies are aware that the effective delivery of emergency services cannot be achieved in isolation from all hospital services. It is necessary to take a whole-system or system-wide approach involving primary care, acute care, and sub-acute care and community care in tackling the problems in accident and emergency departments.

I will outline the range of measures to be taken and give the House an update on progress in the first weeks of the year. In this regard, consider the new minor injury units, chest pain clinics and respiratory clinics. The benefits of locating these within accident and emergency departments is well-established, as has been mentioned by a number of Deputies. Specialist medical and nursing staff provide a rapid assessment and treatment service for patients in these units. These units will be established or developed in hospitals to improve care for patients through the accident and emergency department and this in turn will reduce the waiting time for patients with minor conditions.

On MRI scanning, rapid access to high-quality diagnostic services are key to diagnosing and treating patients. The provision of a second MRI scanner at Beaumont Hospital will greatly improve access for patients to the latest diagnostic technology. The tender process is currently being finalised. I have asked that the hospital examine options for accelerating the delivery of this additional key service.

Comhairle na nOspidéal's report on acute medical units, which I launched last October, examined the role, organisation and staffing of acute medical assessment and admission units. The report concluded that there exist good reason and real scope to manage effectively and streamline the process of assessment and/or admission of patients who are acutely medically ill. One of the key recommendations was that acute medical units should be developed in all acute general hospitals receiving acutely ill medical patients. We intend to act on this. Acute medical units should provide rapid assessment, diagnosis and treatment of patients referred for urgent medical assessment and/or admission. Acute medical units will be put in place at Tallaght, St. Vincent's and Beaumont hospitals as soon as is logistically possible over the next year. The funding will provide for the required staff and equipment.

Other patients will have higher dependency requirements for nursing home care. Tenders will be sought from suitable private nursing home providers to accommodate up to 100 high-dependency patients. I expect that the notification to tender for these high-dependency beds will be published in the coming days. The scope for using greater numbers of private nursing home beds to alleviate pressure on acute hospitals will also be actively pursued by the Health Service Executive.

We will offer intermediate care for patients with lower dependancy needs who have completed their acute phase of treatment. These are older people who are awaiting discharge to nursing home care or who are going back to their own home with appropriate supports. This arrangement will provide intermediate care for up to six weeks to patients as they prepare to go home. It is expected that about 500 people will benefit from this initiative annually. Invitations to tender to private nursing home providers have been published in the EU Official Journal and the national media in the past few days. I have asked for an accelerated process to be put in place to ensure that these beds are available as soon as possible.

Most older people who need care prefer to live in their homes and communities, if at all possible. Care in the community is preferable from many points of view. The success of initiatives in the Dublin area such as Slán Abhaile has allowed older people to live independently at home in dignity and comfort. Expanded home care packages will be put in place to support 500 additional older people at home. I have asked the Health Service Executive to accelerate the provision of these packages in line with the assessed needs of individual patients.

Very successful out-of-hours general practitioner services are in place in many areas throughout the country. This service can reduce the number of inappropriate attendances at accident and emergency departments. It has long been recognised that the absence of an out-of-hours service on the north side of Dublin has placed additional pressure on the accident and emergency departments of Beaumont and the Mater hospitals. I have asked the Health Service Executive to bring forward plans to develop a general practitioner out-of-hours service to meet the needs of specific areas. Already general practitioners in north Dublin have responded positively for this renewed focus on achieving reliable out-of-hours services. The model that works will be implemented.

We are all aware, particularly patients and their families, that accident and emergency departments do not always meet the standards of cleanliness that we rightly expect. There can be no excuse for dirt. The Health Service Executive will work with hospitals to ensure effective management and monitoring of standards of cleanliness. The key issue here is not funding, it is pride, standards and management. There will, however, be some funding to cover necessary refurbishment or redecoration of existing facilities.

It is also totally unacceptable that patients and staff do not, at times, feel safe in the caring environment of an accident and emergency department. Therefore, funding is being made available to hospitals to improve security measures and to take whatever other measures are necessary to ensure patient and staff safety.

The further expansion of palliative care facilities, particularly in the Dublin region, will ensure that terminally ill patients can spend their remaining time in the most appropriate environment thereby freeing acute hospital beds for incoming patients from accident and emergency or other planned admissions.

General practitioners have highlighted the need for access to diagnostic services. While the establishment of acute medical units will improve access for general practitioners to these services, additional arrangements will be put in place to enhance direct access for them to diagnostic services. The Health Service Executive and my Department will progress these arrangements. These are the ten actions that I set out at the publication of the Estimates for 2005. I expect real and measurable improvements to take place in the coming months in the delivery of accident and emergency services. To ensure that the measures I have outlined are implemented, a high level accident and emergency steering group is being established to include senior representatives from the Health Service Executive and the Department of Health and Children.

As an aid to progress, I welcome the recent intervention of the Health and Safety Authority which has a clear statutory role in regard to health and safety in the workplace. This is not the first occasion on which it has intervened. We all want to ensure that patients and staff working in hospitals have a safe and healthy environment.

The Health and Safety Authority has investigated specific incidents in hospitals in the past and has worked with the hospital authorities to ensure that satisfactory mechanisms are put in place to safeguard health and safety. The authority has asked hospitals to carry out a comprehensive risk assessment of their accident and emergency departments. This will be done with the co-operation of management and staff in each hospital.

In addition to the ten-point plan, at the end of 2004, my Department requested that the then Eastern Regional Health Authority and the health boards take action on several key areas in the management of accident and emergency departments and processes. Health agencies were requested to undertake a detailed analysis of patient flows in order to identify patient profiles, bottlenecks and improved ways of treating patients; to review work practices, particularly in the nursing, radiology and laboratory areas, in a partnership context; to roster medical and nursing staff in accident and emergency departments to match peak patient attendance times; to ensure that ward rounds by consultants or registrars are undertaken regularly to facilitate prompt discharge of patients and or transfer to other services; and to enhance information collection to measure performance regarding the provision of service to accident and emergency patients. This should include measurement of the length of time from triage to see a doctor, the length of time from the decision to admit to being placed in a bed and the overall waiting time in the accident and emergency department.

The agencies were also asked to give renewed attention to streamlining discharge arrangements for all patients, including the young chronic sick and high dependency patients, to reduce or suspend the admission of elective patients where there is a high level of pressure in the accident and emergency department and to implement escalation policies if there is a surge in accident and emergency demand. The Health Service Executive which was established on 1 January 2005 will pursue these actions.

Accident and emergency departments form a litmus test for me, the Government and the people of whether the health reform is working. By focusing our analysis, funding and energy on this area, we will achieve tangible improvements. I look forward to keeping the House and the Oireachtas Joint Committee on Health and Children well informed of our progress.

8:00 pm

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Dublin West, Fianna Fail)
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The Tánaiste and Minister for Health and Children has outlined her action plan to improve the delivery of accident and emergency services which will significantly improve patients' experiences of accident and emergency services. The Government has devoted significant attention to, and investment in, accident and emergency and related services. Last October, Comhairle na nOspidéal published a report on accident and emergency services. A key finding was that a hospital-wide response was needed to meet the requirements of accident and emergency services and this recommendation has informed and underpinned our approach. Improving the care of patients through emergency departments via minor injuries units or medical assessment units is an important aspect of the hospital-wide response needed, but not the only one.

Delivery of the emergency service at hospital level is interdependent with the inpatient elective service, day and outpatient care, and community services. The effective delivery of emergency services, therefore, cannot be dealt with in isolation from the delivery of all hospital-based services. The key point in addressing the problems is a whole system approach which addresses the needs of people on a timely basis in the most appropriate setting.

This approach is also consistent with the report of Capita Consulting which was commissioned to carry out a national review of the bed management function by the Health Service Employers Agency. Capita reviewed 23 selected pilot sites where 24-hour, seven day a week, accident and emergency services existed. The report identified system-wide problems as affecting bed and patient management in acute facilities, including shortage of acute beds; a high rate of bed occupancy; acute beds blocked by patients who are ready for discharge and capacity problems for long-term care.

Capita also identified a wide range of issues at hospital level that had a serious impact on bed utilisation. One clear message that comes through from the various analyses of hospital services is the need to address the problem of acute bed capacity. The Government is well on the way to building up the acute bed capacity in the hospital system. We are committed to increasing acute hospital bed capacity as set out in the health strategy which identified the need for an additional 3,000 acute beds in the period to 2011. Following publication of the strategy in December 2001, funding was provided to open an additional 700 beds.

Last September, the previous Minister for Health and Children, Deputy Martin, approved the commissioning of 200 beds in several new units in acute hospitals throughout the country, funded under the national development plan. These developments will provide modern health facilities particularly for cancer care, medical assessment units and accident and emergency departments. New day facilities, theatre and diagnostic capacity will result in improved patient flows through the hospital system and ensure better use of existing inpatient beds. These new units will open during 2005. Health agencies are recruiting the additional staff required to operate these new units.

Last week I had the honour of officially opening the new hospital development at the James Connolly Memorial Hospital, Blanchardstown, which was one of the new units announced in September 2004. This new development is a good example of the Government delivering on its promises to improve health infrastructure and expand hospital capacity.

Building at Blanchardstown began in October 2000 and a phased opening of the new facility began when the coronary care and cardiac unit, the therapeutic psychiatry of old age unit, the day hospital and the rheumatology service transferred into the new building in September 2003. In September last year, the Minister approved funding of €10.7 million for the commissioning of further services to the new wing of the hospital, including the new surgical block, the accident and emergency department and the critical care unit and operating theatres, all of which transferred to the new building in the latter months of 2004.

I would like to focus on the new accident and emergency department at the hospital. It is a state of the art facility, incorporating a chest pain assessment unit and observation area, a resuscitation unit and a minor injuries area in line with recent trends in emergency medicine. Other facilities include a plastering bay for orthopaedic injuries, an eye injury room with specialist eye equipment, an ENT room, ultra sound facilities and a procedures room for suturing. Since the new department opened there has already been an increase in activity of 8%. It is projected that this could grow as much as 20% this year, resulting in an increase in the number of new attendances at the department from 30,000 to 36,000. This emergency department in Blanchardstown now has the lowest waiting time in the eastern region. Its core team of dedicated doctors and nurses is supported by the work of advanced nurse practitioners, patient liaison officers and local general practitioners who attend on a regular basis.

As a Deputy representing the area and as a Minister of State at the Department of Health and Children, I keep a close eye on developments at the accident and emergency unit. It is important we work on ensuring that accident and emergency units develop the procedures, protocols and staffing arrangements that ensure overloading does not take place. It requires a major intellectual, social, management and, above all, staff effort to guarantee that overloading does not take place.

The hospital will now also have a new theatre suite with two additional theatres bringing the total number to five. These include a specialist clean air orthopaedic theatre with state of the art facilities. The provision of additional beds in the intensive care unit and in the coronary care as well as the provision of additional day beds is good news for patients and will result in greater numbers receiving treatment and care. This hospital is also well known for its care of the elderly services and the progressive day hospital operates a rapid access service helping to reduce admissions to the emergency department.

One of the most important projects being implemented in that hospital is the respiratory pilot project. This is an associated development intended to also have an impact on accident and emergency services. The project was approved in July 2004. It is a major development for the hospital and will see it become a centre of excellence for the provision of respiratory care. The project will ensure that respiratory patients are seen quicker, that there will be a reduction in the average length of stay, that there will be improved liaison with general practitioners and that all respiratory patients will be under the care of respiratory consultants.

There are also other developments in the system. The Tánaiste and Minister for Health and Children will open the new medical assessment unit at the Midland Regional Hospital in Mullingar tomorrow. The new accident and emergency department at Cork University Hospital is expected to open in March of this year. A new accident and emergency department is under construction at St. James's Hospital. New hospital buildings will also be provided at St. Vincent's Hospital in Dublin and at Tullamore General Hospital.

I trust that I have shown in my contribution that improving the delivery of accident and emergency services is a top priority for the Government. In the Department of Health and Children we will continue to work in the best interests of patients and staff. I am confident that we can and will improve the delivery of accident and emergency services so that patients receive the appropriate treatment as quickly as possible.

Since the appointment of the Tánaiste as Minister for Health and Children, she has clearly signalled her determination to tackle these issues. She has set herself clear deadlines in that respect. From the basis of her political record, I know that she is determined to produce results in this area. It is not something that can be done overnight. We all know the difficulties that exist. In the Tánaiste's tenure in the Department to date she has shown a determination to tackle these issues. I have no doubt her efforts will result in success.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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I wish to share time with Deputies Neville and Ring.

Séamus Pattison (Carlow-Kilkenny, Labour)
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That is agreed.

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)
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I am delighted the Tánaiste and the Minister of State, Deputy Brian Lenihan, are present. Deputy Gormley of the Green Party said earlier that the Tánaiste seems to have a charmed relationship with the media in terms of the coverage she gets on what is happening in the Department of Health and Children. All Ministers seem to have a charmed relationship with the media. Perhaps it is something to do with the amount of money being spent by the Government on public relations and spin doctors. It is increasingly my belief that many Members of this House are expected to get information from the media after it has been properly sanitised by the public relations people.

Regardless of what the Tánaiste said in regard to her budget estimates, up to this point we have had no great idea about what she was planning to do to address the accident and emergency crisis. I went to the trouble of reading an extensive one page article on the Tánaiste in the Irish Examiner on Monday to glean more insight into what she was thinking of doing to address the crisis in health care, but I did not get any more knowledge on that. This shows that the spin is much better than the substance of what the Government often says inside and outside this House which does not stand up to critical scrutiny.

In the article to which I referred, the Tánaiste pointed out that the Hanly report has more or less been permanently put to bed. In explaining why this was the case, she said that the problem with Hanly was that it was presented to the public or maybe pursued by certain vested interests which led to a lot of unnecessary fear. I do not know what she meant by "a lot of unnecessary fear" when the essence of her speech and that of the Minister of State, Deputy Brian Lenihan, focused completely on the accident and emergency services in Dublin and across the country. The essence of what Hanly stood for was the closing of accident and emergency departments and providing such facilities in regional centres. The Tánaiste is conceding that she does not agree with over-centralising the health services. She is now talking about regionalising services. Does that mean that the radiotherapy report, which was published, is also more or less finding its way to the bin and that radiotherapy units will be provided, as we would have expected given that such units constitute appropriate medical care, in Cork, Dublin, Galway, Limerick and Waterford, or is that something that will be announced next year?

I was disappointed when I heard the Tánaiste say that for her the standard of accident and emergency departments form a litmus test in respect of the health services generally. The crisis in accident and emergency departments is a sign of the botched job that has been done to the health service for the past seven years and of a crisis that has got progressively worse during that time. For the Ministers to merely point out all the measures they will take and which we are expected to believe will make the delivery of the service excellent, is rubbish. The accident and emergency crisis should have been sorted out five years ago. The Government has shown no great dedication to addressing problems in the health services. The health strategy in 2002 was deceitfully published, given that the people expected that additional investment would be made in the health services from 2002 onwards. The Minister of State might say that extra money has been invested in the health services but that is not the same as extra investment. Most of the money that has been put into the health services is to cover the cost of benchmarking pay awards. Little has been put into the system, certainly in the past two, if not four, years, to improve the level of services.

The Minister of State said a significant report was published in October 2002 by Comhairle na nOspidéal on accident and emergency services. It is more than two years since that significant report was published. It has now cropped up in the Chamber as if it was something new and unique when it is not.

The Capita report identified system-wide problems as affecting bed and patient management in acute facilities. A group of experts got together and wrote that report in which they identified a shortage of acute beds, a high rate of bed occupancy, acute beds being blocked by patients who were ready for discharge and capacity problems in relation to long-term care. We have known that since 1997 when the Government parties came into office. Presenting that information as if the Government only found this out last week and will now do something about it shows that in some respects the Government had no interest in what was happening in the health services.

I noticed an interesting point which I probably should not raise here. The Tánaiste said she has appointed Prospectus to examine a way of mixing public and private investment in the health services. I received a request recently from a student for Fine Gael's views on its health policy and what it considered was the way forward in regard to health services. I am always willing to help any student to become more educated on the health services and I would even help the Minister if she needed help, which seems to be the case. The only reason I did not reply to that student was that the email address I was given was @prospectus.ie. Perhaps we should cut out the middlemen and work together on this one.

It seems the Government has no idea what it wants to do with the health service as highlighted by developments in the past 12 months. What about the treatment of pensioners? The Minister should read the scripts from the High Court and Supreme Court in regard to the Government's treatment of them. It has been stated in this House that those who are sick in hospital beds will be the ones to pay if the Government has to pay back this money.

Mr. Justice McCarthy asked a senior counsel whether it was appropriate to raise the appalling vista scenario regarding the cost of meeting potential claims. The senior counsel stated those alive should get their money back. No facts regarding those alive, dead or over 70 years of age were presented to the Supreme Court. The Minister knows the legislation to which I refer, that dealing with nursing home charges. Counsel even pointed out that they were not impressed with the speed of the passage of the legislation through the House.

As the Minister is aware, when the legislation was being debated in the House, many problems in the Department of Health and Children, including the waste of time and money, were highlighted. For example, a meeting was held in the Gresham Hotel in December 2003 but the minutes of that meeting seem to have been totally ignored. This led to the crisis in which legislation had to be rushed through the House in the last sitting days before last Christmas. Now we are expected to believe the ten point plan the Minister has presented will cure all ills in accident and emergency departments and other health services.

The Government will achieve little because it does not recognise the problems. The Minister should state why an MRI scanner in Beaumont Hospital is so important to solving the accident and emergency crisis. Why does it get precedence over the operation of 24 hour CAT scanning machines in all other hospitals? Beaumont Hospital needs an MRI scanner because patients with significant head injuries in many hospitals outside Dublin must be transferred to be scanned. Many of the patients who travel there for a scan are then sent back in an ambulance to the hospital from which they originally came. In some respects, much of this debate points up that the Government responds more to the media than to a medical crisis. The Minister should seek to make CAT scanners available on a 24 hour basis in regional hospitals in order that patients can be treated there. She should not focus on delivering an MRI scanner to Beaumont Hospital and think this will make everything wonderful.

The medical admissions units are another interesting issue. A report was drawn up by Comhairle na nOspidéal well over a year ago. However, it was not until the Tánaiste was appointed to the Department of Health and Children and some regard was paid to the crisis in accident and emergency units that the report was even published. Now the Minister is diving headlong into the setting up of such units. Does she agree with me that there should be a consultant in charge of them? If so, are we just making them into a medical form of an accident and emergency unit? Does the Minister believe consultants should not be in charge? Does she believe the units should be the responsibility of all consultant physicians in order that they have ownership of them and that, therefore, it would be in their own interests to ensure they empty at 7 p.m. or 8 p.m.? Does she believe it is in the interests of consultants to free up acute beds within hospitals and, therefore, have the progression we expect such units to deliver?

Medical admissions units on their own will not solve the crisis. A ten bed medical admissions unit may be opened in the coming days but such units which operate efficiently and effectively in Kilkenny and Wexford have stopped working at the same success rate as they are full of patients who cannot get a bed in a ward because trolleys are backed up in accident and emergency units and are now backing up in the medical admissions units.

The problem is that the focus is on quickly putting beds into hospitals. The people have been told that some 500 beds are being provided in private nursing homes. Why did the Government wait so long for this? Why was this not done three years ago when the problems were as acute as they are now? Why did the Government not bother in the past three years to investigate the issue of patients waiting on trolleys? Why did it wait until the crisis is such that patients are more or less dying on trolleys in hospitals?

No matter what is said in the House, much of it is too little too late. It is based on the attempt by the Government to bail itself out of the mess it has made of the health service in the past seven years. It has done a botched job and caused this crisis. It would be better off facing up to its responsibilities and admitting it was wrong. It should invest properly in the health service. It has no intention of delivering on its commitments on primary care because it has already stated it will not make a significant investment until 2007.

All the Government is trying to achieve is to tidy up matters for the next general election in order that it can walk back in on the premise that it somehow improved the health service. However, the people are copping on to this and to the fact that pouring money into the service does not equate with better health services. This is where the Government has failed.

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
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At the time of the recent Cabinet reshuffle we were led to believe health was to be a priority of the Government. I listened to the Government and spin doctors stating what they were going to do. I thought the Government had learned its lesson at the local elections but it did not. I was prepared to give the new Minister for Health and Children, Deputy Harney, an opportunity to deal once and for all with the health service but she has failed. She has allowed a situation to develop in which the unions and vested interests — doctors, general practitioners, consultants and others — control the health service while the Government has lost control.

This is highlighted by the Government's decision to guarantee 15,000 health workers that they will not be transferred and can remain in their current jobs, even if there are no jobs for them to do, despite the fact that the health service is in disarray. It is similar to the cases of Bord na Mona and the ESB in that we will be paying workers in the health service until they retire because the Government has done a deal with them. If it was serious about the health service, it would have had its business in order, would not have had a row with the unions and would have been able to make changes. It has ensured 15,000 workers will not have to reorganise or change, which is a disgrace. It has sold out the people.

Ireland is supposed to be medically advanced and have the best treatment available, yet I regularly meet people who have contracted MRSA or the hospital bug. One man told me he had gone into hospital with a serious illness, had contracted the hospital bug and had not been well for the past two or three years. What is going on in the health service? I was sick over Christmas and my doctor advised me to go to hospital. I said I would not go into hospital, that I would prefer to stay at home because I was afraid of contracting the hospital bug. Why can we not control this, given all the medication, personnel, doctors and funding available?

BreastCheck was made available in the east of the country and women in the west and surrounding areas were told it would be in place in their areas from 2005. We are now told it might not be in place until 2007 or 2008. This is discrimination against women. Why should women in the west and other areas have to wait that long? It would have been rolled out by now if the Government was serious about women's health. We have let women down and forgotten about them. This is wrong and should be dealt with.

I wish to deal with the Government's attack on the elderly, a matter on which I expect the Minister to respond later in the debate. I heard Deputy Twomey referring to the High Court and Supreme Court. I am going to bring a case shortly if the Minister of State does not do something about this matter. Let me cite an example of what is happening in the health service. I know of a woman in Ballycroy in north Mayo who is over 80 years of age. She had a hospital appointment 75 miles away. She is in receipt of a widow's pension and was always brought by the health board to the hospital for appointments. She has now received a letter from the health board, as have thousands more like her, telling her that it will no longer bring her to hospital for her appointments. How can this woman, on a pension of €150 a week, afford a taxi to bring her to Galway and back home again? She might have to make this journey two or three times a month. That is abuse of the elderly by the State. We preach about sick, weak and old people but this is the best we can do for them. When they retire and need transport to hospital services, the best we can do is send them a letter stating hospital transport will not be provided.

I want someone from the Minister of State's Department to deal with this matter immediately in order that he can respond tomorrow. There are no officials present. Why would there be? They can do what they like. They are guaranteed jobs for the rest of their lives in the package arranged by the Government. I want the Minister of State to note what I have said and respond; otherwise I will bring an elderly person into the High Court where I will say the woman mentioned was not treated properly, was not looked after and had been let down by the State. I want this matter dealt with quickly.

We have talked about the health service since the foundation of the State. We have talked about hospitals, doctors and improved services but all I see happening is that those involved in the service are getting richer, while patients are getting sicker. People are not getting the service they deserve.

Over Christmas people from Castlebar had to travel to Westport where there are a number of general practitioners. However, in spite of all the money they are getting under the GMS scheme, they could not even organise a rota system for Christmas. As they are receiving big money from the State, they should provide a service. If they are not going to do so, they should be removed from the scheme altogether. We should not have a situation where people in the county town of Mayo are expected to do without the services of a doctor for two weeks from Christmas Eve. This matter should be investigated and somebody should have to pay a price. If we are paying that kind of money, we should have a medical service, including GP cover during the holiday period.

We would not have had half as many in hospital if a GP had been on duty at that time. It was a sad situation for the people affected, some of whom had to travel 11 miles to another town to consult a doctor. The Government has had its chance and the people will speak in two years' time. What is happening is wrong. When somebody gets sick, he or she expects the best service and expects the State to be there for him or her. People pay their taxes and do not expect to be left on a hospital trolley. They expect to have access to doctors and nurses. They expect the best treatment possible but the Government has failed them and let them down. There is a shortage of doctors and consultants but no shortage of Government spin-doctors.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I wish to share time with Deputy Crawford.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Is that agreed? Agreed.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I am glad to have an opportunity to speak to the motion. I wish to deal with the continuing neglect of mental health services. This year the Minister announced an increase of €15 million towards improving mental health services. This figure is derisory, given the requirements to be met. Compared to spending in other areas, the Minister of State will agree it is totally unacceptable.

In Limerick alone €7 million needs to be invested in a special secure unit. Two patients committed suicide in the city's hospital in the past two years. A further €7 million will go towards meeting the Government's commitment to improve the Central Mental Hospital. That would account for the €15 million allocated to mental health services if the Minister decided to spend it on what was required in just two areas.

I also wish to mention the black spots in terms of psychiatric inpatient treatment which have been drawn to our attention by the inspector of mental hospitals whose annual report stated some locations "were unacceptable for the care and treatment of patients because of seriously unsatisfactory conditions". To have such conditions in 2005 in any part of the health service is totally unacceptable.

The areas highlighted by the inspector as having these "seriously unsatisfactory conditions" include most of the Central Mental Hospital; the entirety of St. Brendan's Hospital; almost all of the old building at St. Brigid's Hospital, Ballinasloe; some long-stay wards in St. Finan's Hospital, Killarney; St. Edna's and the current female admission wards in St. Loman's Hospital, Mullingar; the admission wards at St. Ita's Hospital, Portrane; the female admission ward at St. Senan's Hospital, Enniscorthy; Vergemount Clinic, Dublin; some continuing care wards at St. Luke's Hospital, Clonmel; and some wards at St. Joseph's Hospital, Limerick.

That is an unbelievable list of places where there are totally unsatisfactory conditions for the treatment of patients. The list has been supplied to us in the inspector's report which also states: "In addition, some relatively acute units did not provide safe observation facilities, such as St. James's Hospital, Dublin". I have referred to Limerick Regional Hospital in this regard but St. James's Hospital does not have a special, safe observation facility for psychiatric patients who are suicidal. The report continues: "Some of the smaller private hospitals catering for elderly patients were unsuited for this purpose because of the structure and layout of the premises, with many small rooms spread out over several floors".

Groups of people who are neglected by the psychiatric services include the homeless, prisoners and others who come under the ambit of the criminal law. Immigrants and asylum seekers are also affected by the co-morbidity of intellectual disability and psychiatric care and the co-morbidity of substance abuse and psychiatric illness.

Just before Christmas I tabled a parliamentary question regarding a person who had committed an offence, had been determined by two doctors to be psychiatrically ill and committed to the Central Mental Hospital. To appear in court an insane person must be certified as sane. The same person must be certified as insane again when returned to the Central Mental Hospital. Surely this procedure would not be accepted in any other area of general medicine. Such a practice in this day and age is ethically questionable.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank my colleagues for affording me the opportunity of saying a few words on the health issue. I thank those involved in getting Monaghan General Hospital back on-call but the aftershock was the fact that its budget was cut by €380,000 because it had not met certain criteria. That is absolutely unacceptable. I ask the Minister of State to rectify this. If a hospital was held off-call for two and a half years, how could it meet the criteria laid down for a normal hospital? It is totally wrong to reduce the allocation to Monaghan General Hospital. If the Minister and her Department are serious about trying to improve services and relieve the chronic situation in Cavan and elsewhere, this matter must be rectified as a matter of urgency.

It also happened to a lesser degree in Cavan where there is an ongoing problem. The Minister must treat this issue extremely seriously. It must be remembered that the North Eastern Health Board had to cater for the single biggest population increase in the country in the past 30 years, yet there was no corresponding increase in its budget.

It is unacceptable to see Monaghan General Hospital back on-call to a limited degree while having its budget cut. I beg the Minister of State to ensure the Tánaiste and Minister for Health and Children is made fully aware of this. It may be a blip in the computer system but surely we do not deserve this after two and a half years.