Liz McManus (Wicklow, Labour)
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I move:

That Dáil Éireann:

—notes that over a year has passed since the Tánaiste became Minister for Health and Children and that since her appointment the problems in the health service, in particular for emergency patients, has actually deteriorated;

—records with regret the unnecessary death of Mr. Pat Joe Walsh at Monaghan General Hospital;

—deplores the abject failure of the Tánaiste and Minister for Health and Children to ensure delivery of her ten point plan to resolve the accident and emergency crisis;

—recalls that the Tánaiste and Minister for Health and Children said on 25 January 2005 that the accident and emergency crisis was a litmus test for her and for the Government;

—expresses its concern at the continuing serious overcrowding in accident and emergency units, which reached unprecedented levels during the summer months and notes that according to the Irish Nurses Organisation (INO) as recently as 11 October there were more than 300 patients on trolleys;

—recognises that, despite the Tánaiste and Minister for Health and Children's promise that there would be significant improvement by this autumn, 378 patients in the main Dublin hospitals are still inappropriately occupying acute beds and waiting times for accident and emergency patients have increased; and

—acknowledges the deep public anger at the massive waste by this Government in the health service amounting to hundreds of millions of euro on botched projects like PPARs and FISP;

calls on the Taoiseach and the Tánaiste and Minister for Health and Children to:

—accept political responsibility for the delivery of health services;

—deliver on their promises in regard to the accident and emergency crisis;

—open immediately all outstanding hospital wards and facilities;

—develop as an urgent priority, community nursing units to relieve pressure on the acute hospital sector;

—re-balance the incentive system that is creating a dearth of GPs in areas of disadvantage and adding pressure to accident and emergency departments;

—ensure supports are put in at community level so that patients can be cared for in, or close to, their homes; and

—tackle the worrying rise in MRSA infections effectively.

I propose this motion on behalf of the Labour Party. It is a record of the failure of the Minister for Health and Children who has been in office for over a year. It is also a template for action which the Government should adopt but which it will, as so often before, choose to ignore. The Tánaiste's appointment as Minister for Health and Children was warmly welcomed. She was seen as a straight talker, one who would get the job done after the lamentable record of her predecessor whose main achievement was to commission 143 reports and working groups. When action was needed the previous Minister, Deputy Martin, gave us promises. Later we learned he did not even meet the basic duty of a Minister which is to keep himself or herself informed and to read a brief. His failure cost the taxpayer millions of euro and yet with the support of the Taoiseach and the Tánaiste he has successfully evaded any responsibility for that debacle. A year on the public is coming to understand that far from making the position better the Minister for Health and Children, Deputy Harney, has presided over a deterioration in the health service. Her promises have acquired the same hollow ring as those of the previous Minister, Deputy Martin.

It is worth reminding ourselves that the Minister, Deputy Harney, said at the beginning of the year:

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.

These were brave words but they have turned out to be absolutely worthless. Despite the promises by the Minister, Deputy Harney, the accident and emergency crisis has got worse. We know from figures released by the Health Service Executive that the average number of people waiting for admission to the Mater Hospital in Dublin for more than six hours has risen by an extraordinary 70% between September 2004 and June 2005. The long waiting times in accident and emergency units have, in reality, got significantly worse since the Minister, Deputy Harney, took over.

The waiting times are longer and the number of people waiting is greater. On 18 November 2004 on the day when the Minister, Deputy Harney, announced her ten point plan to address the crisis in accident and emergency units there were 163 patients waiting in trolleys in accident and emergency units. Almost a year later, on 11 October 2005, the numbers reached a staggering 321. The CEOs of the main Dublin teaching hospitals recently described the position in their accident and emergency departments as chaotic. Dr. Aidan Gleeson, accident and emergency consultant at Beaumont hospital, has said that having 40 patients on trolleys is not unusual and that the position is worse now than last year.

Last year the Minister, Deputy Harney, said she expected real and measurable improvements to take place in the coming months in the delivery of accident and emergency services. The months have come and gone and the only change in accident and emergency services is a worsening of a situation that was already almost unbearable for too many patients.

In the case of one emergency patient his wait ended horrifically. At Monaghan General Hospital while staff looked on helplessly, Mr. Pat Joe Walsh bled to death because our health service was unable to provide him with the straightforward emergency surgery that he needed. People are deeply shocked by what has happened to this man. One letter printed in the Irish Independent encapsulates the feelings of revulsion and dismay that his death has engendered in all of us. It reads:

What use is all our money, all our technology, all our positive economic and government spending statistics and this nebulous and indefinable 'feel-good factor' when Patrick Walsh, may the Lord be good to him, is now nearly a week dead from a thoroughly preventable and treatable problem?

What good is it that a family has lost a loved brother, uncle and friend and these people can get no answer to this needless death, no explanation as to what went wrong, no explanation as to why our health care system in the North East failed so spectacularly, and for them so tragically?. . .

Why do the Walsh family, the people of Monaghan, and indeed the taxpayers and citizens of Ireland see only blank faces when they ask the pertinent questions as to the overall political thrust driving the management of the health system in this country?

Why do they hear only hollow expressions of sympathy . . . and calls for the issue not to become a political football? Surely the governance, performance, financing and management of one of our biggest areas of public spending — health — is a very political matter that deserves vigorous and probing debate.

In response to this tragedy the Taoiseach said in the House, "It is sad when anyone dies but it is wrong to intervene politically." In reply to Deputy Connolly's questions, the Tánaiste reverted to her timeworn and threadbare defence that it was a matter for the Health Service Executive.

Such abdication of responsibility is the hallmark of a degenerate Government that has only one goal and that is to cling to power at any cost. Health care, as the letter writer has said, is an intensely political issue and the needs of the health service demand good political leadership. Instead we have a Taoiseach who does not have the vaguest understanding of those needs and a Tánaiste who is now setting about to use the health service as a testing ground for her ideological views. Her solution is to hand over large chunks of the health service to the private sector for-profit companies who cannot believe their luck at the money to be made at the taxpayers' expense.

When she took office the Minister for Health and Children set the measure by which she would be judged. She said, "Accident and emergency services is a litmus test for me, for the Government and for the people of our country". Those were her words, not mine. She invited us to judge her by accident and emergency services so she cannot complain now when the public judge that she has failed abysmally. Her ten point plan promised minor injury units, chest pain clinics, respiratory clinics, acute medical units and direct access for general practitioners to diagnostic services, none of which has materialised. By this September three of the Dublin hospitals worst hit by overcrowding at accident and emergency units were still waiting for the go-ahead for these new units, nine months after their announcement. In another example, general practitioners are waiting seven months to have a mammography and ultrasounds done at Sligo General Hospital. A consultant radiologist at the hospital expressed herself as embarrassed about the situation. In marked contrast the Minister for Health and Children appears incapable of being embarrassed by anything that fails, and so spectacularly fails, within her remit.

Foolishly, the Minister rammed through the start-up date of 1 January 2005 for the establishment of the Health Service Executive. Her lack of preparation for change has led to an unholy mess of administration across the country which was epitomised by one assistant chief executive officer who complained wistfully that since this change of regime he has had six different job titles. As serious and more corrosive to good government is the fact the Minister, Deputy Harney, has stripped out every bit of accountability from the health service. With the demise of the health boards there is no local accountability or public scrutiny. Answers to parliamentary questions are delayed and go unrecorded. Such a climate is bad not just for democracy but for a health service struggling to meet the challenges set it.

This incoherence within health care management extends to the top of the new structures. The Minister and the Department of Health and Children were to be responsible for policy while the CEO and the Health Service Executive were to be responsible for management only. Yet following the revelations of gross wastage of public money in failed computer systems the Minister, Deputy Harney, has announced her intention to be involved in micro-management to the point where she will approve every outside consultant contract, while the CEO of the Health Service Executive, Professor Drumm, is regularly making major policy announcements which often run directly counter to Government policy. The Minister, Deputy Harney, promised her accident and emergency plan would deliver significant results this autumn.

Professor Drumm has said it will take at least two years to resolve the crisis. Government policy is to provide 3,000 new acute hospital beds. Professor Drumm is on record as opposing this. The Government imposed an embargo on recruitment while Professor Drumm has rubbished the embargo. The Minister announced her plan to hand over 1,000 acute beds to the private sector and Professor Drumm cast doubt on its real cost. Despite all the Government's claims to the contrary the number of acute hospital beds per head of population, far from increasing during the lifetime of the Government, has decreased over the past five years.

The Tánaiste and Minister for Health and Children promised to move hundreds of patients to rehabilitation beds to free up beds for patients stuck on trolleys in accident and emergency departments. Despite millions being spent and repeated claims by the Tánaiste of action, the results are disappointing. Most information about the health service reaching us is coming from Martin Wall and other journalists and not from the Tánaiste or the HSE. According to a leaked memo, in the Dublin area alone 378 patients still inappropriately occupy acute hospital beds. That figure more than any other is an indictment of the failure of the Tánaiste's plan to release beds where they are most needed. This comes from a report from the National Hospitals Office which claims a 22% reduction in the number of people on trolleys between April and September. However, these are meaningless statistics because a reduction always takes place during the summer months.

Some facilities that have been built are still idle because the Government could not find the money to staff and equip them. A figure of €4 million worth of facilities has been cited in the media as still unused. The public wonder why the Government could not find money to open these facilities and then discover that hundreds of millions of euro have been flushed away in a series of failed computer projects. The most grotesque example of delays in delivery of facilities is the extension to Longford-Westmeath General Hospital which includes an operating theatre, general medical ward, rehabilitation unit, child and adolescent psychiatric unit, OT department, education facilities, general surgical wards and an acute psychiatric unit. For more than eight years this facility has been left on hold and the health service in this instance alone is losing 100 new beds. Even within the existing system questions have been raised about the availability of beds. Consistently the Irish Nurses Organisation which represents nurses working at the coalface of the acute services has demanded the opening of up to 480 beds that they maintain remain closed within the system.

It is worth underlining the allocation of €70 million to the Tánaiste's failed ten-point plan. This is only a fraction of the money lost in the PPARS and FISP scandal. I am still receiving calls from people working within the health service itemising other abandoned computer systems. One was attempted in the HIV/AIDS treatment area and was abandoned because it was inoperable. Apparently it only cost approximately €4 million, which the Government seems to regard as acceptable.

On Sunday night the Taoiseach was interviewed on RTE's "Week in Politics" programme and spoke about the PPARS fiasco. He said, "In most Departments, officials were trying to improve the service. Okay, maybe there should have been a check every year, but nobody went out to waste money." The Taoiseach did not tell the true story. A formal body was established, the health service performance verification group, which commissioned progress reports from CEOs of 20 health agencies. These were essentially applications for pay rises under the benchmarking scheme. The CEOs of eight of the nine agencies where PPARS was deployed highlighted the system as a driver of value for money and a justification for pay increases. These reports were verified by the PVG and the increases were paid. Not only were systems in place, presumably designed carefully to verify value for money, they also became part of the problem rather than part of the solution. This is the system, PPARS, which has been abandoned by the HSE as a gross waste of public money.

In the same interview the Taoiseach explained his perspective on his Government's record in the following way:

We've put so much resources into health, so much staff into health, so much capital into health and we still seemingly don't get to where we get now.

It is unlikely that members of the public disturbed by what is happening to their elderly, vulnerable, sick relatives in overcrowded accident and emergency departments will find solace in any opinion expressed by the Taoiseach on the issue of health care. His comments show how out of touch the Government is and how it is floundering rather than tackling the serious problems that face us as we enter the winter period which is a time of pressure on our emergency services. It is important that we do not allow such flimflam to detract from the task that a new Government will face. Political leadership can alter the most intractable difficulties. We know that from our recent experience as a society.

When any Government is focused for example, as Governments have been, on resolving the deeply challenging conflict in Northern Ireland we have seen the strength and power of good political leadership. If the same effort, intelligence, resources and determination that have gone into providing a democratic resolution to a terrible conflict could be diverted now into tackling the deep-seated, endemic problems in our health service we would have the world-class health service that we can well afford. Instead the Taoiseach offers us gobbledegook and the Tánaiste hides behind the Health Service Executive.

The CEOs in the main Dublin teaching hospitals have presented a carefully prepared document for the Tánaiste and Minister for Health and Children in the last few weeks. In it they state:

At the present time we estimate there are in excess of 250 patients who will not be facilitated within the current arrangements being promoted [in the ten point plan]. It is clear to us that if these beds were created as a once-off initiative the beds in the acute hospitals could be used to create medical assessment units.

This clearly shows the plan set out by the Tánaiste is flawed and it shows her and her predecessor's lack of forward planning in not providing the community nursing units that are so desperately needed. Since 2001, according to the CEOs, fewer than 1,000 beds have been created in the system. The effect of this limited bed capacity is compounded by two significant factors, namely an increased level and intensity of activity and the requirements of elderly patients admitted to acute hospitals. The assessment by these experts underlines the case made by Professor Drumm for the need to resource community-based beds and primary care services, an argument the Labour Party has made on many occasions. Two principles need to apply in the health service, namely, an integrated service to give equality of access and a major shift out of the acute hospital sector and into primary care. Regrettably so far the Government has failed to act on either count.

The Government is good at producing strategies. However, even its own primary care strategy has withered on the vine. It has been starved of funding and the Tánaiste is advising GPs to go to the private sector to seek funding. She wants to see general practice privatised in a new form in a way that I believe will lead to dominance by companies which are driving an agenda to increase the use of pharmaceuticals and medication, which while relatively low is highly lucrative. If we go down that road we will be in great difficulty in a part of the health service, general practice, which works. It will not work unless something is done to address the growing shortage of general practitioners. General practitioners as a group are ageing. In many cases they are not being replaced and even where they are being replaced they are generally replaced by young women who will not work the extensive hours that is the norm for GPs and family doctors. The Tánaiste knows this. She has been told many times that we must make a start on this and should have long before now. This should have been dealt with in the medical schools in this academic year. More than half our medical undergraduates are non-EU citizens who are accepted here because they bring money with them which provides funding for the medical schools. If we do not train our own doctors, we will not have the necessary network and supply of GPs. It takes ten years to grow a family doctor, so to speak. The Tánaiste has said that something will happen in this regard, hopefully in the Estimates or the budget, but she has not been specific.

We should remind the Tánaiste, who seems to suffer from amnesia, that when it comes to issues and decisions made by the Cabinet while she has been Tánaiste and making decisions about the health service, she carries the collective responsibility.

The previous Government, comprised of the same parties, made a total mess of the over 70s medical card scheme. It introduced a form of inequity into the GMS system that never before existed. It created two systems of awards and incentives for family doctors. If a family doctor looks after a wealthy patient aged over 70, a retired judge, a businessman or newspaper magnate, for example, he or she is paid four times more than the standard medical card payment for caring for that person. If the doctor cares for an average worker who has qualified for a medical card, he or she gets one quarter of the over 70s payment. What is happening as a result? The obvious is happening. Doctors are no different from anybody else and operate on the basis of incentives. There is now a dearth of doctors in areas of disadvantage in cities and rural areas.

A Government that is seriously committed to increased access at primary level and to reducing the flow of patients into accident and emergency departments would have introduced incentives to rebalance the system. Such incentives would ensure that GPs were attracted into poorer areas and areas of disadvantage and would set up there to provide services at primary level. That is not happening. The wealthier and older urban areas are attracting the GPs while those areas of our cities that have large populations who need health care, where often there is a concentration of socioeconomic groups who have particularly acute health needs, are the areas having most difficulties. It is these disadvantaged people who largely end up in accident and emergency departments, putting pressure on the system even though they would prefer to be cared for in their communities.

The north side of Dublin is the most extreme example of this problem. There have been long-standing problems there with pressure on hospitals such as the Mater and Beaumont, a shortage of GPs, and difficulties with out-of-hours services which still have not been addressed. Despite the fact that this was part of the ten-point plan, we have still not seen any action..

Another of the Tánaiste's grand plans that has foundered is the Clean Hands campaign designed to combat the spread of MRSA in hospitals. Recently released figures show that in 2002 there were 445 cases of MRSA, in 2003 the figure rose to 480, in 2004 it increased to 550 cases and for the first six months of this year, the number of cases is 314. This steep curve upwards looks set to continue.

Of greatest concern is the fact the Tánaiste doesn't even know how many people have died of MRSA. She admitted this in the House last week when asked how many people had died from this condition. It is an infectious condition that is prevalent not just in hospitals but also in nursing homes and the wider community and the Tánaiste does not know how many people have died as a result of contracting MRSA. What we do know is that five babies in the National Maternity Hospital have been infected with MRSA. Dr. Susan Knowles, consultant microbiologist in Holles Street Hospital has stated:

It is a major problem that we have a total lack of isolation facilities in the neo-natal intensive care ward. There is just one room in the unit. The cots are too close together and like many hospitals, we fall behind the isolation guidelines of the new MRSA guidelines in how far apart to space the cots.

Elderly patients suffer on chairs and trolleys in the corridors of accident and emergency departments. Small babies are at risk from preventable infections picked up hospitals that are supposed to provide the best possible chance of a healthy start in life. We should not and will not blame those who work to provide health services in such difficult and stressful conditions. However, we in the Labour Party challenge those in Government who have been in power for so long and who bear responsibility for this crisis, no matter how much they try to wash their hands and deflect responsibility for it elsewhere.

Joe Sherlock (Cork East, Labour)
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I am pleased to see the Minister of State, Deputy Seán Power, present but I am very surprised that the Tánaiste and Minister for Health and Children, Deputy Harney, is not present to listen to this debate. I am disappointed that no representatives of the Health Service Executive are listening to this debate.

Owing to the shortage of beds in general community hospitals, elderly people who need full time care and attention must accept beds in private nursing homes. Elderly people are compelled to accept this situation without reference to means. I am aware of a health service liaison officer in a hospital who directs people to private nursing homes without making any provision for the full payment of the charges that are due.

In the health service area of Cork and Kerry, 489 elderly people await enhanced subventions. Think of their plight; they know neither they nor their families can afford to pay the nursing home fees. While elderly people in community hospitals benefit from the new method of assessment, those in private nursing homes and who have the same means are asked to pay more than €600 per week. Think of that situation under the Health Service Executive which we were told would end all of the problems in the system. There is no reference to the problems of the elderly in society.

In one case, the daughter of a person in a private nursing home was advised that her father would be discharged at the end of the month because of arrears in the payment of charges. This happened in the Cork-Kerry Health Service Executive area. Imagine the plight of this woman who cannot afford to pay for her father who is being discharged because he has not received the enhanced subvention promised to him on admission to the private nursing home. There are private nursing homes in almost every parish but no extra beds in community hospitals. People are forced to accept beds in private facilities, but these are not being paid for by the State. An ombudsman said that if elderly people are entitled to medical care in a hospital, they are entitled to free medical care. It is on record that elderly people are entitled to long-stay care, which is not happening. I feel aggrieved about it under a Government that is telling everyone how great it is, which is not the case.

Kathleen Lynch (Cork North Central, Labour)
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The comprehensive Labour Party motion deals with the record of the current Minister over the past 12 months. The amendment to the motion tabled by the Government is a direct contradiction of everything the motion proposes. That contradiction is about deluding itself because no member of the public believes we have a first world health service. No one believes it because anyone who has had contact with the health service knows that it falls down in every aspect.

No one in Ireland is unaware that the previous Minister for Health and Children, Deputy Martin, came from Cork. Therefore, it would appear, as usually happens in a Fianna Fáil Government, that Ministers look after their own constituencies. However, that was not the case with the bold Micheál. Micheál did not look after anyone's constituency. He did not look after his own, Cork North-Central, Dublin Central, Dublin South-Central, Donegal, Monaghan and so on. As a result, a new accident and emergency department was built as a skin on the original Cork University Hospital. This meant the accident and emergency department, which was used up to recently, was now in pitch darkness because all the windows had been blocked off by the new accident and emergency department, which was not open for three years. Not only did it not have the new facility, but it made the old facility worse. One might find that difficult to imagine, but it is a fact.

The Tánaiste, Deputy Harney, then took over as Minister for Health and Children. She did so on the basis that she could do no wrong. After all, she was the Minister for Enterprise, Trade and Employment for seven years, but then again, if one put a five-year-old, with one year of pre-school, into that Department in the past seven years, he or she could have run it because it was virtually running itself, as long as one did nothing to damage it. As she was in charge of that Department, she believed she could tackle the Department of Health and Children, and do so quite well. I imagine for the first year she has been in that office, she has gone into a type of semi-coma. She met so many problems that she has simply thrown her hands in the air and asked herself what is she doing. Perhaps she believes the Minister for Finance's proclamation when he left the Department Health and Children that it was like Angola and she is desperately trying to find an exit strategy.

Let me tell Members about the hospitals in Cork. In Cork University Hospital's outpatient department, people still queue along a corridor for hours. As someone who did so in the past few months, let me recount what the conditions are like. One must queue for the dressing clinic along a corridor where trolleys pass, equipment is moved and people who are seriously ill are brought for X-ray. It is like something one would see in one of the advertisements for Trócaire or GOAL. Nurses desperately try to deal with people as quickly as possible because they are aware of the queue. Nurses are constantly being hailed from other departments to help in the dressing area. It is no wonder infections are being contracted by patients because staff are dealing with people in such volumes and under such poor conditions that it is virtually impossible to give anyone the attention they require, yet they try desperately to do so.

Let me tell Members about the other hospital in Cork, the South Infirmary-Victoria. It is the ready made set for a Dickens novel. There are wards in the hospital that still contain 30 and 40 beds. It is open plan — I suppose that is the modern term. These wards are filled with people who should be somewhere else, but there is nowhere else. This is the Government that manages our wealth and tells us we have the best economy in Europe, which we have, but anyone going into any of these two hospitals would be forgiven for thinking we cannot do anything about it because we are too poor. We are not poor, we are wealthy. It is just that the Government chooses not to spend the money on the people who created the wealth.

Let me tell Members about the people who should be somewhere else. These people should be at home, but because the former Southern Health Board, the HSE or whatever the Minister wants to call it, has reduced the home help hours by 20% in the Cork city and county area, they cannot go home because there is no one to look after them. As we are all living longer, we will need these facilities and specialties, but they are the services on which the Government has chosen to cut back.

On the disabled person's grant, people at home or in hospitals where they should not be, continue to fill out forms, send them in and wait for occupational therapists and companies to call to the door, and wait for approval by the local authority. Surely in a modern society, when visiting the reception in any hospital to give details about going into hospital, it should be easy enough to figure out that when the patient leaves hospital, he or she will need home help and adjustments to his or her home. However, it appears to be beyond the Government to do anything in a reasonable or rational way. The only thing it appears to be capable of doing is wasting taxpayers' money. There is waste and want. No one is saying that running a country is the same as running a home because it is not the case. However, I guarantee the Minister of State that if people ran their homes in the same way the Government is running the country, the marriage breakdown rate would be much higher because no one would put up with it. The Government is a disgrace and it should hang its head in shame.

There is one other figure in regard to the Cork area, which is important and which should be dealt with. This relates to the orthodontic service, to which Members on this side have been referring for years. The number of children waiting for treatment in Cork city and county is 2,549. These are the children of taxpayers and those who created the wealth the Government is squandering, and even at that level it cannot get things right. When we talk about health, we are really talking about quality of life for the people who created the wealth. Every country can provide proper health services, but it is not the case in this country because the Government is incapable of doing so.

Seán Power (Kildare South, Fianna Fail)
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I move amendment No. 1:

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

—expresses regret at the tragic and untimely death of Mr. Pat Joe Walsh at Monaghan General Hospital recently;

—welcomes the initiation of an independent report into the circumstances of Mr. Walsh's death;

—looks forward to the Health Service Executive implementing operational policies in the light of this report and others so as to ensure patients in each region receive all necessary treatment to the highest standards of safety and care;

—commends the Tánaiste and Minister for Health and Children and the Government for the substantial reform actions taken in the course of the last year including:

—the establishment of a single, unified Health Service Executive with maximum financial responsibility and accountability to replace the outdated former health board system;

—the comprehensive range of initiatives to deal with all the factors causing difficulties to patients at accident and emergency;

—the first ever independent audit of cleanliness across major hospitals;

—the opening of new acute beds throughout the country to bring the total to 900 more than in 2001;

—the opening of new accident and emergency departments in Cork University Hospital and Connolly Memorial Hospital, Blanchardstown;

—a 29% increase in medical card income guidelines, the largest increase in 30 years;

—the introduction of doctor visit medical cards to enable families on modest incomes visit their GP free of charge;

—the impetus for the Health Service Executive to seek tenders for a GP out of hours service in north Dublin;

—the resolution of industrial relations disputes and the opening of contract talks with representative bodies of consultants, non-consultant hospital doctors and general practitioners;

—the development of a national radiotherapy network to provide essential cancer services for patients in each region of the country;

—a specific focus on the needs of older people and the development of long-term care policy, including the preparation of clear standards for nursing home care; and

—establishing after 29 years a clear and legally sound basis for contributions by care recipients to the cost of shelter and maintenance in residential care;

—welcomes the efforts which are being made by the Health Service Executive to address the issue of hospital acquired infections, including MRSA; and

—expresses confidence that the continuation by the Tánaiste and Minister for Health and Children and the Government of substantial reforms matching increased investment will deliver improved care for patients.

I apologise on behalf of the Tánaiste who cannot be here this evening because she is meeting with the Walsh family. I wish to share time with the Minister of State, Deputy Tim O'Malley. I welcome the opportunity to underline the Government's commitment to improving patients' experience of accident and emergency services in hospitals.

I was shocked to learn of the tragic death of Patrick Walsh at Monaghan General Hospital and, like everybody else, I extend my sincerest sympathies to the family. I do not intend to debate the circumstances surrounding the death of Mr. Walsh. The Health Service Executive has commissioned Mr. Declan Carey, a consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen's University to carry out an independent and external review of these circumstances. The review is to be completed and a report issued within eight weeks. The full truth will emerge and nothing will be hidden.

Kathleen Lynch (Cork North Central, Labour)
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And nothing will be done about it.

Seán Power (Kildare South, Fianna Fail)
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I will not prejudge the report. A timeframe of eight weeks has been provided within which the report will be completed and we are confident that will happen. The full facts will emerge at that stage.

Many people judge our health services by their experience of the accident and emergency services, which might be described as the shop window of the delivery of acute hospital services. People from every background with almost all medical conditions use accident and emergency departments. The extent and quality of service at such departments is affected by factors and issues right across health services from long-term care for older people to general practitioner services, diagnostic facilities, clinical and hospital management and investment programmes.

Accident and emergency departments deal with approximately 1.2 million attendances each year and, therefore, almost 3,300 people a day visit accident and emergency departments for treatment. Addressing the needs of patients who require emergency treatment and providing the necessary and appropriate care is a challenging task for health care systems generally, both in Ireland and internationally. The Government has allocated priority funding this year of €70 million for a ten-point plan to deal with the most pressing issues. This is not the total investment required for accident and emergency solutions but it does come on top of substantial funding provided for hospitals, long-term care, home help, primary care, general practitioner co-operatives and so on. These actions are also being implemented in conjunction with the health capital investment framework which provides €3.2 billion in Exchequer funding up to 2009.

The Health Service Executive is advancing the implementation of a series of measures to improve the delivery of accident and emergency services. These measures are aimed at improving access to such services, improving patient flows through accident and emergency departments, freeing up acute beds and providing appropriate longer-term care for patients outside the acute hospital setting.

A particular focus has been placed on those patients in acute hospitals who have completed their acute phase of treatment and are ready for discharge to a more appropriate setting. The HSE is making sustained efforts to arrange for the discharge of these patients to have more acute beds available in hospital for emergency patients. High dependency beds and intermediate care beds in private nursing homes along with home care packages are being used to ensure patients are appropriately placed.

Joe Sherlock (Cork East, Labour)
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They are placed in private nursing homes without subvention.

Seán Power (Kildare South, Fianna Fail)
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The number of delayed discharges in the major Dublin hospitals stands at 377. This is the lowest number since January 2005 and has been achieved as a result of the various measures implemented to improve the delivery of accident and emergency services.

The following additional actions have been taken: 48 high dependency beds have been contracted in private nursing homes for those patients with more demanding care needs; 388 patients have been discharged in 95 intermediate care beds for six to eight-week stays since contracts with private providers commenced in May; and additional home care packages delivered by nurses and care assistants and enhanced subventions have facilitated the discharge of 262 and 94 patients respectively in the Dublin area.

A HSE steering group was established in July 2005 to tackle the issue of delayed discharges in the Dublin hospitals. A number of additional initiatives have been implemented by the group. A total of 365 patients in public long-stay facilities have been transferred to private nursing homes pending the re-opening of 65 public long-stay beds closed in nursing facilities on the south side of Dublin. A total of 41 beds have re-opened in homes, including Leopardstown Park Hospital, St. Colman's Hospital and St. Brigid's, and the HSE is working towards opening the remainder of the beds as soon as possible. The HSE has confirmed no acute beds are closed owing to lack of funding. Patients in St. Mary's in the Phoenix Park were identified in consultation with clinicians and families for transfer to private nursing homes.

Joe Sherlock (Cork East, Labour)
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Is this the Government of private nursing homes?

Séamus Pattison (Carlow-Kilkenny, Labour)
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Order, please.

Seán Power (Kildare South, Fianna Fail)
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The 70 beds freed up allowed for the discharge from the Mater and Beaumont Hospitals of 35 patients each and investment in home help and community enhanced subventions. A sum of €6.6 million is being targeted for home help and community enhanced subventions nationally from funding under the ten-point plan. This will act as an important preventive measure and facilitate the discharge of older people from acute hospitals.

At the turn of the 20th century, it would have been very unusual to live to the age of 65, whereas today, most of us can expect to live well into our 70s and beyond. This increase in life expectancy has been one of the great achievements of western societies in the 20th century. With advances in living standards and health services, illness and dependency do not feature in many cases until the final few years of a person's life or not at all.

A number of people require medical attention and support to varying degrees, which must be delivered in the most appropriate setting to meet the needs of the individual. One of the best ways to acknowledge the debt we owe them is by providing them with every opportunity to remain in their homes and communities for as long as possible with all the necessary community supports in place. Research has found that those receiving care in their homes live on average two years longer than those in residential care. It has long been the expressed wish of the majority of older people to remain in their homes.

The cornerstone of public care provision is the home help service. This is invaluable in keeping older people at home for longer and often fulfils not only a functional role in terms of helping older people with everyday tasks but also a social role in terms of helping them to stay out and about and active in their community. Supporting care in the community has long been the core Government policy relating to older people. Home care packages are being delivered by the HSE to people whose needs are often complex and go beyond what home helps can provide. Such packages are comprehensive, multidisciplinary and have been making a difference to the lives of people who would, most likely, have ended up in long-term institutional care without this support. They are proving to be a crucial tool not only in helping people to move from acute care back into the community, but also in keeping people in the community where they belong. Various packages are available in different parts of the country. However, one standard package should be available throughout Ireland with one needs assessment process in place. The establishment of the HSE will help to ensure a standard approach is adopted in the future.

No home care package will replace the role of the family or other services provided by the State or voluntary agencies. Rather, home care packages should be used to complement existing services and care. Sheltered housing is a crucial component of community based supports for older people, as it allows older people to remain within the community while offering support and solidarity.

There is no denying that long-term residential care will always be required in the health system. However, currently some 28% of residents in long-stay beds are in the low to medium categories, in other words in residential care for social reasons. This represents over 5,000 people and some of these could be cared for at home if the right level of support were in place. In some cases a minor change may be necessary, allowing the person to live in dignity in his or her home. We will implement a number of measures to make that possible. Entering long-term care should not spell the end of a person's involvement in the community, and nursing homes have an important role to play in ensuring residents are facilitated and encouraged to keep up some level of contact with society.

In line with Government policy, my Department has been examining a number of procurement options with a view to finding the approach that will deliver 850 additional long-stay beds and provide the best services and value for money to the Exchequer. The Department of Health and Children and the Department of Finance have discussed an initiative based on entering into a medium-term service level agreement with the private sector to deliver additional long-stay beds for highly dependant patients. The proposal is being developed further to evaluate its cost effectiveness.

This Government is committed to improving the delivery of accident and emergency services and, by adopting a system-wide approach, I am confident the improvements made will be sustained. In respect of care for the elderly, raised by Deputy Sherlock, the Government announced a package of €50 million on minor capital works throughout the country. This money will be spent immediately, improving the conditions in which people live and making a difference to the quality of their lives.

A number of areas have been mentioned. Speakers from the Labour Party criticised the health service as if there was nothing good in it. We realise we are in the process of reforming the health service and are tackling the difficulties that exist. Over 100,000 people work in the health service, and they are committed to improving the circumstances of the people they treat. It serves little purpose to criticise them continually.

Joe Sherlock (Cork East, Labour)
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Will the Minister of State increase subvention in private nursing homes?

Seán Power (Kildare South, Fianna Fail)
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In the near future the Government will make a number of changes to the home help and home care subvention packages. Care of the elderly has always been a priority for this Government and this will continue to be the case.

Tim O'Malley (Limerick East, Progressive Democrats)
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I am glad of the opportunity to speak in this debate. Improving the infrastructure of acute hospitals has been and will continue to be a priority for this Government. In the past five years alone capital funding of some €80 million has been invested in new accident and emergency departments around the country. New departments have been provided at Cork University Hospital, Connolly Hospital in Blanchardstown, Naas General Hospital and Roscommon General Hospital. A new 25 bed accident and emergency admission unit for the Mater Hospital is expected to be operational by the end of the year. The commissioning of a new accident and emergency unit at St. James's Hospital is almost complete while new hospital developments are being provided at St. Vincent's Hospital in Dublin and at Tullamore.

There is a particular onus on individual hospitals to ensure the care of patients through the hospital is regularly reviewed. Attention must be given to looking at the profile of patients attending accident and emergency and to examining alternative care pathways for people who may not be in need specifically of accident and emergency services but who undoubtedly require treatment, intervention or advice. The HSE has arranged for the assessment and analysis of clinical and organisational processes in ten hospitals nationally. This exercise has been completed and draft individual hospital reports have issued to relevant hospitals. A draft overview HSE report on the findings from the ten hospitals, drawing out the wider system messages and potential for best practice, is being prepared. The Department of Health and Children expects to have the final report shortly.

General practitioner out-of-hours services are particularly lacking for the population of north Dublin. As a result, particular difficulties are being experienced in the accident and emergency departments at Beaumont Hospital and at the Mater Hospital with an apparent high level of clinically inappropriate attendances. In order to address the situation the HSE has commenced the procurement process for the provision of general practitioner out-of-hours services on the northside of Dublin.

As soon as difficulties with PPARS were brought to the Tánaiste's attention, she acted quickly and decisively. The Secretary General of the Department met with the HSE and this led to a review of the system by the HSE. On 6 October the HSE decided to put on hold further development and to maintain the system in the four current live sites, namely, the north western area, the midland area, the mid-western area and St. James's Hospital. The HSE has set up a high-level group to establish the long-term value of PPARS. The Department of Health and Children and the Department of Finance are represented on this group. The Comptroller and Auditor General is also carrying out a value-for-money examination of PPARS.

On 11 October the Government decided on a new system for the management and control of major ICT projects and on new measures to improve the management of consultancies. Over 32,000 members of staff are covered by the full PPARS solution which covers organisation, management, personnel administration, time management and payroll. In addition approximately 40,000 staff in the HSE western, eastern and north eastern areas are covered by phase 1 of PPARS, which covers organisation management and personnel administration. So far this year a total of 560,000 payroll slips have issued. The Department of Health and Children and the Department of Finance are working with the HSE to ensure an effective central governance structure for ICT is put in place in the HSE. It will be up to the HSE to decide on the future of the project taking all relevant factors into account.

An Agreed Programme for Government includes a commitment to expand public hospital beds in line with the health strategy commitment to increase total acute hospital bed capacity by 3,000 by 2011. Substantial investment in additional bed capacity in acute hospitals has already taken place. Funding has been provided to open an additional 900 inpatient beds or day places in public acute hospitals throughout the country. The HSE has informed the Department that as of 14 October 2005 some 806 of these beds or day places were in place and the remaining 94 beds will come on stream over the coming months. In addition, a further 450 acute beds or day places are in various stages of planning and development under the Capital Investment Framework 2005-09.

In July of this year the Tánaiste announced an initiative that will provide up to 1,000 additional beds for public patients in public hospitals over the next five years. The HSE has been asked to begin to develop an implementation plan and to prioritise proposals with reference to the public hospitals' requirement for additional bed capacity. Initial discussions have already taken place between my Department and the HSE on this matter. These additional beds or day places will go most of the way to achieving our commitment in the programme for Government to increase total acute hospital capacity.

The health strategy acknowledges that a significant proportion of additional capacity in the acute hospital system will be supplied in future by private providers. The Department of Health and Children, in conjunction with the HSE, will be reviewing public capacity requirements in the acute hospital sector in the light of developments since the health strategy was published and the progress of the initiative announced in July.

MRSA is one of the most well known antimicrobial infections present in hospitals, not alone in this country but internationally. It is also seen increasingly in community health care units such as nursing homes. These infections pose significant challenges for clinicians and hospitals and the Health Service Executive is working to combat hospital acquired infections, HAIs.

There are two types of MRSA cases: colonisation, which can refer to any person who has simply been in contact with this common bacteria but has no symptoms, and blood isolates, which refer to patients who have an infection with symptoms. Data on bloodstream infection are collected by the Health Protection Surveillance Centre. There were 550 cases of bloodstream MRSA infection in Ireland in 2004. The increase in the reported number of cases of MRSA in recent years is mainly due to increased surveillance as a result of more laboratories participating in the reporting process.

Effective infection control measures, including environmental cleanliness and hand hygiene, are central to the control of hospital acquired infections, including drug-resistant organisms such as MRSA. Good hand hygiene is one of the simplest and most effective measures that can be used to stop the spread of MRSA and other infections.

The national hygiene audit, arranged by the HSE, has been completed and a report presented to the director of the National Hospitals Office. This involved visits to each of the 54 acute hospitals in the country by a team of independent consultants. The purpose of the audit was to assess the standards of environmental hygiene and cleanliness in each hospital and to provide baseline information. The Tánaiste has already given a commitment that the results of the hygiene audit will be published.

The HSE will also publish national infection control standards and national cleaning standards — a consistent and robust set of hygiene standards for our hospitals. Where previously standards may have depended on the approach of a particular hospital or health board, the HSE can now ensure every hospital will share and meet the same high standards of cleanliness and infection control.

The HSE has published guidelines on hand hygiene and guidelines on the control of MRSA for hospital and community settings. These two significant documents give clear policy and practice guidance to health care workers on the control of hospital acquired infections, including MRSA. The Department of Health and Children is continuing to engage with the HSE to agree a series of actions over the coming period to ensure that MRSA can be effectively dealt with and that we can achieve a reduction in the incidence and effects of these infections.

I am confident that the actions being taken by the Tánaiste, supported by the Government, will generate an appropriate multi-faceted and multi-dimensional response to the accident and emergency service problem. I trust I have demonstrated that improving the delivery of accident and emergency services is our priority. We will continue to work in the best interests of patients and staff. That is reflected in the response under development to hospital acquired infections, including MRSA. 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.

Liam Twomey (Wexford, Fine Gael)
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We often refer in this House to programmes and quote what a member of the Government or the Opposition said. The Fianna Fáil Ard-Fheis was held over the weekend. The Taoiseach appeared on a television programme on Sunday night but he did not appear to know much about what was happening with the health services in his own back yard. He was not sure what was happening with GP services or outpatients appointments in Beaumont Hospital or the Mater Hospital.

This morning, the Minister of State, Deputy Tim O'Malley, and I were interviewed on local radio in Limerick and during the interview the Minister of State blamed the consultants for not negotiating their contract and thereby causing the crisis in the acute hospitals. He then went on to blame the general practitioners for holding up the doctor only medical card scheme and accused them of not being available out of hours in both Limerick and Dublin.

Tim O'Malley (Limerick East, Progressive Democrats)
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That is correct. A total of €1 million is going back because it was not spent by ShannonDoc.

Liam Twomey (Wexford, Fine Gael)
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That appears to be the only reason the Progressive Democrats are privatising everything they lay their hands on since they got into the Department of Health and Children.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thought Deputy Twomey supported co-operatives.

Liam Twomey (Wexford, Fine Gael)
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I will get to that point. Not only has the Tánaiste, Deputy Harney, blamed the nurses for many of the problems in the health services but she has also told us we have too many nurses. The Minister of State came into the House to make a speech but he made statements outside the House which confused the general public because they do not know if he wants to take responsibility for what he was elected to this House to do.

The plastic socialists in the Fianna Fáil Party sitting behind the Minister give us a completely different story. They go on about the fact, and unfortunately we heard the Minister, Deputy Martin, say this also, that the Opposition has no policies. If there is one thing the Minister, Deputy Martin, was not short of when he was in the Department of Health and Children it was policies and reports. He published them at a rate even I could not keep up with.

I want to deal with three of his policies, the ones I would consider to be significant. He published the Hanly report. Is that still active or is it due to be resuscitated?

Kathleen Lynch (Cork North Central, Labour)
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It is on a ventilator.

Liam Twomey (Wexford, Fine Gael)
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There was also the Hollywood report, which was interesting because it took four years to publish. The Minister, Deputy Martin, told us that the report was written by experts and, therefore, radiotherapy services would only be available in Cork, Galway and Dublin. The Tánaiste, Deputy Harney, then came into office and did a U-turn on it. She said radiotherapy services could be provided in Limerick, the south east and the north west. They have not been delivered by the Government but that was a total U-turn on its own policy.

Tim O'Malley (Limerick East, Progressive Democrats)
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Is the Deputy against that?

Liam Twomey (Wexford, Fine Gael)
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There is then the gold standard of Government policy on health services, the health strategy, Quality and Fairness: A Health System for You. If ever a policy has not been implemented, it is that one. In some respects, the Minister of State suffers from a worse crisis than that of which he accused the Opposition. He has more than enough policies but he just cannot appear to implement any of them, certainly as far as the health services are concerned.

One of the objectives of the health strategy, Quality and Fairness: A Health Service for You, published in November 2001, was a policy for funding care of the elderly into the future. Ministers come into this House and tell us how concerned they are about care of the elderly but where is the policy that will show how this Government, if it remains in power after the next election, will fund care of the elderly into the future? It has not been published because there is none available.

I take exception to some of the figures both Ministers of State quoted in their contributions tonight. The document given to us by the Government states that there are 900 extra beds in the health service compared to the 2001 figure. That is not the case. The Minister of State came close to the truth in his contribution. He said there was an extra 800 beds and another 94 pending.

Tim O'Malley (Limerick East, Progressive Democrats)
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I said there were 94 funded but not——

Liam Twomey (Wexford, Fine Gael)
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The reality is they are not available. People are still lying on trolleys and it is no good telling them that if they come back next week they will get a bed. That is the problem.

There are not 800 extra beds in the system. I got a reply from the HSE a month ago which indicated that there were less than 650 new beds in the system since 2001, the exact figure promised by the Government by the end of 2002. The Minister of State cannot simply make these figures up as he goes along. He cannot say there are 800 this week and 900 next week when they do not exist. There are only 650 extra beds.

Kathleen Lynch (Cork North Central, Labour)
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They are counting the chairs and the trolleys.

Liam Twomey (Wexford, Fine Gael)
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They are counting everything. I love the comment about the National Treatment Purchase Fund sanitising the waiting lists to make them acceptable to the Government when it runs in the next general election. The Minister must be realistic. The most important thing to patients is the length of time they must wait from the time the general practitioner writes a letter of referral for them to when they are seen by the consultant. It does not matter whether it is an appointment for an ear, nose and throat specialist, orthopaedics, rheumatology, ophthalmology, neurology or neurosurgical outpatients follow-up. Patients are waiting anything from three to six years for those outpatient appointments. That is the measure of a health service. As the Tánaiste made clear in one of her great speeches to the PD constituents, it is not about facts and figures; it is about a person's experience of the health services and these are not good experiences——

Tim O'Malley (Limerick East, Progressive Democrats)
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What about the 35,000 people who have availed of the National Treatment Purchase Fund? Do they exist or are they a figment of our imagination?

Liam Twomey (Wexford, Fine Gael)
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What about the 30,000 people waiting for their medical card since the beginning of January? The Minister of State cannot blame that on the GPs because that was his own problem. People should stop being unrealistic and lying to the people.

In his contribution, the Minister of State, Deputy Seán Power, talked about the 850 additional long-stay beds. He then referred to "a medium-term service level agreement with the private sector to deliver additional long-stay beds", but does anyone remember where they heard that before? In 2003, the previous Minister for Health and Children, Deputy Martin, and the Minister of State, Deputy Callely, announced those beds at least five or six times. Those beds were supposed to go to Cork and Dublin. Perhaps the idea of the Minister of State, Deputy Seán Power, is a new one, but the previously announced beds never came to fruition. They were quietly dropped when nobody would take them up. It is more Government spin because there are not an extra 850 beds, private or public, in the system. They are not being promised or delivered and one must be realistic about this.

The Government's response to the Opposition concerning nursing home charges included a plan to establish, after 29 years, a clear and legally sound basis for contributions by care recipients to the cost of their shelter and maintenance in residential care. The previous Minister, Deputy Martin, did not bring forward that proposal voluntarily. He was dragged kicking and screaming through the Oireachtas Joint Committee on Health and Children before making those changes. He squealed his way through the committee and claimed the reason he never knew about the illegal nursing home charges was because he never read the memos and nobody ever told him.

Kathleen Lynch (Cork North Central, Labour)
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He was blinded by the flash of the cameras.

Liam Twomey (Wexford, Fine Gael)
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He was too busy getting his picture taken. The only reason we have seen changes is because the matter was raised consistently in the House.

The Government response referred to a specific focus on the needs of older people and the development of a long-term care policy, including the preparation of clear standards for nursing home care. When the Leas Cross crisis broke before the summer recess, the Taoiseach and the Tánaiste said they would establish an independent health service inspectorate before the end of the year. This plan was also contained in the health strategy published in 2001. After the summer recess, however, the Taoiseach and the Tánaiste were relaxed and forgot their purpose in this respect. Their proposal disappeared from the agenda but it has not been forgotten by those who want to see protection for elderly people in nursing homes. Only 5% of elderly people go into nursing homes but an inspectorate is required to protect their human rights in such situations. It is a disgrace for the Government to say it cannot be bothered to do it this year and that it might do it next year. Ministers pretend they are concerned but they are not because they have done nothing about the matter.

The Minister of State also said that the Health Service Executive will address the issue of hospital-acquired infections, including MRSA. It is ridiculous, however, to do an audit and state that the baseline will be an examination of the MRSA problem and other hospital-acquired infections. Why does the Minister not ask those in the hospitals to take responsibility for the jobs they are paid to do? Some people are paid to clean hospitals and maintain acceptable levels of hygiene there. We insist on clean restaurants and meat factories, so we should at least expect the same cleanliness in our hospitals. Someone should be responsible for achieving that.

Infection control requires specialised personnel, including microbiologists and nurses, to take responsibility for the issue. A once-in-a-lifetime audit will not change anything. The Minister should have followed our suggestion of establishing a flying squad to turn up unannounced at hospitals and carry out a thorough audit. Under that plan, no one would be aware in advance of when such a team would arrive. That is the way to change people's perceptions of how a health system should be run.

I am glad the Tánaiste is meeting the family of Mr. Walsh tonight. I am disgusted by the way in which Ministers jump into their Mercedes and travel throughout the country to cut a ribbon on any capital projects that are developed. It is disgraceful that what happened in the north-east region last week attracted only glib comments from the Government side of the House. A Minister should have been sent there to talk to the family concerned as well as visiting all the hospitals involved before reporting back to the House on what happened.

There is no need for an eight-week delay while awaiting yet another review. At least four reviews have been carried out by eminent consultants in the north-east health area. I am shocked that in our health care system a citizen bled to death in front of the very doctors and nurses who were supposed to be looking after him. I was disgusted that the Government never felt it was important enough for any Minister to go and see what had occurred.

Voters will not accept a situation whereby the HSE takes responsibility for the health services in the same way as the National Roads Authority is responsible for building roads and bypasses. People consider the health service to be much too important to be handed over to a body like that. Whoever is the next Minister for Health and Children, he or she should take personal responsibility for citizens' health care instead of handing it over to some organisation like the HSE.

Dan Neville (Limerick West, Fine Gael)
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I am pleased the Minister of State, Deputy Tim O'Malley, is present because I wish to raise the issue of mental health with him. Earlier today, the Oireachtas Joint Committee on Health and Children's sub-committee on the high level of suicide in society heard a presentation on psychosis. The early intervention programme for psychosis was outlined for members of the sub-committee by Professor Eadbhard O'Callaghan. The programme aims to reduce unnecessary delays in obtaining treatment as well as providing treatment in community-based settings in a way that is both young adult-friendly and holistic. It addresses not just pharmacological but also psychological, social and vocational aspects of a person's situation to maximise the likelihood of recovery.

Professor O'Callaghan informed the sub-committee that early intervention programmes for psychosis work. They reduce the unnecessary delays in getting treatment and so people are less unwell when they come for treatment. Such intervention programmes have been shown to reduce the need for involuntary admissions, reduce suicidal behaviour, increase the prospect for recovery and be cost effective. They are preferred to conventional services by individuals and their families. Professor O'Callaghan is carrying out a pilot study in the south-east Dublin and Wicklow area with a population of 371,000.

Psychosis is an umbrella term used to describe conditions that affect the mind where there has been some loss of contact with reality, including hallucinations and delusions. The suicide rate for people with psychosis is 20 times the rate in the general population. There is a very high risk of suicide among people with psychosis, but it can be reliably identified and effectively treated. Those with psychosis constitute a suitable group to target to try to reduce suicide.

In the Dublin area at present there is an average duration of untreated psychosis of 23 months. Professor O'Callaghan told the sub-committee that such a delay is unacceptable for young people. The duration of untreated psychosis ranges from one month to 240 months.

The sub-committee also heard statistics concerning the length of time a person with psychosis is left untreated and the incidence of attempted suicide. If such people are treated within 13 months, they are never suicidal. If, however, the treatment delay is between 13 and 22.5 months, they contemplate suicide, and if the treatment is delayed for up to 39.9 months, they will seriously attempt suicide. The best predictor of whether a person will get better from a psychosis is the length of time it took to get effective treatment.

The early intervention system of treating psychosis has been prove

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I wish to deal with two sections of this important motion, namely, the unnecessary death of Mr. Patrick Walsh and the deep public anger over the hundreds of millions of euro that are being wasted.

I deplore the fact that the modern theatre and top quality staff at Monaghan General Hospital are not being fully utilised. Some Ministers have accused those of us who raised the tragic death of Mr. Walsh of doing it for political reasons, as if to make out that we have no right to highlight the ongoing mismanagement of the health system in County Monaghan and the north east region. The Taoiseach refused to admit in the House that staff and consultants in the hospital could not have operated on Mr. Walsh because of the protocols in place. He knew he was wrong. He and the Tánaiste must not hide any longer. They must give the same commitment to Monaghan General Hospital as they have given to the hospitals in Ennis and Nenagh.

Mr. Walsh should never have been moved from Drogheda but when he was in Monaghan there should have been freedom to act. Surgical procedures in Monaghan General Hospital must be brought back on-call. How can the Government justify the failure to utilise the new modern theatre and top quality consultants and staff at Monaghan General Hospital? Before the hospital was taken off-call in questionable circumstances, it was carrying out contract surgery for patients north of the Border. The decision to close was taken by non-consultant executives. All surgeons in Monaghan and Cavan have asked that Monaghan General Hospital would be brought back on-call for surgery. All consultants in Monaghan General Hospital have made the same request.

In 1939 my own mother and her premature newborn baby boy were both rushed to the then Monaghan hospital with a 40% chance of survival. Both were saved by an excellent staff 66 years ago.

Where is the Celtic tiger for Monaghan General Hospital and the people of Monaghan? Some of the €150 million that was lost on an IT project would benefit it. Even the €3 million spent on photocalls for the Minister for Enterprise, Trade and Employment, Deputy Martin, could save lives there. The National Treatment Purchase Fund has the freedom to spend money as it wishes. Why is the equipment in Monaghan General Hospital not utilised?

Last, but by no means least, 100,000 people are no longer eligible for medical cards and cuts have been made in the home help scheme. That is the current state of the health system.

Jimmy Deenihan (Kerry North, Fine Gael)
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I wish to refer to accident and emergency services, particularly at Tralee General Hospital. It is acknowledged by the Health Service Executive, and by everyone else, that the accident and emergency facilities there are totally unsuitable and inadequate to cater for the requirements of patients and staff. When the hospital opened in the early 1980s the accident and emergency department had a throughput of about 13,500 patients. Now it has 31,000 patients with the same four cubicles and one toilet for both staff and the public alike.

Only one accident and emergency consultant operates in the hospital with the assistance of six SHOs, five who work by day and one at night. The SHOs are typically junior doctors. There are no registrars in the accident and emergency service in Tralee General Hospital. Tullamore hospital, which is a band 2 hospital like Tralee General Hospital, has six registrars while Tralee has none. There are now rumours that the consultant at Tralee General Hospital will be leaving shortly. This would be a major blow not only for patients but also for the morale of existing staff.

No cleaning staff are available after 5 p.m. in the hospital, although the person cleaning the rest of the hospital can be called on in emergencies or if there are spills. In this age of the MRSA, surely a cleaner should be on duty at all times of the day and night?

I call on the Minister to appoint a design team forthwith for the new accident and emergency unit in Tralee General Hospital. The development will feature a resuscitation room, additional treatment and observation facilities, improved waiting areas and special facilities for children. I appeal to the Minister of State, Deputy Tim O'Malley, to convey this to the Minister as soon as possible.