Michael D Higgins (Galway West, Labour)
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The background to this matter concerns whether there is a level below which guarantees concerning health will be made to Irish citizens. Professor Drumm seems to be operating a system which is based entirely on a business model. He says he must function within an allocation and, in order to meet it, will let staff go if necessary. What happened in Galway is a dramatic anticipation of that. For example, this morning the number of patients awaiting admission to the emergency department at University College Hospital Galway hit an all-time high with 40 patients on trolleys. Six of those had intravenous infusions and had to be treated in the public waiting room of the accident and emergency unit.

I support the statement issued earlier today by the Irish Nurses Organisation, which made the point that yesterday two nurses were expected to assess 96 patients who checked in between 1 p.m. and 8 p.m. Who is responsible for this situation? Is it Professor Drumm, the Minister, the HSE or the Department of Health and Children? Whoever it is, they are responsible for allowing health care to sink to a level at which professional standards cannot be sustained. This is a most serious matter. University College Hospital Galway simply ran out of space.

I recall that a former Attorney General ruled that the Minister is responsible for the minimum care of every citizen. It is not a delegable responsibility, so she must answer for this. In my view, Professor Drumm is not free to operate the model he is currently operating, which includes 40 patients on trolleys in Galway. Shamefully, in many cases, there are no cubicles for patients who are accommodated on trolleys, and no space for them in the hospital corridors. Therefore, there is no privacy or any concept of a minimum level of dignity. In addition, nurses are being asked to compromise their professional standards. To its credit, the INO says it cannot stand over the quality of care it delivers to patients in such circumstances. The INO further states that such things are happening daily in our hospitals.

Over a long period, I have received unsolicited e-mails from the HSE telling me about the number of people waiting in accident and emergency units practically all over the country. I do not want to receive such e-mails, but I do want to know who is guaranteeing the minimum standards in situations such as the one I have described. Will the Minister accept responsibility? Will she intervene through the Department under the HSE, not only regarding accident and emergency units but also concerning respite care and home helps? The Government will be held accountable in this House to provide a basic, minimum service. Those affected in Galway were very patient yesterday. Most of those who witnessed what took place accepted that there had been breaches of the Health and Safety Authority's guidelines. They also accepted that the staff were doing their best. They are hard workers but should not be put in such a position. At midday today, after I had submitted this matter for discussion on the Adjournment, there were 25 patients awaiting admission at the accident and emergency unit in Galway.

Professor Drumm should get out of the way if he is obstructing decent standards in hospitals. The Minister has a constitutional and legal responsibility to this House. She never got the right to transfer and delegate responsibility for basic minimum health standards to anybody else.

Pat Gallagher (Donegal South West, Fianna Fail)
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I am taking this matter on behalf of the Minister for Health and Children, Deputy Mary Harney. She has asked me to apologise to Deputy Michael D. Higgins as she is unable to attend the House at this time.

The Health Service Executive has advised that University College Hospital Galway has been extremely busy over the past 24 hours or so. Deputy Higgins has provided information to the House in this respect. The HSE has also advised that the hospital put in place a contingency plan to address these pressures in order to ensure that all patients are accommodated today and that no patient is required to wait more than 24 hours for admission.

The HSE has also advised that it has made significant progress at University College Hospital Galway by improving the discharge planning process and increasing the uptake on day care in line with the findings of the bed utilisation review commissioned by the HSE.

Michael D Higgins (Galway West, Labour)
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That is just a load of old rubbish.

Pat Gallagher (Donegal South West, Fianna Fail)
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In addition, as part of the developments to improve accident and emergency services, a 13-bed medical unit is under construction at the hospital, which is expected to be completed towards the end of this year. Improving the delivery of accident and emergency services continues to be a top priority for the Government and the Health Service Executive.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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When did that start?

Pat Gallagher (Donegal South West, Fianna Fail)
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At national level, significant additional resources have been provided to address the problems which manifest in emergency departments.

Michael D Higgins (Galway West, Labour)
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The Minister of State should set it to music.

Pat Gallagher (Donegal South West, Fianna Fail)
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Among the developments which have taken place are additional public and private long-stay beds, additional home care packages and home-help hours.

Michael D Higgins (Galway West, Labour)
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They have been cut.

Pat Gallagher (Donegal South West, Fianna Fail)
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The developments also include major capital developments in emergency departments, the provision of acute medical assessment units, a hospital-in-the-home service in the greater Dublin area, rapid assessment clinics to support the catchment population of the Mater Hospital, and an expansion of the GP out-of-hours services in north Dublin.

In terms of waiting times, a revised target of 12 hours waiting, from decision to admit, was introduced in October last year. This built on an initial maximum target waiting time of 24 hours. The HSE has advised that the majority of patients in the accident and emergency unit at University College Hospital Galway have been admitted within 12 hours since the 12-hour target was introduced. The HSE is also committed to monitoring and reporting on the total length of time patients spend in emergency departments, irrespective of whether they are admitted. A number of hospitals have commenced reporting this information and the HSE expects to be in a position to publish data on up to 18 hospitals in the next few months.

Michael D Higgins (Galway West, Labour)
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This is just self-justifying rubbish.

Pat Gallagher (Donegal South West, Fianna Fail)
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The HSE is also working closely with those hospitals that are experiencing difficulties in meeting waiting time targets. The focus is on improving and streamlining hospital processes and patient pathways to ensure that care is provided in a more timely, appropriate and efficient manner.

Targeted initiatives include setting up consultant-led clinical decision units and acute short stay units with a dedicated number of beds and integrated discharge planning implemented on a seven-day basis, including nurse facilitated discharges.

Michael D Higgins (Galway West, Labour)
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I think this is an internal memo.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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We are used to getting them as we get nothing else.

Pat Gallagher (Donegal South West, Fianna Fail)
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Other targeted initiatives include updating the bed management system and processes with a focus on improved discharge planning, reducing inappropriate referrals from GPs to emergency departments, reducing admissions with the duty medical registrar deciding on admissions, standardising assessment processes and enhancing diagnostic capacity.

The initiatives I have described are designed to free up capacity during 2008 to allow for more timely admissions to emergency departments and further movement towards a lower target of six hours waiting time from the decision to admit.

This is the aspiration and we hope to achieve it. I note the very strong case Deputy Higgins has made regarding the number of patients on trolleys in University College Hospital, Galway, and the number of nurses who deal with the waiting patients. I do not doubt his assertion that two nurses deal with 96 patients. I will bring his strongly held views to both the Minister and the Health Service Executive shortly. I am anxious to ensure this situation is resolved.

Michael D Higgins (Galway West, Labour)
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I thank the Minister of State.