Finian McGrath (Dublin North Central, Independent)
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Question 34: To ask the Minister for Health and Children his policy plans to deal with the crisis in our accident and emergency departments [7846/11]

James Reilly (Dublin North, Fine Gael)
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The waiting times for patients attending emergency departments in many hospitals during last winter and in particular the first week of January of this year were unacceptable. I am determined that this should not happen again.

The difficulties in emergency departments cannot be resolved solely within the emergency departments themselves and must be addressed on the basis of a health-system wide approach. This must start with ensuring that patients are treated in the most appropriate way in the most appropriate location. This means that where and whenever possible patients who can be treated in the primary care setting receive that treatment in a timely manner. This will ensure that patients can be confident of receiving the necessary treatment on time and that there is less need for patients to attend at emergency departments. Specifically, we need to address waiting lists for inpatient procedures - as patients are left waiting they become emergencies and end up in emergency departments.

I am in discussions with the HSE and my Department and we will have a clear plan of action to address the problems in emergency departments both for the coming year and in the long term. I am confident that with careful planning, with the implementation of the HSE's emergency medicine programme and related clinical programmes, and the roll-out of acute medicine units we will be in a position to reassure patients that the experience in emergency departments during last winter will not be repeated.

I have already stated my intention to establish a special delivery unit to tackle the problem of waiting lists including difficulties in emergency departments. Intensive work is now being undertaken in preparing the ground for the unit's establishment. I have held a range of meetings to discuss with my officials and the HSE the most effective methodology for setting up the unit and we are progressing this work with all urgency. I am very pleased to say we are getting very good co-operation.

Finian McGrath (Dublin North Central, Independent)
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I thank the Minister for his response. This is the first opportunity I have had to congratulate him on his appointment as Minister for Health and Children. I wish him all the best. While I know it is early days yet, there are many health policies that I would strongly support. I will revert to him in 12 months to see how he is getting on.

Is it acceptable to have patients lying on trolleys and chairs while beds are lying idle upstairs in those hospitals? Would the Minister agree that it is a national scandal to have senior citizens and very sick people lying on trolleys in corridors where there are disorderly people? Has the Minister ever witnessed the drunkenness, intimidation and violence on a Saturday night in accident and emergency departments? Does he agree that after ten years of massive wealth and extra finances, it is criminal that the accident and emergency issue has not been sorted yet? How long will it take for the Minister to sort this problem out for once and for all?

James Reilly (Dublin North, Fine Gael)
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I will answer the easiest question as to whether I have ever experienced Saturday nights in emergency departments. I have experienced them numerous times because I worked in them. However, that is not to make light of the situation where people feel threatened - both staff and the people lying there ill and distressed. The drunken and violent behaviour of some of our citizens is not acceptable. The real issue is a health service that has not been functioning and has not been joined up.

In order to answer the question in a comprehensive fashion, it is very clear that we need to reduce the inflows into emergency departments by having more prevention and more chronic illness care in the community along with more early diagnosis and treatment. Family doctors should have access to X-ray, ultrasound and blood testing to diagnose and treat patients so that they do not end up in the emergency department. When they end up there and once a decision is made to admit, there ought to be a bed in the hospital to which that patient can go. We are looking for ways to achieve that because not only do we have the beds that have been closed, as Deputy Kelleher has pointed out, but we also have a host of other beds unavailable because of delayed discharge, where people are awaiting placement in the community. I have a team examining the issue to determine how we can alleviate the problem particularly in urban areas where the problem is most acute. Furthermore, downstream we also need to have more rehabilitation in the community. We are going out into the field to get quotes for those services from nursing homes so that we can expedite the passage of patients through the system.

As I mentioned earlier, the medical care programmes are considering how to discharge patients earlier and the mechanisms of how hospitals work. These are basic time and motion studies to help move patients through quickly. People do not want to be in hospitals any longer than they need to be as we all know.

Finian McGrath (Dublin North Central, Independent)
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The Minister said he hoped last winter's situation will not be repeated. How does he intend to deal with that? He mentioned preventive measures and the community response issue, but how is it possible to stop people getting into a violent situation at 10 p.m. or 11 p.m. on a Saturday night entering hospitals when there is no GP service? Part of the solution is that we must have the beds to provide for the patients.

James Reilly (Dublin North, Fine Gael)
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The Deputy has asked a series of questions and I doubt if I can answer them all in the time allocated to me. There are some things we can do to alleviate the situation in the very short term over the next few months; there are other things we can do in the more medium term for the winter; and then there is the longer-term solution which I have outlined already. In answer to the question as to how to stop people getting involved in violence, with no disrespect-----

Finian McGrath (Dublin North Central, Independent)
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I am referring to people turning up at the hospital.

James Reilly (Dublin North, Fine Gael)
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----- they turn up at the hospital because they have been injured and I suppose they need hospital care. If it is an issue that would be more appropriate for them to attend a general practitioner service, that is something we are also looking at. The reality is that if there has been a fracas and there are suspected fractures etc., without having diagnostics in the community they will turn up at emergency departments.