Gerry Adams (Louth, Sinn Fein)
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Tá mé fíor-buíoch don Cheann Comhairle as ucht seans a thabhairt dom labhairt ar an ábhar dáiríre seo. Cé go bhfuil áthas orm go bhfuil an Aire Stáit anseo linn, tá mé míshásta nach bhfuil an Aire, an Teachta Reilly, i láthair. Is ceist an-thábhachtach í ceist na ndaoine le TB.

This morning, I visited Our Lady of Lourdes Hospital in Drogheda. I visited it several times in recent months and witnessed many patients, some of whom were elderly, lying on hospital trolleys or sitting on chairs or the floors while waiting to be treated by an overstretched and overworked medical staff. Níl a fhios ag na n-othair seo cathain a fheicfidh siad dochtúir, nó an mbeidh leapacha cearta acu. Tá an córas slándála atá againn sa tír seo ar nós córas sa Tríú Domhan.

Last Friday, it was revealed that a patient who had been on a trolley in the emergency department for five days had TB.

Gerry Adams (Louth, Sinn Fein)
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I do not want to cut across the Minister of State and Deputy Ciarán Lynch. Gabh mo leithscéal - tá mé ag caint faoi rud an-thábhachtach. Three other patients and an undisclosed number of staff are being screened for this dangerous disease.

The deterioration in the hospital's situation is not unexpected. Bhí mé ag tabhairt amach anseo faoi sin. Chuir mé eolas faoin slí criticiúil ina bhfuil saoránaigh sna otharlanna seo roimh an Aire agus an Taoiseach. Three weeks ago, Deputy Tóibín, Dr. Ruairí Hanley and I wrote to the Health Information and Quality Authority, HIQA, to ask it to launch a full public investigation of the hospital's emergency department urgently and immediately and to publish the findings. We did so because Drogheda has consistently ranked as the hospital with the worst waiting list in the State. For months, the number of patients on trolleys at the hospital has consistently exceeded 30, resulting in significant pressure on the emergency department. This represents a clear threat to patient safety and welfare. Management at the hospital has responded by putting into effect the full capacity protocol, which means that it identifies spaces in wards in which to place patients even though the wards may not be appropriate to the patients' health needs.

HIQA declined to order an investigation. In light of the TB case and the ongoing crisis in the emergency department, I am calling on HIQA to reverse its decision. I am disappointed that the Minister for Health is not present, although I am grateful that the Minister of State is substituting for him. If HIQA continues to refuse to order an investigation, the responsibility for doing so falls to the Minister. I am calling upon him to do it.

Róisín Shortall (Dublin North West, Labour)
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I thank Deputy Adams for raising this issue. The Minister, Deputy Reilly, is not in a position to take the debate, but I will do so on his behalf.

The incident raised by the Deputy related to a patient who presented to the emergency department of Our Lady Of Lourdes Hospital with symptoms unrelated to TB. In all, the patient spent five days in the emergency department. During his time there, he was given a chest X-ray and was found to have TB. Following the discovery of TB, appropriate isolation and treatment commenced.

During the period that the patient spent in the emergency department, three patients were identified as potentially having had contact with him for more than ten hours. They have been contacted, counselled and offered testing for TB. All staff with potential contact have been offered counselling and TB testing. Our Lady of Lourdes Hospital has reassured the public about the incident, saying that contact had been made with the patients involved. The HSE is satisfied that the incident has been appropriately handled from the points of view of infection control and contact tracing.

While it is important that any public concern be allayed, I will address the wider issue of emergency department waiting times. The Minister does not consider it acceptable that a patient should wait five days. To tackle unacceptably long waiting times in emergency departments, he set about establishing the special delivery unit, SDU, immediately following his appointment. Its aim is to unblock access to acute services by improving the flow of patients through the system. The SDU is focusing initially on emergency departments and will be working to support hospitals in addressing excessive waiting times for admission to hospital.

Gerry Adams (Louth, Sinn Fein)
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I have a great deal of sympathy for the Minister of State, who has probably been handed a script to read out, but her reply was unsatisfactory. She did not mention that the patient was on a trolley for five days. Instead, she stated: "In all, the patient spent five days in the emergency department" and the Minister "does not consider it acceptable that a patient should wait five days". Today is Tuesday. The Minister of State should imagine being restricted to a trolley, even in the best of health, until Sunday. Her reply is not worth the paper on which it is written. Will there be an inquiry? Were we advised of measures that will be put in place to discover how this situation occurred?

In its five point plan the Fine Gael Party pledged to reform the health service and cut waiting lists, but it is prepared to perpetuate the mess initiated by Fianna Fáil and the Progressive Democrats. Today there are 344 patients on trolleys across this State and 28 of these are in Drogheda. The waiting list for hospital treatment has increased by 40% since the start of this year.

The health service is not being properly funded. That is obvious to the professionals - I met with the management briefly today - and to the patients. The Government says the money is not there but that is not true. Politics is about choice and everybody present in this Chamber knows that. The Government is making political choices. A political choice was made to read a script such as the one the Minister of State read. It contains a big lie in that it omits the fact that this person was on a trolley. A political choice will be made on 2 November to give €700 million of the people's money to unguaranteed banks. The Government is making a political choice in paying off unguaranteed bondholders instead of the fixing the health service. That is not acceptable and I do not mean this personally in terms of the Minister of State, but tá a lán rudaí mícheart leis na rudaí anseo. There are many things wrong but this is one issue and one problem which can be fixed.

There is a hospital up the road from Drogheda that has a 23-bed ward which is closed. Across that region there are 62 patients, mostly elderly people, who have already been medically discharged but have nowhere to go because of the mess in regard to the fair deal scheme.

This matter needs to be resolved. With all the fine rhetoric that sometimes flows about citizens' rights, the republic and so on, when it comes down to it if one is lying on a trolley in a hospital corridor and contracts TB, that is how one measures one's republic.

Róisín Shortall (Dublin North West, Labour)
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When I responded to the Deputy's matter, I told him the factual position. The patient concerned was in an emergency department for five days and during that period was discovered to have TB. The appropriate action was taken at that point in terms of isolation and treatment.

I said at the end of my reply that the fact that anybody is on a trolley for five days is not acceptable. That is why this Government is setting about introducing fundamental reforms to the health service. It is an absolute priority of both parties in government to bring about that reform. They are the political choices that this Government is making. We are setting about a root and branch reform of the health service and considerable work has been done to date. It is one of the reasons we are committed to introducing a single tier health system because it is not a question of tinkering at the edges with the existing health system. The issues are much more complex than simply being about funding. The whole system needs to be changed and we are determined to do that. That is set out clearly in the programme for Government which commits to introducing a single tier health system based on providing care on the basis of a person's need rather than on his or her ability to pay. That will happen as soon as possible. We are introducing an insurance-based health system. We are doing that as soon as possible and in the short term we are introducing significant reforms in the primary case area.

In addition to that, very soon after being appointed, the Minister established the special delivery unit, SDU, whose job is to act as a hit squad, as it were, to target those hospitals where there are difficulties, where systems are not properly functioning, to enable them to deal with the kinds of demands that they have. That work by the SDU is well under way. It has examined a number of hospitals and identified 15 that provide unscheduled care and those hospitals that need urgent support from the SDU. Among those hospitals are eight that currently account for approximately 60% of the trolley count. Our Lady of Lourdes Hospital is one of those eight hospitals. Those hospitals have been identified as needing urgent and high level support from the SDU. The eight hospitals have recently been asked for proposals setting out measures that could be taken quickly in the hospital and-or in a closely related community setting which would significantly relieve pressure on the emergency department by, for example, addressing delayed discharges and having step-down beds. Proposals relating to seven of the hospitals or associated community services have just been received and will need to be given very detailed consideration by the SDU. These proposals from the seven hospitals include proposals from Our Lady of Lourdes Hospital and the SDU is examining those urgently with a view to implementing them very quickly.

A good deal of action is being taken. The Government is committed to longer-term reform and that work is well under way and in the shorter term the SDU is addressing the current logjams that exist in many of our hospital emergency departments. The proposals have just been received from Our Lady of Lourdes Hospital and they will responded to very quickly. I thank the Deputy for raising this issue.