Sheila Terry (Fine Gael)

I welcome the Minister of State to this important debate. No one here hopes to get sick or hurt or to have a family member with a need to go to an accident and emergency unit this coming weekend, whether in Dublin or elsewhere. If we are unfortunate enough to need such units, we may as well bring our weekend cases with us. We will be there for as much as a day and a night. If one sprains an ankle, requires stitches or falls seriously sick, it is a weekend job.

The overcrowding in our accident and emergency units is in a state that would not be found in a Third World setting. Dublin is the worst, Beaumont Hospital and the Mater Hospital in particular. How can we address this problem? I accept that the Tánaiste has a difficult job and has inherited a bad situation and I wish her well in trying to deal with it. We must examine some of the causes and solutions. One significant cause is that there are 3,000 fewer hospital beds in Dublin now than in the late 1980s. They were taken out of the system and have not been replaced. We must consider our increased population, elderly and otherwise, and address this urgent problem.

The number of elderly people occupying beds in hospitals through no fault of their own was mentioned. We must look after our elderly and I respect that the Tánaiste is trying to do so. However, 400 elderly patients in Dublin hospitals should not be there. They need long-term institutional care. Many could go home if services were available, leading me to another issue. There are no institutional long-stay provisions or community services to allow some of these patients to return home. The lack of community care services is wrong and must be addressed.

Home help hours have been cut in some of Dublin's health districts. An elderly person now receives home help for two hours per week. I do not accept this as enabling a person in hospital who requires home care to go home but this is all some people are getting. I was surprised to learn from a public health nurse this morning that patients are asked to contribute whatever they can towards the costs of the two hours, be it €5 or €12. What type of country is this when we ask people to do this for two hours per week? It is difficult to get home helpers but there are excellent home help workers out there. We must employ and keep them with us but if we cut their hours or cannot employ more people, they will get jobs in other areas. There are 27 elderly people on a waiting list for two hours per week of home help in south inner city Dublin. Community services must be improved if we are to return some of these people to their homes.

We need minor injuries units to alleviate the problems in our accident and emergency services. There is no point in taking up a place in an accident and emergency department if one sprains one's ankle or needs a stitch in one's finger if sitting beside a person with a heart condition, high blood pressure or suffering an asthmatic attack. It was mentioned that acute medical units will be set up in two hospitals but I am unsure what these units will constitute. Will the Minister of State explain what they are? Are they assessment units for minor injuries or sport injuries? Are they acute medical admissions units? A decision has been taken to introduce them into two Dublin hospitals. Will the Minister of State tell us where they will be located?

If the acute medical units will be similar to the unit established in St. James's Hospital, they will be a waste of time. The unit in St. James's Hospital could only transfer patients into an acute medical ward if they stayed there for no more than one week. This reverted to being a long-term ward. If we are to ring-fence units and beds, we must ensure they are available for their intended purpose. I invite the Minister of State to examine the matter of palliative care beds. I support the establishment of special oncology units in two Dublin hospitals because we must provide services for patients who need palliative care. The service is unacceptable at present.

Staffing of nurses in our accident and emergency units is another issue. It is not fair on the patients or the present staff when agency nurses are brought in. I spoke to somebody last night who told me about a friend who was feeling very ill who, for eight weeks, went around different hospitals in Dublin and its environs but was not admitted to any. She went to Beaumont Hospital twice, to the Royal Victoria Eye and Ear Hospital twice, because the problem related to her ears and head, and to two private clinics in Clane and Tullamore. Finally, her sister, who happens to be a nurse, brought her to Blanchardstown hospital and insisted the woman was seen and admitted. She is seriously ill and will spend some weeks in hospital in Blanchardstown. Our diagnostic services leave a lot to be desired. I wish the Tánaiste well and hope she will be able to make improvements.