Fergal Browne (Fine Gael)

I welcome the Tánaiste and her officials to the House. She referred to people being kept on trolleys overnight but her Government has been in office for eight years. It is very shocking that a person could present at an accident and emergency unit and leave in a worse state. This was highlighted in the report by the Health and Safety Authority. It stated that as a result of overcrowding there is a risk of violence breaking out between patients and that staff are under pressure. It is outrageous that a person could go to an accident and emergency unit with a minor injury such as a broken finger, be assaulted while there and come out in a worse state. This highlights the chaos which exists.

The Tánaiste referred to money being expended on the service but value for money is not being provided. There is a clear difference in quality of service in any of the countries mentioned by the Tánaiste. There is not value for money for the resources being invested. The health service is not lacking in money; the problem is how it is managing the money.

I made a telephone inquiry to the Department of Health and Children regarding the accident and emergency unit in St. Luke's Hospital in Kilkenny but my call was not returned. I question the sincerity of the Department on these issues. I commend St. Luke's Hospital in Kilkenny. There are no patients on trolleys, not as a result of its facilities but because of its management. The hospital has an excellent minor injuries unit and it maximises its very inadequate accident and emergency unit. The fire escape door is contained within a patient cubicle as was highlighted in the report. The unit is awaiting an upgrade. The staff are working under very difficult circumstances. In some hospitals patients are afraid to use the toilet in case their trolley or pillow is taken while they are absent.

Telephone calls to the "Liveline" programme last week were shocking in their content. Many people are angry. It is appalling that in 2005, in this prosperous country, yesterday 336 people were on trolleys, with neither dignity nor privacy being afforded to them. One is at one's lowest when sick. Patients cannot talk confidentially to doctors and may be exposed to the MRSA superbug. We should be looking after people far better than is the case.

The Tánaiste has been in Government for eight years and she is a member of the Cabinet which approved the now infamous primary care strategy in 2001. At that time the Government promised to spend €1.27 billion over ten years to provide 600 primary care centres across the country. Four years into that strategy, as far as I am aware, €15 million has been expended so far out of €1.27 billion and ten pilot projects are in place out of 600.

I ask the Tánaiste to consider her Government's record on medical card services. Currently 200,000 fewer people have medical cards compared with 1997. She has acknowledged this fact and has introduced GP-only medical cards. This is April so why are we still waiting for those GP-only medical cards to be distributed? I have spoken to the Health Service Executive but no guidelines have been issued on this matter. The legislation has been passed but when will those 200,000 promised medical cards be available?

The Tánaiste promised 30,000 additional full medical cards. How many of those 30,000 full medical cards have arrived? The Government's record is atrocious. The Tánaiste acknowledged in her contribution that the lack of a medical card is causing a problem because people are going to accident and emergency units instead of to a GP. I understand this is a significant problem in north County Dublin as is the shortage of GPs in that area where the ratio of GPs to the population is far lower than in south Dublin.

The report highlighted poor safety training and inadequate protection of health care workers from the risk of violence. It stated that overcrowding in accident and emergency units would lead to increased risk of violence and aggression, an increased risk of injury due to slips, trips and falls, manual handling, aggression, violence and increased risk of infection. It has the potential to compromise fire evacuation procedures and may increase the risk of stress among staff. A person could present in an accident and emergency unit and instead of coming home cured could come home in a worse state.

I suggest the Tánaiste should focus on value for money for the taxpayer. The issue of medical cards is very significant. Problems with accident and emergency facilities cannot be tackled in isolation. Primary care is key and it is time to refocus on the primary care strategy. Why are only ten pilot projects in operation out of the 600 that were promised? Why has only €50 million out of €1.27 billion in funding been spent?

The HSA's report should not be left on a shelf as is the case with numerous other reports. Action must be taken. We should have proper and safe accident and emergency facilities for the benefit of both patients and workers. Patients deserve dignity, privacy and confidentiality and this is not possible if they are accommodated on trolleys. There is plenty of food for thought on this issue. The Tánaiste has been a Cabinet member for eight years and has been in her current Ministry for almost seven months. It is not good enough that she should return to this House to outline the same difficulties in the health system.