Mary Henry (Independent)

I very much agree with the Tánaiste that the accident and emergency services situation is not in itself a problem; there is just an obvious manifestation of problems in the health service. We are spending an enormous amount of money on the health service. Sometimes, I wonder where on earth the money is going. I know that most of it has gone on pay for those working in the service, and their increases are well deserved.

The major problems in accident and emergency services have been brought to the fore because of the fact that, every night, so many people in hospitals around the country find themselves on trolleys. There is no gainsaying that fact. It is terrible for those people. At least they are being seen and someone knows their diagnosis.

There is greater concern about those who are waiting to get into accident and emergency units to be seen. That is a particularly dangerous time. I have asked some departments for figures to find out what has caused that to be the case. Has there been a significant increase in the number of people coming to accident and emergency departments? The answer is "No". Over the past four or five years, there has been an increase of just 1% in Tallaght, but there were 53 people on trolleys there last night. The real problem was the significant cutback in the number of acute beds introduced in the early 1990s.

Additionally, as the Tánaiste mentioned, we have a larger and older population, and far more sub-specialties are being dealt with at the hospitals concerned. For example, the number of oncologists in the country was minimal a few years ago. Now, there are quite a few of them. Many people with cancer are living much longer because they are now getting hospital treatment, and they must obviously occupy beds while getting that treatment.

The same applies to cardiology. We do not have people dropping dead with coronary attacks half as much as we used to. Patients are having stents put in, angioplasty and all sorts of other things done, and those people require beds. In a way, our success in those areas is promoting the problems in accident and emergency departments. The only thing we can do is increase the number of beds or, as the Tánaiste has rightly pointed out, do as Dr. Conor Burke said and ensure those who are fit for exiting the hospital do leave. His report was very worrying. I remember reading that about 30% of people in hospital were there inappropriately for too long.

As an aside, it is extremely difficult to get Dubliners to leave hospital on a Saturday. They will say, "Saturday's flitting is short sitting." It can be a matter of trying to shove people out the door at 6 p.m. telling them it is almost Sunday and asking them what they are worried about. That is a real problem.

My colleagues from accident and emergency departments tell me that minor injuries do not present that great a difficulty. It is a good idea to channel patients to minor injuries units within accident and emergency departments as quickly as possible.

I am concerned about the private minor injuries clinics being set up by VHI Healthcare, for example, and I have made my concerns known to the VHI. For a start, what if a person goes to a VHI minor injuries clinic and it becomes perfectly obvious that the injury is not minor and needs to be treated at an accident and emergency department? I have been told that people in that situation will be taken to such a unit by ambulance immediately.

I asked whether they would go to the top of the queue there. Some people seemed to think that that would be what would happen. I see the Tánaiste shaking her head: she is quite right to think that should not happen. Crucial time might be lost in serious cases if patients first go to a minor injuries clinic but then discover that their fall on the head has resulted in more than just a little cut, and that they have a subdural haematoma. They will then go into the waiting area, which is the area that all my colleagues say is the danger area in the accident and emergency department. There will be one triage nurse trying to decide whom to bring in fastest. People have to get their card, check in and so on. I do not like the idea of minor injuries clinics at all. People will simply lose time or an apartheid situation will set in, whereby those who have money and go to private clinics will end up at the top of the queue when they arrive at accident and emergency departments. I am sure that colleagues would not like that, but that is what could happen.

We might also end up with a dreadful leakage of skilled accident and emergency staff to the private minor injuries clinics. I looked at the charges proposed by the clinic in Galway. People must first go to their general practitioner. Let us say that will cost €40. They will then attend the clinic with their GP's letter and pay €120 to register. Then, treatment will start at €100. That means spending big money almost immediately, which will be impossible for many people. It would be far better to have minor injuries units within hospitals. I gather that is not a problem.

It is also well worthwhile to have acute medical units. I applaud hospitals such as the Mater Hospital, which has an asthma room, which people with acute asthma can attend. I was told that room only has armchairs and that the rule there is, "Don't let them get into a bed." The patients need to be kept in the armchairs and cured there. For the patient, reassurance is frequently the main thing, as asthmatic attacks are unpleasant. I applaud that initiative and I call for more such facilities to be set up.

The stress felt by staff in accident and emergency departments is a serious issue, and we must be worried by the health and safety report. Nursing staff are expected to deal with about three times the number of people they ought to be dealing with. I welcome the proposal that there should be more lavatories in accident and emergency departments, and the suggestion that could solve everything, but the patients are not there to go to the lavatory. They are only supposed to go to the lavatory while they are waiting or before going home. They are not supposed to be in need of those facilities on an ongoing basis. That sort of measure will not solve anything.

As Senator Glynn said, medical staff are now almost entirely non-EU staff. I suggest that we must be seen to be treating those staff in a better manner than has been the case, or we will not have any staff at all. A dreadful problem has arisen with anaesthetists, who were the cream of the crop in India and Pakistan, and who were brought here following the massive recruitment drive in 2000. They were told they did not need to sit the temporary registration examination. However, they now find they are being denied permanent registration unless they sit either the temporary registration or the fellowship examination.

I do not want to see the standards of people on our specialist registers downgraded in any way. However, if promises were made in the past in respect of them — I must re-examine the legislation under which they arrived — we must be fair to such people and not bring them here under false pretences. I was interested to see that the last accident and emergency consultant appointed in the country was a graduate of Karachi university. People from Ireland or the EU are not applying for these tough jobs and they are also not applying for orthopaedic jobs associated with accident and emergency departments. Not one EU graduate applied for the last consultant post in orthopaedics. That is also interesting.

I applaud all the Minister is trying to do to achieve better home care services for people. When I was working in a hospital as a junior we used to keep people in because of poverty at home. Now that does not happen, but we do have a different situation where the extended family is not close by. For example a mother could live in Ringsend but as the family could not afford a house there, they live in Gorey. It would be very difficult for them to drop in on her, as would have been the practice years ago. Very often it is not a lack of care or love on the part of the families, it is simply that they are not in a position to do anything. Home care services can be extraordinarily important in assisting people in leaving hospital.

I am glad the Minister for Health and Children acted so quickly on the Ballymun Health Centre. That was a disgrace. I do not understand the turf war which means the unit, which cost so much to build, has not been in action for two and a half years. While it is still not in action, at least something is being done. I am sure there were wrongs on every side but that should not mean fast action cannot to be taken to get a useful unit up and running. If similar situations exist around the country they should be dealt with as quickly as possible.

The Minister also referred to the national treatment purchase plan. It has meant people have been removed from waiting lists, which is good. The Minister also mentioned the fact that people attend accident and emergency units because there are such long waiting times to get an out-patient appointment. This happens all over the country and is dreadful. It is one of our worst scandals.

Making some hospitals available for elective surgery only is well worth while and Cappagh Hospital, which does elective work only, is a great success. I used to work in the combined Meath and Adelaide Hospital, where the only accident and emergency department was in the Meath Hospital as the one in the Adelaide Hospital was closed. Everyone in the Adelaide Hospital had their heads down doing elective work.

If a major accident occurs, such as a car crash involving a number of vehicles, it must be given priority. Theatres are taken over by such cases and the elective work is put back. This leads to problems rescheduling appointments. I am sorry that places such as Cavan and Monaghan cannot work like that, whereby, for instance, all elective work would be done in Monaghan. While there is a distance between Monaghan and Cavan, those involved might find after a while that they were getting a considerable amount of work done that would not otherwise be done.

I wish the Minister for Health and Children well in what she is trying to do. GPs are disappointed about the primary care units and I support Senator Browne's views on this. I also support the establishment of caredoc units, such as that in St. Luke's in Rathgar and as we may be able to do in Peamount. It means that people can contact a GP service as the units in question are not being used at that time of the day. Where they are in use they are successful.