John Minihan (Progressive Democrats)

I welcome the Tánaiste and Minister for Health and Children to the House, and welcome the opportunity to contribute to this debate. There is no doubt that the health service, particularly accident and emergency departments, are to the fore of much recent political activity. Our health service needs to be focused and directed at patients, who must be at the centre of all actions and decisions we take.

Sir John Harvey Jones, the world-renowned industrialist and trouble-shooter is quoted as saying: "Managing the health service is a nearly impossible task and even if you did manage it nearly perfectly, I still think the system needs more money." Although he said that in 1992, his view today would be the same and all sides of the House would agree. People may say that nothing has changed. This debate will no doubt centre on one or both of the key elements referred to in that quote, management and money. However, there will be no reference on this side of the house to the impossibility of the task. Managing the health system and accident and emergency units is not impossible. It is difficult and testing but it can be done.

Much has changed since 1992. Over the intervening years we have built up economic success and the country has been transformed. At that time we felt many of the challenges we then faced were impossible to overcome. Many were the result of economic stagnation and recession. Today we have new challenges but I refuse to adopt a pessimistic view and would rather have to deal with these challenges, which arise from success rather than failure. In this regard, the Tánaiste is committed to seeing the fruits of our economic performance invested in the health care sector. This commitment is most apparent in the increased investment in services for people with disabilities and those with mental health problems.

It is time to apply the energy and methods that have served us in the past to our current challenges, which include accident and emergency units. I am glad that of the five priority areas outlined by the Tánaiste, accident and emergency units are top of the list. They perhaps pose our greatest challenge but it is not an impossible task.

People judge their experiences of our health service by their experiences in accident and emergency units. Over 3,000 people per day, that is more than 1 million patients per year, are judging our health service in this way. Success in tackling accident and emergency units will have real benefits for many people and health reform will also provide benefits for the 120,000 people working in the sector. That is a huge incentive to meet this challenge head-on.

The complexity of health service reform is continually recounted. I will park that idea for the moment, but before I do I will refer to a recent keynote address by the Tánaiste when she stated that she had brought forward a ten point accident and emergency plan for this year, that every action in the plan is being implemented now and if new action is needed it will be taken. She also stated that if new decisions are needed they will be made. This is testament to her commitment.

This sector is complex but we must, and thankfully do, have a pragmatic and determined starting point. That has not always been the case. Unlike in the past, reaching points at which difficult decisions must be made will not block progress. They must and will be overcome.

People are on trolleys at a time when others stay in hospitals for a weekend just to get test results. People attend accident and emergency units to access all kinds of services, including securing long-term care. I know at first hand the problems that exist. Last month the accident and emergency facility in Cork University Hospital had to close its doors to all but ambulance admissions due to overcrowding. Staff found that there were up to 30 patients waiting on trolleys.

These problems must be overcome. Sometimes taking on a challenge can set one back but we cannot shy away from this. Despite the negative comments from some quarters, the Tánaiste did not shy away when a prolonged problem in the health service had to be tackled.

She tackled the nursing home charges issue, she took on the challenge of the failure to implement properly the decision made by the Supreme Court 29 years ago. The State will honour its obligations, although the costs will be high. There is no doubt that the administrative and financial costs will divert energies away from tackling the accident and emergency services challenge, but we have to get on with things. If new actions are needed, they will be introduced. If new decisions are needed, they will be made. No one will shy away from those responsibilities. Encouraging people to leave acute beds to take up nursing home care has been made more difficult as a result of the current situation. However, this has not prevented the Tánaiste from tackling the nursing home issue and she will not be frustrated in tackling accident and emergency services. That is the committment she has made.

There are two aspects to this, money and management, which will be central to most statements in the House today. That is inevitable. Health spending accounts for a quarter of all Government expenditure and the Government has given top priority to this area by allocating €11 billion, an increase of 9.9%. The allocation of €2.8 billion for disability services is a powerful statement of the committment of this Government. The ten point accident and emergency services plan is fully funded. The Minister has allocated €70 million of current funding and €10 million of capital funding for accident and emergency services. Let us not get bogged down in figures though because they are scant comfort to those people on trollies or awaiting test results. However, they are evidence of the committment that exists. Every day we see evidence that real committment and dramatic action are needed.

I welcome the programme of inspection of the 11 accident and emergency units by the Health and Safety Authority, which began in March. I expect that the Health Service Executive will use the time given to it by the HSA to address the issues raised in the report. I also welcome the HSA's plans to visit four more accident and emergency units. The Health Service Executive, established in January 2005, has the responsibility to manage and deliver health services. People expect those health services, accident and emergency and other services, to be delivered in a safe manner and in compliance with health and safety law. This raises further challenges, but the Minister has shown throughout her career that she sees challenges as opportunities. I have no doubt she will embrace this opportunity to make progress on this matter, with clear planning, investment and determination.

I have had personal experience of the problems in the accident and emergency unit in Cork. However, because of planning, investment and determination, progress has been made in Cork. The new accident and emergency department became operational on Monday last. The unit, which is two and a half times the size of the old one, was developed at a cost of €11 million and will have the capacity to deal with 50,000 patients per annum. Before we listen to more negative comments from some quarters, I also point out that staffing has been increased by more than 70%. Planning and investment are making a difference. The project in Cork took eight years to complete. It is part of a €200 million expansion at Cork University Hospital. We are all working hard, no one more so than the Tánaiste, to ensure similar progress is made elsewhere. Problems must be acknowledged but so too must progress. Our objective is to make more progress and to do so quickly.

Historic problems have meant that facilities are inadequate or sometimes non-existent. Building new facilities takes time but they are needed now. That is why we are looking at new ways of addressing the issue. We know the old ways do not work. No matter what noises are made by other parties, we must face up to the challenge of providing facilities quickly in whatever manner is feasible.

Let us examine some of the facts. For the next five years the Government has set aside €2.5 billion for health capital investment, an enormous sum of money. Providing the physical buildings and equipment will result in that money disappearing very quickly. We need new ways to address this problem, ways which appear new in Ireland but are not new abroad. Combining public and private investment to develop health facilities has worked in Europe and Australia and there is no reason it cannot work here. There are people who are willing to invest money, at home and abroad, in sectors of demand. There is urgent demand in the health sector, for radiotherapy, BreastCheck and a new children's hospital. If private investment can be introduced in true partnership for the benefit of patients, we must make it happen.

Managing the health service is an almost impossible task and even if it were managed perfectly, it would still need more funding. That was the assessment of Jones in 1992. With the Tánaiste holding the Department of Health and Children portfolio, I have no doubt she will make certain the health service is managed as perfectly as it can be. The €11 billion budget provides more funding than ever before. The plans to introduce new sources of funding will ensure the system gets even more money.

The accident and emergency services challenge is a serious one. The lack of services causes distress and outcry, and rightly so. However, the challenge is being met head-on by the Minister and this Government. It is easy and opportunistic to point out problems for political or parochial gain, but the action the Government is taking is providing real benefit to patients. We are making progess. Thanks to our policies in the past, we now have more resources than ever to make progress. This is due in no small way to the work of the Minister and I welcome the fact that she addressed the House today.