John Paul Phelan (Fine Gael)

I know Dr. Courtney and I have spoken to him several times about the facilities in the hospital. Several of those in charge of the accident and emergency department of St. Luke's Hospital to whom I spoke this morning expressed serious reservations about the facility and noted significant problems with it. I will address these a little later.

I am surprised and disappointed that the emphasis of Government Senators appears to be on the amount of money being spent on the health service. Senator Feeney, for example, listed a number of countries which spend less per capita on health than Ireland. Despite this, our health service is much worse than that of the countries mentioned. We have spent more per capita than other countries for several years but place no emphasis on achieving value for money or obtaining a return on investment.

All Senators have heard horror stories about accident and emergency units and this debate offers a welcome opportunity to raise the serious issues involved. The problem in our accident and emergency facilities revolves around overcrowding, as mentioned already, which is a function of the increase in the number of patients visiting the units, and blocked access, which is the problem of finding beds for incoming patients. These two separate issues are sometimes confused or no distinction is made between them.

In preparing for this address I spoke to several people who work in the health service in St. Luke's Hospital in Kilkenny and Waterford Regional Hospital. I was impressed by one doctor who referred to the system of key performance indicators operated in Australian and New Zealand accident and emergency departments. Once patients have seen a triage nurse, they are graded according to the gravity of their condition and placed in one of five categories. A period of time is indicated for each category within which patients must be seen by the doctor on call. A similar approach could be adopted here with great effect. The so-called Manchester system introduced in some Dublin hospitals to grade patients has not worked to date.

The time patients must wait before being seen in accident and emergency units is a serious problem. Thankfully, the last time I attended an accident and emergency department was a couple of years ago. Even then, however, I had to wait several hours before being attended to. My secretary told me this morning that she attended the accident and emergency facility in St. James's Hospital around two years ago and spent two days, most of it attached to a drip, sitting on a chair in the waiting room. This occurred during the first crisis in accident and emergency departments which struck in the winter of 2002 or thereabouts. Unfortunately, the problems experienced in hospital accident and emergency units each winter have not been satisfactorily addressed by the Government.

I admit that when the Tánaiste, Deputy Harney, was appointed Minister for Health and Children I was confident she would achieve change because I regarded her as the right person for the job. I expected action following the years of dillydallying under the previous Minister. After eight months with the Tánaiste in charge I regret that little action has been taken.