Cyprian Brady (Fianna Fail)

I am grateful for an opportunity to debate the issue of accident and emergency services and welcome the Minister of State to the House. I congratulate the Tánaiste and Minister for Health and Children on putting herself forward for a portfolio which everybody accepts is particularly difficult.

As is evident from the contributions, Senators on all sides accept and realise that problems remain with regard to the lack of progress in tackling the issues surrounding accident and emergency services. This issue must be considered in the context of the health service as a whole. The accident and emergency service is just one piece of a complex jigsaw. If one piece is missing, we do not have a complete picture.

Major strides have been made in recent times to resolve the problems in accident and emergency units and I welcome Senator John Paul Phelan's admission that money is not the problem. In recent years, major changes have taken place in the health service in general, with improvements in cancer and cardiac services, provision of enhanced mental health services and community rehabilitation units as well as additional respite day and long-term day places for the physically and intellectually disabled. Ireland is recognised worldwide for its efforts in research and development. All these developments have occurred over time.

The accident and emergency service is the first port of call for most people. It is the coalface of our health service and therefore its most important element. A vast number of dedicated, committed, highly-skilled people work in the health service, particularly in trauma treatment and accident and emergency services. In general, these workers want to provide a top-class service to the public and it is our task to assist them to do so. All efforts made, and I refer again to the efforts made by the Tánaiste and Minister for Health and Children in the short time she has been in the portfolio, have been directed towards enabling workers in the health service to provide that service.

A number of Members have mentioned that financial, accounting and resource management are the key to the provision of such a service. Demands on the health service have changed. People now live longer. If we are to provide an adequate service, there must be future planning. This is a key issue. The Brennan report stated there was "a managerial vacuum at the centre of the health service" and "an absence of a system of structured accountability".

These are the issues we must tackle. The provision of staff, facilities and adequate backup systems are also issues, but we must plan for the future. Senator Ryan pointed out that we are in our current situation with accident and emergency services in particular because no forward planning was carried out back in the 1980s. Things were tight and decisions which have proved to be inadequate were made based on the situation at the time. We are still playing catch-up, despite the huge investment over the last number of years and the commitment of this Administration and its predecessor to tackle the problems. Previously, successive Governments had failed to tackle the problems head on and failed to provide adequately for them.

I welcome the establishment of the Health Service Executive from 1 January 2005, which was another recommendation from the Brennan report. It will go a long way towards centralising responsibility and will concentrate on the day to day administration of the health service without becoming involved in policy or future planning. That is the responsibility of the Minister and the Department of Health and Children. The Health Service Executive will provide adequate facilities and backup for the day to day running of the health service.

Senator Feeney pointed out that more than 3,300 people per day or 1.2 million people per annum are treated by our accident and emergency services. The Tánaiste highlighted a number of steps which are worth repeating. For example, she mentioned the 500 step-down places in private nursing homes, which is a major issue. Every hospital in the country will admit there are people in hospital who should not and do not need to be there. Tackling this issue is only one part of an overall strategy. The GP out-of-hours service is another issue. I could not believe that the GP service stops at 5 p.m. People have no alternative but to go to accident and emergency departments at the weekend. There is nowhere else to go. I am glad the Tánaiste's discussions with the consultants on working hours are continuing. She is also continuing her discussions with nurses and nursing unions. Great efforts are being made and all these elements are essential.

I welcome the health and safety report on hospitals. It is a positive and progressive step because it points out the inadequacies in the system. Over the years, I have heard people say that the winding down of the involvement of religious orders in staff training and day to day running of hospitals is an element of the problem. Our approach and the demands on the system are changing. Huge resources are being put into major cleaning contracts in hospitals. Cleanliness is an important issue, as we can see currently in the UK.

As Senator Feeney has stated, major issues exist, which we could debate for a longer period. While everyone accepts there are still problems, major steps are being taken to resolve them. No one should be left in the position currently faced by some people. We hear the horror stories but not the good news. For example, last Saturday night, there were four people on trolleys at one stage in the Mater Hospital in Dublin. We heard no mention of that. This is a priority for the Government which it will tackle.