Brendan Daly (Fianna Fail)

I thank the Minister of State, Deputy Seán Power, for the work he is doing on care for the elderly. He recently visited County Clare and he is aware of the problem with Alzheimer's disease. The people in Clarecastle and Carrigoran are anxiously awaiting the Minister of State's return with some support to enable them to continue the work they are endeavouring to do in a difficult situation.

One cannot divorce many of the problems in accident and emergency departments from the general problems in hospitals and, in turn, the problems that arise for elderly people and people with various other problems, such as dementia, that need attention. I will focus my contribution on the situation in Ennis.

Ennis General Hospital is part of the regional structure of the Health Service Executive, mid-western area. The Minister of State must direct the attention of the Tánaiste to the hospital's uncertain position. It is over a year since a high-powered delegation, which included Members from County Clare and the representatives of the Ennis General Hospital development committee, attended a meeting with the Tánaiste in Dublin to emphasise how important it was to press ahead with the hospital's development. The hospital was built in the 1940s, at a time when its design was adequate for the needs of the people of Clare. The nursing and medical staff have given an outstanding service to the people of Clare. That is why there is widespread apprehension in Clare as to the hospital's future.

Over the past six years, the then Mid-Western Health Board worked on an overall hospital development plan for Ennis which included the upgrading of the accident and emergency department. The department is a small unit in the hospital complex, inadequate to meet the needs of those attending it. Approximately 22,000 people a year attend the department, of which 5,000 are admitted to the general hospital. One problem that is delaying the throughput of patients is the absence of a CAT scan facility. A patient requiring urgent X-ray facilities must be transported to Limerick which clutters up the hospital system. It is of vital importance that the CAT scan facility for Ennis General Hospital, which was included in this year's capital budget, is approved. A location in the existing hospital complex has already been set aside for it. Arrangements must be made immediately for its installation.

Ennis hospital has the same problems as others. In recent times, there has been an escalation in the aggressive attitude of patients at its accident and emergency department. They attend the department, invariably accompanied by friends and relatives, in an aggressive mood brought about through the over-indulgence in alcohol and, sometimes, drugs. The hospital has had to employ security personnel to keep law and order there at the weekends. On several occasions, the Garda has had to be called to restore law and order in the department. This is unacceptable. No Member can expect nursing and medical personnel to put up with such behaviour. Any solution to deal with this will be welcomed. In so far as it is an issue, it is not a major one in Ennis but it is becoming more prevalent. The Minister of State at the Department of Health and Children, Deputy Brian Lenihan, will be familiar with this in his work with children's issues.

An assessment unit for the elderly has been established in Ennis General Hospital where the particular needs of individual patients can be quickly assessed. In many cases it is found that a patient may not need acute hospital facilities but some form of hospital accommodation until such time as he or she is fit to return home. The Minister of State will be aware of the high level of dependency there is in west Clare. In the communities, voluntary organisations endeavour to provide care facilities for patients in these circumstances. A network of community facilities exists such as the community hospital in Kilrush which has 55 patients and is run by a local charitable organisation and business people. When the hospital was closed, the group organised a good facility to provide accommodation for 55 patients who would otherwise be in a desperate situation.

The same applies to the Friends of Ennistymon Hospital with local people working together in the old district hospital, providing accommodation for people who are not fit to return home. The Friends of Ennistymon Hospital raises funds to match funding from the Health Service Executive. The same applies to Raheen in east Clare which has an excellent facility with respite beds for elderly people.

The solution to the many problems experienced in acute hospitals is through having more partnerships and co-operation between community voluntary organisations and the Health Service Executive in providing community hospitals. It would take pressure off acute services and enable those patients who require acute treatment to be dealt with effectively and speedily. I pay tribute to the work being done by these voluntary organisations such as the Friends of Ennistymon Hospital, the Friends of Raheen Hospital, the Kilrush community hospital and the private organisations such as St. Theresa's nursing home.

I appeal to the Minister of State to use his good offices with the Health Service Executive to expedite the development plan for Ennis General Hospital which has been hanging around for five years.