Camillus Glynn (Fianna Fail)

Any statistic that muddles the figures for accident and emergency attendance is unhelpful. We have excellent general practitioners and people should present to them in the first instance. We all know the use being made of the accident and emergency units.

Having been a health professional in the midland region and having dealt with Mullingar Regional Hospital, Tullamore Hospital and Portlaoise Regional Hospital, I know they provide an excellent service. Part of the problem with acute beds has been referred to by the Minister of State and others. When the acute phase of a person's illness passes and he needs further treatment, it is imperative that facilities be provided for that.

On people causing difficulty in accident and emergency wards, I have said in the past, and I am glad Deputy Kenny used my phrase, that we must hit the thugs where it hurts — in the pocket — whether they are drunk or on drugs.

It is also important to remember it is not only accident and emergency units that have problems. To a lesser extent, acute psychiatric units have problems with people applying to be inappropriately admitted. On one occasion I had to notify gardaí during my time working in that area. It is the responsibility of the person in charge of a unit to notify gardaí as they are not inspired and will only come when notified. My profession received great assistance from gardaí, often much needed assistance. This is not a new phenomenon nor is it just pertinent to accident and emergency units. There is no question but that these people must be dealt with efficiently. People who have a social drink or have a small amount of drink and are involved in accidents should be treated differently, but the thugs full of drink should be treated as thugs.

The Government is committed to improving patients' experience of health care and of accident and emergency services. Meeting the challenges in our accident and emergency units means a whole system approach which will tackle problems across all aspects of the health care system. The volume of activity in our hospitals has increased significantly and various factors impact on the service provided, including the increase in population, longer life expectancy, a greater inclination to avail of services and undergo elective procedures.

During my chairmanship of the Midland Health Board from 2001-03, I was delighted that we got three accident and emergency consultants appointed in the region, one for Mullingar and two for Tullamore who also provided sessions in Portlaoise. The system in the region works very well. We cannot overstress the value of accident and emergency consultants to an area as they are vital to a good service.

We must accept that some people access hospitals through accident and emergency departments because they cannot access an appropriate outpatient department. These various factors must be assimilated into our system. Our health reform plans will bring a new coherence to the services. It is recognised that a range of short, medium and long-term measures are needed which will transcend immediate operational issues in accident and emergency departments and be integrally linked to the development of primary and support care services for the elderly. It is axiomatic that these services be developed as they are complementary to the development of a good accident and emergency service.

Tackling the current difficulties with accident an emergency services must be the Government's top health priority. The service being provided to some patients in accident and emergency departments is unacceptable and must be improved. Our objectives must be to reduce the numbers waiting for admission, the time spent waiting and the turnabout time for those who can be treated in such departments but who do not require admission.

The Health Service Executive continues to implement the ten-point action plan. In addition, it has been agreed that a number of additional measures will be implemented by the executive, including the setting of performance targets for individual hospitals, which is important. In terms of implementation, the HSE is taking the approach of tackling the issue on a hospital by hospital basis. There must be a reason that a number of hospitals experience serious difficulties in their accident and emergency departments while others do not.

The HSE will develop hospital-specific time-based targets for accident and emergency departments and delayed discharges, develop financial incentives linked to performance in these areas and develop additional targeted initiatives aimed at delivering an immediate and sustained impact. In the immediate term the executive will introduce a series of measures to improve facilities for patients and staff in accident and emergency departments. Long-term care beds will be secured from within the private sector to facilitate the discharge of patients who have completed the acute phase of their care.

The acute beds that become available as a result of this initiative will be ring-fenced for patients awaiting admission in accident and emergency departments. Funding will be made available within the capital programme to develop admission lounges to ensure patient privacy, dignity and comfort are preserved while awaiting admission to an acute bed. I will not defend what is not true and admit that in some accident and emergency departments waiting facilities for patients are less than acceptable.

Funding has been provided for an additional 900 acute bed day places since the publication of the review of acute hospital bed capacity in 2002. More than 800 of these are in place and the HSE has advised that the remainder will come on stream over the coming months. A further 450 acute bed day places are in various stages of planning and development under the capital investment programme.

The achievement of improvements in accident and emergency services is dependent on fundamental changes in both hospitals and other areas of the health service. It is not just a question of increasing the number of acute beds. We should not be afraid to push out the boat. If we are involved in the provision of a service that is not working as well as it should be, we should not be afraid to change it. Everybody has a role to play in the change.

As a former member of the nursing profession it will not come as a surprise to hear me praise it. Nurses working in accident and emergency departments and throughout the general medical services deal with ongoing and increasing pressures. Different challenges confront them day after day. They are dealing with those challenges, sometimes with difficulty.

The HSE has established a dedicated task force to oversee the implementation of the framework for improving the efficiency and effectiveness of services in our accident and emergency departments. The task force will support individual hospitals in identifying and addressing specific problems. In other words we will have a team that will look at and try to address what is going wrong in different hospitals. The HSE will work with hospitals to try to introduce a system of whole hospital performance measures to improve patients' journeys not just through the accident and emergency department but through the hospital system from admission to discharge. By improving hospital processes and procedures, by providing additional step-down beds for patients who do not require acute hospital care and by expanding and enhancing primary and community care services we can achieve a sustained improvement in accident and emergency services.

I am aware of a further problem with regard to patient discharge. On many occasions I found that people who had gone through the acute phase of their illness but who required further treatment were a problem because of the need for step-down beds. However, there was a further social problem. Some people did not have a decent home to which they could return or their relatives did not care whether they lived or died. I have seen this as a real problem, one from which we cannot walk away. In the past six or seven months I was made aware of the case of an individual in an acute hospital, whose wife did not want him home under any circumstance. I went through seas of sorrow trying to find a private bed for him. The nub of the problem was that the family were people of means, but they did not want to pay a cent for the person's care. This type of problem may not be a significant problem in the overall context, but it is still part of the problem.

The Health Service Executive is advancing the implementation of a series of measures to improve the delivery of accident and emergency services. It announced in March 2006 that it is establishing a dedicated accident and emergency team to tackle the individual issues affecting a core group of approximately 15 hospitals among the 35 hospitals providing accident and emergency services. While improvements have been achieved through the accident and emergency ten-point plan, this group of hospitals will be supported by the newly-established team to identify the particular issues impacting their accident and emergency performance and the way to address them. The HSE has stressed that improving accident and emergency departments is its number one priority this year. This task force is about practical actions to improve patient care in accident and emergency units and in hospitals.

It is important that hospitals have been given targets for improvement to ensure everybody can measure progress. Targets are important. Patients are to be seen more quickly at accident and emergency departments and fewer are to experience long waiting times on trolleys. I visited France last year on business as a member of the Joint Committee on Health and Children and in one of the bigger hospitals in Paris there were people on trolleys. It is not a phenomenon that is pertinent to Ireland alone, therefore, but it is still not acceptable. If there are people on trolleys for long periods, which is the case, we must resolve that problem. There is little point in saying that a similar position obtains elsewhere. If people elsewhere jump in the water, there is no reason we should do likewise. We must try to address the problem and improve it.

These targets for improvement will be a minimum. They are to be breached, not just reached. The Government and the HSE are prepared to do all they can to provide acceptable standards of care in accident and emergency departments and they will not hold back on any practical action that will work. Everybody must work together positively to achieve that aim. It is not only a Government or health service problem; it is a societal problem and it can only be resolved in that context.

There are short-term actions as well as long-term solutions. As a Government and people delivering service, we must do both. That means that targeted resources for improvements will be made available by the HSE. Changed practices and better patient care will be rewarded. Diagnostics and tests will be provided at weekends and evenings. That is welcome because in the service in which I worked there were no CPN services at the weekend. Nobody was supposed to get sick or develop florid symptoms over the weekend. One could only get sick by appointment, which is nonsense.

New beds will be assigned immediately to accident and emergency areas to ensure that old people do not sleep overnight on trolleys. That is welcome. People will be discharged each day of the week to keep beds available. Patient discharges will be planned to ensure home care will be ready when they are medically fit for discharge. That involves a pivotal role for our public health nurses and liaison nurses. People will be helped to move out of hospital beds by the provision of many more home care packages and nursing home places. The HSE will step up the pace of availability of home care, which is also important.

The fourth commandment might not go astray because there is a view among many people that "they" will look after them but who are "they"? It is important that the people who are the pillars of this society, the old people who have now reached the winter of their years, be treated with the dignity and respect to which they are entitled. As I have said on more than one occasion, perhaps in different fora, it is imperative that the dependants of those people be reminded of their obligations. Those people will always talk about their rights but, in many cases, they carefully ignore their obligations.