Fidelma Healy Eames (Fine Gael) | Oireachtas source

I welcome the Minister and wish him a happy new year. It is very welcome news that BreastCheck is being extended to women from 65 to 69. With a bit of luck that should improve their health outcomes and that is what I would call a good policy initiative. The Minister mentioned the universal GP service, that it has to be worked out with GPs, as I thought, and that it is optional for GPs. How does the Minister get spread in that case? Can he address that in his summing up? If, for example, in Galway, only three GPs sign up to the scheme, how will there be universal free GP care for those under six and over 70?

As far as I can recall, the Minister did not mention investment in health promotion and prevention in the budget. Will he note that figure? I will talk about accident and emergency in a minute but if we could ensure people take greater responsibility for their health and if we keep people well, which I know the Minister is trying to do with the universal GP service, then we would have fewer people in accident and emergency departments.

In terms of the accident and emergency crisis, how much has the Minister put into the budget to re-orientate services towards the community and to have better diagnostic equipment in the community? How much has been invested in IT services, so that there can be communication between the primary health care centre, for example, and the centre of excellence? How much of an improvement is that on previous years? Is the policy of re-orientating care from the hospital setting towards the community working at all? Will the Minister give me an account of the improving trend on that over recent years?

I refer to the accident and emergency situation, in particular in University Hospital Galway. I spoke to six or eight accident and emergency nurses on this issue. The facts are as follows. There is an average daily attendance of approximately 200 to 220 people. On average, the wait is two hours to see a triage nurse and on average, a wait of eight to 12 hours would be normal to see a doctor. That is very off-putting. What is happening is that people are leaving without being seen. They are getting no service. They go back to their GP and then they are back to the accident and emergency department again. Older patients are on trolleys for 24 to 36 hours, with no one to speak to them. As the Minister knows, they are not allowed to be served hot food, so it is less then suitable.

I will give the Minister an example. A patient was referred from Letterkenny to Antrim and then transferred to Galway for plastics, due to a finger injury. There were no beds, so the accident and emergency team had to see the patient for plastics admission. I point out these situations because we need good practice in these areas. I will give the Minister one example of very good practice, which is working. Advanced nurse practitioners are dealing with minor injuries. They can discharge within two hours, without seeing a doctor. That is working well. The Minister needs to look at the specific problems emerging and introduce good practice to match those problems.

The accident and emergency department in University Hospital Galway was built for a population of 50,000 but we now have a population of 250,000 in Galway alone. The Minister knows Galway is being used by a much wider geographical area. It is a centre of excellence for the region. What are the Minister's plans to improve space in the accident and emergency department in Galway? We are losing senior staff to private settings and to public health and are losing general practitioners, due to too much stress.

In June 2014, 30 staff were approved for appointment through the national recruitment service but only nine of those have been appointed. What are the Minister's plans to push on that appointment process? The Minister might define the boundaries of the Saolta Group when summing up. University Hospital Galway's accident and emergency department is now taking from Tullamore and Athlone because the consultants are taking patients way outside the Saolta Group boundaries. For example, spinal surgery in University Hospital Galway is on Fridays. We had a case of a patient waiting in Tullamore who was taken into University Hospital Galway. The Galway Clinic is sending patients to University Hospital Galway and that adds to the problem because they want private beds in a public hospital - beds which are currently taken up with isolation units.

The nurses fear losing their registration due to working in unsafe conditions in terms of health and safety. People who call me looking for a bed or to complain about the services praise the staff but the staff, in particular the nurses, are at their wits end. Do not close St. Rita's ward, which has 19 beds and is due to be closed, until there is a solution to the capacity issue.

I have raised some macro issues and some micro issues but if we are to solve the accident and emergency crisis, we really need to introduce good practice in some of the areas I mentioned. I thank the Minister for his time.