John Gilroy (Labour) | Oireachtas source

We need to deal with reality.

The first point to make, which has not been mentioned yet, is that political responsibility rests with the Minister for Health. He will be judged on his performance and how he handles not just the accident and emergency crisis but the myriad of other challenges, rather than crises, in our health system. The term "crisis" can be overwhelming and can lead to an inability to act but the Minister is not overwhelmed to the point of inactivity. He is out there, doing what is required to be done.

We must examine the culture of delivery within our health service.To give an example, I train a couple of soccer teams and one Sunday morning just before Christmas, a young fellow went over on his knee. While driving him to the accident and emergency unit in the car, the symptoms with which he was presenting were quite obvious. He was in distress and it was clear that a cruciate ligament injury or something like that was what was wrong with him. While on the way there, he asked me what was going to happen when he went into the accident and emergency unit. I told him we would be obliged to wait at reception, would register and would go to the triage nurse. I told him we would then be called in, he would be taken for an X-ray and thereafter he would be given some sort of treatment after he had been diagnosed. This of course is exactly what came to pass except it took eight hours for it to happen on a Sunday morning. We queued at three different locations. What if an enhanced role was given to non-medical professionals in accident and emergency departments and throughout the services so that, for instance, instead of seeing the triage nurse, the patient perhaps could have seen an advanced nurse practitioner who could have referred him directly to the X-ray department? Everyone knows that is what is required for minor injuries and limb injuries. In general, they are uncomplicated and advanced nurse practitioners are trained up to a point that is at a similar level to most of the medics one meets in accident and emergency units. They are different professionals and have different specialties but ultimately, they are competent to perform these roles.

Although non-medical professionals are being introduced into the health service, there is much opposition from other professionals. While I do not wish to name any professionals, everyone knows who I am talking about and there is a territoriality associated with it. When one refers to vested interests within the health service, it is automatically assumed that the vested interests lie within the trade union movement. While there undoubtedly is a vested interest in that regard, there also is a vested interest in respect of the other top administrators and consultants. The Minister is aware of this and while one may not wish to acknowledge it too widely, I worked in the health service for 30 years and it is clear to me. There also are many cultural difficulties facing us.

In addition, were one to state that the post-discharge solution of providing more step-down beds is the answer, the same problem would present as with the provision of more inpatient beds, which is that no matter how many nursing home beds one might provide, ultimately, they will be filled. My colleague, the Minister of State, Deputy Kathleen Lynch, did state she hopes this ultimately will be a demand-led scheme. While one can envisage the challenges in that regard, ultimately it probably is part of the package solutions surrounding this issue. However, simply to lay the blame at the feet of our elderly population is both unfair and factually incorrect as there are several other issues at play. I refer to the possibility of giving a more enhanced role to the general practitioner, GP, service. I understand that the GP contract is causing much difficulty and perhaps more investment is also needed in this area. The GPs are the gatekeepers of the services and perhaps consideration should be given to how to better involve and integrate GP care into the accident and emergency and hospital services in order that the transition from one to the other is seamless. I could speak here for the rest of the evening about what I think is wrong with the Health Service Executive.