Wednesday, 20 April 2005
Dáil Eireann Debate
Mr. Kenny: We know that 33,000 fewer patients went through accident and emergency units in 2003 than in 1998. Last week in response to a question in the Dáil the Taoiseach admitted that accident and emergency facilities were, in his words, “not up to scratch”. What is a crisis in the rest of the country, and what has driven nurses the length and breadth of the country to protest outside hospitals during lunch time, is simply “not up to scratch” in the eyes of the Taoiseach.
This morning we learned that the situation is much worse. The independent report of the Health and Safety Authority has criticised the level of congestion in accident and emergency units around the country. It says this increases the risk of injury, infection and violence from frustrated patients. There are reports of trolleys, chairs and medical equipment being stored in fire protected corridors. Some eight of the hospitals inspected since March have been reported to fire officers because exit doors and corridors have been blocked. Yesterday 283 patients were on trolleys in accident and emergency departments and there are serious reports of deep frustration and of anger verging on violence among some patients in some units.
The Government’s response to this has been to fly a kite about the availability of a hospital at St. Bricin’s, which will not happen now. There are complaints from nurses of being intimidated by management when highlighting the impossible conditions in which they are expected to work. The Tánaiste has said that the nursing home charges issue is putting patients off moving out of hospitals.
The Taoiseach has been, or is supposed to have been, in charge for the past eight years. This situation in the fourth richest country in the world is unacceptable. Conditions in accident and emergency hospitals in some places around the country are appalling. What does the Taoiseach intend to do about this——
The Taoiseach: I will not go through the numbers. I have already explained how many people go through our accident and emergency units. I am glad Deputy Kenny has distinguished between ones that are overcrowded and those that work extremely well. That is the position.
As I said previously, the action is that this year alone we have put a substantial part of both the capital and revenue budgets into providing extra facilities. Those facilities range from better cleaning to better complex tasks such as MRI scans——
The Taoiseach: ——in Beaumont as part of this year’s plan. We are providing acute medical units in Tallaght, Beaumont and St. Vincent’s Hospitals. This will mean that people who go to hospital with problems and medical conditions such as respiratory illness or diabetes can be assessed and observed without waiting for long periods in accident and emergency units. Other hospitals around the country have found that these units work well. Comhairle na nOspidéal has also pointed this out.
The Taoiseach: We are buying beds from the private sector for step-down care for hundreds of patients this year who no longer need to stay in hospital. I assure Deputy Kenny that this is working and has been happening over the past few weeks. People are moving from acute beds into private nursing homes. This is a costly way of dealing with it, but the Government is doing it. We are contracting for long-term nursing care beds for many people who need higher level care than would be available in the community. We are providing special home care packages for 500 people currently awaiting discharge from acute hospitals. This will help families and older people in their homes and communities and free up beds. We are ensuring we will be able to get access to general practitioners outside of normal working hours so that people do not have to go to accident and emergency units with normal problems.
The Taoiseach: All of these are not long-term actions but are under way now. Deputy Kenny raised the issue of the Health and Safety Authority’s report which is out today. The authority has completed its programme of inspections in 11 accident and emergency departments. It has acknowledged that the hospitals are fully engaged in the process of addressing health and safety in accident and emergency units. The report also says there should be management changes. There should be changes in bed practices within hospitals. The CEO of the HSA met the chief executive of the HSE yesterday.
The Taoiseach: ——that it will highlight in its actions the recommendations of the inspectors. The HSA has secured the commitment of the HSE to examine the health system in the wider sense. This follows a meeting that took place yesterday.
Mr. Kenny: The Taoiseach’s response sets out the scale of incompetence and devastation. After eight years, it has taken an independent report by the Health and Safety Authority to trigger the measures to which he referred. If a major hotel had blocked fire escapes and trolleys in its corridors, there would be calls by Members to close the facility.
Will the Taoiseach give an assurance that patients attending hospitals in the coming period will not be in danger given the violence, frustration and carry on mentioned in the report? God forbid but if there was a serious accident following the Luas derailment earlier, could hospitals have coped and implemented the major accident and emergency plan?
My final three questions relate to the Tánaiste and Minister for Health and Children’s ten-point plan. When will the minor injuries units be developed and expanded? Where are they? When will they open? When will the Government provide the MRI scanner at Beaumont Hospital? Will it be this year or next year? Will the Taoiseach, for God’s sake, see to it that scandalous conditions in toilet units in hospitals are cleaned up once for all?
The Taoiseach: The second MRI scanner will be provided in Beaumont Hospital this year. The resources have been made available for the medical units. I cannot be certain about when the work will be finished on them but the money has been provided this year. Hopefully, they will be ready as soon as possible. The major accident and emergency plan is in place and, thankfully, it has always served us well. It creates disruption for others in hospital when it is invoked but it works well and it is upgraded all the time.
All these initiatives are under way but they are additional to ongoing work. Issues such as cleaning and so on should not arise because costly contracts are in place but I accept this report has highlighted some of these issues.
The Taoiseach: Everybody accepts that once one gets through accident and emergency, hospital services are excellent. There is a problem in accident and emergency and we are trying to deal with that. We have put huge resources into staff, equipment and the physical infrastructure to address this issue and we are committed to continuing to do what we can to get them all up to the same standard.
Mr. Rabbitte: Máire Geoghegan-Quinn was right about that much. The Taoiseach will probably be aware that the Minister of State at the Department of Justice, Equality and Law Reform, Deputy Brian Lenihan, launched a report yesterday on the childhood development initiative. The report deals in great detail with the impact on children as young as ten of anti-social behaviour.
If the Taoiseach has not seen the report, I recommend it to him, because when I raised the question of anti-social behaviour with him last week, I was completely bemused by his reply, as were people outside the House. If the Taoiseach had received as big a response to the issue as I have, he would know the extent of the breakdown of the fabric of society in many communities. Instead, he wandered, making a number of different claims. He said we have 14,000 gardaí but, according to a reply to a parliamentary question by the Minister for Justice, Equality and Law Reform, we have 12,200. The Taoiseach then detailed at great length his struggle to implement the Criminal Justice Act but that was introduced by a Fine Gael-Labour Government.
The Taoiseach made a most unfortunate choice. That particular garda and the events of May Day are something that ought not to be celebrated or defended in this House. There is no single, simple solution to this phenomenon that threatens the fabric of society in many communities and neighbourhoods but community policing is one of the solutions. The resources devoted to community policing are entirely inadequate and inconsistent.
Mr. Rabbitte: The Taoiseach is well aware that, for example, initiatives such as the JLO scheme have as many gardaí devoted to them as the Garda driving pool. The resources are not put into the measures that could address this issue in society. Unfortunate people are being tortured in their own communities because of the actions of young thugs and hooligans who are out of control, with no parental responsibility. The Taoiseach’s answer the last day sought to trivialise rather than deal with a serious social issue.
The Taoiseach: I do not know why the Deputy takes an account of something I did not say last week. I did not in any way trivialise it. I said the Criminal Justice (Amendment) Bill 2005, which the Minister for Justice, Equality and Law Reform is bringing in, is a serious Bill and I asked Members to support it. It contains strong measures and criminologists and others have stated the Bill is too tough. The Bill’s provisions will address the point made by the Deputy. It will strengthen the investigative powers of the Garda. We are recruiting to get up to 14,000 gardaí.
The Taoiseach: The legislation will deal with powers of arrest, search and detention powers, powers to fingerprint and to take DNA samples. The Minister has stated he will introduce additional provisions on Committee Stage to address other issues relating to criminal gangs, the control of firearms, curfew orders and powers to place civil orders on individuals whom, as Deputy Rabbitte rightly said, act out of order in society. We have an enormous range of powers and, in so far as the current legislation is not strong enough, the Minister will strengthen it with, I hope, everybody’s support in the House.
A small number of individuals, some of whom are very young and some of whom may be under the influence of drink and drugs, believe they can intimidate their communities. The only way to deal with that is through the Garda. I said last week nobody should recommend that there is another way to deal with this, though people at times get frustrated about these issues. The only way to do so is to have sufficient gardaí and a force of 14,000 would put Ireland much higher on a pro rata basis than every country in Europe.
The Taoiseach: They have sufficient legislative powers to deal with these criminals in a tough and rough way. I do not think anyone outside the House is saying the curfew and civil orders to name and isolate such individuals in their communities are not tough law. The Government is introducing what is necessary, and the Minister for Justice, Equality and Law Reform, Deputy McDowell, will bring it before the House in this session.
Mr. Rabbitte: The Taoiseach is out of touch. I read in one of the newspapers this morning about his doing six hours’ canvassing on Saturday and another few hours on Sunday. If he did it at the right times of the day, he would know that the issue is not law but the lack of enforcement. The Taoiseach keeps coming to the House and offering solutions in the shape of more law and tougher speeches from the Minister for Justice, Equality and Law Reform. The fact is that considerable powers are available to gardaí, but they either do not have the resources or they are not deployed in a fashion that allows them to implement the law. People in extremis in their own homes are dialling Garda stations from which they receive no response. There is an absence of community gardaí patrolling neighbourhoods. Gardaí are simply not there to do the job that modern living conditions require. People are besieged in their own homes, persecuted and harassed for no apparent reason.
For example, the Taoiseach talks about more law. What about the Child Care Act? It has been on the Statute Book for the past four years, but the Taoiseach has still not invoked major sections. Part 8 covers widespread community sanctions, but it has not yet been implemented. If there were such widespread community sanctions and those young vandals were required to clean up some of the mess they had created——
Mr. Rabbitte: ——in those neighbourhoods, that would be real action. However, while tough speeches promise more laws, there is no action in the neighbourhoods where people suffer harassment and persecution for no reason but that they are old, vulnerable, women living alone or merely different.
Mr. Rabbitte: People are being driven out of their own estates and desperately seeking transfers from local authorities. We have witnessed the breakdown of society in many of those areas, and it is not good enough to come to the House asking if the Opposition will support tough laws.
The Taoiseach: Enormous resources have been made available to the Garda Síochána regarding its numbers, overtime, equipment and intelligence. I do not think it takes too much Garda strength to deal with 13 or 14 year olds, or, as Deputy Rabbitte said, 12 year olds. They are not armed criminal gangs. Most of what Deputy Rabbitte has been talking about has been done by children causing disruption in their own areas. The Children Act 2001 — not the Child Care Act, as Deputy Rabbitte said — has sections relating to trying to counsel families and rehabilitate such children. One cannot lock them up, and I will not enforce such a policy.
The Taoiseach: The sections regarding family counselling, trying to establish control, home liaison and teaching such children that life has a proper order are being implemented. For those who must unfortunately be removed from society, large amounts of resources are being made available, as the Minister of State at the Department of Education and Science, Deputy Brian Lenihan, said yesterday.
Deputy Rabbitte did not mention it, but I am sure that he, like me, has attended many public meetings where gardaí have said in front of several hundred people that there are cases where they do not have the powers to act regarding young people. The gardaí are continually pointing this out. They say that night after night, in hall after hall, to the citizens of this country, and they do so not because they want to dodge their responsibilities but because they believe they need tougher powers to deal with some of those gangs of hoodlums and thugs who simply want to manipulate communities. No one has any respect for them, and there are cases where they simply have to be removed from their communities, but we do not have the powers to do so. We have to have civil and curfew orders to deal with it; that is the point the gardaí are making. We can pass the legislation and then, one hopes, our gardaí will enforce it.
I agree with Deputy Rabbitte on this point. We passed laws in this House many years ago about not drinking in public or walking around with boxes of drink or ghetto-blasters. Many of those powers are ignored, but they exist for the gardaí to implement tonight if they so wish.
Caoimhghín Ó Caoláin: Last week some 300 people protested outside the gates of Cavan General Hospital in the pouring rain in solidarity with the Irish Nurses’ Organisation’s campaign entitled “Enough is Enough”, and with citizens and patients who continue to suffer daily in accident and emergency units throughout the country. They were joined in Cavan and elsewhere by elected representatives of all opinion, including from Fianna Fáil. Is the Taoiseach not aware that citizens are absolutely outraged that this crisis in accident and emergency units continues despite all the promises and commitments that have been made and the money that has undisputedly been spent on the health services? It happens despite all the pledges by the Tánaiste and Minister for Health and Children, Deputy Harney, when she took up her position more than six months ago.
The honeymoon period is long over, and it is now time for the Minister to be accountable, not only to this House, but to the citizens. I ask the Taoiseach to forget the text that he used in his response to Deputy Kenny. Instead, I ask him to stand here today and, in his own words, tell the House what he and Deputy Harney intend to do today to address the situation. It is outrageous that eight hospitals have been reported to fire officers because exit doors and corridors are blocked. That means not only that citizens are suffering on trolleys in accident and emergency units but that they are also at risk from fire and such other potential hazards and emergencies that might arise.
Caoimhghín Ó Caoláin: Will the Taoiseach and the Tánaiste meet the Health Service Executive and call on it not to go ahead with its plan for 2005, which entails a cut of some 600 jobs at the coalface of health care delivery and which the INO itself has said will result in bed closures and make the situation in accident and emergency even worse?
Caoimhghín Ó Caoláin: Where are the additional 2,250 acute hospital beds, the 4,000 elderly care beds and the 60 primary care units promised in the Government’s health strategy? This is a very serious issue, and the Taoiseach’s textbook reply will simply——
The Taoiseach: I have already answered this. The Deputy asked me to explain matters in my own words, something I did for Deputy Kenny. He wanted to know what actions were currently being taken, and I gave him those. They are under way now, in addition to what has already been put in place. I will give those points again. Those actions are significant.
Why is there a problem in accident and emergency? Many people argue there is not a problem in that department but with beds elsewhere. That is why we have added 500 beds. Step-down places are being provided in the private sector so that people in acute hospitals can move to suitable and excellent care facilities not in such hospitals, thus freeing the beds so that people can move through accident and emergency more quickly. That is the issue.
As I said, everyone accepts that, whether with cancer, cardiac or other services, when people are in hospital, they receive good treatment, operations and aftercare. However, with accident and emergency, because of people staying a long time in beds — far longer than was traditionally the case — one needs more beds. That is why we have the step-down beds. We already have 200 extra public beds this year, as well as out-of-hours GP services. People do not stop getting sick at 5 o’clock in the evening. Where there are no such services in communities, people go to the accident and emergency department, and that exerts further pressure.
When people are blind drunk or drugged and start to fight or become involved in public order disturbances, they often end up in accident and emergency departments, which puts further pressure on such services. A significant proportion of the €11.5 billion allocated each year to the health service, which has 100,000 staff, is spent by the Government on measures to improve the accident and emergency service. The Government is confident that such measures will help to alleviate some of the difficulties we have encountered in recent years. The Deputy is aware that the Government is also investing in a substantial capital programme that will bring new hospitals and services on stream.
Caoimhghín Ó Caoláin: The Taoiseach did not answer my questions in his response. The electorate will not be convinced that the Taoiseach has addressed the serious matters raised by Deputy Kenny and me in a satisfactory manner. How does the Taoiseach respond to the pathetic excuse offered by the Minister for Health and Children last Monday? She said that the issue of nursing home charges was to blame for her failure to deliver on the ten-point plan she has proposed for dealing with the crisis in accident and emergency departments. Is the Taoiseach aware that the fire service in Dublin has indicated that the crisis in accident and emergency units is affecting its ability to respond to emergencies because fire brigade crews have to queue with patients after being called to attend to various problems? If fire fighters are stuck in long queues, they will not be available to respond to other emergencies which arise. What is the Taoiseach doing to address this very serious matter?
What does the Taoiseach have to say to nurses who have pointed out that the employment ceilings imposed on the health services are preventing the recruitment of additional staff to ease the crisis in our accident and emergency departments? Is it true that the moneys which are being allocated to implement the Tánaiste’s ten-point plan are being taken from the original financial allocation made to each hospital? The redistribution of such moneys will result in other cutbacks in 2005. It is time for the Taoiseach to respond.
The Taoiseach: I remind Deputy Ó Caoláin that the provision of an additional €1 billion can hardly be described as a cutback. I hope the resources being invested in the health system will solve all the problems in that sector.
The Deputy made a point about beds and facilities. He said that people should be able to access step-down places. Nobody has said that the controversy about nursing home charges has caused the problems mentioned by the Deputy. The Tánaiste made the point, which I had made previously, that hospitals have argued that people are now less inclined to leave acute hospitals to go to nursing homes. That phenomenon has been reported by nurses — I presume they have also mentioned it to Deputy Ó Caoláin. I assure the Deputy, if he is interested in what we are doing rather than me giving anything else, that people are starting to receive the special home care packages to enable them to leave hospitals. Some 500 step-down places are being provided by the private sector and nursing home places for long-term stays will soon be contracted.
The Taoiseach: The Health Service Executive is putting in place a permanent system of audit and inspection for cleanliness in acute hospitals. The system is already working. The Government has provided money for the acute medical units and an MRI scanner will be acquired for Beaumont Hospital this year. An eminent physician in this city said recently that the new accident and emergency unit in Blanchardstown, which has just been opened, is the best such unit he has seen anywhere in the world. Deputy Ó Caoláin should acknowledge the improvements which have been made.
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