Adjournment Debate.

School Accommodation.

Mr. Naughten

I thank the Ceann Comhairle for selecting this matter for discussion on the Adjournment. In the early 1970s there were three second level schools in Elphin: the Convent of Mercy, the vocational school and the grammar school. Elphin was earmarked for a community school. However, the Sisters of Mercy withdrew from the second level sector. There was talk of amalgamation between the grammar school and the vocational school and subsequently, in the mid-1970s, a system of common enrolment was put in place. There were initially two management systems and the then Department of Education funded the rental of the grammar school at an exorbitant rent. Today, there is a single management system, combined with enthusiastic young staff, and there is increased parental confidence and better morale within the school. Parents are also satisfied with the range of subjects currently on offer. The school offers transition year and the leaving certificate vocational programme as well as a range of extra-curricular activities including public speaking, debating, drama and trampolining.

The difficulty is that there is a split campus. The two campuses are half a mile apart. The school has a system in place under which subjects are timetabled so that pupils' movements between the buildings only occur at lunchtime, but this is still not satisfactory. The problems resulting from the split campus include arranging supervision, loss of time moving between schools, safety concerns, discomfort to pupils on wet days, the cost of rent and maintenance and the poor state of repair of the rented building, the Bishop Hudson grammar school. There seems to be a blatant lack of interest within the Department of Education and Science in the vocational school in Elphin, which has received no funding from the Department since 1942. It was set up initially as a junior cycle school and was never funded to teach leaving certificate subjects, as it does at present.

The social implications of the loss of pupils from the area and the demise of the community that would result if the school is not developed, are serious. Losing the school would be critical for the town's viability. The Department, as we know, has a one-school-per-town policy. The proposal put before the Department ties in with that. In addition, the Department could save money over the long term if the rent it is paying at the moment were diverted into a capital project. Parents are extremely disappointed with the lack of progress that has been made in locating Elphin community college on one single campus.

In 1999, Roscommon VEC applied to the Department for the provision of additional accommodation at Elphin community college. The schedule of accommodation works was prepared on the basis of a long-term projection enrolment of 175 pupils. The proposed extension would provide 952 sq. m. of additional accommodation consisting of specialist rooms, library, store, general store, PE hall, kitchenette, staff accommodation, toilets and circulation social areas.

The design team was appointed in August 2000. In February 2002, the VEC was requested to prepare and submit a stage three plan which was submitted in June 2002. In the 2003 building programme, Elphin community college came under section 7, which meant that the project would not proceed further. The only exception to this general principle is a post- primary school resulting from an agreed rationalisation that can proceed in planning to the pre-tendering stage. Elphin community college fits into this criteria, as stated by the Department, and yet has been long-fingered.

On February 7 2003, the Minister for Education and Science stated to me in correspondence that the extension project to Elphin community college will be considered for the 2004 building programme, as was hoped in Elphin. However, in the 2004 allocations, Elphin community college was still at an architectural planning stage. In section 9 of the programme, which refers to the pre-planning permission stage, the community college is at band three of the post-primary categories. A band three assignation means a project is less urgent. The consequences of not supplying what is necessary are less drastic and, critically, it may be impossible to implement alternative solutions to satisfy the needs presenting. In short, it is less critical and the fulfilment of the need is more a medium-term target than short-term one.

Will the Minister of State at the Department of Education and Science, Deputy Brian Lenihan, explain how it could not be a short-term target? The parents want to know, once and for all whether the Department will approve this project in principle and what the timescale involved will be.

Minister of State at the Department of Education and Science (Mr. B. Lenihan)

I thank the Deputy for giving me the opportunity to outline to the House the Department's proposals for the provision of an extension at Elphin community school, County Roscommon. The 2004 capital programme was published in December 2003 and full details of individual projects are available on the Department's website at http:// www.education.ie.

The Department has accepted that there is a need to provide additional accommodation for students of Elphin community college. I am pleased to inform the Deputy that a full design team has been appointed and architectural design of the project has commenced. An extension for the school is listed in section 9 of the 2004 school building programme. This project is at stage three of architectural planning. This stage involves a detailed sketch scheme detailing room layouts and other measures. It has been assigned a band three rating by the Department in accordance with the published criteria for prioritising large-scale projects.

The architectural design of additional accommodation is based on nine stages. The design and planning of the project is covered by stages one to five, during which the project is developed from the assessment of site suitability through the detailed design, including the obtaining of planning permission, to the point where detailed bills of quantities are prepared. At stage six, tenders are sought in line with public procurement procedures and subsequently a tender report is prepared and examined. Assuming that the outcome of the tender process is acceptable in terms of procurement procedures and providing value for money and that funds are available to meet construction costs, a construction contract is placed at that stage and the construction of the project begins. I am sure the Deputy is aware of the substantial increases allocation that have been made in the Estimates this year for school building.

Mr. Naughten

That is not much use to the people of Elphin.

Mr. B. Lenihan

Stages seven to nine cover post-contract cost control throughout the construction period, construction and practical completion of the project, including hand-over of the building to the proposed occupiers and the completion of the cost analysis in the form of the final account, ensuring that cost control was maintained.

The budget announcement regarding multi-annual capital envelopes will enable the Minister to adopt a multi-annual framework for the school building programme which, in turn, will give greater clarity regarding projects that are not progressing in this year's programme. The Department of Education and Science will make a further announcement in that regard during the year. I thank the Deputy once again for giving me this opportunity to outline the current situation to this House.

Mr. Naughten

With all due respect, that was the most pathetic answer I have heard in the House.

Mr. B. Lenihan

The Deputy should learn more about construction contracts.

Mr. Naughten

I know all about them.

Rights of the Child.

Mr. Ardagh

I thank the Ceann Comhairle for the opportunity for raising this matter on the Adjournment.

I appeal to the Minister of State with responsibility for children to put in place a care plan for a 17 year old child and who has not to date received the care and attention from this State which is his right and the State's duty. To protect his identity, I will give a short synopsis of his story in the first person:

When I was one year of age, my family first came to the attention of the Eastern Health Board social work department because my mother had difficulty coping with her family. When I was five years of age, I exhibited difficult and disturbing behaviour and I was referred to the child guidance department of child psychiatry at St. James's Hospital. When I was eight years of age I was first brought before the courts for failing to attend school. The school attendance officer was supportive but not successful.

In November 1996, when I was ten years of age, I and four of my siblings were taken into the care of the Eastern Health Board and spent eight days in Cherry Orchard Hospital. My mother was suffering from depression and struggling to cope with her alcohol problem. At 11 years of age, I was referred to the child guidance department of child psychiatry in St. James's Hospital but I was not offered an appointment because of my family's poor attendance history. At 12 years of age, I was again before the Children's Court for failing to attend school. A psychiatric assessment was carried out while I was in the location which recommended that I be placed in a residential unit.

Two months later, I was sent to a residential unit in County Tipperary and my progress there was greatly hampered because I ran away many times. At 12 years of age, a consultant child psychologist said I was seriously emotionally and behaviourally disturbed with a borderline to mild mental handicap and an anxious attachment to my mother. At 13 years of age, a social worker referred me and my siblings to Our Lady's Children's Hospital for various medical complaints but we did not keep any of those appointments.

At age 14, I was involved in a serious road traffic accident when I was the front seat passenger in a stolen car. I was discharged from hospital but suffered damage to the left side of my brain, affecting my cognitive and emotional faculties. My behavioural problems worsened. At 15 years of age, as a result of my deteriorating behaviour and health, a case was brought to the High Court, judicially reviewing the State's failure to provide adequate care for me. Still at 15 years of age, I was placed in the basement of St. Patrick's Institution pending my placement in a residential centre. I was placed on protection for four weeks in the basement of St. Patrick's Institution which is normally used for punishment. I was in virtual isolation as I was only 15 years and the minimum age for St. Patrick's is 16 years.

In December 2002, unfortunately my mother died. I was placed in a boys' home in Dublin but this fell through because the placement unit did not have the support that was required for me. I returned to live with my family. By now my older sister was a chronic heroin addict and her partner was an alleged drug dealer. In 2003, I was remanded in custody for a week and the judge directed that I receive immediate medical and psychiatric treatment. By the time I came out, no assessment had been carried out at St. Patrick's Institution. I was then remanded to Clover Hill Prison where it was arranged for me to be seen by a psychiatrist from the Central Mental Hospital.

In June 2003, it was stated that I had limited intellectual ability and psychological assessment confirms that I function within the upper end of the mild range of learning disability. Furthermore, psychological assessment confirms that my powers of conceptual reasoning, social judgment and general knowledge are significantly impaired. These skills, which were already limited, were further exacerbated by the severe head injury which I sustained in the road traffic accident. I was then released from custody on 17 June 2003. I was arrested again in September 2003 and remanded to St. Patrick's Institution. At this stage, I threatened to hang myself at the thought of going to prison. I was subsequently put on 24 hour watch.

I left the family flat in October 2003 due to violence there and I started using out-of-hours homeless services for juveniles. At 17 years of age, I indicated a guilty plea on public order offences. At the time, a clinical neurosurgeon said he had serious reservations about my cognitive and emotional capacity to defend myself in a court of criminal proceedings. I was accepted for a short time in a centre in Dublin. I was thrown out after Christmas because there was no suitable accommodation for me and I appear to need a more structured and robust care than a probation hostel. I am now in Clover Hill Prison until next Wednesday, unless something can be done in the meantime.

Mo náire thú to society and the bureaucratic system which does not cope with seriously disturbed children. The Minister of State, Deputy Brian Lenihan, has been fully engaged with this case in recent days and I thank him for that. I want to ensure that in the future we care for all our children, particularly unfortunate children like the one we are discussing today.

Mr. B. Lenihan

I welcome the opportunity to reply to this matter, which has been the subject of public debate recently. It is not the usual practice to comment on individual cases. However, as detailed reports about this young man have already appeared in the media, I propose to give some up-to-date information to the House.

The 17 and a half year old youth referred to is currently the subject of criminal court proceedings and is currently on remand in custody in Clover Hill, as outlined by Deputy Ardagh. The youth has previously been in the care of the South Western Area Health Board. The young man and his family have been known to the social services since 1987, when his mother presented with a number of problems. Following an assessment in 1994 he was diagnosed as having serious emotional and behavioural disturbance. A special needs group was recommended and offered, but the offer was not followed up.

In 1998 further assessments were carried out and the young man was placed in St. Joseph's, Clonmel, until June 2000. In October 2000 he was involved in a serious joyriding accident, resulting in severe head injuries. He was transferred to the National Rehabilitation Hospital where, I understand on his discharge home, his behaviour deteriorated.

He was admitted to the Eastern Regional Health Authority's special care unit in August 2001 and he was reported to have made good progress with certain therapeutic interventions. However, during this period his mother became seriously ill and died at the time when he was being prepared for his follow-on placement and the young man refused to engage with services after this time.

Three case conferences have been held to consider alternative care options for this young man. Disability services advised that an assessment could be done to find appropriate occupation for him. However, they were unable to contact him for the assessment despite house calls. The mental health service did a domiciliary assessment and the result stated that there was no indication that he was suffering from a psychiatric disorder.

When in court recently he was deemed suitable for a probation hostel but it was decided on further examination that this would not be a suitable placement. Contrary to media reports I have been assured that it is not the case that there was no co-operation between the Department of Justice, Equality and Law Reform and the health and social work services in relation to his placement.

Following receipt of a letter from his solicitor late last week, I sought a report from the regional chief executive of the Eastern Regional Health Authority. I discussed this case with the chief executive and yesterday he provided a detailed report on the person in question. In order that the South Western Area Health Board can establish accurately this person's care requirements, the board's senior area medical officer reviewed all of his records, some of which were only made available recently. Following completion of this assessment of the medical reports by the senior area medical officer, the advice available now confirms that he requires a specialist service designed to meet his particular needs.

The authority has informed me that the area board has been in contact with a number of service providers in relation to this young man, including a facility in the United Kingdom which specialises in treating such cases. Of course the ideal solution would be to find a care placement within the jurisdiction so that linkages could be maintained with his social work team. Arrangements have been made with the National Rehabilitation Hospital to carry out a comprehensive assessment of his needs, which is to take place next week. This will facilitate the South Western Area Health Board in its discussions with various service providers to source a suitable targeted care package for him as quickly as possible.

It must be appreciated that a case such as this does not lend itself to easy solutions. The referral process now envisaged by the health authorities will be contingent on the individual himself agreeing to co-operate and attend a service. This will need to be explored in a sensitive manner with the individual himself and his representatives.

Questions have been raised in recent media reports about the funding and resources required for this young man. The difficulties which have arisen in the case do not relate to the funding and resources required by the relevant health board to put a care placement in operation for him. I have been assured by the authority's regional chief executive that the question of providing funds should not be a hindering factor in this case. The chief executive has also assured me that the question of age is not an issue either. It has been suggested in the media that the relevant authorities and agencies were being tardy in this matter because they would have no obligations when the individual reached 18 years of age in a few months. This is not correct. The obligations of the local service to this individual do not turn on the age of the individual. He clearly requires a care placement.

The difficulty which has arisen relates to the identification of a suitable and appropriate placement which can provide the necessary care package to meet this person's complex needs. My Department will liaise with the Eastern Regional Health Authority regarding the actions being taken to bring about a satisfactory solution to the matter in the shortest possible time.

Hospital Services.

Dr. Cowley

I am grateful for the opportunity to raise on the Adjournment the pressing need for a magnetic resonance imaging device, or MRI scanner, at the Mayo General Hospital. Thankfully our first consultant orthopaedic surgeon commenced duty yesterday at Mayo General Hospital and we hope that another two consultant orthopaedic surgeons will be appointed in the near future. This is a great boost to the county because of the great distances people had to travel in the past for this essential service. Every fracture sustained, particularly those life-threatening fractures affecting old people, meant a trip all the way to Galway for a service needed in our own county. After many years of campaigning, which I started, we now have an orthopaedic surgeon and a 33-bed orthopaedic unit and an orthopaedic operating unit.

However, we need an MRI scanner. In any facility orthopaedics is the biggest user of MRI services and if we are to have a world-class orthopaedic service, which the third largest county in Ireland deserves, we need an MRI scanner as soon as possible. The hospital looked at the possibility of a mobile MRI scanner, which would begin as a monthly service before becoming available fortnightly and eventually weekly. However, in the long term we need a full-time scanner in the hospital. The cost would be approximately €1 million as well as building costs, but there is already room in the radiology unit where the MRI scanner could easily be accommodated.

We also need day ward operating facilities for orthopaedics at the hospital and the MRI facility is ideal for the assessment of severe injuries following road traffic accidents. It would be useful to the hospital across the board, particularly with brain and neck injuries. We had a clear example of the need for an MRI scanner recently when a young man, Christopher Flynn, had to wait for three weeks in Mayo General Hospital for a full neurological assessment and MRI scan. If he had that MRI scan it would have been a great help to the consultant in the hospital, who would have been able to pass information up the line to the neurosurgeons. He might not have had to go to Beaumont Hospital in Dublin, where thankfully he was fully assessed and received an MRI scan which proved very useful. Please God he will continue to make a good recovery, though he is still in the intensive care unit of Mayo General Hospital.

An MRI scanner would have been invaluable to consultants in treating that man's brain and neck injuries. Public patients must wait at least six weeks for an MRI scan but private patients can access the service in days. It is demoralising to see people wait six weeks or more for an urgent scan. These people are in terrible pain and one does not know if they have prolapsed discs or metastatic cancer. The MRI scanner is invaluable in that regard, with painful rotator cuff injuries, which can be very hard to diagnose correctly, and in diagnosing osteonecrosis. The alternative would be to use a bone scanner for diagnosis but that is not available in Mayo General Hospital. There is a vacancy at present for a consultant radiologist in the hospital, as the consultant who was employed in that position has left, though he had MRI scanning experience. It will not be possible to have a world class service and to retain consultant radiologists with MRI experience unless Mayo General Hospital has its own MRI scanner. I urge that this be done. Recruitment for the vacant post of consultant radiologist with MRI experience is proceeding.

MRI scanners are invaluable across the board. There is a significant population of older people in Mayo. MRI scanners are invaluable for diagnosis of intercranial bleeds and strokes so that the proper treatment can be instituted. These scanners are working to full capacity in both private and public health care. They generate little or no radiation and provide a safe and non-invasive treatment.

Last night there were 11 trolleys in Mayo General Hospital. Each day there are up to 15 trolleys in the hospital. The situation is getting worse. The winter crisis has become an all-year crisis which points to a lack of capacity. We need more beds and an MRI scanner for our new orthopaedic unit in Mayo General Hospital.

Mr. B. Lenihan

On behalf of my colleague, Deputy Martin, the Minister for Health and Children, I am glad of the opportunity afforded to me this evening by Deputy Cowley to discuss Mayo General Hospital.

I refer to the unprecedented investment in services at Mayo General Hospital over the past number of years. Phase 2 development at the hospital began in 1998. The capital cost of this development was approximately €50 million. The development included a new accident and emergency department, a medical assessment unit, a geriatric assessment unit, an obstetric and delivery suite, CT scanning facilities, a new helicopter landing facility, an improved mortuary and post-mortem room, a new information technology system and a new administration and medical records department.

The development includes provision for an increase in the number of in-patient beds at the hospital to over 300. The development provides for a completely new service to be provided at Mayo General Hospital.

As part of this development, the new 33-bed orthopaedic unit will be a particularly valuable addition to the hospital and of great benefit to the people of County Mayo. I provided funding to begin the development of this service. I understand that a new consultant orthopaedic surgeon has recently taken up his appointment with the hospital.

Phase 2 also includes a new day care facility. This reflects a shift in modern medicine from in-patient to day case work. A new psychiatric unit with accommodation for 35 patients, treatment facilities, day facilities and a crisis intervention service has also been provided.

The health strategy provides the framework for growth and development of our health services over the coming years. It addresses issues of capacity of services, and the reform and modernisation of the health system.

The Government's strategy for the development of acute hospitals is to achieve regional self sufficiency through the development of a network of regional and general hospitals. What this means is that, apart from highly specialised services which, for reasons of critical mass should only be provided on a national or supra-regional basis, the people of the Western Health Board region should be treated within the region.

The provision of services, including MRI services for people in Mayo, is a matter for the Western Health Board in the first instance. I understand that MRI services are provided at University College Hospital Galway for people in the Western Health Board region, including those from Mayo. The Western Health Board has informed me that it is its intention to extend the operational hours of radiology services including MRI services on a pilot basis at the end of this month. This is with a view to reducing waiting times for diagnostic services, which were referred to by the Deputy in raising the matter on the Adjournment.

The Minister has asked Comhairle na n-Ospidéal to carry out a review of neurosurgical services and to prepare a report for his consideration. Comhairle has been asked to focus, in particular, on the provision of adequate capacity and consideration of equity of access to neurosurgical services having regard to best practice in the provision of quality health care. I understand that the work of the Comhairle committee on neurosurgical services is ongoing and that a report should be available later this year.

The recent investment in major projects in all of the acute hospitals in the region was aimed at achieving this goal. The further development of acute hospital services will be undertaken in the context of the findings and recommendations of the National Task Force on Medical Staffing, known as the Hanly report. I recently announced the composition of a group to prepare a national plan for acute hospital services. This group will build on the work of the National Task Force on Medical Staffing, the Hanly report. The group will prepare a plan for the interim Health Services Executive for the organisation of acute hospital services throughout the country.

Ms McManus

This morning, due to the large number of patients in the accident and emergency department awaiting a hospital bed, St. James's Hospital invoked its major incident plan. Clinicians and management at the hospital took the decision as the department could not function with 41 patients waiting on trolleys for in-patient beds. Members of the nurses organisation, the INO, described the situation this morning as unsafe.

I raise this matter because of my concern and the concern of those working in our emergency medical services about the unbearable pressure being experienced in a range of accident and emergency departments. Two days ago the chronic overcrowding in accident and emergency departments was itemised by the Irish Nurses' Organisation as follows: the number of patients waiting on trolleys or chairs in Tallaght Hospital was 42, Naas General Hospital, 37, the Mater Hospital, 30, Beaumont Hospital, 28, St. James's Hospital, 28, James Connolly Memorial Hospital, 23, St. Vincent's Hospital, 13 and St. Colmcille's Hospital, 6. In total, 207 patients were involved. In the Mid-Western Regional Hospital, Limerick, 33 patients were waiting, in Cork University Hospital, there were 18 and in the Mercy Hospital, Cork, 11.

The overcrowding in accident and emergency departments is steadily deteriorating. It is worse than this time last year. Some 200 acute hospital beds are closed, bed blocking is endemic and promises made by the Minister of Health and Children and the health authorities have not been realised.

On 13 January 2004 the Eastern Regional Health Authority promised to re-open 196 acute and non-acute beds. Almost a month has passed, yet this has not happened. The Minister for Health and Children promised 3,000 new hospital beds under the health strategy, yet this year no money has been allocated for that purpose.

Yesterday the accident and emergency service at Wexford General Hospital was described as being in chaos; 29 patients were on trolleys throughout the hospital. Meanwhile the new accident and emergency department at James Connolly Memorial Hospital in Blanchardstown, due to open last June, is still closed.

In the face of this ongoing crisis the silence of the Minister of Health and Children is very disturbing. We are entitled to know precisely what the Minister is doing to relieve the intolerable pressure on our emergency health service. We are very well informed about his views on tobacco smoking but we know nothing about his approach to dealing with this pressing, distressing and potentially dangerous situation. It is simply not acceptable to have a woman in her mid-70s spend the night on a chair on a drip in one of our hospitals, yet such incidents are happening more and more frequently.

How does the Minister intend to resolve this crisis? Will he bring forward the much needed new initiative that combines speed and efficiency and includes dedicated funding for beds and staff, better management to reduce bed blocking, the inclusion of general practice units in the accident and emergency service and improved community services for early discharge cases, or does he intend to let the crisis deepen?

Mr. B. Lenihan

Emergency medicine departments can be subject to higher attendance at this time of year. This is mainly due to the high number of patients presenting with circulatory, respiratory and viral conditions, especially among the elderly community. Particular difficulties arise where an increased number of patients require admission to hospital for treatment. I fully understand the demands and pressures placed on staff working in the acute system and value the tremendous work they continue to do. The Department has been informed that, at individual hospital level, hospital management is actively involved in working with medical and nursing staff on an ongoing basis in order to deal with the current pressures. As regards the Dublin hospitals, the Eastern Regional Health Authority has reported that the protocols that are in place to deal with the increased demand on services are being fully adhered to.

Many of the difficulties and delays experienced in emergency medicine departments reflect system-wide issues such as the demand experienced by each hospital, the resources available to it, as well as the structure, organisation and staffing profile of the hospital. Therefore, in tackling the problems in emergency medicine departments it is necessary to take a whole system approach involving primary care, acute and sub-acute care, and community care.

I assure the Deputy that the Department has been engaging with senior management in the various health agencies to look for solutions to these difficulties. In order to deal with the current pressures on acute services both in the shorter term and in the longer term, I would like to outline to the House some of the key actions that the Minister for Health and Children has taken. Increasing the bed capacity of the acute hospital system nationally is a key priority in improving access to acute services. More than 560 new beds have now been provided in hospitals throughout the country under the acute hospital bed capacity initiative, of which 260 beds are in the eastern region. The Department has provided funding to the ERHA and the health boards to commission the remaining beds approved under the first phase of this initiative.

There are a number of patients in acute hospital beds that have completed their acute phase of treatment and are ready for discharge to a more appropriate setting. These delayed discharges can add to the pressures on the hospital system, in particular the emergency medicine departments. Initiatives in the ERHA, such as Homefirst, Slán Abhaile and home subvention are all contributing to providing alternative care packages for older people so that they can be discharged.

The availability of suitable sub-acute beds is a particular problem in the eastern and southern regions. In this regard, additional funding of €12.6 million has been provided in 2003 and 2004 to the Eastern Regional Health Authority and to the Southern Health Board to facilitate the discharge of patients from acute hospitals to a more appropriate setting, thus freeing up acute beds. The Eastern Regional Health Authority has reported that more than 220 patients have been discharged from acute hospitals as a direct result of this funding. The Department has been informed by the ERHA that it is currently working closely with the major acute hospitals in Dublin with a view to re-opening beds that have been closed due to staffing difficulties. The ERHA is also continuing with a campaign to recruit additional nursing staff.

As part of the winter initiative, an additional 20 emergency medicine consultants have been appointed from the 29 approved. Additional appointments are being progressed by the health boards and the ERHA. The availability of senior medical staff in emergency medicine departments should facilitate rapid clinical decision-making, enhanced management, diagnosis and treatment of patients. It is accepted that the bed management function is fundamental to the consistent application of admission and discharge policy within acute hospitals. Reviews of the bed management function and nurse staffing levels in emergency departments are being progressed by the Health Services Employers' Agency in consultation with health service management representatives and the nursing unions.

The processing of patients through the emergency services of a hospital has been greatly assisted by the use of medical assessment units. One such hospital is St. Luke's in Kilkenny where innovative solutions and a hospital wide response have improved the delivery of emergency services to patients. The benefit of having a medical assessment unit on site has facilitated the rapid assessment and treatment of medical patients. Another recent development is the acute medical assessment unit at St. James's Hospital. This unit has contributed to a noticeable improvement in the delivery of emergency services at the hospital.

Improving the physical capacity and surroundings is an important element of the provision of an efficient emergency service. A number of capital developments have been completed in recent years and others are under way around the country aimed at improving emergency medicine departments. Emergency medicine departments may sometimes have to deal with injuries and conditions that are more appropriate to a primary care setting. General practitioner out-of-hours co-operatives have been established and are operating in at least part of all the health board areas, with one health board, the North Eastern Health Board, having a region-wide project. A total of €46.5 million has been allocated for the development of out-of-hours co-operatives between 1997 and 2003.

I accept that the nature of emergency medicine presents a particular challenge in relation to the appropriate measures needed to deal with the issue. As I have already said, the various problems can only be addressed on a system-wide basis. I assure the Deputy that we will continue to work with the various health agencies in looking for short-term and longer-term solutions to the current difficulties.

The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 10 February 2004.

Dáil Éireann debate - Thursday, 5 Feb 2004