I cannot keep up. With a general election looming, the Government has pinned its hopes on an overblown health strategy, but it has failed to provide the funding needed if the plan is to live up to its hype. The Taoiseach said at the launch of the strategy last November that he was resolved to focus on long-term solutions rather than quick fixes, but we have not seen any evidence of such an approach. It was clear within days of the announcement of the strategy that the Government had not made any funding commitments beyond the end of the current year. The practical application of the health strategy means that people on low incomes who are just above the medical card limit will be offered no help or support. The Government insists on concentrating the provision of medical cards on those over 70, even though we know those in that age group who are in the top 20% of earners will receive the benefits. I have no problem with extending the medical card scheme, but I believe all people should get free GP care at the point of delivery. The Government made a deliberate decision in favour of wealthier people over 70 and against poorer low income families who are just above medical card limits. The health strategy is meaningless to the latter group as it has nothing to offer them.
According to the Minister for Health and Children, much needed measures to deal with prob lems in accident and emergency departments in acute hospitals can only be introduced if the cost of such initiatives can be met within current resources. Any reasonable person would take that as an indication that improvements in accident and emergency wards will mean a withdrawal of funding from, and less improvement in, other health services. The struggle between competing needs is most acute in emergency wards. The solution to overcrowding is often to cancel elective procedures, but the knock-on effect is that patients on waiting lists for treatment are pushed further down the line to make way for emergency cases. This happens to an increasing number of people and the solution must be to meet both needs. We should endeavour to manage and resource the health service to provide for those who need emergency care, without denying those who are entitled to other forms of care.
The stark comments of Dr. Patrick Plunkett, an accident and emergency consultant at St. James's Hospital, sum up the Government's failure. He explained at a recent press conference that he resigned from the hospital's board of management because he could not accept that poor, sick and aged people who are too sick to be sent home should have to lie on trolleys in public corridors for hours or days because elective admissions are given precedence. Last Monday, 22 patients were on trolleys in the accident and emergency department of the hospital, waiting for beds in wards. Dr. Plunkett said that one such patient had been waiting for an emergency bed in a psychiatric hospital since the previous Friday. The fact that a new generation of doctors is learning to examine patients on busy thoroughfares in full view of other patients and passers-by is, according to Dr. Plunkett, a sad deterioration in professional standards. This may be acceptable after an earthquake has levelled a hospital, but in Ireland in the 21st century it is a cause of shame.
One of the factors regarding the health service from which we have always taken solace and a certain amount of comfort is the high professional standards of medical and nursing staff. However, in conditions such as those described by Dr. Plunkett it is impossible for those high professional standards to be maintained. The point he makes is that it is unsustainable to expect that high level of professionalism to pertain in such a poor environment and in such working conditions.
Even more shameful is the evidence given by nurses working at the coal face on a daily basis who are struggling to cope with a deepening crisis. In SIPTU's submission published recently the experience of one nurse is truly harrowing. This nurse spent one night watching over an accident victim so she could claim the bed when the time came for another patient in her care. The victim was a young, 28 year old man who she knew was about to die. This nurse stated that all she wished to do was to care for this patient in his last moments. She did not wish to watch over him in order to claim his bed.
Another psychiatric nurse brought an elderly patient from a psychiatric hospital to an accident and emergency unit because the patient needed urgent attention. The nurse was severely rebuked by a doctor on duty because the unit was already overcrowded and she had to leave in tears. For these nurses who already work in a stressful environment, fears for their safety have become a growing issue. SIPTU and the INO are calling for proper security provisions to make accident and emergency departments safe places in which to work. A key demand is the immediate introduction of measures to enhance security within these departments, including, where required, improved lighting, closed circuit television, security doors and the presence of security personnel 24 hours a day, seven days a week. These demands tell us all we need to know about the circumstances in which professionally trained people are trying to deal with emergency cases which come into over loaded departments. Is it any wonder that nurses have decided to take industrial action given the overcrowded conditions in which patients sleep on trolleys and in which nurses are constantly under pressure and often face aggression. More than 90% of nurses balloted voted to take this action. Striking is not something they set out to do. There has been only one nurses' strike which was taken under equally difficult conditions. It is significant that, in this case, the issue is not about pay or conditions, but the needs of patients and the capability and capacity of the hospital service to meet those needs.
It is vital that this threatened industrial action is prevented and pre-empted by the Minister for Health and Children. He must seize the opportunity which the nurses have given him by delaying their action until 13 March. He has time to implement a clear set of measures to tackle the fundamental deficiencies in the accident and emergency service which he has so far failed to address.
An analysis carried out by Geraldine Regan and published in an accident and emergency nursing publication two years ago outlined the main reasons delays in these departments were so lengthy. In her research interviewees saw the main cause as the high proportion of inexperienced junior medical staff. The crisis in hospitals is only added to where junior staff in accident and emergency departments are ill-equipped or insufficiently trained to cope. Patients must be assured that they have access to consultant care when needed.
Another problem which was clearly identified, and which is still unresolved despite the Minister's announcements, is the shortage of beds. We have to ask why, after five years of economic buoyancy in which health spending doubled, people are still forced to wait, often in pain and distress, in accident and emergency departments before they can see a doctor. People often have to wait to get into a cubicle, then wait again to be admitted or forwarded to another department or hospital.
An article in today's edition of The Mirror highlights the case of a young Kerryman who was kicked unconscious on the streets of Killarney and who was taken to Tralee General Hospital. On arrival it was discovered that he had severe head injuries and was soaked in blood. However, because there was no head trauma specialist available, he was forced to wait on a trolley in the accident and emergency department corridor for 15 hours, from 5 a.m. until 9 p.m. During this time he continued to remain soaked in blood and in much pain.
Will the Minister for Health and Children tell the House if this is the kind of health service over which he stands? Why was this young man – an innocent victim of a brutal attack – left to suffer even further because this Government has failed to upgrade, resource and where necessary, redesign accident and emergency services? The requirements have been set out by the INO and SIPTU and have been itemised by medical practitioners working in the field who have continually pointed out what needs to be done, and where, to improve accident and emergency services. We need more consultants, anaesthetic facilities, endoscopy services, facilities for minor surgery and general practitioner services. However, in addition there is a clear direction in terms of better management which must be spearheaded by the Minister who is ultimately responsible. He can transfer blame and responsibility to the health boards, hospital management and so on, but at the end of the day the buck lands on his desk. He has to take a real and effective initiative in this regard.
The chief executive officers of hospitals with accident and emergency departments must be central to whatever management changes and reorganisations are required. Long before now we should have seen the implementation of measures such as the restructuring of the role of nurses, the greater use of nurse practitioners, a more efficient admission and discharge policy in accident and emergency units and improved liaison measures between hospital and community services.
This issue has not arisen out of nowhere and this crisis should not come as a surprise to anyone. The Government is almost five years in office. We have just come through what I imagine has been a painful experience for many women, particularly those who experienced crisis pregnancies and who went to Britain for abortions. That experience demanded a great deal of resources, time and energy from the Minister to whom I pay tribute as he did not shirk his duty. He was willing to debate the issue on any occasion. Unfortunately, the Taoiseach was not as willing to do likewise. Considerable resources and energies were put into this issue by the Minister and his officials to try and drive through an abortion referendum which was unnecessary and unnecessarily divisive. That energy and those resources should have gone into dealing with the crisis in our accident and emergency departments which are affecting patients – the born of this country, the elderly and the sick.
One of the main reasons what is happening in accident and emergency departments is not forgotten is because it does not matter whether one is rich or poor, if one needs that kind of care one goes to such a department. Even Charlie Haughey ended up availing of such a department. If we had private departments we probably would not know half of what is going on. However, we do not have private accident and emergency departments so everyone goes to a public hospital when necessary. Most people who attend such departments point out that the nurses and medical staff are great, but that they are overworked and the conditions are often appalling. There is genuine shock that at a time when this country is so financially secure that we have a Taoiseach dreaming about national stadia and changing the Constitution in totally unnecessary ways, we cannot get the floors of our accident and emergency departments swept clean or have units upgraded and staffed to meet the needs of poor, sick and vulnerable people. Those people need the Minister's attention but, so far, have not got it.