Bernard Durkan (Kildare North, Fine Gael)

I welcome our guests and congratulate them on the indicative progress at all levels, which is very welcome. Like the Chairman, I have had personal experience of our hospital services in recent times. I was really impressed with the manner in which everybody, from orderlies to consultants to everybody else involved, fulfilled their duties. We should mention also the number of foreign-born staff who are evident in all our hospitals at present, up to 90%, I would say, in some cases. We need these people with the appropriate qualifications at every level nowadays and we should be very grateful to have them. Our congratulations go to the organisation in general.

The first word I want to mention regarding both addresses this morning is "organisation". Organisation is what counts, as well as the utilisation of what is available and co-ordinating that with what is required. It is coming to pass. It was slowly getting started. There were a number of hiccups and a number of ditches here and there but, generally speaking, it is getting organised now. The demand is greater and will be greater, and that is a fact of life. It is, however, the small things that count, as well as the very small glitches in the supply chain at any given time. Even the lift system going wrong, for example, can mess up the whole day's work for somebody else at a different level.

Something does not happen within ten, 20 or 30 minutes and, the next thing, the entire schedule is knocked back. Those small things, when put together, mean the organisation of services in the hospital or health facility for the day is affected, which leads to another and another, and it goes on and on. Congratulations for identifying those issues in the way that has been done and on the progress. Everybody can see two sides to everything. For some, the glass is half full in some cases and half empty in other cases, depending on whom one talks with at any time. We must progress on the basis of having the glass half full and filling more, because the greater requirement is there.

In the examples that I saw, I think that the organisation on the floor, whatever it is, from the front door to the theatre, makes a huge difference. If the layout is right, the degree to which the staff can respond makes it easier and puts much less strain on them and on the organisation in general. For instance, as mentioned, we have seen a fairly substantial reduction in waiting lists, as we have wanted and called for. Something is really happening now in the sense that it is beginning to progress in a way that a passer-by can see. That is commendable. There are still a couple of stitches that we need to deal with. We want to be aware of the fact that things can go wrong. Things go wrong in all walks of life from time to time. We need to try to avoid it insofar as is humanly possible and to make sure that they do not go wrong.

Given all that, we need to prepare for what happens next if things go wrong. What is the fallback position or plan B, as they say nowadays? When something is likely to go wrong, there is a need to put in place a schedule that will pick up the slack and move on. For example, we still have unacceptable waiting lists for scoliosis. We should be able to get that organised. It is not beyond the bounds of possibility. If we cannot do it in our own hospitals, the treatment purchase system is there and should be utilised. There is no sense saying otherwise to the patient on that waiting list, who is suffering and whose family is suffering, looking at the child or whatever the case may be. They see it as a simple thing to get done. We can do it but we do it too slowly. We wait, have to organise and consult. The organisation and consultation should be done. The provision is there for treatment purchase and has been for some years. For heaven's sake, let us utilise it quickly and put those procedures in operation much more quickly than has been the case heretofore.

I would say the same about any area of services where there is a problem; for instance, cataracts. The treatment for cataracts is very simple. It can be done around the corner anywhere in the country. What are we waiting for, for God's sake? It is so simple to do it. One can get it done in any town or village in the country within a few miles. We make a big hurrah about carting patients almost around the world to get a simple procedure that is well within our reach. If we cannot get it in the public sector, which we can, we can get it through treatment purchase adjacent to the homes of people without any organisational feats at all. It is simple.

The other point, which I have raised before at these meetings, is that people cannot wait, especially people who live on their own who have a need for cataract treatment and whose sight is diminishing at a rapid rate. They are dependent on driving and that is the only way out. They live alone and are isolated entirely. Many of those people's friends have got together to collect the necessary money to have it paid for. I brought this up before as well.

If it was not approved beforehand, the patient was on a waiting list for a couple of years, waiting for something to happen. It should not be that way. It is being dealt with now in the forthcoming scheme, but we should also try to help pensioners who have had to get private treatment even if it is after the event. Nobody is going to look for reimbursement of the full amount, but it would be a very nice gesture to those we could not accommodate on the waiting list within the required timeline to at least make a contribution that takes the sting out of the time they waited and the fact they had to get it done privately. Those are a few of the simple things I have dealt with in respect of patients locally.

I do not want to go on as I have said all of these things before, and I am sure others want to speak, but I refer to accident and emergency departments, and I have experience of two or three of the major hospitals in Dublin. Although they are very good, they are overcrowded and there are a lot of people with addictions in the waiting areas who should be waiting in different outlets. The problem is that older people who go in there who are concerned about two things - first, about getting treatment and the waiting times for that and, second, about unruly behaviour, threats or violence in the accident and emergency departments. We cannot say that does not take place because it does. There is considerable abuse being turfed out to medical staff, nursing staff, orderlies and others who are working in the system, trying to make it work.

Any interference with the smooth running of the system is not on. We can continue as long as we like, but as long as there are people hurling abuse at, threatening or assaulting staff, or attempting to assault one another, in accident and emergency departments up and down the country, the system is not viable. We need to identify these places. By all means, we should treat those who present with alcoholism or drug-related illnesses, but they should not all be in the same place because that is at cross purposes. We must to deliver to everybody, as is required, but at the same time there are those with specific requirements who need to be dealt with differently.

I visited a couple of the drug treatment centres around the area during the break. One of the things I noticed was that I knew most of the people there. These are people who fell by the wayside, who had a bad turn or two, or more, over a short time or a longer time. It is so sad that they have to hesitate to consider the implications for themselves. They need to have the appropriate treatment and it needs to be quickly and readily available, along with counselling and so forth and we do not need the system where I always run into difficulties. Methadone is very important in those situations, and we need it, but it must be a means to an end. If methadone is going to solve the problem, it has to be used to ensure a diminishing reliance on drugs.

We see what has happened in the past few weeks with drug trafficking all over the globe and in a big way in this country in particular. There are many drug barons making an awful lot of money from other people's misery. We need to come to grips with that and recognise that we need to give treatment to patients with a view to reducing their reliance on the drugs now coming into this country.