John McGuinness (Carlow-Kilkenny, Fianna Fail)

As I did last week, I welcome this debate on health matters. I hope that we will have ongoing debates on developments within the Health Service Executive, focusing on the current spend provided by the Department of Health and Children to the HSE, how it is being used and how services are being delivered. By way of debate, we should continue to ensure that the patient is at the centre of our health service and that spending is directed to the service's front line to bring about improvements in the regions.

During the course of this debate, reference was made to the case of Rosie in St. Luke's Hospital, Kilkenny. As someone who represents Kilkenny, I want to say that everyone sympathises with the case. The hospital recognised its error, which highlighted an issue in the hospital that must be dealt with. St. Luke's Hospital delivers a fine all-round service and has been recognised nationally as a model of best practice. As a result of the unfortunate incident, the hospital has reviewed its services and I am glad to say that it has identified the need for a day care unit, which has been funded to the tune of €300,000 by the HSE.

Hospitals that take initiatives in which patients are at the centre should be rewarded quickly. I consider the grant of €300,000 to be a reward and I hope that the patient, Rosie, will agree that something good for patients in general has come from the case. I encourage the Minister to continue to examine St. Luke's and to conduct the hospital reward scheme around the country so that consultants and hospital managers can see a way to improve their services, take initiatives, be rewarded and benefit patients.

Like other speakers, I acknowledge the amount invested in cancer care since 1997, that is, more than €1 billion, but more needs to be done. I appreciate that 110 consultants are being appointed and that not only has the number of cancer patients increased, but they are being seen more efficiently. However, a number of issues are of concern to cancer patients in the south east, where more remains to be done. The commitment to provide a cancer care unit at a site co-located with a private hospital was given, but there seems to be back-tracking on that project in that it will be delivered by conventional means. People at the coalface of cancer care in the south east and those who have been campaigning for many years for an improvement in the centre are concerned that the HSE is not as clear on the development as it was.

The Minister has stated her case, but will the HSE come clean on what it intends to do and state whether it will provide a service within the timeframe specified, namely, two years? To know where we are going in terms of the campaign on improvements in services, we need to know what is happening. I appeal to the Minister of State to establish the up-to-date position and ensure that the HSE follows through on its political commitment, which can be delivered on. I do not mind that it will be delivered in the conventional way rather than through a public private partnership or co-location. All that concerns us is whether the service will be delivered. Will the Minister of State take this information on board and bring clarity to the debate?

Some €6.5 million is needed in terms of capital and required positions to bring the palliative care service in the south east to a minimum level. I understand that the project received €1.2 million in 2006, but that the HSE did not spend the money. There is no clarity on how the money was spent. Why was it not spent on palliative care, what does the HSE intend to do about the issue and why did it not fulfil part of its agenda? In the south east, there are two palliative care consultants who do not work at weekends. The HSE has not succeeded in making a deal with them in terms of a weekend service. As home care teams are active on a 24-7 basis, I ask that the situation be reviewed and resolved.

Regarding dialysis, public patients are being referred to a private clinic in Kilkenny. At the Whitfield Clinic in County Waterford, a radiation oncologist must visit patients, examine their condition, decide on their standards of care and have them referred to the private facility. At a similar project handling dialysis cases in Kilkenny, the HSE was reluctant to put in place efficiently a service contract that would enable public patients to be referred. The debate is ongoing.

The bureaucracy and red tape should be removed from the system and the Minister should intervene to ensure that this type of service is established at the Whitfield Clinic as soon as possible and that public patients are referred to the centre immediately. Without political intervention, the matter will drag on for months on end, as has been the case at the Kilkenny dialysis unit. Kilkenny patients are being referred to Dublin and vice versa. It is hardship for the patients and it must be corrected.

The position of cancer patients is worse because they must travel all over the country. Regarding patients who must travel to Limerick or Dublin, CERT, a charitable organisation, arranges transport for cancer patients in the south east. It is poorly funded and cannot be advertised because it would be overcome by the numbers who would want to use the service. The HSE has a role to play in that it must ensure sufficient funds to transport patients in an appropriate mode to get them to their appointments in comfort and without stress, which is not the case currently. The promise in the Hollywood report of innovative transport measures has not been fulfilled. If the HSE, which is aware of this report, has not returned the €1.2 million it must put it to work to transport patients effectively and efficiently in a way that is available to all. While we are waiting for services to be provided in Waterford for those cancer patients, we should have a transport system in place.

Much needs to be done in the context of the management of the HSE and I ask that we continue to debate these issues until management is made more efficient and made to deliver. With the money it is getting, it should be able to fulfil some of the basic needs of these patients.

See this speech in context