Seán Fleming (Laois-Offaly, Fianna Fail)

I welcome the opportunity to contribute to this debate and I thank my colleague, Deputy Billy Kelleher, for putting forward this motion, which covers a variety of issues in the health area. They are issues of concern for the majority of people.

Every household interacts with the health service over the course of the year, whether it is at local level with the general practitioner, accident and emergency unit or local hospital or if people are obliged to travel further afield to get specialised treatment. Most families also interact with the HSE. A large number of them have medical cards, and there is a great deal of interaction with the HSE in the course of applying for them. I will discuss that issue further.

However, I wish to refer in the first instance to the Dublin - mid-Leinster service plan which was announced this afternoon and was published on the HSE website. It is shocking reading for people in the midlands, and particularly those in Laois-Offaly. There is no provision for major capital expenditure in the Laois-Offaly region, although there is some for other parts of the Dublin - mid-Leinster region. Nothing is provided in the service plan under the various headings in the area of primary care. A number of new primary care teams are required in the area, as well as a number of new primary care centres. There is no provision for capital investment in the acute hospitals in Portlaoise and Tullamore, or for investment in facilities for older people. Shockingly, no capital investment is provided for mental health facilities. In those four key areas, the plan writes off an entire area of the country in terms of capital investment even though there is significant investment funding available to the HSE and the Department of Health. To take a couple of counties out of the plan, as if they do not exist, is totally unsatisfactory. The management in the Dublin - mid-Leinster service area should re-examine this.

Medical cards were mentioned by earlier speakers and will probably be mentioned in this debate by speakers from all sides of the House. I have a single question for the Minister about what is happening with medical cards in the centralised facility in Finglas. I might be in a minority but, personally, I believe that if the Department of Social Protection can handle applications centrally, the HSE should be able to match it. However, it is not doing the job. It might need outside assistance because it has not previously operated on a national basis in the provision of a service such as this to 1.5 million people. Perhaps some staff could be seconded from the Department of Social Protection given that they are used to administering nationwide schemes from centralised locations.

I am not familiar with the building in Finglas; I have never visited or seen it. However, when I ring and occasionally get through to the staff on the telephone, the staff, who must be on the first or second floor, tell me that when they send the file to the fourth floor it gets lost. If the Minister does nothing else this week, he might visit the fourth floor of the building in Finglas. I do not know what is in it but other staff in the building tell me that files get lost there. I appeal to him to find out what happens there. Letters come from there dealing with meaningless issues. I accept that staff must make various requests for the supply of information, but when people are obliged to call to my office to scan a copy of their car registration certificate to send to the HSE to verify whether a member of the household has a car, we are pushing the boat out too far. What is being done about the excessive red tape in that department?

Cathal Magee, the chief executive officer of the HSE, has said he will examine this matter and try to ensure the files dealing with renewals are put into a different queuing channel so they do not clog up the new applications channel. New applications inevitably take more time. Where the person is elderly or has had a medical card for a few years and it is a straightforward renewal, there should be a separate queue to deal with that. Renewals could then be dealt with quickly and with the minimum of fuss. However, they seem to get caught up in the main system which involves starting the entire process again.

The waiting list for orthodontic treatment for children in the midland area is two to 2.5 years. It is a nationwide issue. Certainly, it is embarrassing to get a reply from the HSE, on foot of a parliamentary question to the Minister on orthodontic treatment, stating that the waiting list is in excess of two years. That reply came in writing from the Minister's staff.

The Minister is familiar with Portlaoise hospital. It is an active and busy maternity hospital as well as having a number of other very good departments. It is a maternity hospital for Laois, parts of Offaly, much of Kildare, parts of west Wicklow and part of north Tipperary. It is a regional maternity hospital at this stage. It has a very good pediatric and child care unit. Sometimes one tends to think that a hospital in a certain county only serves that county, but this is a regional facility and not just within the traditional midland health board regional boundaries. It serves other parts of the Leinster area and even north Munster. I urge the Minister to ensure there will be sufficient front-line staff in the maternity ward next month to replace the staff that are due to retire between now and the end of this month. The problem is that some of the staff have already left HSE employment. When they gave in their notice they might have had a month of leave left over from last year or holiday leave was carried forward, so they were obliged to leave almost on the day they handed in their notice or they would forfeit that leave.

The main issue I wish to highlight is contained in the Dublin - mid-Leinster service plan published today. I have an extract from the 2012 plan dealing with financial information, which is on page 123, and the corresponding page from the 2011 service plan. The horrific figures in this are under the heading for community care for the midland region. This refers to community hospitals for older people, and the Minister is aware I will refer to Abbeyleix and the community hospital in Shane. The figure for last year was €295 million, while the figure in the plan produced this afternoon is €275 million. That is a cut of €20 million. It is the biggest cut in any section or department or in any of the hospitals in the Dublin - mid-Leinster area.

This €20 million cut means, in effect, that a decision has already been made by some people to close those hospitals, and it is the wrong decision. If there must be a cut of €20 million, it can only be based on a serious number of beds being cut. There is provision for cuts but they are falling disproportionately on the Abbeyleix and Shane areas. The Minister met the Abbeyleix representatives some time ago. I was with the delegation and the people were happy with that meeting. However, a commitment was given that night that representatives of the HSE would meet with the committee to scope the decision and deal with the terms of reference for how the decision was made to close Abbeyleix community hospital.

The Minister stopped that decision in its tracks because the staff in the HSE did not know the legal position. They had announced the closure before giving the required six months' notice. The meeting between the HSE and the Abbeyleix committee has not yet happened. I am sure my colleague from County Laois has referred this to the Minister on various occasions as well. We are anxious that it happen. We are told the consultation period will commence next month. That simply means the HSE, which made the wrong decision in the first place, will now make the same decision but ensure it does not get tripped up by using incorrect procedures.

In addition, three beds in Abbeyleix community hospital are currently empty and could be utilised. People in Portlaoise hospital could transferred there. It is costing the HSE approximately €21,000 per week to keep the patients in Portlaoise hospital while keeping the three beds idle in Abbeyleix. That is false economy and false budgeting. It is utterly unfair. I do not believe there is proper management in this area.

I submitted a freedom of information request and received a response to it at the end of January. It stated the information I received was discussed in the Department of Health in July last year. In a letter dated 4 July 2011 from the area manager, whom I will not name, he stated with regard to Abbeyleix that "the physical infrastructure at the hospital is totally unsuitable and a complete rebuild would be necessary to meet HIQA standards". This is clearly untrue. I am very pleased that the Minister visited the hospital, in his low key way, over the Christmas period. There was no fanfare or people gathering at the gates. I believe that was not the Minister's view of that building. It meets HIQA standards at present and with some improvements it could be brought up to the proper standard not for 33 patients but for 50.

The entire decision process that worked its way up to the Minister's desk was based on an untrue assessment of the HIQA report by the regional manager, who said the required renovation could not be completed to meet HIQA standards. That was wrong and untrue. It was an assertion by the regional manager.

I cannot blame the Minister, although politically I would like to do so, for allowing that decision to be implemented. He took what was presented to him at face value. If he looks at the letter of 4 July 2011, which is in the Freedom of Information file I received, he will see the decision was based on an inaccurate, improper, untrue and unfair reading of the HIQA report. I ask the Minister to revisit this matter and to use his sense of fairness as a doctor in doing so. I understand the Minister was impressed by the facility. I ask him to do the same for the hospital in Shane.

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