Michael Healy-Rae (Kerry South, Independent) | Oireachtas source

Yes, but there were plenty of times the Minister could have handled situations differently, yet he used the system in the same way as previous Ministers did. I will save criticism also for past Ministers who were from parties other the Minster's one.

It is nationally and internationally recognised that our community hospitals are not just essential, but also vital in delivering health care throughout the country. The Minister is a lot older than I am, so he can remember when we had Government Ministers who thought it was a good idea to close down our community hospitals. In the county that I represent, we once had a Minister who thought it was a great idea to close down the hospitals in Kenmare, Killarney, Caherciveen, Skibbereen, Millstreet and a couple of others, at one stroke of a pen. That Minister thought this would be better for the delivery of health care. If that had been allowed to happen it would have been one of the most disastrous political decisions ever made. Thankfully, however, there was a very forceful chairman of the old Southern Health Board at the time. His name happened to be Jackie Healy-Rae and he laid it on the line to the then Minister that those hospitals would only close over his dead body. A determined argument was put up against their closure and consequently they were saved.

The current Minister knows that every Deputy works on a daily basis with community hospitals in their areas. They know how important they are. They provide long-stay beds for people who are not fit to enter nursing homes because they need special medical care. They also offer physiotherapy services and respite care. In addition, patients in larger hospitals who are not fit to go home can be cared for in step-down facilities in community hospitals.

I wish to pay a special tribute to the matrons and nurses in those community hospitals who do Trojan work. I know the Minister would also wish to pay them tribute. They really work above and beyond the call of duty. We should realise what it means to be a nurse or other front-line health worker today. Every day I am contacted by people working in the health service who highlight problems and inadequacies in their workplaces. They are under great strain and genuine hardship in carrying out their daily work. It is staggering. We are dealing with an ageing population which brings added pressures to the system.

Younger nurses have their own troubles with high mortgages and husbands who may not be working as they did in the past. Therefore, they are under strain at home and when they go to work they are under severe strain. I am no different from other elected representatives who know people in such predicaments personally. Such people are really feeling the strain, but they keep saying that there is no accountability at the top. They say that everything is being thrown at them and it is up to them to deliver the service with very limited resources, so they are being put through the mill.

I would not be doing my job properly if I did not also highlight the issue of psychiatric services and how the HSE system works in that regard. A change has been made recently with regard to assisted admissions. In the past, they were done through the Kerry health services but they must now go through a company in Kildare. The Minister should think about this matter. Instead of doing an assisted admission within County Kerry, we are employing a company from Kildare to do the work. I have nothing against Kildare, they are great people there, but why must we employ people in Kildare to work on assisted admissions in Kerry? Perhaps the Minister can prove me wrong, but I estimate that it will cost five times as much to carry out an assisted admission through this company rather than doing it locally in Kerry. The difference however - it is like a three-card trick - is that the cost will not be borne by the Kerry services. It will be borne nationally by the HSE, so it will not as though the budget for admissions in Kerry is going through the roof, but the exact opposite. The cost will go down because it is not being charged to Kerry but is being absorbed nationally by the HSE. This is one of the many examples of changes that are being made but to no good purpose. It does not make sense to me. Can the Minister deal with this matter? I tabled a parliamentary question about it, but I was certainly not happy with the reply I received. It does not make financial sense and neither does it make for good work practices.

In every constituency, health staff are being taken out of day centres to fill the required staff levels in hospitals. This, in effect, is leaving day care centres short staffed. By their very nature, such centres are assisting predominantly elderly people. It is a vicious circle, however, because such people are being kept out of community hospitals. We have always been told that it is better to take care of people's needs at home or as near to home as possible. That is why our day care services are invaluable. I work closely with many day care and health centres in County Kerry and I see at first hand the excellent service they provide. Less than a few hundred metres from where I live there is an Alzheimer's unit which provides an invaluable service to the wider community in my region. I can see the positive impact that unit has on elderly people in the early stages of Alzheimer's. I compliment the management and staff who provide great care in all such centres around the country.

It is great that the Minister for Health is also a medical doctor because he can appreciate and understand that the patient must come first at all times. We must recognise, however, that we cannot squeeze any more from health service staff. One can only squeeze so much and no more.

In recent months, certain situations have dogged the health system. One only has to examine the Government's decision to centralise the processing of medical cards. One may ask what that has to do with the delivery of health care locally, but it does have an effect. People with medical problems that require treatment want to obtain a medical card, yet they are unable to do so because the connectivity that was there in the past in local regions has been centralised.

There was a brilliant system in place, in which the people who processed the cards were able to deal with community welfare officers and community welfare nurses and could get information about locals. They were able to work together to ensure the speedy and timely delivery of a medical card. If this did not happen and if a person could not afford to get his or her health care taken care of because of the delay arising from the Government's centralising of the processing of the cards, it meant the health of the person in question would deteriorate. What might have been a problem that could have been dealt with in a community hospital would worsen suddenly and the person would be obliged to attend a regional hospital and take up an acute bed. More than anyone else in this House, the Minister knows the cost of an acute bed in one of the main hospitals. It costs enormous sums of money and as one wishes to avoid having people lying in trolleys, it again comes down to early intervention, while always remembering that the patients' concerns and health come first. I acknowledge the Minister appreciates this point.

In the future, the great working relationship with the general practitioners must be continued as by using their common sense at all times, they do their best to get people the care they require while avoiding unnecessary admissions.

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