Dara Calleary (Mayo, Fianna Fail) | Oireachtas source

I thank Deputy Billy Kelleher for once again giving us the opportunity to discuss issues relating to the health service, in this case the Health Service Executive's service plan for 2014. Government amendments to Private Members' motions are always worth a read. In this instance the amendment states: "[T]he 2014 national service plan provides a comprehensive basis for the Health Service Executive, HSE, to continue to deliver safe and high quality health and social care services to the general public throughout the year." This is a document which sets out various grandiose plans but includes a funding hole of €108 million in respect of what are referred to as unspecified pay-related savings. The Minister, Deputy James Reilly, confirmed at the health committee last week that €108 million in savings must be found, yet we are presented this week with an amendment which refers to comprehensive and high quality health and social care.

The service plan has all the elements of the dog ate my homework scenario about it. It has targets, lovely graphs and all types of other things, but it is not at all reflective of the reality for people who avail of the health service. The Minister of State, Deputy Alex White, will know from his own constituency what is happening in terms of medical cards, ambulance services, cancellation of surgeries at short notice and so on. That is the reality of the health service.

The issue of medical card probity is something that has been the subject of much discussion both inside and outside this House since last October. I have almost gone beyond being shocked at some of the decisions that are being made. This is no reflection on the staff of the processing centre in Finglas, who are doing an excellent job. Since they got their systems up and running, they have proved a pleasure to deal with, willing to engage and generally doing their best. Last Monday morning, I met a woman at my clinic whose husband has the use of only one lung and is blind. Even though he and his wife are pensioners, they learned last week from their GP that their medical card is being revoked. One can only imagine the additional stress this is causing to two people who are already under a great deal of stress. We have to go through the whole process with them of getting their GP letters and contacting the team in Finglas. We are hoping for a positive outcome. This situation is simply not fair.

The Taoiseach and the Minister, Deputy Reilly, keep telling us there never was a system of discretionary provision of medical cards, but we all know that is not true. Medical cards were always, in the past, allocated to persons with certain medical conditions. The Minister of State is looking surprised, but it a fact that under the health boards and formerly under the HSE, before the Minister, Deputy Reilly, got his mitts on it, credence was given to patients with cancer. That certainly was my experience in my part of the country.

On Monday I met a woman who was diagnosed last October with a very aggressive form of breast cancer. She is a business owner and, as is always the case, had to jump through a series of hoops. This is not just a HSE issue but arises right across the system. It is almost as if business people are hiding something or sitting on a pile of money. This woman is undergoing chemotherapy and approaching a mastectomy. It is crazy what she is being asked to go through, which is adding to the stress of her illness. Again, this is not fair and it is not right.

There must be an acknowledgment that there are conditions for which a medical card used to be provided, although not necessarily on a consistent basis across the country.

It is only right, by God, that a person diagnosed with a very serious form of cancer should get some sort of temporary medical card in order that the financial stress he or she is experiencing might be alleviated. If the person involved has means, then the matter can be discussed at a later date and the money reimbursed. Do we honestly expect people to jump through hoops in the first months following diagnosis and provide information relating to their accounts and income, while also expecting them to travel across the country for treatment? What people are expected to do is simply awful.

In the context of his remit, I ask the Minister of State, Deputy White, to examine the position with regard to the rural GP service, which is creaking under the pressure. It is increasingly difficult to get young GPs to commit to practising in rural areas. In the past we got many young GPs involved in rural practices. They built medical centres and took various other measures in order that they might provide services. These individuals are now under huge pressure as a result of their ambition for their patients and they have experienced huge reductions in their incomes since taking the steps to which I refer. Action must be taken. I am not suggesting that their should be a write-off of their debts but some form of support needs to be offered or entire swathes of the country will be left without properly-resourced GP services. This will lead to increased pressure on accident and emergency departments which, in turn, will have an impact on waiting lists.

Consultants are being frightened away from working in this country. I welcome the report in Monday's edition of The Irish Timesto the effect that the Minister, Deputy Reilly, is finally waking up to the position in this regard. The consultants' contract is driving away people. Individuals who gained experience abroad and who want to return to Ireland in order that they might use this to the benefit of patients are not prepared to do so. They are being offered jobs but they are not taking them because they cannot afford to do so. The value of their experience is not being recognised. I welcome the Minister's initiative in respect of this matter. There is no doubt that urgent action is required in respect of it.

One issue in which I have taken a particular interest in recent weeks is that which relates to the national ambulance service. The other Minister of State, Deputy Kathleen Lynch, has just left the Chamber. I wish to acknowledge that she intervened on my behalf in respect of a particular matter that was brought to my attention. Last October it took two hours for an ambulance to be dispatched to attend at a serious incident. When I investigated the matter I discovered that the ambulance had to travel to the scene from Boyle in County Roscommon, a journey of some 40 miles. The ambulance was obliged to traverse an area known locally as "the Gap". On the same evening, another ambulance responded to a call in Ballina. It came from Clifden. This was because the Ballina ambulance - as we used to think of it - had responded to a call in Roscommon. Therefore, one ambulance travelled from Roscommon to Ballina and another travelled in the opposite direction. Apparently, this is now the norm.

When I contacted the ambulance service about the matter to which I refer, I was informed that my thinking in respect of ambulances is wrong, that these vehicles are no longer static and instead move around and that Mayo is now part of a region. In geographical terms, Mayo is the third largest county in the country. It is not like Dublin city, which one can traverse relatively quickly at night. I tabled a parliamentary question on this issue in November and, after the exertion of much pressure, I received a reply from the HSE ten days ago. Actually, I received half a reply. I obtained a full reply this week when the Minister of State, Deputy Kathleen Lynch, intervened on my behalf. It appears that at night there are two ambulances on call in Castlebar, one in Ballina and one in Belmullet. The call status of the ambulance in Belmullet is different from the call statuses of the other three vehicles. Belmullet is the capital of the Erris Peninsula, which, in geographical terms, is as big as County Louth and in which the Corrib gas field and many natural heritage areas are located. One ambulance serves this entire area. Castlebar, one of the biggest towns in the country, has two ambulances and these must also provide cover for Westport. Two weeks ago, the three ambulances on call were out of the county. If one of the ambulances is obliged to respond to a call in north Roscommon, it is obliged to transport the patient to Mullingar Hospital. Had there been an incident on the night two weeks ago to which I refer, there would have been a scramble to get ambulances in from Galway, Roscommon and Sligo. Thank God no such incident occurred.

Any basic management information system should be capable of supplying statistics. However, I have asked for statistics in respect of the number of occasions on which ambulances have responded to calls outside the county and I have been informed that such statistics are not available. I welcome HIQA's intervention in respect of this matter. The service plan indicates that HIQA's target for ambulance response times in certain parts of the country is 18 minutes and 59 seconds - 19 minutes in anyone else's language - and that should be met 95% of the time. The HSE hopes it will achieve a figure of 80% in that regard this year. It certainly will not do so with three ambulances serving a county the size of Mayo, particularly if those vehicles are obliged to respond - at any given time - to calls outside the county. I cannot understand the reluctance to provide information in respect of this matter. It would be easier to extract information from North Korea than it is to obtain it from the national ambulance service in the context of how it operates. Deputies McHugh and McConalogue both referred to the appalling incident which occurred in Donegal during the Christmas period. Reference was also made to another appalling incident in Louth. How many more incidents must occur before those who run the national ambulance service wake up to the fact that the model of service provision which has been adopted is not suited to the kind of geography which obtains in this country? If those to whom I refer are intent on sticking with this model, then they need to purchase more ambulances. It is not good enough that there are only three ambulances to cover a county the size of Mayo. The gap in service in the context of both geography and response times is not acceptable.

It is only fair to state that some good things are happening. The response to what happened in Letterkenny Hospital is a good example of how the hospital groups are beginning to work. In the immediate aftermath of the flooding at the hospital, food for patients was prepared in Castlebar and then ferried to Letterkenny. However, gaps remain in ambulance, rural GP and other services and waiting lists - currently at nine months - are beginning to climb again. With regard to the latter, the Minister has become obsessed with Trolley Watch. His mantra seems to be that the numbers on trolleys should be kept down and that those on waiting lists can be allowed to increase. Surely it is possible to arrive at a better way of dealing with people who are stuck on those lists and awaiting surgery.

I wish matters were better. Many Government backbenchers have had a go at Deputy Kelleher and others for frightening people. I wish they had been present during the lifetime of the previous Dáil in order that they might have heard some of what we were obliged to put up with from the Minister, Deputy Reilly, when he was in opposition. I refer, in particular, to the concerns to which his comments on the cancer control programme gave rise among people. We must get things right. The Minister of State, Deputy White, must examine the position with regard to the rural GP service, which is creaking under the pressure being exerted on it. Unless action is taken in respect of it, the pressure on other services will increase.

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