Éamon Ó Cuív (Galway West, Fianna Fail) | Oireachtas source

I seem to be receiving more inquires about matters relating to health than ever was the case previously. I accept that major challenges exist. A common remark which tends to be made in this House is that there is no money. I decided to check the position in that regard and discovered that the Estimate for health for 2014 is €13.162 billion. In 2006, during the height of the Celtic tiger era, the amount allocated was €13.146 billion. The two amounts are almost identical. It might be stated that inflation has taken its toll but cuts to people's wages in the interim have countered most of the effects of inflation. Two issues arise. The first is that according to the HSE, insufficient money has been allocated in respect of the services which must be provided. Mr. Tony O'Brien has made that very clear. The second issue which arises relates to the areas on which we should focus our efforts. In the context of the first issue, I refer Members to the shambles which marked the introduction of the budget for this year and the famous issue of probity. Instead of negotiating a plan, achieving the best service at the lowest possible cost and seeking the necessary funding, the budget was worked out on a horse-trading basis. The HSE was informed that the money to provide the services it stated were necessary was not available and that regardless of the fact that it was not possible to argue that they were necessary, the level of funding allocated would be cut in any event. When the budget was presented to the House, figures were bandied about at random until they were picked up on. That is not the way to budget in respect of health services.

There is a need to make choices. The Government allocates almost €53 billion each year in respect of voted expenditure. That money relates to day-to-day services and 25% of it is allocated in respect of health. The question which arises is whether more should be spent on health and whether that money should be taken from another Department's budget. I am of the view that the Ministers in the Cabinet should swap portfolios every now and again. Perhaps Deputy Burton could serve as Minister for Health for a while. She always seems to get in early to secure funding for the Department of Social Protection and is then very capable of defending her position against all comers.

Even when the service plan is presented to the Minister which shows a certain requirement for money that was not greatly above what is available - hundreds of millions rather than billions of euro because the billions are not there - she can always hold on to the money, whereas the Minister for Health cannot. The top-end structures are always being changed, including the making of grandiose appointments and changes to the HSE and hospital groups. We are obsessed with structures on the one hand, while on the other hand, we are often very slow to deal with the day-to-day aspects as a means of making life a lot better for people.

I cite the example of queues for public services. It always fascinates me that anyone going to see a doctor in a private clinic will be given an appointment time and seen at that time, give or take five to ten minutes. However, the same type of procedure or examination at a public clinic will involve everyone being given the same appointment time. I have often said that queues cost money. Staff are needed to service the queue and to answer queries on the telephone. Much of this is down to simple mundane management. Similarly, it is the practice in accident and emergency departments that everyone must be processed through that department. If this system was practised in an hotel so that every client who wanted to go to the bar for a pint was required to check into the hotel, there would always be a queue and chaos at the front desk. Quite sensibly, everyone looking to use a hotel or any other business is not put into the same queue; people are segmented depending on what service they require.

The accident and emergency departments deal with the very significantly ill, including those who have suffered very serious injuries and those who need a quick check for a minor matter. For example, when I was managing an Irish college, it was often necessary to bring a student to an accident and emergency department for an X-ray in case of concern that a bone had been broken. It was often the case of waiting eight hours for an X-ray, not because the X-ray machine was busy but because that was our position in the queue, which was a general queue for all complaints and injuries. I refer to Kilkenny hospital which for years has an efficient system in place to deal with queues. I was in Kilkenny at a football match. One of the players had come from London and needed to return there that evening. He was brought to the accident and emergency department at half time but he was back on the bus by the time the rest of the team had finished the match. This turnaround would not be possible in the regional hospital in Galway.

I will make some points about the ambulance service. We are always told about the golden hour. We need a service that will get an ambulance to a patient, no matter where he or she lives, within a fixed period of time. That should be easy enough to organise. It will mean that the rural areas should have that same opportunity of the golden hour as anyone living anywhere else in the country. In my area we tried to resolve this issue because it would take two hours for an ambulance to come from Galway. When I was Minister we encouraged communities to provide their own ambulance service. We gave capital grants to set up voluntary ambulance crews on a self-help basis. All were either Order of Malta or Red Cross validated personnel. Six months ago because there was some argument that they might not have some qualification, they were told they could no longer bring patients to Galway even though the ambulance was within ten minutes of the patient. If I was sick and I was given the choice of going with the ambulance staffed by these trained personnel - people in the community who had done a lot of training - compared to waiting for the other ambulance to come from Galway, I would take the local ambulance any time. It is time to support innovative solutions rather than argue that it was better to die waiting for the perfect service than live using a service that was 99% good enough. That issue needs to be examined, in particular, for the more isolated communities where it will not be possible to get an ambulance to them with any great speed. As my colleague, Deputy Calleary said, if the Clifden ambulance is taken away, it takes two hours each way to drive from Galway to Ballyconneely in an ambulance. It would be better to get sick on the Aran islands than on most of the mainland in Connacht away from the urban centres.

There is a lot that could be done. I suggest that reform should start with getting the mundane simple things right. If they were right, the structures would fall into place rather than thinking that changing the structure at the top will deliver a more efficient service at a time when the organisation of many of the services is for some reason designed to be endemic, with queues the norm.

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