Dáil debates

Wednesday, 29 January 2014

Health Services: Motion (Resumed) [Private Members]

 

The following motion was moved by Deputy Billy Kelleher on Tuesday, 28 January 2014:That Dáil Éireann agrees that the 2014 National Service Plan of the Health Service Executive is inadequate to meet fully all of the growing demands being placed on the health services and that the lack of sufficient resources will not be in the best interests of patient care and this is already evident in accident and emergency departments.

Debate resumed on amendment No. 1:To delete all words after "Dáil Éireann" and substitute the following:"agrees that the 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; notes that the overriding priority reflected throughout the 2014 national service plan, at a time of undoubted financial constraint, is the commitment to patient safety; notes that the HSE has set the advancement and implementation of the Government's programme of health reform at the centre of its service planning for 2014; and notes, in particular, the progress that has been made in reducing the waiting times for patients on trolleys in emergency departments, with a reduction of 8,814 in the year to 27 December 2013, down 34% from 2011."- (Minister for Health)

5:50 pm

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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The next slot is shared by Deputies Wallace, Maureen O'Sullivan, Healy and Clare Daly. The Deputies have two and a half minutes each. Obviously, we will make up the time at the end.

Photo of Mick WallaceMick Wallace (Wexford, Independent)
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The Euro Health Consumer Index 2013 ranks Ireland in 14th place and it looks like we are still falling. The Government was elected to office on promises of free general practitioner care for all and universal health insurance. In reality, the Government has cut services and increased health care costs for the public year on year. This year, 35,000 people over the age of 70 years will lose their medical cards due to tougher eligibility rules. They will instead receive GP cards, thereby removing their claim to free medication and public hospital beds while doing away with the exemption from accident and emergency department charges.

The Government's failure in the health service manifests itself most starkly in the number of people on waiting lists. Last September, more than 49,000 people were on hospital waiting lists compared with more than 41,000 in September 2012. Even though the Minister for Health, Deputy Reilly, accelerated upgrades at Wexford General Hospital at the behest of the Minister for Public Expenditure and Reform, Deputy Howlin, the situation there continues to worsen. Some 280 adults and children were waiting for inpatient and day case appointments at the hospital at the end of September, an increase of 102 on the same period in 2012.

Wexford Hospital is also experiencing direct cuts to resources and a recruitment embargo that has led to junior doctors working excessively long shifts without proper periods of rest. Some doctors are working 36 hours without a break.

All this has been taking place against the backdrop of austerity cuts to the health services that are destroying people's lives. As noted by Michael Taft yesterday, since the beginning of the crisis, health expenditure has been cut by 12.6%, with a further 2.6% cut planned this year. Health spending was once seen as a positive investment that carried tangible economic and social benefits, but now we have a neoliberal government with a different vision. While our public services are getting bad press, the ground is being made fertile for the bogus claim that the private sector must step in to pick up the slack, while failing to mention that this would mean reinforcing the two-tier system where the poor are punished for their inability to pay and the rich are rewarded for their ability to pay. This further entrenches inequality in Ireland, which is currently four times the OECD average. Ministers may claim that they have a different vision on how things should be done, but it is probably a bit far fetched to call it a vision.

5:55 pm

Photo of Maureen O'SullivanMaureen O'Sullivan (Dublin Central, Independent)
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Ar dtús, ba mhaith liom aitheantas a thabhairt do na buntáistí agus na rudaí dearfacha a bhaineann leis na seirbhísí sláinte. It is important to acknowledge the progress that has been made. I would like to acknowledge the palliative care available to people here. I had experience of it before Christmas, and it was an excellent service. Waiting lists are improving, but the difficulty now is that while people are getting the initial appointment quicker, the delay then starts. I would love to see the statistics on the time between the initial appointment and the actual date of the operation, the treatment, the occupational therapy or the physiotherapy, or the detox bed, or presenting with an eating disorder or a mental health issue.

Before Christmas, the director general of the health service gave a briefing on the service, and I was one of three TDs who attended. It was excellent for the three of us because we had real one to one engagement. It was very obvious, looking at the plan, that there are challenges and reductions, and it is difficult to see the match between the requirements and the increasing demands and resources and funding available. It is happening today with a further increase in private health insurance, which will see more demands on the public service.

I would like to list a couple of examples which show that we are very far behind, one of which is related to CAHMS. I am hearing from the management of schools and from doctors who are referring young children to the Child and Adolescent Mental Health Services, and who are being refused. They do not make those referrals lightly, so I do not know if it is a resource issue or if the criteria have changed, but certainly there are many more refusals and there is still a big gap for those presenting with issues in the 16 to 18 age group.

Diabetes is an area in our medical system that does not get very much attention, but I think there is a need to look at those presenting with chronic diabetes in a much more holistic way. If patients come into an accident and emergency department with a kidney or heart problem, it should not be seen in isolation from the diabetes. I hear from people who have serious difficulties because they have chronic diabetes. The same is the case with stroke victims. While the therapies are good, there can be shortfalls in medical care.

I want to make one plea on substance misuse in the service plan. I hope that all of the local knowledge and the initiatives that have been built up in the communities most affected by the drugs issue will not be lost, and there will be supported drug recovery and accommodation. We must separate those in recovery from those who are actively using.

In the Government amendment there is a commitment to patient safety, but I recently came across an incident of a young woman delivering a baby in one of our maternity hospitals who was sent home and came back on three occasions because she continued to bleed for ten days after birth. It was discovered on the third occasion that the cutting had happened during birth. With the extent of the loss of blood, that is not patient safety.

Photo of Séamus HealySéamus Healy (Tipperary South, Workers and Unemployed Action Group)
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Serious and significant damage has been done to the health service over the last five to six years, with huge cuts of €3 billion and 11,000 staff. Again this year we have €619 million of cuts and 2,600 staff lost. I pay tribute to health staff all over the country who work above and beyond the call of duty, every hour of every day. I especially wish to pay tribute to the dedicated and committed staff at South Tipperary General Hospital. This is a progressive, modern hospital which, in spite of a loss of one quarter of its budget and almost 200 staff, has increased its activity levels over the last few years. It is now akin to a regional hospital, with patients attending from north Tipperary, Waterford, Cork and Limerick.

Cuts to budgets and reductions in staff have serious implications for patients, and one of the serious problems at the hospital is the ongoing difficulty for patients on trolleys, not just in the emergency department, but also in the corridors and the atrium of South Tipperary General Hospital. This is simply unacceptable and must stop. I have made continual representations on this. I finally got a commitment from the HSE for the opening of ten beds which were closed in the hospital. Even though there is a significant number of patients on trolleys, beds were actually closed in the hospital. There is a commitment to open those beds and to provide additional staff for the emergency department. However, the national recruitment service is simply unworkable and there are huge delays in filling posts. I call on the Minister to allow for local recruitment in cases such as this. There is an ongoing difficult situation in respect of patients on trolleys. Beds have been closed and we have approval to open those beds, but that has been delayed by the delay in appointing staff through the national recruitment service. That could and should be done locally and I ask the Minister to ensure that approval is given for filling those posts through local competition.

Photo of Clare DalyClare Daly (Dublin North, Socialist Party)
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We used to aspire to having a society and a health service where we look after people from the cradle to the grave, but I want to deal with the period before we get to the cradle and the crisis that exists in the maternity services in this State. Since 2001, the directors of the midwifery services and the CEOs of the three major maternity hospitals have spoken about having a scenario of too few obstetric staff, too few midwives and overstretched to the point of raising fundamental concerns about safety. Despite that, in response to the closure of the Mount Carmel Hospital last weekend, the Minister for Health states, without a shred of evidence, that the existing hospitals will absorb the 1,000 plus births that Mount Carmel used to deliver. How could this miracle possibly happen? It is true, as the Minister stated, that the birth rate has declined slightly, but we are nowhere near the levels that we were at in 2007 and 2008, when at that time the HSE commissioned a report into our maternity and gynaecological services in the greater Dublin area which declared a crisis. The report stated that the hospitals were understaffed and they needed an additional 20 obstetricians, 221 midwives, 20 neonatal nurses and 35 theatre staff across the three main maternity hospitals. Since then, the birth rate has increased by about 40% and the CEO of the Rotunda said at the end of 2012 that the figures given to staff those hospitals, at a full-time equivalent of 707.73 staff, were not sufficient. Yet last year, the hospital was given 679.42 full-time equivalent staff.

This crisis is replicated around the country. There are high sick levels, there is an embargo on recruitment and staff and midwives are leaving. The result of this is the type of analysis that we got in the report commissioned by HIQA in the services at University College Hospital Galway last year, where there was deemed to be a general lack of provision and fundamental care. The answer to this has been to cut funding further. Unless we have a radical overhaul of our maternity services, then further lives will be put at risk. The safest way, with the best results for women and their children, has been established as an investment in midwifery and midwife services, yet this Government has failed to replicate the pilot programmes that were carried out. If we were to invest in that, we would save money and have a better outcome for women and their children. Cutting budgets and failing to attend to that will not deliver.

6:05 pm

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I welcome the opportunity to speak to the service plan for the health service. I agree with some of the commentary on what needs to be done in the health service and the challenge facing the Heath Service Executive and Department of Health. As Deputy Maureen O'Sullivan acknowledged, we are, for the first time, advancing a planned service. Some areas have made much greater progress than others in this regard. The areas with which I am most familiar are mental health and disability services and services for older people.

In the areas of disability and mental health, my main aim has been to ensure people are removed from institutions and, where this is not possible, to provide for sufficient inspection safeguards for such institutions. That we have managed to pull this over the line through the establishment of the Health Information and Quality Authority and the provision of residential places for people with disabilities is a significant achievement.

We are also continuing with our programme of closing mental health institutions. It is sometimes thought that this job has been done now that the large Victorian institutions such as St. Senan's Hospital in Wexford, Our Lady's Hospital in Cork and St. Columba's Hospital in Sligo have been closed. That is not the case because many smaller units also need to be reconfigured. We are in the process of doing this.

Approximately 95% of the posts provided for in 2012 have been filled. In today's Topical Issue debate, a Deputy spoke of the need to allow recruitment to take place at local level in highly specialised areas. We are examining this issue and the barriers that surround it. It is of little value recruiting someone to a post in the Central Mental Hospital if he or she is waiting to move to Tralee when a post becomes available there. These types of barriers and structural issues need to be examined. The same position pertains in respect of the posts provided for in 2013. We have not yet started the process for 2014 because a business case must be made in terms of what is available and where the gaps are. This applies not only in the areas of nursing and psychiatry but also psychology, speech therapy, occupational therapy and specialised nursing posts.

I am asked to account for myself more frequently than other most other Ministers because I have responsibility for mental health. This is understandable given that mental health services are starting from a very low base. I repeatedly point out that we are doing our best and moving as quickly as possible. While I understand there are barriers in place, I am also annoyed by the resistance to change we encounter. Everyone is in favour of the strategy A Vision for Change until it reaches their patch.

The message we send out in respect of mental health is very important. Anyone who knows anything about mental health will be aware that those who have a mental health difficulty are very sensitive to the message that is sent out. While I do not have a problem if people argue that we have not done this or that or that we made this or that promise, the negative messaging must stop for the simple reason that one cannot ask people to seek help and, at the same time, send out a subliminal message that help is not available.

I may have to return to the House to beat myself up for making the following prediction. This year, for the first time, we will not have a crisis caused by people leaving school in the summer and failing to find training places. We have allocated €12 million specifically for this purpose and emergency placements. This type of forward planning is in place for the first time.

Furthermore, despite the circumstances in which we find ourselves, we have secured €4 million for disability services for children aged up to 18 years. This money will be used to ensure children who are not attached to a particular service and wish to be mainstreamed will have access to the same services and will not have to sign up to a particular service to obtain a service.

We have also reallocated €23 million from the fair deal scheme to enhanced home care packages. If I or any other Deputy is asked where we want to end our days, our preference will be to spend our final days at home or in the community. We are making progress and taking a more enlightened approach to doing business.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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I welcome the opportunity to speak to the motion. Reading through the text, I was struck by the line "the lack of sufficient resources will not be in the best interests of patient care". One could also propose that all Deputies support world peace as both statements are obvious and lack depth. I mean no offence to the author of the motion, Deputy Billy Kelleher, but those were my first thoughts on reading the motion.

This is a timely opportunity to examine the reason for the current lack of resources. Winds can change very fast. The Minister of State, Deputy Kathleen Lynch, referred to negative messaging. This week, an RTE programme featured a claim that hospital consultants need to be paid more because there is a shortage of consultants in the system. While this is a sensible argument, it was not long ago that people were screaming that consultants were being paid too much. There is a danger that we will get carried away and forget that we are still in a difficult position. We need to be a little more realistic and mature in this debate. We are in this position because we have only recently exited a bailout programme and the country is broke. People have endured horrendous challenges and I do not need to remind the author of the motion of the reasons we ended up in circumstances where every budget and Department had to be squeezed to the nth degree to ensure the State could survive with some semblance of financial security. In that respect, we are not out of the woods yet.

Expenditure on health has been reduced by €3 billion per annum and the health service is operating with 10,000 fewer staff than when the Government took office. People on hospital trolleys were a common sight in the heyday of the so-called Celtic tiger. The solution offered by the Government at that time was to throw more money at the health service. This was false revenue that must now be repaid, however, because it was generated by a building boom. The then Government's solution to all problems was to throw more money at them. In the case of the health sector, that policy achieved nothing. To cite only one example, the number of people on trolleys was much higher during the boom than it is now, despite the billions of additional funding available to the health service at the time.

When the Government took office in 2011 it decided to face the challenge by doing more with less. That is real politics. Will Deputy Kelleher or the party he represents make some constructive proposals on sources of additional funding for the Department of Health? Should they include the Department of Social Protection or the a reduction in the number of gardaí by the Department of Justice and Equality? When the Deputy's party makes some grown up choices we will be able to have a substantial debate on the issue.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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Irish Water is one option.

Photo of Jim DalyJim Daly (Cork South West, Fine Gael)
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In the absence of substance, it is difficult to debate a motion which states that a lack of sufficient resources will not be in interests of patient care. We are debating in a vacuum.

I commend the Minister for Health, Deputy Reilly, and the Minister of State, Deputy Kathleen Lynch, who is present, on the work they have done and the challenges they have both faced and embraced since taking office. Notwithstanding the unwillingness of many Opposition Deputies and some members of the media to acknowledge them, the Ministers have introduced significant changes at various levels of the health service with a budget that has been reduced by €3 billion and with 10,000 fewer staff. I would prefer if Deputies used this debate to be more constructive and examine issues in the health service such as the high rate of absenteeism or how we could improve the management system. Addressing a myriad of similar issues would be much more constructive than debating the merits of pouring more money into the health service.

Photo of Tom BarryTom Barry (Cork East, Fine Gael)
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I welcome the opportunity to address the House on this motion.

We all want delivery of an excellent health care system. The national figures are improving. This should not be taken for granted because they are improving at a time when there are huge constraints on our finances, our population is increasing and there is an embargo on recruitment. We are trying to do the impossible and it is being done. It is a brave person that would take on the health portfolio at this time. At the time the Minister took up office up to 5,000 people a day were ill, which meant addressing the health service was a huge task. The health service is being addressed by a number of Ministers.

It is important to set out the facts. For decades and under many Administrations, it was feared that Mallow General Hospital would close. Many Members of the House will recall the huge task it was to ensure it remained open. It is now regarded as part of Cork University Hospital. I do not think people realise the huge amount of work being done at Mallow General Hospital. Approximately 40-day care surgeries are carried out at the hospital. While all surgery requiring specialist surgeons is undertaken in Cork University Hospital, other less serious surgery, which can be carried out on a day-care basis, is being undertaken at Mallow hospital. The hospital has a future, which is great news for all those who rely on its services. This did not happen by accident. Many sacrifices had to be made, including the replacement of the accident and emergency department with a minor injuries unit, which is working very well. I recently attended the unit with my son. The treatment received was outstanding.

The Minister is to be complimented on what has been achieved at Mallow General Hospital. When we met with the consultants at the hospital their enthusiasm was almost infectious. They wanted to make this work. The hospital is a template for the future role and functions of small hospitals. There is also a new endoscopy unit at the hospital, which is the first new additional building there during my lifetime. These are huge changes. I invite the authors of the motion to travel around the country and see the fine work that is being done rather than engage in criticism of what is or is not being done. Fine work is being done.

There is nothing more devious and upsetting than negative commentary around people's health. I agree with the Minister of State, Deputy Lynch, that this negative commentary must stop. If members opposite take nothing more from this debate than that point I will be happy. While some people have serious mental illness others are suffering from depression. All of us meet people in our clinics on a weekly basis who have genuine concerns. Negative commentary about our health system is shocking. Fianna Fáil should be ashamed of itself for instilling fear in people. That is what they are doing.

We are all aware of the challenge that is the health service. However, the model is working. I take this opportunity to acknowledge the challenging work being done by staff in the HSE. While the HSE is often fairly criticised this does not mean that everybody in the HSE deserves criticism. There are some very good people in the HSE and this must be recognised. What we are doing is delivering better services to patients with fewer resources. We are moving in the right direction. Money does not always solve the problem. Often what is required is organisation, for which no one will be thanked. However, this should be recognised.

6:15 pm

Photo of Regina DohertyRegina Doherty (Meath East, Fine Gael)
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I am rarely party political in my contributions to debates. However, this motion is attention seeking. It is akin to a bold child looking for notice. I concur with Deputy Barry that the people who provide our health services are fine, upstanding and extremely hard-working people. Fianna Fáil, in tabling this blatantly political motion, does a disservice to those people.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The Deputy clearly has not read the motion.

Photo of Regina DohertyRegina Doherty (Meath East, Fine Gael)
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It goes without saying that reform of our health services is challenging. This Government is the first in a long time to concentrate on outcomes for patients rather than throw money at the delivery of health services. We are all well aware that if money alone was the answer, Fianna Fáil would have provided a state of the art health service during its tenure in office. However, that did not happen. The reality is that for years thousands of people have been waiting years for outpatient appointments. The number of people now waiting 12 months or longer for an appointment has reduced by 99%. During the tenure of former Minister for Health and Children, Mary Harney, there were 569 people on trolleys on one day in January. The number of people on trolleys has now been reduced by 34%, not least because of the reforms put in place by the current reforming Minister and the dedication and hard work of the staff who have to carry out those reforms, all of whom are to be commended this evening.

I take particular umbrage with the sentence in the motion which reads, "[S]ufficient resources will not be in the best interests of patient care". For anybody that has bothered to read the health service plan, patient safety is mentioned 54 times. This was also reiterated by the director general of the HSE at a meeting of the health committee last week when he stated that every single thing done in terms of the delivery of services in this country is patient focused and patient led. The patient safety agency is fundamental in this regard. My only concern is the lack of resources to finance independent patient advocacy groups such as the Irish Society for Quality and Safety in Healthcare, ISQSH, and Patient Focus, both of which had their funding reduced over the past few months. I look forward to the day when that funding can be provided again.

I wish Dr. Stephanie O'Keeffe well in her new role as director of health and well-being. The reform agenda ensures a vital shift in this service plan towards prevention, promotion and improvement in the health of Irish people. This is recognised throughout the service plan. Dr. O'Keeffe is charged with developing a three-year health implementation plan for a healthy Ireland. I am sure the impending appointment of members to the health council will provide her with the back-up and support she needs in this regard.

The Irish Pharmaceutical Union, representatives of which met recently with the Minister, has stated its willingness to participate in moving towards prevention rather than cure, extension of the vaccination programme, the provision of a smoking cessation service, medical use reviews and the discarding of old medicines, all of which is to be welcomed and encouraged. I appreciate that the Minister is in negotiations with the IPU in this regard and wish all involved well.

I welcome the health identifiers Bill and in particular the use of IT services across our health services. As somebody with a history in IT, I was astonished to learn that we have 1,700 different IT systems across our health services, the vast majority of which cannot share information. If we cannot share information how are we to focus and concentrate on outcomes for patients in a real and meaningful way? I believe the health identifiers Bill will assist in that regard.

In regard to medical card reviews, I welcome the €37 million provided in respect of the provision of medical cards for 250,000 children under six. However, I would like to focus on children with Down's syndrome. I welcome the Minister's commitment to review the long term illness scheme.

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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Deputy Doherty is eating into another Member's time.

Photo of Jerry ButtimerJerry Buttimer (Cork South Central, Fine Gael)
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Last night, the Minister for Health outlined the improvements that have been made in respect of outpatient and inpatient hospital treatment. The HSE service plan which is the subject of this debate includes an ambitious programme of key health reforms.

No member of Fianna Fáil has served as Minister in the Department of Health for over a decade. They ran from that Department. The current Minister is a reforming Minister. He has compiled the first list in terms of outpatient appointments, in respect of which there has been a 95% reduction, for which the special delivery unit, the National Treatment Purchase Fund and staff in our hospitals are to be commended.

Deputy Kelleher will be interested to hear that no person in Cork is now waiting more than 12 months for an outpatient appointment. The figure in this regard last March in respect of Cork University Hospital was 5,000 and for Mercy University Hospital was almost 400. The figures today are zero. There are still more than 300 people waiting more than 12 months for an appointment at South Infirmary Victoria University Hospital. While some improvements have been made there are still 300 people waiting for an appointment.

There has also been a reduction of more than 90% in the number of people waiting between one and three years for an appointment. The reduction in respect of those waiting more than three years is over 80%. Inpatient waiting lists have also been reduced. There has been a 27% reduction across the inpatient waiting list at Cork University Hospital, with no one now waiting more than eight months. The number of people on the inpatient waiting lists at Mercy University Hospital and South Infirmary Victoria University Hospital for between three and 12 months has been significantly reduced and there is no one waiting more than 12 months.

The staff and management of the hospitals deserve our congratulations for their efforts and commitment. They have delivered on behalf of the people and the patients who require services. Their work is improving the situation for patients.

The Minister had six Bills passed by the Oireachtas in 2013, more than in any other calendar year since 1997. In 2013 the Minister also put through 57 statutory instruments. That represents one Bill every two months and more than one statutory instrument every week. Let us contrast that with Deputy Micheál Martin when he was Minister for Health. On average, he got three Bills passed per year, while Ms Mary Harney did somewhat better but still only passed three Bills per year on average. With this reform and change the Minister and the Health Service Executive service plan are delivering on behalf of the people.

I wish to address mental health. The Members opposite have a new spokesperson on mental health and I am sorry he is not in the House tonight. Anyway, some weeks ago he put out a tweet decrying the Government for spending more on photography than mental health strategy. I wish to put on record that the Government is spending €766 million plus €20 million on mental health each year, more than 2,800 times what Deputy Keaveney claimed in his tweet. I hope he will clarify and correct that tweet in the interests of the people, patients, families and service users who require the treatment and services of the Health Service Executive.

We live in extraordinary times. We do not have what Fianna Fáil had in the boom, a pot of money to throw at things. We have built reform and change. Key reforms are part of this Health Service Executive plan. Those who write about and comment on the Health Service Executive plan and those involved in debating it should examine the facts rather than discussing what they would like to see in the faraway hills.

We have difficulties, there is no doubt about it. We cannot expect a health service to continue as normal when there has been a 20% reduction in the health budget, a 10% reduction in staff numbers and an 8% increase in population. However, what the Government is doing is meeting the needs and putting in place a reform plan to best serve the people. I am confident that when the history of this Government is written, the Minister and the Ministers of State, Deputy Lynch and Deputy White, will be seen as transformative, reforming Ministers in respect of the delivery of health on behalf of our people.

6:25 pm

Photo of Michelle MulherinMichelle Mulherin (Mayo, Fine Gael)
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I welcome the examination of the HSE national service plan for 2014. Since the health portfolio is so vast, often in debate it is easy to rubbish or take a position to instil fear in vulnerable people in respect of the health service. If we examine the health service plan we see that there is so much to be considered and so many checks and balances in respect of what has been a limited and reducing budget such that many things are considered and covered.

Rather than dwell on acute services I wish to focus on community services, especially services for older people. People at this stage of life can be particularly frightened by news items and statements made in the media for political reasons.

I welcome the fact that, at least to begin with, the level of home help and the standard home health care packages will remain the same as in 2013. I am keen to see this area of the budget increased more and more because it is cheaper to provide care for people in their own homes but they need support for that to materialise. I know this was a particular problem last year because when there are budget crunches, such as those of last year, community services are often the first areas to be squeezed. People who receive home help had reductions in their home help care last year. However, when we consider the value to the State of allowing people the dignity to stay in their own homes, we see it is important to invest in this area. Otherwise it will cost us. If people cannot get out of hospital they will have to stay in acute beds, when others need to be in those beds. Really those people could be in their own homes. To that end, I welcome the €23 million which has been transferred from the fair deal scheme budget to community services. This is welcome and practical too. The measure will ensure more individualised home care packages. An extra €10 million is being spent on this area, some €3 million of which will go towards providing additional intermediate care on community support beds. This will give a greater range of care options, which is what is required to be achieved and what is being talked about. Some of this €10 million funding will go towards making up a shortfall in the funding of public short-stay beds. All of these are welcome and practical proposals within the service plan.

I am aware of the HIQA deadline for the facilities of community nursing homes to be upgraded by June 2015. Since we have an ageing population we need to ensure proper plans and provisions are in place for the future. Furthermore, we need to ensure that we will have spaces in community nursing homes. I welcome the substantial funding being put into the Sacred Heart Hospital nursing home in my county. However, I call for reassurance to be given to other community nursing homes in due course, including St. Augustine's Community Nursing Unit, Ballina, the Dalton Community Nursing Unit, Claremorris, and the Mac Bride Community Nursing Unit, Westport. Their facilities need to be upgraded.

Deputy Regina Doherty made a particular point as she was concluding. I very much welcome the Minister's commitment to require the HSE to put together a review group to ascertain how the medical needs of people with long-term medical conditions such as Down's syndrome or Crohn's disease can be provided for more compassionately. This is a humane development and presents an opportunity to examine how people who have a lifelong medical condition, which we know will not change, can be properly catered for. I look forward to hearing the progress of the review group.

Photo of Joe McHughJoe McHugh (Donegal North East, Fine Gael)
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I am thankful for the opportunity to speak on health-related matters. Specifically, I wish to acknowledge the Minister's direct role in response to the flooding at Letterkenny General Hospital last summer. I wish to acknowledge Noel Daly, Ambrose McLoughlin and Bill Maher for their hands-on role in ensuring that the temporary accident and emergency unit was up and going within six weeks. On 3 March the new accident and emergency unit will be up and going again. It is important to acknowledge their role. It is also important to point out that we will have infrastructure and services second to none. Some €6 million is going into radiology services infrastructure and possibly a total of €30 million plus will go to rebuilding the hospital. I wish to acknowledge the difficulty for the staff who are working in an environment which is only half a hospital as well as the duress they are under and the heroic efforts they are making.

I wish to highlight the Minister's proactive role in bringing forward the HIQA review into ambulance services. It was the untimely, sad and tragic death of Mrs. Maura Porter in Carndonagh that led to the review being brought forward from quarter 2 to quarter 1. I hope that the Porter family's experience will be recognised during the review and investigation. It is an absolute tragedy that a person has to die along the side of the road when there are ambulances in the area and in the county unable to come at the particular time. It is important to take this review seriously and I am keen to see a close examination of the circumstances of Mrs. Porter's tragic death.

I do not intend to use the two minutes available to me as a political football opportunity. Fianna Fáil was in the Department of Health and created the system. We have inherited the legacy. That is the reality. I remember when Ms Mary Harney was the Minister, the Fianna Fáil Members in my neck of the woods used to blame her and said it was not the fault of Fianna Fáil. I do not intend to waste time on that issue but I have had an opportunity to see the weaknesses within the system. There are vast challenges involved in reforming the system. The Minister, Deputy Reilly, and the Minister of State, Deputy White, are certainly making great efforts to reform the system. It is not without its difficulties and there are weaknesses. I came across an example this morning. I met in a gentleman who has been waiting seven years for a hip replacement. That is totally unacceptable and the system which lends itself to this example is totally unacceptable. I am from a farming background and Deputy Billy Kelleher has experience as a farmer. No farmer would wait seven hours to bring an animal to the vet. In this case, it has been seven years and the gentleman cannot sit down or stand up without pain.

When I asked whether he experienced any relief when he is in bed, he replied that he had not slept in years.

This is just one example of the legacy we inherited and the weaknesses within the system. The question is how we go about addressing them. We in this House have a responsibility and obligation to help the people who are trying to change the system. We can continue with the banter across the Chamber, making the issue into a political football, but that will not solve anything. We must work together with the people who are charged with implementing change. There are proactive and reforming people in the health sector, pioneers in their field and people who have experience in other jurisdictions. We must assist them to build a system under which it is no longer acceptable to have people waiting seven years for a hip replacement.

6:35 pm

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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I propose to share time with Deputies Dara Calleary, Éamon Ó Cuív and Seamus Kirk.

Photo of Seán BarrettSeán Barrett (Dún Laoghaire, Ceann Comhairle)
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That is agreed.

Photo of Michael KittMichael Kitt (Galway East, Fianna Fail)
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I support Deputy Billy Kelleher's motion regarding the Health Service Executive's service plan for 2014. The plan is not adequate to meet the growing demands on the health services, as is evident from what is happening in hospital emergency departments throughout the State. I would be failing my constituents if I did not mention the busy 24-hour emergency unit at Portiuncula Hospital in Ballinasloe. Ballinasloe Town Council is seeking clarification on the status of the hospital, which is currently a level three facility. The council is anxious to allay concerns in this regard and to remind the HSE and this House of the guarantees and promises given regarding the retention and upgrading of services in Ballinasloe. It is requesting a guarantee from the HSE that there are no plans to cut services at the emergency unit. The status of the hospital is of vital importance to the services it provides not only to people in Ballinasloe and County Galway, but to a broad hinterland which includes Roscommon, Clare, Tipperary, Offaly, Longford, Westmeath and other counties.

Another issue of concern is the forthcoming controversial report that is expected to recommend the downgrading of the maternity unit at Portiuncula Hospital and the transfer of services to Galway city. This proposed amalgamation was reported in last week's edition of The Connacht Tribune. It is very difficult to see how Ballinasloe could, as proposed, retain a midwife-led service after the main maternity operation has transferred to Galway. Portiuncula Hospital has scored very well for perinatal care on the Rate My Hospital website and accommodates more than 2,000 births per year. I understand representatives of HSE management said at a recent Oireachtas committee meeting that they would like to roll out a national perinatal service but are not in a position to do so.

Given the ongoing speculation regarding potential cost-cutting measures, hospitals throughout the country would like to know what funding they will receive in 2014. Like all public representatives in Galway, I hope we will discover at the meeting taking place this coming Friday what the position is in regard to the hospitals in the region. The downgrading of mental health services at St. Brigid's Hospital in Ballinasloe has already led to great upset and protests locally. Any attempt to reduce the maternity service at Portiuncula Hospital will meet similar strong resistance. In a week when there was good news regarding the clinical trials to manufacture stem cells at Galway University Hospital, the local media were more concerned with the cancellation of all non-urgent surgical procedures scheduled for Wednesday, Thursday and Friday of last week and the hospital's refusal to say how many patients are affected. The article in The Connacht Tribune was entitled "Galway surgeries cancelled due to Emergency Dept overcrowding".

Specialist trainees in emergency medicine have written to the Health Information and Quality Authority to highlight the continuing and unacceptable overcrowding in emergency departments throughout the country and the risks arising for patients and staff as a consequence. There must be an effective system of planning to address emergency department overcrowding. The Irish Association for Emergency Medicine has pointed to several causes of this overcrowding, including fewer beds, inefficient use of beds, reduced staff numbers and lack of access to long-term community care. Until solutions are found to these problems, emergency department overcrowding will continue to be a problem. The association has said it is time for the HSE and its special delivery unit to adopt a zero tolerance policy when it comes to overcrowding. The reality, however, is that the 2014 service plan envisages catering for fewer inpatients, outpatients and day cases in hospitals, in a context where the HSE initially told the Government that it anticipated needing €545 million to provide all the services it considers necessary this year.

The evidence of a shortfall in funding is clear across the health sector. Every public representative knows there is increased demand for dental treatment services, for instance, which will require additional funding. There has been a long campaign for an ambulance service in north Galway. I was one of several public representatives who organised petitions to have the ambulance base located in Tuam. We expected a 24-hour service, but what we received is a day service which is not yet operational. There is not even a timetable available. On the one hand we are told there is an embargo on recruitment and, on the other, that there are staff willing to transfer to provide the service. In the meantime we can only wait.

It is time now to review the situation in every county. There is much talk about reconfiguration of hospitals from Galway up to Donegal. What I find difficult to accept, however, is the lack of equity and fairness in the health service plan. This inequity is having a particular impact on rural areas, and especially on older people living in rural areas. The plan does not address the serious deficiencies in services, of which I have had time to mention only a few. I ask, in particular, that the emergency department issue be investigated by the Department.

Photo of Dara CallearyDara Calleary (Mayo, Fianna Fail)
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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.

6:45 pm

Photo of Éamon Ó CuívÉamon Ó Cuív (Galway West, Fianna Fail)
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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.

6:55 pm

Photo of Séamus KirkSéamus Kirk (Louth, Fianna Fail)
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This debate is held against the background of the health service plan for 2014 which has significant budgetary implications of savings of €619 million in addition to projected deficit problems of €419 million. Those statistics alone have profound implications for the operation of the plan in the coming year. Deputy Ó Cuív outlined the statistics which show that significant taxpayers' resources are being utilised to support the health service, therefore, the issue of very great demand for services and cutbacks has serious implications which are profound.

Last week the House discussed the fair deal scheme. The service plan proposals have serious implications for that scheme. The population is ageing and the demand for places in nursing homes is increasing. The budgetary provision is such that there will be a decrease in the number of beds available. This is a serious situation. I have written to the Minister of State, Deputy White to outline an individual case which I hope he will consider. The circumstances of the case graphically illustrate the problems and difficulties arising in the fair deal scheme.

I refer to a local constituency issue, which is the availability of ambulances in the Drogheda area in the proximity of Our Lady of Lourdes Hospital. The Garda Síochána brought a seriously injured man from the Rathmullen estate to the hospital because the ambulance was otherwise engaged. It begs the question whether there is a sufficient number of ambulances. It is a concern in particular during peak times such as Friday nights or at the weekends. The rostering of ambulance staff needs to be examined.

The unexpected emergency can arise at any time, whether on a Monday or a Tuesday as distinct from a Friday or a Saturday.

Earlier today somebody mentioned to me a pilot scheme in place in the UK where at weekends, in particular, in the large cities and towns, the St. John Ambulance, in some instances manned by volunteers, is available to treat minor and superficial injuries in order to take pressure off the accident and emergency service. There are huge pressures on the accident and emergency department in every hospital, in particular at weekends. We need to look at the possibility of moving the treatment of minor injuries away from the accident and emergency departments in order that more time and resources are available to deal with the serious cases.

A few months ago I and my party spokesperson on health, Deputy Kelleher, visited Daisy Hill Hospital in Newry, and it was certainly enlightening. It is embracing new technology to enhance efficiency, the well-being of patients and the alacrity with which the health service can be delivered. For instance, it has a technological linkage with Craigavon. Some personnel from the HSE, although they may be aware of it, should look at that to see if there is something we could adopt to enhance and improve our health service.

We should actively pursue the possibility of developing cross-Border synergies and co-operation in certain areas. With the movement of population towards the east coast and the Dublin-Belfast corridor, where there are densely populated regions, inevitably the demand for health services will be all the greater. This is a small island and the health services on both sides of the Border are growing and more resources are being put into them. I am not sure of the current position of CAWT, the agency set up to look at the possibility of developing synergies and co-operation between the North and the South, but we need to look at that area as there may well be potential to enhance the health service in the Border areas.

7:05 pm

Photo of Alex WhiteAlex White (Dublin South, Labour)
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I thank the Deputies for a lively and engaging debate on our health service in the context of the 2014 national service plan. It is an issue of vital importance to us all. Throughout the deliberations, there has been, understandably, considerable focus on the financial constraints within which the HSE has been required to deliver its service plan commitments over recent years. These constraints apply again this year. Notwithstanding these constraints, the HSE and its workforce are to be commended on their continued focus on minimising the impact on front-line services by utilising their reduced resources in a more efficient and effective way.

The delivery of services by the HSE has, as a consequence, focused over recent years on the dual challenges of protecting patient outcomes and reducing costs. This has required increasing emphasis on models of care which treat patients at the lowest level of complexity and provide safe quality services at the least possible cost. Despite unavoidable resource reductions, successive plans have managed, to a very significant extent, to maintain core services while also supporting growing demand resulting from population growth. Deputy Ó Cuív needs to have regard to that when he shows that the overall budget has not changed over a period of years. We have had population growth, increased levels of chronic disease, increased demand for drugs, a higher number of medical card holders, which is up by 590,000 since 2008, and new costly medical technologies and treatments. The HSE, in its 2014 national service plan, has again sought to minimise the impact of constrained financial resources on front-line services and to maintain patient safety in line with the Minister for Health's stated overriding priorities for the service plan.

I will not have an opportunity to address many of the issues raised, but perhaps I might touch on one or two. In regard to medical cards, several Deputies claimed that I stated there is no such entity as a discretionary medical card, and they are correct. I said that in reply to a parliamentary question because it is true. There is only one medical card. Medical cards provided on the basis of means or where discretion is involved are identical and provide access to the same set of health services. The contention that there is a major policy change in the awarding of medical cards on a discretionary basis, even to the extent of "erasing medical cards from the system", as has been suggested, could not be further from the truth. Such spurious and unfounded comments only serve to cause concern and distress.

I have consistently said, as have my colleagues in the HSE, that the assessment procedures used to determine eligibility for medical cards and GP-visit cards have not changed. The scheme continues to operate in such a way that those who suffer genuine financial hardship as a result of a medical condition receive the benefit of a medical card. It is important to note discretion is not a stand-alone exercise. Exercising discretion has been, and remains, an integral part of the assessment process for a medical card. In previous years, there was a decentralised process across 100 locations throughout the country. This meant people may have been awarded discretionary medical cards in some parts of the country while they would not have been in others because of the lack of a centralised and standardised approach.

Deputy Calleary raised a number of compelling and thoughtful points in his contribution but he made the point in regard to discretionary medical cards that there was always such a thing. The particular example he gave related to people suffering from cancer. The only basis on which the HSE can award eligibility to any individual in the State must be on the basis of a statute and we have a statutory provision in the 1970 Act. It is very clear that a medical card can be awarded on the basis of undue hardship.

I understand the humanity of the case Deputy Kelleher and others, including many in my party, make that persons who become ill suddenly are in a situation of great need and great stress. The fact is that the system put in place in 1970 determines eligibility on the basis of financial means. The medical situation only enters into the equation when a person's medical situation affects their financial means. Deputy Kelleher knows that is what the law states. If we are to change that, we would have to look at the medical illnesses for which we would give an individual a medical card. Would there be any medical illnesses for which a person should not have a medical card? We would end up adding illnesses and adding conditions to the law all the time.

What I would prefer to do is to look to introducing universal access to GP services. Again, I invite Deputy Kelleher to support me and the Government in this regard. The programme for Government refers to universal access to GP services. We are starting this process and I will meet the medical organisations this Friday. We will introduce this within the lifetime of the Government and we are starting on the long road.

No one has shown in this debate, and there have been many interesting contributions, how the HSE could manage the resources it has in a better way. There have been many criticisms but nobody has shown a better way to manage the resources the HSE has, and it is doing this admirably.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I welcome all the contributions to the motion I moved on behalf of Fianna Fáil. What surprises me is that praise was lavished on the Minister for Health, the Minister of State, Deputy White, in his absence-----

Photo of Alex WhiteAlex White (Dublin South, Labour)
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It never is when I am here.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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-----and on the Minister of State, Deputy Lynch, by Deputies opposite. However, in view of the fact so much praise was lavished on them in our Private Members' time, I cannot understand why they pulled the six hour debate scheduled for Government time when it would have given the Government Deputies more time to lavish more praise on the Ministers because, as we well know, most Ministers' appetite for praise is insatiable. That debate would have facilitated their need for more praise.

Photo of Alex WhiteAlex White (Dublin South, Labour)
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The Deputy should speak for himself.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The real reason they pulled the six hour debate scheduled for today was not because Fianna Fáil had tabled a Private Members' motion on health but that it would have stifled debate. Six hours on top of our three hours would have brought it to nine hours. That would have given Deputies ample time to go through the detail of the HSE service plan and to highlight their concerns and, in the event of praise being required, giving a fair amount of that also.

I would like to think I am reasonably fair as an Opposition spokesperson. If there are areas in the HSE service plan which should be acknowledged, I will do so. For example, an issue on which we all campaigned and for which we are appreciative is the inclusion of the bilateral cochlear implant programme and the expansion of that in Beaumont Hospital. That is a very positive step and it will have a transformative effect of the lives of a number of people.

My motion was very short, concise and to the point. I was accused by several Deputies on the other side of the House of frightening people or of scaremongering. In my view, this four-line motion could not scare anyone. It is much more frightening to see people standing outside hospitals with placards saying that people will die if certain services are removed. That would scare people. There is a lack of credibility on the other side of the House regarding many health issues because of the Government's attempts to row back on many of the commitments that were made before the last general election.

Reference has been made to the politicisation of the health service. I would like to think the HSE was set up as part of an effort to depoliticise the health service. The general purpose of the establishment of the HSE was to allow public representatives to engage in a constructive debate on broad policy, with the implementation of that policy being done by the HSE at one remove from the political establishment. That was the reasoning behind it. We realised we were unable to ensure that health services in certain areas would provided on the basis of need, as opposed to being provided on the basis of forms of interference from the political process, such as the lobbying that used to be done by Ministers, Governments and the old health boards. That was the reasoning behind it. The rationale was that a single organisation should be overseeing the delivery of health care throughout the country.

I assure those who have suggested that my motion has been tabled to grab headlines or seek attention that I could find many more imaginative ways of seeking attention. I am doing my duty by standing in this Chamber to highlight the issues that concern the public in a calm and rational way. I believe the contributions to the debate from Deputies on this side of the House, like the motion itself, have generally been fair and reasonable in their observations. I agree that everybody must come up with solutions. If one is to identify a solution, one must first identify that there is a problem. There are many problems in the health service. My motion came about because of what we are experiencing on a daily basis and what is being said by those who are directly responsible for the delivery of health care in this country. The major problems in our health services are being highlighted on a daily basis by the director general of the HSE, Mr. O'Brien, and by senior clinicians, consultants, medical professionals and front-line service providers in all areas of the HSE. Those who are professionally involved in health service delivery are making it clear that patient safety is being put at risk.

While I do not wish to be alarmist, I would be failing in my duty if I failed to highlight the facts which are being outlined by organisations that represent people who have a central role in the delivery of health care, including the Irish Emergency Medicine Trainees Association, the Irish Nurses and Midwives Organisation and the Health Information and Quality Authority. Other groups, including those representing consultants, hospital management and front-line service providers, are stating that there are issues of concern. I would be failing in my duty if I were to sit here quietly and say nothing. That is why we used our Private Members' time to highlight the deficiencies in the HSE service plan. I think the removal from the schedule of this Parliament of a six-hour debate that was planned for this week was a very cheap shot. It stymied Deputies on all sides of the House who wanted an opportunity to express their views on the HSE service plan. Approximately €13 billion is to be spent under the plan, which makes it the second biggest tranche of State expenditure every year, after the expenditure of the Department of Social Protection. That is why we tabled this motion.

Last night, the Minister, Deputy Reilly, announced with great fanfare his major achievement of reducing the number of people on the waiting list for outpatient appointments from over 100,000 to approximately 4,500. I know that is a public relations stunt, as by any stretch of the imagination it involves a complete massaging of the figures. We will expand on that in the next few days as the drip-drip of information from the Department continues. When we analyse the figures in detail, we will realise that "all that glistens is not gold" in the context of the pronouncements we heard from the Minister, Deputy Reilly, yesterday. We know for certain there is a bulge in the figures as they relate to people who have been waiting list for outpatient appointments for less than 12 months, and particularly those who have been waiting for between six and nine months.

The Minister did not point out that many of those who were on the list when more than 100,000 people were waiting for outpatient appointments might never have presented. They were never going to go in the first place, even if a genuine referral had been made on their behalf some time previously. We all know that the list which is being used as a benchmark could have been whittled down. Many of the 100,000 people on the list were there in name only. Having said that, I welcome the fact that individual people - I am not talking about the broad generics of a list - who have been on the list for over a year will see consultants within a reasonable space of time. The major problem is that a significant number of people have been waiting to see a consultant for less than 12 months, but will have to wait for close to 12 months before they see that consultant. That is happening across the health service in the context of outpatient appointments. As I have said, I will comment further on this aspect of the matter when the Minister, Deputy Reilly, announces the figures in more detail at some future time.

The Government's spin is evident in its amendment to my motion, which states that the Minister "notes, in particular, the progress that has been made in reducing the waiting times for patients on trolleys in emergency departments, with a reduction of 8,814 in the year to 27 December 2013, down 34% from 2011". One would normally expect a year-on-year comparison to be included with such a statistic. The amendment should have mentioned that the 2013 figure was 2% higher than the 2012 figure. That is what the Minister should have said, but instead he decided to pick out a figure from which it could be extrapolated that there had been some kind of major achievement. The harsh reality is that the number of people on trolleys last year was 2% higher than the number of people on trolleys the previous year. There is no point in denying the statistical fact that it is going in the wrong direction. We should also note that behind the statistic in the amendment is that fact that some 410 people were on trolleys in this country's hospitals yesterday. That is an indication of the major difficulties that exist and are being highlighted on a continual basis by clinicians and other professionals who work at the coalface in accident and emergency departments throughout this country. They are saying consistently that this is an issue.

When we talk about the HSE plan, we are talking about the investment of public funding in the provision of health care in this country. In that context, I want to draw the Minister of State's attention to the issue of private health insurance, which equally funds the public health system through the various charges that are levied as part of the system of full cost recoup for private patients in public beds. The cost of private health insurance is escalating. My attention has been brought to a statement of claim from Laya Healthcare regarding treatment provided at the Mater Private Hospital from 9 September 2013 to 10 September 2013. The statement makes it clear that the patient in question was in semi-private accommodation in the hospital for one night, and that the amount of claim was €17,280.75.

7:15 pm

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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That is shocking.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The amount paid by Laya Healthcare to the Mater Private Hospital was €16,905.75, meaning the person in question owed the Mater Private Hospital €375. Those figures relate to the accommodation only. The cardiac surgery itself cost €2,000. Laya Healthcare paid €17,000 for one night's accommodation in the Mater Private Hospital. The difficulty we have with all of this is that the private health insurance market is now unsustainable for many reasons, including the fact that the economic downturn has meant there are fewer people at work and income levels have dropped. Private health insurance is being systematically undermined by the Government's policies, which are inflating prices. Just four months ago, the Minister for Finance, Deputy Noonan, announced in this House that he intended to cap tax relief on gold-plated health insurance policies. It subsequently transpired that almost every health insurance policy that has been retained by the average family in this country will be affected by that taxation measure.

Photo of Alex WhiteAlex White (Dublin South, Labour)
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That was the subject of a report by the Commission on Taxation.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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When one is in government, one must make decisions and stand by them. I do not think the Government should hide behind the Commission on Taxation with regard to this issue.

Photo of Alex WhiteAlex White (Dublin South, Labour)
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We are not hiding.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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This is a tax on hard-pressed families that are already finding it extremely difficult to retain their private health insurance. The Government intends to move to universal health insurance in the next few years, but what will we have in the meantime? The Government and the health insurers are out-competing each other to inflate the cost of private health insurance for families.

Photo of Alex WhiteAlex White (Dublin South, Labour)
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Does the Deputy have any proposals?

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I have. I will outline them in good time.

However, the Minister is being hoodwinked to a certain extent. I give this advice. It is not in the private health insurers' interests to keep down the cost of private health insurance to families because they know that the Government, if it continues with its universal health insurance policy, will row in at some stage and pick up the slack. That is the problem the Government will face in time to come. Certainly the Government should publish the White Paper on universal health insurance and do so quickly because we will be discussing private health insurance when we will have no more private health insurance that will be affordable to ordinary families. Those policies need to be assessed very quickly.

Between 2007 and 2013, the cost of private health insurance for the average family almost doubled, which is not sustainable in the present climate. It will do nothing to help underpin the Government's stated policy of universal health insurance. I know there are divergent views in the Government as to whether universal health insurance will follow a social insurance model or whether the private insurers will decide the element of care to be provided.

Many speakers made reference to older people and the fair deal. We can look at page 44 of this fictional piece of work on funding of our health services. It is stated in the opening that this will not sustain the level of service required for 2014. I am not making this up. The director general of the HSE, Mr. Tony O'Brien, stated this emphatically. The Cabinet had an exchange of views with regard to sanitising the truth behind the publication of the HSE national service plan. There were also other changes in the plan. A blunt statement in the introduction to the plan, signed by Mr. O'Brien, declared that the level of investment required to meet many of the critical service priorities cannot be met.

7:25 pm

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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Priorities - that is new services.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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It was changed in the published version to "some service priorities...may not be met."

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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New services.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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That was sanitising the truth in terms of what will be achieved in the provision of service in this plan.

Photo of Brendan HowlinBrendan Howlin (Wexford, Labour)
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New services.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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All of us here tonight, including those on the other side of the House, know that if this plan is to be implemented in full, there will be further cutbacks in services; it is written into it. This will include cutbacks in the area of the fair deal scheme, funding for the elderly, provision of long-term and respite care, and provision of home helps and home-care packages. All these are being squeezed to the point where the acute hospital system is under pressure, as is evidenced by what we see in emergency departments throughout the country. The circle is narrowing the whole time. The Ministers present, as Labour Party Ministers, should accept that it is not possible to continually cut without something giving. In this context patient safety is under pressure, as stated by many front-line people. That is why we tabled this motion.

While I could go on, I urge the Ministers present along with the Minister for Health, Deputy Reilly, to look at the matter quickly in the context of the escalating costs of private health insurance to families. There are many other areas to be looked at. I commend the motion, which was not tabled to frighten people throughout the country. It was tabled so that we could have a constructive debate in this Chamber. We should also have had a further six hours to have a constructive debate to give every Deputy a chance to congratulate and condemn the Government in equal measure.

Photo of Alex WhiteAlex White (Dublin South, Labour)
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We all spoke up.

Amendment put:

The Dáil divided: Tá, 80; Níl, 41.

Tellers: Tá, Deputies Paul Kehoe and Emmet Stagg; Níl, Deputies Seán Ó Fearghaíl and Michael Moynihan.

Níl

Amendment declared carried.

Motion, as amended, put and declared carried.

The Dáil adjourned at 9.30 p.m. until 9.30 a.m. on Thursday, 30 January 2014.