Denis Naughten (Roscommon-South Leitrim, Independent) | Oireachtas source

The old Western Health Board religiously implemented the law with regard to discretionary medical cards. It is now far more difficult to obtain such a card than was previously the case. Part of the problem is that there is a standardised system in place. For example, people who are diagnosed with cancer are treated in the same way, regardless of whether they live in Dublin or Roscommon. A person who lives in Roscommon will have additional transport costs and he or she will usually be obliged to bring someone with him or her when travelling for treatment. That individual will be obliged to take a day off work. These considerations are not taken into account in the overall assessment.

My first question relates to disability services. I welcome the commitment that people will be communicated with before the end of the school year. I acknowledge this significant step forward. However, has an assessment been carried out of the financial requirements in providing for those 700 school leavers and the progression cases? What is the amount involved? The difficulty with the additional sum of €4 million is that it is being distributed on the basis of demography. This means that approximately €280,000 will be distributed to counties Roscommon and Galway. We need double that amount to deal with school leavers and progression cases. There are a number of complex cases involved and the relevant families are going to be obliged to fight for basic services once again. Allocations based on demographics do not take account of the fact that the area in which I live is extremely rural and we do not have public transport services. Much of the funding not spent on direct services for clients is, therefore, spent in the provision of transport. This would not be the case in Dublin or some of the regional centres.

On ambulance services, we are aware of the tragic case in east Cork. The ambulance service in the west has consistently failed to reach target times. The service in my area has the poorest response times in the western region. The national figures in the performance reports were available up to the end of 2012, but they have been erased from the 2013 performance reports. In addition, the HIQA target for response rates is now 85%. However, the target set in the report under discussion is 70%. Instead of improving targets, there has been a 20% reduction in the objective which must be achieved in 2013 in comparison with what has been set down by the HSE. Sadly, this is leading to the loss of life and placing further lives at risk. Why is it not possible to obtain a regional breakdown of response times? I asked the Minister this question in the Dáil on 20 March, but I did not receive a reply. I specifically requested a regional breakdown and it was not supplied. Why is it not possible to provide such a breakdown? Has progress been made in respect of the public service agreement in the provision of staff for the Tuam base, the west Roscommon bases and other ambulance bases throughout the country?

My final point relates to stroke services. People who have a stroke cannot go to the 22 stroke units at 4 a.m. because they cannot be thrombolysed. At Portiuncula Hospital there is only one consultant who specialises in stroke medicine. At other hospitals CAT scan machines are not available on a 24-7 basis. How many of these units provide thrombolysis on a 24-7 basis? What steps are being taken to deliver rehabilitation services for people who suffer a stroke?