Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I apologise to the Minister as well for being late. I was listening to Deputy Buttimer's fine contribution on the cystic fibrosis unit in Cork and the difficulties experienced in trying to come to an arrangement with those who were involved in the fund-raising. I hope there is a speedy resolution. I took a copy of the Minister's reply and I will have time to peruse it later.

We are where we are again in the context of the discussion of Estimates for 2014 for the Department and the HSE. My party is tabling a Private Members' motion in that regard this evening and there was to be a debate in the Dáil tomorrow for six hours as well. Unfortunately, the latter has been withdrawn, and we will raise that in the appropriate forum, the Dáil.

The Minister outlined in some detail the Estimates for the Department and the HSE. The key issue is the legislative proposals that will transfer the Vote from the HSE to the Department of Health. In his reply, the Minister might give an indication of roughly when he expects that to happen.

An issue that sticks out, not because of the figures but because of the issues that have been raised in recent times with regard to the ambulance service, is that of the Pre-Hospital Emergency Care Council. The primary function of the council, which was established in 2000, is to develop appropriate standards in pre-hospital emergency care. It is in this context that the council is pursuing the development of professional and performance standards for ambulance services and ambulance service personnel in addition to the accreditation of institutions providing training for pre-hospital care providers. There are major concerns among broader society about response times, the stress and pressure under which the front-line ambulance service is working, the delays caused by the lack of resources and personnel, and whether centralisation is working effectively and efficiently and providing the service that people expect. At times of crisis, particularly in emergencies such as myocardial infarctions, persons not breathing, or massive trauma such as car accidents, there is concern that we do not have an ambulance service that is fit for purpose in dealing with the pressures and demands that are placed on it from time to time. We recently had cases in which there were up to eight ambulances waiting outside an emergency department because they could not discharge patients. I note that ambulance service funding has been cut by 3%. I am not making an issue out of that. Would the Minister enlighten me as to what exactly they are doing, given that HIQA is also in place to audit the national ambulance service call-out times to see whether they are in compliance with the guidelines of 7 minutes and 59 seconds and 18 minutes and 59 seconds for first response and second response, respectively? I seek clarity on that issue.

The Minister referred to Financial Emergency Measures in the Public Interest, FEMPI, Act 2009 and said the cuts to GPs and pharmacists would save €70 million in a full year. We have had a dispute on this. I have stated on a number of occasions that I believe that GP services are in crisis. They are working under extraordinary financial pressure. One may argue that there is no sympathy for doctors, but I have sympathy for patients who may not be able to access doctors. That is an area that we must look at before a crisis lands on our lap. With the Minister's knowledge as a GP and his former advocacy role - I am not being sarcastic and I am sure he is proud of this - there is a need for us to assess the impact of the FEMPI cuts on GP services, coupled with the fact that in May or June of this year the Minister will roll out free GP services for children aged five and under. I wonder has any audit been done. Has there been any assessment of the impact this may have on front-line GP services?

Rightly, strong emphasis is put on primary care. The backbone of primary care provision in this country is the GP service, both in-hours and out-of-hours. On a continuous basis, we meet GPs who say they simply cannot sustain the level of cuts and cannot provide the services that they would like and feel obliged to provide because of the cutbacks and other issues being foisted on them. I do not expect any government to make announcements that would tie its hands in negotiations or discussions with an organisation or grouping, but at this stage we must take a strategic look at the role of GPs, how they are playing it, and whether or not they are being severely affected, not only for their sake but for the patients.

We now find that the roll-out of free GP care for those aged five and under will be on a voluntary basis. I am not quite sure how that will work. We could end up with a situation in which those who opt in would become paediatric-type GP services while others would go for other age cohorts, and that would not be healthy in view of the fact that most associate the scheme with their family doctor. They go to their family GP as a family. A little thought should be put into this. I genuinely have concerns about the impact that this could have. There is a strong relationship between the family and their GP. It is not something that people take lightly. If their GP for whatever reason cannot fulfil his or her commitment to those aged five and under, then the parent must up sticks and head off to another GP. I wonder whether this has been thought out. Is it possible that there could be large tracts in which there will be provision of GP services for those aged five and under, and those wanting access to a GP will not go to the GP services that provide for those aged five and under because they are crowded with children and will move elsewhere? It could create upheaval given the strong bond between GPs and families throughout this country.

I suggest that be looked at again because of that concern and many other concerns I have in that regard.

Having met with the National Association of General Practitioners and others, and following discussions with the Irish Medical Organisation and meeting general practitioners individually, I am aware there is a problem and the Minister cannot afford to ignore it because as he said, they are the front-line service providers. We are trying to make them more central to the provision of care to ensure people do not end up in the acute hospital setting but the Minister has been dismissive today of those difficulties that GP services are facing.

I ask for clarity from the Minister on an issue that was raised, that is, consultants. I asked here last week or the week before whether there were any difficulties in general in recruiting consultants, and stated that many posts were vacant. The Minister implied there was no difficulty except in one or two highly specialised areas. It may be that somebody is leaking inaccurate reports but it appears there is a report somewhere, either with the Minister or RTE, that suggests there is a major problem in recruiting and retaining consultants in this country. I was accused of being a mouthpiece for the GPs. I am not a mouthpiece for GPs or for consultants but I would like to be a mouthpiece for people who are trying to access health care. The Minister does not like the term "consultant-led clinical care" - he has changed his vocabulary on that issue - but regardless of what we are talking about it is important that this country has the required number of consultants of all specialties and disciplines. If there is a problem in recruiting consultants, and if there is a report on that either in the Minister's office or in RTE, we should see that report and have a discussion on it because it is in all our interests to ensure we have a remunerative package that is internationally comparative, career pathways in place that will be attractive to consultants here, and attractive working conditions also. I ask for clarity on that.

On the issue of emergency departments, and this is an inherent criticism, 410 people were waiting on trolleys to be treated today. I accept there is a seasonal aspect to that trolley count and that there are fluctuations. The Minister takes credit when the trolley count figure is down to 150 or 160, which equally is because of seasonal factors or that patients are not booked in for procedures at certain times of the year when people are on holiday or there may not be the full complement of staff, but there is a major problem in the emergency departments of our hospitals throughout this country. Any perusal of the Irish Nurses and Midwives Organisation, INMO, trolley count, including the ward count where the trolleys are wheeled out of emergency departments into the hospital proper prior to counting in emergency departments, will indicate that a problem is beginning to evolve again in this area. I accept the Minister made some progress in the past but there is no doubt in my mind, and more important in the minds of the people delivering front-line services in our emergency departments 24 hours a day, seven days a week, that patient safety is now an issue. That is an issue that must be revisited. I do not know who is doing the auditing at this stage. The IMNO does its trolley counts and the Department has its own way of counting trolleys but what cannot be disputed is that day in, day out professional clinicians are now saying that patient safety is being compromised.