Sandra McLellan (Cork East, Sinn Fein) | Oireachtas source

The ongoing recruitment embargo and job cuts will have a seriously damaging effect. A further 2,600 whole-time equivalents are to go in 2014, in addition to the 12,500 that have gone since 2007. The entire management of health funding and health services by this Minister and this Government is called into question by their handling of primary care. The service plan refers to the vision for primary care services whereby the health of the population is managed, as far as possible, within a primary care setting but then it cuts €294 million out of primary care in subhead C.1 in these Revised Estimates. That is reflected in a 10% cut in primary care services.

While the provision of GP cards for children aged five and under is welcome, it is in the context of overall primary care cuts. The Government is to take an additional €43 million out of the pockets of medical card holders in increased prescription charges compared to €50 million saved through generic substitution and reference pricing. The Minister and the director general must account for the failure of the HSE to move more quickly in setting reference prices for medicines under the long overdue legislation we passed last year. As recently reported, a range of drugs placed on the interchangeable lists by the Irish Medicines Board have not had reference prices set by the HSE. The entire process has been far too slow and the HSE and the individual patients are not seeing anything like the savings on medicines we should be seeing.

I am very concerned about the cuts to long-term residential care in subhead C.2. The nursing homes support scheme, the so-called fair deal, is being cut again and this has very serious implications for the lives of vulnerable older people and severe knock-on effects for our entire health system. Already, there is a huge waiting list for places under the so-called fair deal scheme and these cuts spell misery for thousands of older people, many of whom are occupying hospital beds because they can no longer be cared for in their homes and cannot get access to nursing home places.

The first State-wide audit of dementia care carried out by Dr. Suzanne Timmons, consultant geriatrician at UCC Mercy Hospital, has just been published. It shows that one quarter of inpatients in our hospitals are affected by dementia.

That is a huge figure.

The audit also shows that our health system is ill-equipped to deal with dementia. The cuts in these Revised Estimates will result in more older people spending more time occupying scarce, acute hospital beds while awaiting nursing home places. This is a totally false economy as well as a source of misery for older people. When my colleague, Deputy Ó Caoláin has raised this issue both the Minister, Deputy Reilly, and the Minister of State, Deputy Lynch, have tried to divert attention from the cuts by pointing to the need to provide greater support for older people to live in their own homes for as long as possible. We all agree that this is the best option and the preferred option for most older people but the Minister must also recognise that there are many older people and others, especially those with dementia, for whom care at home is no longer an option, and they must have long-term residential care. These cuts should not go ahead. We must provide for an increase in nursing home places, provide decent care for older people while also freeing up many hundreds of inpatient beds in our acute hospitals.

I have no doubt that the Minister and delegates from HSE will have to come to the Dáil and to this committee with further Revised Estimates for health during the course of 2014 because the level of provision in these Estimates is totally inadequate and the cuts are unsustainable.