Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

The Chairman knows I am famous for my short questions. Unlike my colleague, Deputy Kelly, with whom I get along very well, I do not agree with having very few people at meetings of this nature. Occasionally, one needs a full house in order to get a comprehensive response to the issues that are likely to be raised by an equally large delegation from the committee. I compliment the Minister and Ministers of State and their officials for their attendance and wish them well in the work they have done so far and the work they are about to do.

I am a bit more radical than Deputy Kelly in the sense that I totally disagree with the concept of the HSE as a vehicle for the delivery of health services. I have always held that view. From the outset, I asked Mr. Brendan Drumm if he thought it was the appropriate vehicle and he said that on the day of his appointment, he did not know. I presume that over time, he came to a conclusion on that as well. I mean no disrespect to the good people here who do an excellent job and the people who have tremendous expertise in their own field and have a huge contribution to make to the provision of health services in this country. It is a second opinion. I believe there can only be one opinion, which is the Minister for Health and the Department, and no policy-making body other than one to carry out the decisions taken, as used to be the case once upon a time when the old health board system was in existence. One of the greatest things about the health board system was the fact that at a meeting of the health board, all the services involved sat in front of one at least a month. It was a great way to keep up to date. The crises such as those one reads about in newspapers did not appear then because there was somebody there in situknowing what was going to happen before it happened. I just want to mention that point. The Minister knows my views on this subject, as did previous Ministers.

I welcome the concept of budgeting with reasonable accuracy. We hope it is accurate at last in order to deliver services. Over the past seven or eight years, nobody could conclude with any kind of security what would be available to spend on anything. Virtually every service is short. Cuts fell on some like a guillotine and nothing could be done about it. Health, education, environmental and housing services have suffered. Everything suffered to a huge extent and the people suffered but the people who suffer most are those directly affected such as households where someone has a disability, whether a child or young adult or where someone has had to care for a relative with a disability for a long period of time, particularly the carer who may be a mother in some cases looking after a father, daughter or whoever the case may be. I and everyone here has seen this. I hope we are getting to grips with this situation. Somebody may have been caring for a relative for 40 years who was originally a child, the care of which became a huge burden over time for the caring relative with consequent damage to his or her own health such as back problems. We all know people who have been affected like that. I acknowledge the presence of Jonathan Irwin. I also acknowledge the late Martin Naughton with whom I launched a service in that area many years ago.

If one looks at a household with a child with severe disabilities and asks how many people are available to care for that child as he or she progresses, we all have seen situations where women in particular may have spent 25, 30 or 40 years caring for the same child in a dedicated fashion, show the stress of it and do not always get the response they would like from the HSE, which is the delivery body at this stage. I am not criticising any of the witnesses. In recent days, I had occasion to try to source a location for residential care because I believe there is an interaction between the residential care and respite care that is available and the carer's ability to care indefinitely. It is not possible to move one without the other. The unfortunate 20 year old was being referred to a nursing home, which is totally inappropriate for a person of that age. I remember visiting St. Dympna's Hospital in Carlow as a visiting committee member many years ago to find a child having an epileptic fit in the middle of a group of much older people. I thought this was appalling. We need to move away from those prehistoric times. While we talk and all claim to know about it, it is only when one meets the person directly involved face to face that one fully appreciates what it means.

I ask the HSE not to allow situations to develop where that kind of resolution is proposed because it is inappropriate and does not work. We need to recognise that the mother, as was the case in this situation and a number of other cases, may have dedicated her whole life to the person needing care. There may be no other partner there to help, as is often the case. The trauma suffered by that carer over a period of time can be really serious. If that person tries to hold down a job, sometimes in the health care area, it makes it even worse because they must now juggle one and the other. Can the HSE seriously consider a form of residential care in particular areas where it is appropriate to cater for those kind of cases? I know the witnesses will tell me that we have respite care but we do not have it in the way we need it. There will be some cases where there is a need for weekly residential care with provision for the person to come home for the weekends, and that can work and has worked quite well.

Due to the budgetary restrictions over recent years, we have had to cut transport provision. Again, this is a huge problem for the unfortunate people to whom I have just referred and who the witnesses all know about. Could the mobility grant or something similar be introduced to replace what was there to ensure we do not differentiate between one patient and another and that if one mother has to drive her child to special educational needs services or work therapy, she is able to do so and is not excluded from a transport service provided to other children at the same time?

In respect of disability and psychiatric services, we could do nothing up to now. We may not be able to do all we need to do in the short space of time offered by the next year or year and a half, but perhaps we could focus on those issues in a way we have not done previously with a view to engaging in the forward planning that is necessary in order that it can kick into place when the time comes.

The home care package is an excellent idea. In a previous incarnation, I used to hear about how wonderful home care packages were and how everybody was going to be cared for at home. That is not so. It is not possible to do that and there will always be a need for institutional care of a high quality for a certain number of people who cannot be cared for at home because it would cost a multiplicity of converging arrangements to provide any degree of worthwhile care for them. The key point here is the quality of life for the person being cared for.

We must put in place the necessary measures to ensure the best possible service to ensure their quality of life can be provided for the person being cared for and also for the carer.

As I said, I welcome the provision of primary care centres but I am a bit suspicious of them. I would have thought the emergence of the primary care centres would show a dramatic reduction in the number of patients presenting at accident and emergency, particularly for minor ailments or even where minor surgery was required. I tabled a number of parliamentary questions to the Minister and his predecessor and I have not got the answer that I want. I am aware that patients still pass by the primary care centre and go on to accident and emergency. That should not be happening because it involves duplicating services and wasting money. One cannot have two staff doing the same job side by side, with one of them overcrowded and the other not. That is apropos of what was referred to by Deputy Kelly in a different context. As the Chairman will be aware, we need to deal with these matters.

On the question of the delivery of services to rural areas, there is a notion developing within some elements of the HSE that if everybody is brought into an urban setting, services can be delivered there. They tried that in the UK long ago and it did not work. It is as simple as that. That was found to be at fault. I would ask that we recognise that the purpose of this exercise is to deliver the highest quality services to the broadest spectrum of the population in the most efficient and effective way, including in terms of both cost and health.

I am in favour of medical cannabis. I assure the Chairman, unlike quite a number of others, that I have not yet even experimented with it and I do not intend to. I have experienced severe pain due to a particular condition I have. I know all about that and I know that those who suffer severe pain will do anything to alleviate it. The most important point is we strictly differentiate between recreational use and medical use. We need to get a second opinion on that to ensure we legislate for the patient, not for the frivolous.

The Chairman will be glad to hear I have come to my last point. This is something I hold a strong view about as well. When I was Opposition spokesman on health, there was a group of public hospitals that provided care for older people. Those hospitals were well established and built up over the years, but gradually they became the poor relation. People said these kind of hospitals brought about a stigma and that we could not have people living like that and so forth. We eventually got to a situation where somebody somewhere decided we would have no more such institutions and we would care for the people in the community. That would be a good idea if it happened, but it does not always happen. There are a number of such hospitals and residential community care centres which are public and which are doing a great job. I do not want to see them replaced by private institutions because there is an important element here that we need to keep on board. We need to be able to compare the private sector delivery with the public sector delivery without overlapping and side by side in order that we can have a clear evaluation of who is doing what.

Close to the Minister's heart is Crooksling where the highest quality of services have been available. I disagree entirely with the antics of the Health Information and Quality Authority, HIQA, in its efforts to reduce it to make it inoperable and uneconomical. There has been a dedicated staff there who have worked diligently to ensure the provision and delivery of the services, and they have done a great job. The patients they have - women only - could not possibly get the same quality of services in the home. It cannot be done.

One cannot deliver the services to 60, 80 or 100 patients in the same way as they can deliver them there in that fashion. As the Minister will be aware, we have a service in Athy in County Kildare and we have an excellent service in my own town, Maynooth. I am sorry for being parochial in these matters but those services are working extremely well and just because some genius, in working out decimal points in some place in the system, has come to the conclusion that he can do a better job elsewhere does not mean that he can. One such person emerged in recent times in the case of the location of GPs throughout the country. I would be delighted to accommodate that argument at any time whenever those individuals want to present themselves.

Generally speaking, the population of this country is almost double what it was in the 1950s. There are double the number of people working in this country than there were in the 1980s. We are in a far more demanding atmosphere than previously. This means that we now carry out an evaluation as to what we require in the future. Senator Colm Burke asked about various appointments, etc. All this information is available at the press of a button. One should not need to dig for it at all. If it is not available at the press of a button, somebody is not doing his or her job. All that information is right there. One can find out what are the requirements, how many staff are retiring, how many spaces are left to be filled, how many consultants will retire next year and how many GPs will retire next year.

Incidentally, I cannot see for the life of me why everybody should have to retire at 65. I assure the Minister that there are several GPs throughout the country who would be quite happy to continue on working well after 65, and well after 70 at which time they are obliged to retire, but who resent being asked to retire. They have given an excellent service which they built up themselves.