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

I want to start on this issue. I have been a member of a health board for a long time. One of the things that I learned was that every crucial decision, that was imminent as of today, usually took about ten years of preparation and another ten years of procrastination when it was approved. I congratulate the Minister and his ministerial colleagues for bringing things to a head in those areas. They were not done as quickly as we would have all liked but they needed to be brought to a head. There is no use talking about what is required unless we provide it because we will waste money if we continue to utilise outdated and unsuitable services in the mental health service or anywhere else for that matter.

There is a huge difference between the co-ordination of efforts between mental health services at community and institutional levels. I wish to also refer to the degree to which semi-residential or day services in the community must continue to receive the degree of attention that they require, in particular the supervision of patients who require medication. All of the problems that I have come across in recent times relate to, in some cases, the patient stubbornly refusing to accept the need for medication, refuses to take medication altogether or takes the medication when supervised but refuses to do so when not supervised. It is a question of trying to ensure the continuity between the level and quality of services available in the residential areas and the community based areas.

I would like time to finish my contribution because I must go elsewhere. I compliment the Minister and his five colleagues. I disagree with people who say that there are too many involved in this area. The health ministry has been identified as a poisoned chalice for some years. I regard it more as a hot potato in the sense that it tends to burn the fingers of everyone involved. The Department requires a combined effort under a number of headings with all hands on deck. With luck, their endeavour will work in the long run.

I wish to discuss the degree to which we do not rely on health and well-being. The topic gets more attention than heretofore. There are many things that the children in school and everybody can do that will contribute to better health. It is quite simple and comes in the form of dietary changes, etc. Simple changes can save a lot of money at some stage down the road. Unfortunately, we do not do enough in terms of health and well-being.

I wish to make two final points. First, I support my colleague, Deputy Louise O'Reilly, in terms of the use of IT in the general hospital services, GP services, and the co-ordination of activity between GPs, the hospitals and consultants, etc. to a far greater extent than happens at present. I do not know how true is the following anecdote but a man told me the other day that he could save the State billions of euro on IT, according to himself. He is probably watching this broadcast so I had better not say anything about him. We need to explore every opportunity as quickly as possible to provide a better service for patients, a more efficient and cost-effective service and a more responsive, quicker service that reduces the waiting lists.

We need to rely more on the ambulance service, as was referred to. The air ambulance service must be co-ordinated and integrated with the ambulance service to a greater extent than it has been. That is a goal we should deal with. The equipping of ambulances is an urgent issue also. We all come across ambulances from time to time that have seen better days. Vintage vehicles are alright at shows but they do not do the job to the same extent. The technology in the older vehicles cannot be available to the level required now.

Incidental to the debate - but with an impact - is the third level education access. I have come across cases of refugees or asylum seekers, for example, with very high IQs but because they do not have residency status in Ireland they cannot get access to third level education. This is a sad situation. It is not a matter for the Minister for Health but it is an issue. There are many possible students with excellent potential who could be well used, who could make a great contribution to the health services and who would have a natural tendency to want to enter the health services - but they cannot. I have taken this up with another Minister, as the Chairman knows.

My last point is around the palliative care residential services. I know the Minister has visited the facility in Harold's Cross, and others I am sure, and I believe these services should be complimented for the quality of the care they provide and their understanding for the patient in very challenging circumstances. All that can be done needs to be done in including them in the overall upgrading of services that is required.

I thank the Chairman and I apologies for speaking at length but I did my best to cover all the points I wished to raise.