Alan Kelly (Tipperary, Labour) | Oireachtas source

Nobody adheres to that and, therefore, it does not matter. I will not repeat questions. I congratulate Deputy Jim Daly on his appointment. He is a good parliamentarian and I am delighted he secured this role. I also congratulate the other Ministers who were reappointed. Perhaps some were nervous but fair play to them. I am delighted for all of them. As a group of Ministers, they are approachable regarding issues, whether they are national or local, and I appreciate that. I cannot say that about every other Department but considering it is such a difficult Department, they are all approachable and I thank them for that.

I will focus on a number of issues, some of which I have raised previously. They are mostly national issues but one or two are local. The eHealth issue is critical and somebody will have to bite the bullet. We have had many disasters as a country as regards IT projects costing a fortune. It has led to reticence among Departments spending large capital amounts on such projects. I had to come in and sort out the Leap card implementation. Now there is an issue with electronic health records. I am a big supporter of the public services card and making that a G2C or a C2G card. Public services cards, travel cards and health records should, with layers of security, eventually become one. Security can allow for access at whatever level and fraud would be reduced immediately but that is for another day. I would like a commitment from the Minister that he will be brave enough to kick the ball off significantly in this space in the capital plan that will be announced following the summer because this is a fundamental health issue. It features in our future of health care report. I know of somebody quite close to me who has spent two and a half weeks in hospital. After two and a half weeks, she has found out the hospital had two charts on her, which they have now brought together. That is insane. Basically, we are unsure about some of the readings and they have to start all over again.

That is just one example.

Fundamentally, if this is all carried out through a proper, electronically recorded system, then that information should be at everyone's fingertips. Some people I know of across some hospitals have systems and pilot projects in place and, by all accounts, they work well. This is not rocket science. The scale of it is huge and the Department will have to spend humongous amounts of money, but someone must kick the ball to ensure this happens. I ask the Minister to do so. I will support it 1,000%. I have been on about it for years. When I was in government, we did not have the money, but someone must kick it off. The problem for the Minister is that it will not be physical building, no one will see the results of it and there is no political capital in it. However, it is the right thing to do and I encourage him to do it.

To move on to political capital, I have had a number of discussions about buildings. I represent Tipperary, and we have two of the worst accident and emergency department situations, namely, at South Tipperary General Hospital and University Hospital Limerick. The new chairman of the latter and I come from the same area. We were together at the opening of the emergency department, which is a fantastic facility. I am open to correction but I think there has been an increase of over 30% in the number of patients going through it, so it is a victim of its own success in that sense. However, the real issue here is speed and capital development. I will take South Tipperary General Hospital by way of example. We had this glorified announcement about the provision of a super-hotel, temporary hotel or whatever the hell it was called at the hospital. I will not get into the politics of this, so the Minister should not worry, but it was a pre-announcement and an overstatement and it should not have happened. I am trying to help the Minister here. It will not be in place for this winter, never mind last winter, when it was said it would be in place. In the long term, unless the Minister says otherwise, I presume South Tipperary General Hospital will be included in the capital plan because it is as clear as the nose on one's face that it is desperate. I remember my time as a Minister with responsibility for housing. Is there a way in which the Oireachtas, myself, as an Opposition spokesperson, and others here can put forward some form of process to fast-track the development of critical capital infrastructure in, say, six to eight hospitals throughout the country? We could all unite politically behind that because it is desperately needed. I had to do this for housing. Can we do it for hospital infrastructure? The Department will have capital, to be fair, but the time it will take will be huge. We cannot bypass the law but measures can be taken from a planning point of view. If the Minister wants to come back to me separately on this, I will work with him on it.

I wish to jump in on the discussion about cardiac issues. I am trying not to overlap with previous speakers' comments to be fair to the Minister. There is the issue of what happened in Waterford. Like everyone else, I am very sorry for the family involved. My wife's family come from south Kerry. I ask the committee to imagine trying to get to Tralee or Cork from Ballinskelligs or Waterville or to hospitals in the region from west Clare or north Sligo, and all the issues relating to these places. The cardiac issues in the north west are very similar to those in the south east. This probably exists already, to be fair to the witnesses, but has a map been produced which shows the critical times it takes to get to every hospital? If it exists, may we have it? I have not seen such a map. If we had sight of it, then we could examine solutions - politically and collectively - here with the witnesses. Unfortunately, this will happen again and again, and we need to take a bit of the politics out of it. We need to plan for this.

The next issue I wish to raise is home help. This is a bugbear of mine. I am trying to help the Minister again. When I began in this spokesman role over a year ago, home help hours were a critical issue. They still are, but the biggest issue now is not the hours but the people. It is the bane of my life. I have two neighbours in their 80s who have 21 home help hours. However, they have never had 21 hours; they have had ten, and very recently, until a very good intervention by a member of the HSE, they were going to be down to two hours. Through working perhaps with the Minister for Finance or someone else, is there a mechanism whereby we can encourage more people out there to be trained up one level and work in this area where it is financially more viable? A lady I know provides home help hours but it is financially only viable for her, given child care and everything else, to provide a certain number of hours. It is not worth her while doing 20 or so hours so she does ten. Can we change this equation? We need these people. It saves the taxpayer a huge amount of money. We all know that the more home help hours, the more we save because nursing homes are so expensive - €1,200 or €1,400 a week - and a bed in an acute hospital costs over €1,000 a day. It is like a step, and if we can keep people from getting into the second or third step by increasing home help hours and getting more people into it, we will obviously gain.

By the way, I agree with Deputy Kelleher about the issues in general practice. I think we passed a motion here on this. It is illogical that one GP organisation is outside the window in these discussions. It is quite obvious that we will have to look at direct GP contracts as part of the solution to this in certain areas where the viability of being a GP is very questionable. I also agree with the Minister about the statutory home care scheme and I will work with him on it. I have always agreed with him about this. Will Mr. O'Brien send out a diktat across the HSE to remind people of common sense because of what happened to the elderly couple this week? Not everyone can get on "Liveline", to be fair.

The model 1, model 2, model 3 hospital relationship must change, particularly when it comes to emergency care. I represent Tipperary. We have a fine hospital in Nenagh that does what it says on the tin. We have Ennis Hospital and there is also St. John's. They have minor injuries units. They do not open for long enough and the pathways to the kinds of procedures they should be doing need to be widened out a little. It would not take much to do so, which will alleviate somewhat the crush and the scale of the situation in Limerick, so I ask the Minister to consider extending the hours, evaluating the safety issues involved and examining various actions that might be taken.

The real issue I wish to discuss in this regard relates to intermediate care vehicles. I have asked about this before. It is farcical that, first, there are not enough of them on the road, second, that there are not enough trained people to operate them and, third, that the vehicles only operate Monday to Friday most of the time. The bugbear we all have is that hospitals should not stop operating for two days each week. If one does not get one's scan reviewed by a Friday, one must wait until Monday. That is insane, but it is a matter for another day. I am really asking about intermediate care vehicles. Such vehicles are, I believe, are part of the solution. They can be used to move people from model 1 hospitals to model 2 hospitals, etc., in order that they do not take up the critical acute beds in Limerick and they can be seen in Nenagh for their aftercare or pre-care or whatever it is. There are not enough of these vehicles on the road. It is simple as that. They are not operating. I know about this because the Mid West hospital group is probably the one that has been in this role the longest.

I have always been of the view that we need to introduce some form of public scrutiny or scorecards when it comes to the numbers of GP referrals - individuals names would not be included- when it comes to emergency theatres in particular. It is quite obvious that in some cases and some areas, certain GPs are referring much more than others. Why is this? It does not make sense. Obviously, some GPs will have bigger lists and we can extrapolate out all of this, but something should be done in this regard. Another issue falls within the same area of publishing for public scrutiny the percentage of work of consultants in private versus public hospitals. I am not saying I have all the answers, but there is not enough public information on either of these two matters and not enough public scrutiny as a result. Both matters cause issues if they are lopsided, where a GP is making too many referrals and the proportion of private versus public work, particularly in public hospitals, carried out by a consultant is on such a scale as to cause difficulties down the road. Those are my questions and they are all different from everyone else's.