Alan Kelly (Tipperary, Labour) | Oireachtas source

In fairness to the Minister, he has only brought three people with him today, not a whole army, so he has learned that lesson.

I have many questions. The horse has bolted. These are the results of the first six months so it is a historical document. It is something we are looking back on, and there is so much detail. There are some positives but there is also some seriously worrying stuff in here regarding targets and, collectively, between the whole lot of us here, we will probably get through quite a few of them. I will go through some priorities that I see and then ask some questions about future issues based on the information we have here.

Regarding the expenditure, we do not see anything about the children's hospital. If there is something about it here, it is hidden.

Why is that? Where is it coming from? Where is the expenditure to date coming from?

I have some questions relating to the maternity strategy. It is a strategy that we are all in favour of and I am hugely supportive of it. I think it is an excellent document. It is one of the best documents relating to the health area ever written in this country. Again, however, we do not see where the supposed expenditure is and the key issue for me is that we are two years into the strategy but it is just not happening. The soft stuff is happening and that is good, but anything that needs money is not happening. I ask the Minister to address that point.

In terms of capital projects in general, what projects have been delayed? Given the figures that have been produced here, it seems that there are capital projects that have been delayed. I ask the Minister to outline where those projects are, what they are and why they are delayed. We can see from the figures that there is an overspend in the acute area while there is an underspend in primary care. We all, in both the Sláintecare process involving the Oireachtas Committee on the Future of Healthcare as well as in this committee, agree on one thing, namely, that primary care spending needs to go on an upward trajectory. We need to see a re-balancing of the percentage spent on primary care vis-à-visacute care. It is still going in the wrong direction and is not being arrested. We are talking here about expenditure to mid-year. We have not even seen the winter. If we are €104 million over in acute care already, what are we going to be over by the end of the year? Last year, the chief executive of the HSE, Mr. Tony O'Brien, wrote to all of the regional CEOs - he did not write to them himself but very controversial letters relating to performance were sent. I have some sympathy for those CEOs in terms of how expenditure is being managed because, in some cases, they do not have full control over the levers. Obviously there are demand-led services and a range of issues in terms of commitments given to them in the context of the capital plan that did not happen and so forth. They still have legacy issues which result in expenditure that they cannot control. If commitments are made in the community and primary care areas, for example, that are not honoured then expenditure in the acute hospital system is going to explode. What will be the result of that?

In terms of primary care centres, the difficulties have been going on for years. We are way behind schedule as regards the roll out of new centres and there are lots of complications. I have asked questions of the HSE regarding certain primary care centres and have not even received a response. I will give the Minister a note on that. I have asked the director general about one primary care project in particular on two or three occasions but I still have not received a response. He delegated to his assistant, who did not came back to me. How much of the spending on primary care centres is actually on new centres?

In terms of the fair deal scheme, why is the expenditure so low? It is way lower than expected. There must be some evidence to explain why that is happening. Given where we are going as a country, demographically, is the Minister surprised by this? Is it related to other macro-economic factors? Why is it happening?

When it comes to the primary care setting, the figures indicate that approximately 30% fewer patients are being seen by nurses in the primary care setting. We want more people to end up in primary care settings and we want more primary care centres. We also need to ensure that those who have issues that can be dealt with by nurses are being seen by them. However, we are seeing an actual reversal of this. Why is that happening?

Every single Member of both Houses of the Oireachtas has had issues with medical cards and the processing of same. We now have a situation where the processing is under target by 64% and we are being told that there are staffing issues. Seriously, what is going on here? That just does not stand up to scrutiny. This is a real issue for people, on a human level.

The Minister knows that I am quite passionate about the area of home help. I firmly believe in home help. I believe we need to develop a new attitude towards home help. I understand the issues with regard to getting staff and training people for this area into the future is critical. Keeping people in their homes means less expenditure on nursing homes and on acute services. The domino effect here is a matter of common sense. It is a win for patients, the public and families, as well as for the taxpayer. The targets for home help hours are not being met. This is an issue that I deal with all of the time, on a day-to-day basis. Granted, there are issues related to finding staff. What is being done in that regard? However, there are bigger issues, including the number of people who are approved for large home care packages but who cannot get their quantum of hours, or anywhere near it. If an elderly couple is granted 20 hours but only gets eight or ten hours, they are nearly happy. That is completely unacceptable.

We have a whole profile here relating to acute hospital targets. Frankly, we could go through this every three months on a continuous basis but at this stage it must be said that some of the targets are just not realistic. They are being missed left, right and centre and in some instances, by some margin. If one looks at prostate cancer under various metrics, for example, one must ask if we need to re-evaluate the targets. I have an issue with regard to the targets.

The data on the ambulance service is jumping out at me. There are numerous issues relating to the ambulance service and we have discussed them previously. I have repeatedly asked the Minister about the roll out of intermediate vehicles and the recruitment of staff for same. We have situations where we have different model hospitals that are integrated into a network but which are dependent on an ambulance system that simply cannot function to the level required, in the context of the network of hospitals and how they operate. In the mid-west, for example, there are people who should be in Ennis or Nenagh but who cannot get transported there on time. At the weekends, certain hospitals end up packed with people who should be out in the model 2 hospitals in Nenagh or Ennis. They cannot get transport, even though there are beds available in those locations. The Chairman, Dr. Harty, knows all about this issue. It has been going on for years. It is basic stuff. The people do not even want to be in Limerick; they would rather be closer to home and there is no need for them to be there.

My final few questions relate to risks and future funding. When will the new winter initiative be announced? How is the Minister going to profile it? Where is he going to find the money for it, given that we are already well over budget?

There is a very interesting court case going on in Ennis at the moment relating to St. Joseph's nursing home. There are two State bodies involved, the HSE and HIQA. They are basically going at one another in relation to the accreditation of the nursing home. I have serious concerns about how this is being conducted. I am concerned about the role of HIQA and about how information about the home has been put into the public arena. In fairness, the HSE is not being treated well here but that is not the real issue. The real issue is that if this case goes in a certain direction, we could end up with a domino effect across nursing homes in this country which will result in serious damage to public confidence and increased expenditure. Is this being profiled for? This is a case that must be settled by the second week in December. What is the thinking in relation to it?

As the Minister is aware, we speak a good deal in this committee about orphan drugs. In fairness to my colleagues, we have spoken about the nine drugs we believe need to be brought through the process and made available to the patients who badly need them. I refer to Entresto and eight others. A very embarrassing situation arose regarding the accreditation of those drugs passing forwards and backwards between the Department to the Health Service Executive, HSE. It was embarrassing for all of us, including the Minister. I happened to be on the "Today with Sean O'Rourke" show talking about that when a major statement came in stating that in July, the HSE would fund all nine drugs. It is nearly October and we have not heard an iota about that since. When will the funding be in place? When will the patients be able to avail of them, as in this year, because the statement clearly indicated they would be available this year? Also, where will the funding come from?