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

I welcome the Minister of State and the statement and information he has given to the committee. There are two or three things that came to my attention. I am delighted to see the move towards programme budgeting. One of my fetishes has always been comparison with the health boards, which always had programme budgeting. Since that finished we do not seem to be able to go anywhere with certainty. That has been one of the intrinsic problems in the health service over recent years. It was a woefully bad decision to move away from that. With programme budgeting, they can assess fairly regularly where they are going in the first, second, third or fourth quarter well in advance. It cannot be done any other way because it is too vague.

In the area of home help carers and home care packages, there is a need for some co-ordination with the Department of Employment Affairs and Social Protection. The carer's allowance is the first step to deal with situations in which older people do not require institutional care or a home care package but can benefit from being looked in on by a friendly neighbour or family member. They can have meals prepared at crucial times and can be looked in on in the morning and the late evening and so on. Most families have done this themselves. Modern labour force requirements do not allow that to happen to the same extent it used to. I saw a file last week where a person caring for a person in his or her 90th year was deemed to be ineligible on the basis the person he or she was caring for was insufficiently immobile. The presumption is that when the person tripped and fell and hit his or her head on something, he or she would become eligible. It is then too late for that level of care and requires either hospitalisation or institutional care. It is quite common, as the Chairman knows. I would like some interaction between the two Departments in that area as a matter of some urgency. It will not cost anything and it will dramatically improve the quality of life for those who need care and will relieve the pressure on the Department of Health.

Waiting times are another of my hobby horses. There are waiting times for everything and I cannot understand it. I will never begin to understand why we have them. It is almost as if somebody decides to pick a time in the calendar and tell people they will deal with them then. I do not accept it. I think it is just as easy to tell a person he or she will be dealt with next week. Waiting lists become longer and longer as time goes by. It is an acute system. We need a fairly rapid response. If we are going to be successful we need a rapid response. I am anxious that all areas where waiting times occur, whether as a result of a lack of theatre space, lack of adequately qualified nurses in theatre, consultants or GPs, waiting times have to stop because they go on forever. It will have to be done. The lists will have to be caught up with and overtaken. The question of how to eliminate those waiting times is important.

I agree with Deputy O'Reilly on the GP contract. We are long enough talking about it. We need to see some progress but not in the future. We are talking about waiting times again. Why do we have to wait for that? Why not do it now and have done with it? At least then we would have some certainty in the future. I do not want to talk about the procedure or negotiate here but it is not helpful to have a long waiting period in which we promise this in the future. It has been long enough promised so we should get on with it and do it soon. Let us produce something in the very near future that will indicate we are serious or not serious about it.

Deputy Louise O'Reilly referred to recruitment and I know the Minister of State may not want to comment on it. Somebody approached me recently about the issue and will come back to me with further information. There are some strange things happening in recruitment. Administrators seem to be of greater importance than the front-line staff. That should not be. I know we have to have administrators but the fact is we are in a crisis and we need the people on the front line dealing directly with the patients. We need them as a matter of urgency or else we are back to long waiting lists again and it will go on forever.

I have some questions for a different time. There are a couple of little niggling parts that I am not too sure about, for instance, the issue of medical cards. The number of full medical cards has dropped and there has been an increase in the number of GP visit cards. We are a bit uneasy about it. It is not always to the benefit of the patient. I would like some comment on it.

I try to avoid being parochial at these meetings but when everybody else does it, I think I should do it. My local hospital in Naas is in the picture. The endoscopy unit extension is much wanted and has been for some considerable time. I am anxious to clear the air, get it out of there, have it approved and get on with it. There is also an oncology unit upgrade required as well. It is a very busy hospital in a very important location. To drag out what is required now only reduces the confidence of the staff in the hospital. We need to avoid that.

The shortfall in the health budget has been reducing slowly but surely over recent years. In 2014, it was something like €600 million or €700 million. Gradually it has reduced to €295 million or thereabouts. Could we be coming to the spot where we can identify almost precisely what is required? I referred already to programme budgeting. I presume that as we move into that area, we should be able to get dead-headed budgeting. We should not need to be vague. A shortfall of €600 million or €700 million is way off target in terms of planning in advance. If we are going to plan for the health services in advance, we need to be more precise about the exact cost, where it will come from and where it will go.