Joe Sherlock (Cork East, Labour)

This motion deplores the failure of the Government to honour the commitments it made and the cynicism it displayed in making promises it clearly had no intention of honouring. The Government amendment refers to the health strategy, Quality and Fairness — A Health System for You, but the Minister for Health and Children knows nothing about quality or fairness. As was stated earlier, the Labour Party opposes the Hanly report which proposes to change the role of general hospitals to implement the European working time directive which requires that junior doctors work fewer hours.

It is a fact that 90% of people treated in hospitals in this country can be treated in the general hospital system without recourse to larger hospitals. The Minister proposes to change the role of our general hospitals, but it will not be easy for him. Mallow General Hospital provides acute medical and surgical facilities, including ear, nose and throat surgery. There is also a 24 hour accident and emergency service with an ambulance base and out-patient and physiotherapy services as well as a laboratory and other ancillary services.

We must not forget the human cost if this report is implemented because it will make it difficult for people living in the areas west and north of Mallow to visit relatives and friends if services are moved to Cork. This applies particularly to older people. There is a distinct advantage to patients when they are healing if their families are in close proximity to the hospital. That is what is described as a sociological argument although I do not know whether the Minister knows anything about it.

Consultants, general practitioners, nurses and the general public have opposed the Hanly proposals. If they were implemented nationally, the current network of 38 general hospitals would be reduced to 12 providing services 24 hours per day, seven days per week. The centralisation of acute care would mean that many patients would have to travel much longer distances than at present to get to hospital. The Hanly report proposes a paramedic ambulance service to cope with this problem. However, that is not acceptable because we have plenty of experience of delays in ambulance services.

I have asked the Minister many times to provide for radiologists, geriatricians and a CT scanner in Mallow. This has been ongoing since 2001. I am well aware that the chairman of Comhairle na nOspidéal is a consultant at Cork University Hospital and is a member of the Hanly group. Therefore he knows what is required. However, the body has begun to downgrade the hospital by stealth. He knew what was envisaged by the Hanly report and, consequently, no appointments have been made of a radiologist or obstetrician and no provision has been made for a CT scanner.

I hope the Minister's officials will listen to my next point. I received information from the Department of Health and Children that it costs €746 per day to treat a patient at Cork University Hospital, while at Mallow General Hospital the rate is a comparatively cheaper €475. How can one justify that with 90% of people being treated in our general hospital at half the rate? The north Cork region has a population of more than 90,000 but no extra beds are being provided in this region, especially in community hospitals, to cater for the elderly. Families have been given subvention claim forms and are being encouraged to apply for beds in private nursing homes. Subventions are not being paid which is resulting in major financial difficulties for families.

In a recent reply, the Minister informed me he had provided €21.4 million to facilitate the discharge of patients from the acute system to more appropriate settings, thereby freeing up acute beds. I will outline a number of cases which have occurred in the past week. A lady referred from the north Cork area who was a carer for her husband was told it would take until the end of 2005 before she would be seen for a gynaecological treatment in Cork University Hospital. We should think about that.

A lady from the Fermoy area whose son was caring for her had an operation in Cork University Hospital. The son was informed he had no choice other than to fill in a claim for subvention. He had no idea what that meant because they had nothing but her pension and a carer's allowance. He was told there were no beds and his only choice was to complete that form. An elderly lady of 78 years in the Fermoy area who was being cared for by her daughter was referred to Dromcollogher in County Limerick, far from her own people. Her respite care had ended there and she has now gone to Tipperary because the Alzheimer Society has provided for her there. More than 500 people are waiting for enhanced subvention in the Cork area and it is always stated that the Minister is not providing the money. The Minister is not closing hospitals but he is downgrading them to be half-way houses for half-cured patients.

In regard to the issue of medical cards referred to by Deputy McManus, an elderly lady recently cried when she went to a chemist and had to pay for what was prescribed for her family from money she could not afford because their income was marginally over the limit. A doctor's letter was submitted with her application but it was rejected. Standing beside this woman was one of the wealthiest people in the area who presented a medical card. The Minister should think about that because it is what he is presiding over. The person in question could not afford the medicine but the elderly wealthy person produced a medical card which is outrageous. I am glad Deputy McManus referred to this issue about which the IMO at national level has also spoken out. General practitioners are annoyed that their letters of recommendation are being ignored by health board officials.

This motion should not be opposed by the Government but rather taken seriously and implemented. If the Minister thinks he will implement the Hanly report in our region, he has another think coming.

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