Seán Ryan (Dublin North, Labour)

The main objective of the Bill is to provide for the establishment of the Health Service Executive. It is now almost 18 months since the Government set in train an interim HSE with the objective among others of facilitating a smooth transfer to new structures. As an outsider it seems to me that the Government has failed miserably. For example, the IMPACT trade union which has negotiated and facilitated change in the health service over the years deemed it necessary to seek a mandate from its members for industrial action, which it secured by a seven to one majority. This was because of what IMPACT alleged was a lack of consultation and the resulting utter frustration. While the Minister may well have taken her eye off the ball at a time when the chief executive officer designate, Professor Aidan Halligan, did a U-turn and refused to accept the post, generally speaking there is no excuse for the state of industrial relations in the health service. I seek a commitment from the Tánaiste that the deficiencies in this important area will be addressed as a good working relationship is vitally important if the new system is to work effectively.

During the debate on the new structures, Ministers, particularly Fianna Fáil ones, came under extreme pressure from Fianna Fáil councillors who were losing their positions on the various health boards. To deal with the issues and to try to address some of them, the Government recommended the establishment of regional health fora. Are these solely to be talking shops or will they be given any legislative power or responsibility? As one who is firmly in favour of local accountability, I need the Tánaiste to spell out the role of the regional health fora.

Deputies Kelleher and Costello referred to accountability. We do not want a situation similar to that which exists with the National Roads Authority where we cannot ask questions and relay queries for our constituents. We need a structure, or an effective mechanism, to be put in place so that we will get answers and there will be accountability.

This legislation will be irrelevant to the public unless there are real and substantial improvements to the health service. As Labour Party spokesperson on older people's issues, I am angry and frustrated at the way older people have been affected by cutbacks in the health service. The lack of services has reached crisis levels in many health board areas. Older people made considerable sacrifices over the years and in difficult times to care for their children and to provide them with the education which has, in many ways, been responsible for the Celtic tiger and made this country one of the richest in the world. What have they received in return? It is an utter scandal that many of these people must lie on trolleys in accident and emergency units in Beaumont Hospital and in the Mater Hospital, the two acute hospitals in my catchment area, for up to 30 hours in some cases waiting to get access to medical wards.

On a recent visit to one hospital, the scene resembled something from "ER". The department was full of nurses and doctors running from patient to patient. The centre aisles and cubicles were filled with trolleys and chairs. As I moved out of one of the units, I came across two people standing beside and consoling an older man on a trolley. One of them recognised me, called me over and said, "My father has worked hard all his life to educate his family on a modest income, he has paid all his taxes and his PRSI contributions and on the first occasion he has required the assistance of the State, he has been left for up to 24 hours on a trolley waiting for a bed." He asked "What sort of society is this?" He was right. The current position is a scandal. I have confidence the Tánaiste will endeavour to respond to this, but there is nothing in the Bill, as far as I can see, that will guarantee an improvement of the service to the people affected.

In the greater Dublin area, people in need of long-term care in a public nursing homes face a waiting list of up to twelve and a half years. That is the reality. The withdrawal of contract beds by health boards on 1 September has made things worse. I have also been advised that the withdrawal of the contract beds means that, on average, only one vacancy arises per month. This usually occurs when a patient dies. That is the reality for many people. During the past two and a half years I raised with the previous Minister the issue of older people trying to get care and the fact that there are vacant beds in private nursing homes, but I was told they could not be used. They are being used now about which I am pleased. It is an issue which must be addressed and this is one of the solutions.

I will not refer to the inappropriate use of acute beds due to the non-availability of non-acute hospital beds for older people but specifically to people living in the community. If we are to arrive at a situation where we can get older people out of the hospitals quickly and back into their homes or prevent them for going into hospital in the first place, they must have supports. Older people are forced to remain at home and to rely on family support at a time when community care and home help services are being cut back. There was a reduction in the provision of 300,000 home help hours throughout the State in 2003 as compared with 2002. Despite all the money available, a service required at local level was cut back viciously. It is imperative that we maintain and improve these services so that older people can return to and live in their own environment following a stay in hospital. Having read this Bill, there is still no guarantee that this range of community-based services will be provided.

In regard to long-term care beds, I am very pleased with the Lusk community unit. Most people try to get a bed in a public community facility because they want to be as close as possible to their families and communities. There is a limited number of beds in Lusk community unit. To cater for the demand in the wider north Dublin catchment area, it is imperative that we get two more community units. I ask the Tánaiste to take that on board.

Recently on the Adjournment I raised the position of 230 people with intellectual disabilities accommodated in St. Ita's Hospital. As I said on that occasion, I am sick and tired of the neglect of St. Ita's and the ongoing broken promises of Government regarding the needs of people who have minimal political influence. Planning permission has been secured, but over six years later a sod has yet to be turned. This scandal must be addressed. I demand that the Tánaiste and the Minister of State, Deputy Tim O'Malley, who has been very supportive in regard to this project, deliver on their promise. I look forward to turning the sod on this project with the Tánaiste in the near future. We cannot shove this group of people aside. This project is ready to commence but it needs the go ahead from the Tánaiste and the Minister for Finance. I look forward to their support.

The Tánaiste is in a difficult Department and I wish her every success in it because it will be in the interests of all of us if she succeeds in even some of her objectives.

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