Pádraic McCormack (Galway West, Fine Gael)

I welcome any reform of the health sector. I am concerned about what the Bill sets out to do and what it may be able to accomplish. It is proposed that the Health Service Executive will replace health boards and CEOs. Does this mean that all health board CEOs will now be redundant or will the new executive create another layer of administration in the health boards? Some 25 years ago when health boards were formed, the health service was run by the local authorities. They were all run from one office, with one executive in charge, and a very small staff. In the opinion of many, the way the health service is currently run is the crux of the problem.

People who contact me on a daily and weekly basis ask how long will their mother, father, aunt, uncle or child have to wait on a trolley in an accident and emergency unit. Does the Minister of State realise the trauma, anxiety and frustration this causes to patients and their families? This is currently the reality in the health service. Is it any wonder there are groups such as the recently formed Patients Together and Patient Focus, in which my wife was involved in Galway? These groups were set up because of the frustration suffered by families because of the manner in which their loves ones were treated, or rather not treated, in accident and emergency units. This is why there are street protests and such groups are set up. This frustration is as a result of many beds being closed, not with the quality of the nursing service provided in accident and emergency wards.

Another issue relates to medical cards for the most neglected and vulnerable sector of our society. These people cannot afford the necessary health care because they are denied medical cards. In An Agreed Programme for Government, the Government promised 200,000 extra medical cards. Currently 100,000 less people are eligible for medical cards. Following a reply to a recent Dáil question, I discovered that in 1997, 73,724 people in Galway city and county were eligible for medical cards while today only 66,400 people are eligible for them. This is a reduction of 10%, despite the Government's promise of 200,000 extra medical cards. The reason for this is simple. The threshold for a single person living alone is just €142.50 per week. If one lives with one's family, the threshold for a single person is €127 per week. If one's income exceeds that threshold they will not be eligible for a medical card. How could anyone live on €127 a week and pay to visit their doctor or for medication? It is time the income threshold was increased. The threshold for a married couple under the age of 65 with no children is €206.50, with two children €238.50 and with four children €270.50. It is impossible for such a family living on €270.50 to avail of any medical service. If one is over the age of 65 and living alone, the threshold is €156. I will not go into all the figures. There are some modest allowances for rents and mortgages but that is not much use to these people.

What does the Minister propose to do — this is the crux of the problem in accident and emergency wards — about the closed beds in hospitals throughout the country? Will she lift the embargo on the recruitment of staff? I was told in reply to a recent Dáil question that there was no embargo but health boards could not exceed the ceiling, which is the same thing. There are some 50 beds closed in University College Hospital Galway because it would take 40 full-time nursing posts to keep the beds open. If the beds remained open, the accident and emergency ward would not be overcrowded, because many of these patients could be let into these wards.

Deputy Cassidy made a good contribution on the building of a 50 bed unit in Castlepollard. Fair dues to him, he is a very down-to-earth politician. He said during the course of the debate that he was an assistant to former Deputy Kennedy in Longford-Westmeath, then he was a postman, he was 20 years in the Seanad and he is now in the Dáil. If one threw in the fire house five and every other occupation in which he was involved, he is a very experienced grass roots politician. He said he wanted a 50 bed unit in Castlepollard. A ten bed unit was built in Clifden two years ago which has not been opened. I raised the issue on the Adjournment three weeks ago. An elderly lady who campaigned for this facility in Clifden will go on hunger strike in December if the facility is not opened. I advised her not to do so. She is threatening to go on hunger strike because she is frustrated that the Western Health Board is not getting the go-ahead to appoint the necessary 14 staff to which I referred on the Adjournment debate. The Minister of State said that provision might be made for the facility in 2005. The people of Clifden and the surrounding area want a commitment in writing as soon as possible that this facility will be open in 2005 to avoid a dangerous situation which is developing. The unit should be open because it would cater for families in the area who can no longer look after their loved ones.

I am sorry I do not have more time to go into more detail on the issue. I appeal to the Minister of State to ensure the people of Clifden that their facility will open early in 2005.

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