Liam Twomey (Wexford, Fine Gael)

Every society changes over time and this change may be evident over ten years or over half a century. This change is sometimes dictated and led by intelligent and broad-minded politicians but all too often it is the politicians who are dragged along in the wake of change with little regard to what they can do about it.

The issue of disability is an issue over which politicians should be in control. We should be seen to lead in the changes in society. For example, Dr. Garret FitzGerald was the prime mover of the Anglo-Irish Agreement in the 1980s when he brought the Governments of Ireland and the United Kingdom together. This was the beginning of the changes in Northern Ireland which brought about the peace process. When Dr. FitzGerald spoke in favour of the Anglo-Irish Agreement, the then Opposition was composed of Fianna Fáil and the Progressive Democrats. It lambasted him from a height for talking to the old enemy and criticised every move he made. He was accused of giving in to the British Government and to British feelings at the time. The Government changed but Fianna Fáil continued with the Anglo-Irish Agreement and it eventually culminated in the Good Friday Agreement which is now accepted by all, despite its shortcomings.

It has been the case that changes occur in society which politicians choose to ignore. In this regard I refer to illegal nursing home charges. The Department of Health and Children was aware of the illegal charges but for some reason the Minister in charge, the Ministers of State and their advisers continued to peddle the line that they knew nothing about it. What was happening then was wrong. It started in 1976, but that was a different time in Ireland. The case of the illegal charges shows what can happen when a Minister is not capable of handling his brief, not capable of handling the daily challenges he must face.

I suggest a history lesson about disability issues. The National Rehabilitation Institute, otherwise known as Rehab, was founded in 1949, 56 years ago, to improve the independence of people with special needs. The Central Remedial Clinic was founded by Lady Valerie Goulding in 1951. We have come a long way from the era of Christy Brown. He was a man whose physical disabilities were very obvious but whose intellectual capacity was totally ignored for many years. It was only the will of his mother that allowed him to show his literary capabilities to the rest of the world. That is what Ireland was like in the 1940s and 1950s, when disability was treated in the same way as cancer, as something that was not talked about and about which very little was done. We should question how far we as a society have progressed in regard to issues of disability.

The early 1950s was also the time of Dr. Noel Browne's mother and child scheme. He wished to improve the lot of mothers and their children. The scheme was shot down by the politicians, the church and the medical profession. However, attitudes have changed since that time. Has our attitude to people with disabilities changed as fundamentally as our change in attitude to other things in the past 50 years? The tenor of much of the debate in this House shows that we have not changed. When the Central Remedial Clinic opened, farmers still used horses to carry out much of the work done in the fields. No farmer would dream of using a horse for such work today. However, we deny people with disabilities the most fundamental and basic civil rights. Each of us in this House must examine what we are about in this regard. In particular, the Government must look closely at this issue because it has the opportunity to change the way society thinks by showing itself to be more broad-minded. The Disability Bill is a narrow-minded exercise which indicates how limited the Government is in its scope of thinking and presents a poor sense of what should be done for those with disabilities.

The National Rehabilitation Centre in Dún Laoghaire looks after those who are unfortunate enough to suffer a severe disability as a consequence of accident or illness. The centre has three specialists who must meet the needs of patients from throughout the country. Many young people who are unfortunate enough to suffer severe disabilities and who have no hope of a full recovery are treated badly by the system. Access to these services, even for those who have some hope of improvement, is woefully inadequate. I have contacted the centre on numerous occasions in attempts to secure the transfer of patients to the facility and to inquire about delays in obtaining appointments. This is an issue that affects many families.

We have seen some improvements from the medical point of view in terms of the manner in which we view disability. There has been an improvement in stroke and cardiac rehabilitation in hospitals throughout the country. Such rehabilitation is somewhat akin to what Christy Brown's mother did for him in that it allows patients to reach or restore their potential. Stroke patients who are properly rehabilitated have managed to reintegrate themselves fully into society. They are able to work and drive, for example, and to continue their lives as they were before they suffered a stroke.

Likewise, cardiac patients can make a complete recovery. Even some who have suffered severe heart attacks can make an excellent recovery because of the combination of medical treatment and proper, well structured and well funded rehabilitative services. One of my patients, after suffering such a severe heart attack that one of the walls of his heart is no thicker than a sheet of paper, is now functioning quite well and is living his life to the full.

However, we deny the same level of rehabilitative service to those with disabilities. It seems to be embedded in our collective psyche that these people are second-class citizens and are incapable of reaching their potential. In the 50 years since these organisations were formed by forward-thinking people to try to seek out the potential of people with disabilities, we have not come far in our own minds. It was long after the foundation of these organisations, as recently as the 1960s and 1970s, that the clothes and bed sheets of a person who had died from cancer would be burned to prevent others from somehow being infected with cancer cells and suffering the same fate. We have come a long way in the treatment of cancer patients who can now hope to undergo chemotherapy and radiotherapy if they are available.

There is, therefore, a changed attitude to many illnesses which can strike us down, but we are stuck in a timewarp when it comes to the development of disability services. The Government has a significant role to play in leading change in this area. In considering the available services, I do not wish to differentiate between those who suffer disability because of a medical illness, mental illness or accident. The issue is how society views those with any and all types of disability. It is not merely a question of the number of doctors and psychologists who carry out assessments but also a matter of the services available for those with disabilities.

For example, physiotherapy services are not available in the way in which they should be. Only those who can afford it can avail of them while those who cannot pay must go without. General practitioners often cannot refer patients to hospital for such treatment because the physiotherapy department will inform them there are not enough physiotherapists and that they are only available to see hospital patients. One may strike gold occasionally in locating a physiotherapist who looks after a day care centre and provides physiotherapy in a piecemeal and ad hoc fashion. Overall, however, physiotherapy is not considered a core element of medical treatment but rather as a privilege or luxury which one receives only if it is available.

Occupational therapy is viewed in a similar light. Most politicians seem to believe occupational therapists are people who are trained to make assessments for the grants which disabled persons require to make changes to their homes. It is often only in this capacity that public representatives have any contact with these professionals. It all comes down to the question of funding and how much is spent on providing the most basic services to allow people, often elderly, to live in their own homes. Again, this service is seen as a luxury and is available only in a limited and unsatisfactory manner. It is not considered useful to train occupational therapists other than as a means to provide a narrowly defined service.

Occupational therapists could provide a fantastic service to elderly people in maintaining their independence at home, helping them to prevent falls and improving the overall quality of their lives. Services such as physiotherapy and occupational therapy must be made a more integrated part of the health system. It is not all about doctors, nurses, operations and cancer treatment. The health system should encompass a much wider scope than this. The question of cost is important to the Government and is the basis upon which it limits medical services while frittering away money in other areas. We do not have large health budgets such as those of France and Germany but we are capable of providing many of these services rather than allowing them to exist as luxuries which are available only to a few.

One reason the BreastCheck service has not expanded and developed is the lack of trained radiographers. I have been aware of this problem since 1997 or 1998 when I began working as a GP and was forced to wonder why there was no CT scanner in some of our larger hospitals. CT scans were already becoming obsolete in other countries such as Canada and the UK while we considered them the great white hope for the Irish medical service. The scanners were switched off at 4 p.m. because there were not enough radiographers to administer the scans. It is crazy that this remains the situation when it is clear that in another decade or two, technology will have moved far beyond the CT scanner.

The Government has shown zero vision and is concerned only with what will happen after the next election. Crises are dealt with as they arise and there is no forward planning. We must begin to consider disability services in a different and better way. In the context of the Disability Bill, we have got into an argument about whether access to such services should be rights-based. The Government knows it could not afford to implement rights-based legislation because of the total neglect of the disability sector, not over the past five or six years but possibly over the past half century. Very little has been done about this situation in the past seven years. Many organisations are concerned about this. For instance, the Disability Federation of Ireland alone represents 150 voluntary organisations providing services for people with disabilities. There are possibly another 150 statutory organisations providing such services.

We need more joined-up thinking to make disability services work better for the people involved. There is considerable public anger and I know exactly what many of the other speakers were talking about. I do not need to go to the RDS or Mansion House to know how people feel about disability because I hear them every day. In the past, I heard them in my surgery. I have met many disabled people since becoming a politician and noted the anger they feel over the way we look at and treat them compared with ordinary citizens. They are extremely disappointed.

There are many people whose expectations have increased because of a booming economy. In some regards, perhaps our expectations have risen too high. The expectations of those with disabilities are often associated with what the rest of us have taken for granted, not in the past six or seven years when this economy really started to take off but possibly over the past century. We should start treating people with disabilities with much greater respect than we do.

Before I became health spokesperson for Fine Gael, I was a member of the Committee on Finance and the Public Service. I remember the former Minister for Finance, Charlie McCreevy, attended a meeting of the committee at which we discussed disabled drivers. He stated he could not allow more disabled drivers to claim back vehicle registration tax because the existing regulations were too generous. He implied that any increase in the number of people who could benefit from the regulations would be regarded as such and stated that one would not get as much money back on the purchase of one's vehicle in other countries as one would in Ireland. Mr. McCreevy felt some people with fairly significant disabilities were not entitled to reclaim their VRT because we were already being too generous to those who were doing so. This creates its own form of apartheid within what some consider to be an apartheid system for treating those with disabilities.

There was no great outcry over Mr. McCreevy's remarks. Many of us on the committee felt it was terrible and that something should be done but the former Minister more or less shook his head and implied that was the end of the discussion, that the matter should be forgotten about and that there would be no change. I noticed that the present Minister for Finance, Deputy Cowen, who in some respects values his credentials as one with great respect for people with disabilities, has been part of the same status quo given his response to drivers with disabilities. He has not done anything to change the regulations either. These are small matters but they greatly affect those involved. What I have outlined is part of the mindset that characterises the Government. It should seek to address this matter and make progress.

It was just after Christmas that an issue arose regarding the St. John of God service in Dunleer which provides respite care for 1,500 families in the north east. A report was commissioned by the Government to determine what was required by the organisation. Funding was not provided to it and it was more or less told that it would have to survive without it. It provides residential, day care and respite services. However, without having had any major discussion on the issue, the Government was quite happy to leave 1,500 people without respite care. It did this through the Health Service Executive which is a great barrier between the Government and patients involved. In spite of the Government's leaving 1,500 people without respite care, it made a great brouhaha at budget time over increasing the carer's respite allowance. In spite of this increase, facilities do not exist in many cases to provide the necessary respite services.

It is as if the disability issue is very much media-driven or as if the Government is saying: "Look what we are doing." It is felt that any increases or improvements to people's lives depend on how they translate into some media soundbite for the Government. This is my belief in respect of what is happening in the health service. It is a question of ten-point and five-point plans. We all know what will happen when the national treatment purchase fund brings itself to bear on the waiting lists. They will decrease but, ultimately, patients who wait for a rheumatology appointment in the north west, an orthopaedic appointment in the south east or a urology appointment in some parts of Dublin will still have to wait three or four years. Patients are still not being seen by neurosurgeons quickly enough, regardless of what may be happening in respect of waiting lists.

One of the best examples I encountered in this regard was when one of my patients entered my surgery and asked me, in my capacity as a politician, to write a letter to Beaumont Hospital to ask the medical staff to see him. The patient was due to return to the hospital for investigation after having been an outpatient and the hospital said it would call him back after six to eight weeks in this regard. I agreed to write the letter. I asked the patient when he was seen by the staff at the hospital and he said that it had been three years previously. I hope the Government takes on board some of the points we make.

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