Beverley Flynn (Mayo, Independent)

Like other speakers I welcome the expenditure of €15 billion on health and compliment the Minister on the significant improvements that have been made in the health service, especially during her tenure. I wish to focus on a number of issues in particular in this regard.

One of the issues that has been close to my heart in recent years is services for older people. As a member of the Oireachtas Joint Committee on Health and Children for the past ten years, especially during the tenure of the current Minister, one of the issues I raised continually related to the equalisation of subvention rates across the country. At one stage the difference between a subvention rate in the west and the east was as much as €500 per week, which was a significant disparity. The Minister made a commitment to the committee to address this matter and I am pleased to say she did so prior to the end of the previous Government. Currently an equal rate of €300 applies across the country. Provision is still available for enhanced subvention and in the east people probably receive a greater enhanced subvention than those in the west.

I would urge that the needs of each individual be taken into account in addition to the costs involved. I accept this is a criterion for enhanced subvention but it is still difficult for people in the west to afford expensive private nursing home care. That said, the situation has improved significantly. I also welcome the increase in home care packages, as it is preferable for a person to be looked after in his or her own home. The provision of funding in this regard by the Government is a big step in the right direction. I am delighted that 2,000 extra home care packages were provided in 2006.

Another issue about which I complained on a number of occasions is that we in the west did not appear to be getting our share of this service. Again, that situation has improved and I compliment the Minister on her commitment in this regard.

Hospital staff is a key issue, especially since the HSE has introduced a ban on recruitment, as is the question of whether services in hospitals have been affected.

In my local hospital, Mayo General Hospital, one physiotherapy position is vacant at present and has not been renewed. I am particularly concerned with this situation, while recognising that the hospital must work within its whole-time equivalent staffing level, which is 1,046 for this year. Staffing levels were as high as 1,088 at times during the year, which is obviously unsatisfactory and means the hospital must get back into line. However, I am concerned about frontline services, particularly physiotherapy services, as there is a waiting list of four to five week at present for people requiring acute physiotherapy and up to nine months for people requiring routine physiotherapy. Given the Minister's statement on this matter, I recognise she is anxious that frontline services will not be affected. I hope this vacancy is filled as a matter of priority.

Moreover, although the matter is currently under review, three radiographers at Mayo General Hospital are on short-term contracts and 14 nurses who have retired or gone on maternity leave have not been replaced. While the hospital must operate within the complement of staff available to it, it cannot operate without 14 nurses, three radiographers and a physiotherapist without affecting frontline services. I am particularly concerned about this matter.

On cancer services, I welcome the Minister's announcement on the centres of excellence, which is the right way forward. It is important that we focus on better outcomes for individuals who have cancer. Unfortunately, it must be recognised that there are no centres of excellence above a line running from Galway to Dublin. It was stated that a centre of excellence must deal with a population of 500,000, which is supposed to justify four centres of excellence in Dublin, but I do not agree with this strategy.

I live in an area for which the centre of excellence will be located in Galway. I do not have a difficulty with this but I hope that, in the next year or 18 months, it will operate in consultation with the consultants who are currently operating in Mayo General Hospital and dealing with 72 cases per annum, and with Sligo General Hospital. Breast cancer services is the area which is probably most in the public domain due to the closure of some of the centres. I do not have a difficulty with such closures because, like the Minister, I would agree that if a hospital is dealing with fewer than 20 cases per annum, it should not be operating in the area of breast cancer. However, given that Mayo General Hospital is dealing with 72 cases per annum, consultants are travelling to Galway to participate in operating procedures and there is a full multidisciplinary team examining all cancers, it is important we keep an open mind and perhaps develop a network approach.

The Minister suggested two years ago at the Joint Committee on Health and Children that we would visit Sloan-Kettering Hospital in New York and we did so. It operates a network service which operates very effectively. We should keep an open mind when dealing with this issue in the west and north west.

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