James Reilly (Dublin North, Fine Gael)

I really wanted to address myself to the Minister for Health and Children who is not present although she will be later. It would have been nice to hear the detail of her plans before I stood to speak. In 2006, the Minister for Health and Children announced the fair deal scheme to address the inequities in funding of long-term residential care for our elderly citizens. In December 2007, the Minister said she intended to introduce the legislation and have it passed by the Houses of the Oireachtas before the Christmas recess. Plans have been put in place to have nursing homes inspected by HIQA to ensure they meet the required minimum standards. I presume budgets have been provided to HIQA for these plans.

In 2007, a sum of €110 million was earmarked for the commencement of the fair deal scheme. The undue delay and blame game or referring to legal complications does not give our elderly citizens much comfort or confidence that the Government will introduce this scheme. Is this the first time that the Department of Health and Children has dealt with patients who have diminished mental capacity? This is an obvious provision that would be in any legislation dealing with elderly sick patients.

The fair deal was promised for January 2008 but has now been scrapped by the Government. We will no doubt be told it will be introduced in 2009. However, with the Minister's current record and the Government's actions I have little faith the scheme will be introduced as promised.

There is now to be a cutback of €85 million from the money ring-fenced for long-term care of the elderly. On closer analysis, this is really €98 million taken from the elderly because the €13 million allocated for contract beds had already been announced last January and is separate to the €110 million.

The first to feel the pinch are the most vulnerable, the elderly in our society who find the Minister picking their pockets yet again. Many of them are still waiting for the return of the money taken from them and their families illegally by the Government. These families have had false hopes raised by the Minister since December 2006 when first promised the fair deal legislation. It is always the most vulnerable who are first to be hit as they have the least voice and are the last to be heard by the Government.

Moneys allocated in the past two years to mental health and palliative care were shifted into other areas. Last year, the Minister promised cutbacks would not affect patients in autumn. They have been felt with operations cancelled, outpatient waiting times lengthening, accident and emergency waiting times lengthening, home-care packages for disabled children removed and home help from the elderly removed. The elderly have been led a merry dance for the past 18 months to find nothing at the end of the road.

I have a constituent whose mother sold her house for a considerable sum of money and has spent €300,000 in nursing home fees. The money is now gone and he has no idea how his mother will be cared for. These are the real hardships which the Minister fails to see as she makes announcement after announcement but axes service after service.

Many of these cuts are unnecessary due to the waste that occurs through the mismanagement of our health service under the HSE created by the Minister. We have in recent times heard of redundancies, an action that should have taken before the HSE was formed. This would have been normal planning in the merging of any two companies, let alone 11. A management structure was put in place before a chief executive was appointed instead of allowing him to appoint his own. Failure to bite the bullet on redundancies early on has resulted in large numbers of patients choking on that said same bullet and dying because of it.

It was announced recently that some of the structures of the HSE will be dissolved. While I welcome this, the HSE has been examining this option for the past 18 months but no details have emerged. I would welcome more regional and local devolution of power across the pillars and more co-operation between the hospitals and the community. This would get rid of the nonsense of a patient being left in a hospital bed at a cost of €3,500 per week because the primary, community and continuing care services will not take the patient on its budget and would only cost €1,200 a week.

Through the lack of proper illness packages for people with diabetes, complications set in costing the State hundreds of millions per annum. Through lack of detection further hundreds of millions are lost as complications develop in 50% of people by the time they are diagnosed. Millions could be saved. I ask the Minister to put in place chronic care packages for patients with diabetes and to talk to the insurance companies also. In 2001 €350 million was spent on diabetes care; the figure now could be as high as €1 billion.

At Cappagh Hospital operations have been cancelled one day a week for the months of July and August. This will result in longer waiting times, people going to the NTPF and having their hips and knees replaced at three times the cost to the taxpayer — more waste. The length and breadth of the country hospital wings are idle, as in Mullingar. In the Taoiseach's backyard there is a new €80 million hospital in Tullamore which was idle up to one week before he became Taoiseach when some patients were placed in it to take the bare look from his backyard. There is a countless number of wards to which this applies, including in Cavan, Clonmel and Sligo. In UCH, Galway and Ballinasloe €4.6 million has been spent on intensive care beds, but there is no money to staff them. The waste is incredible. An excellent surgeon is standing idle at Monaghan General Hospital, with anaesthetists at the ready and a state-of-the-art theatre, built only five years ago. However, he cannot operate because every patient must travel to Cavan. The nonsense is just astounding.

With regard to the cancer strategy, in Cork it is proposed to transfer 300 breast cancer cases per year from the South Infirmary Victoria Hospital to CUH which already has an 80% occupancy rate and lengthening accident and emergency waiting times. We do not have the money to indulge in this shifting of deck chairs on the Titanic. The service provided in the South Infirmary Victoria Hospital is excellent. At over 300, the hospital carries out more operations than any other centre in the country and this year the figure is heading towards 400. Why are we messing about?

Where is there more waste than in the Mercy Hospital, Cork, in which I stood only last week, with state-of-the-art ventilators and incubators which are unable to be used? People are probably dying because of this. They could be used to improve patient care; we have the facilities but will not staff them. It is outrageous.

The primary care strategy is continually being talked up but, ultimately, it is not delivering any real change in patient care, except in a small number of instances. A sum of €1.2 million per team was promised, but they will only receive €200,000. Some 13 staff per team were promised, but they will only receive three. In effect, nothing is happening. No improvement is being seen.

I said the Minister had allocated funding for palliative care, people with disabilities and mental health services but all of those funds were used for alternative purposes. Clearly, this is a Government which has no idea of what a promise means, or how to keep it. It lacks vision or a real reforming agenda and the country now finds itself in a recession. In the boom years money was wasted. There were no real reforms and nowhere is this more evident and the pain felt more than in the health service. Now, because of the approach taken by the Government, the first to be hit will be the old and those with a mental and chronic illness.

This is the Taoiseach's recession. I do not have time to go through all the promises made in the programme for Government, including the task force on obesity. During the boom the vulnerable and the weak were left behind and nowhere is this more evident than at St. Ita's Hospital, Portrane. As regards the co-located hospital planned for the Beaumont Hospital site, a new unit was put out to tender in 2005 but has now been thrown at the back of the queue. The Minister can pursue her ideology of private co-located hospitals, but in 2008 we have 23 men and 23 women in an open ward, with two feet between the beds, one block of three toilets and one shower unit and bathroom. Now that we have hit bad times they are grabbed and placed at the front to take the hit first. It is a disgrace.

Make no mistake, this is the Taoiseach's recession. It is the legacy of four years of appalling management on his part. As my colleague said, it cannot be explained by international factors. No other country is experiencing such a level of job losses, price increases, loss of exports and a house market collapse. International factors have exposed how poorly the economy has been run in the past four to five years. This week we have seen an ill thought out, half-hearted attempt by Fianna Fáil to clear up its own mess but, as usual, it is the old and the weakest, the least influential, who will not be heard by the Taoiseach because he does not listen to those who do not have a voice.

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