Martin Ferris (Kerry North, Sinn Fein)

The Health Service Executive faces a shortfall of over €1 billion in 2009. Our already inequitable health system is now faced with even more savage cuts that will drastically affect the care of patients if the Government is allowed to continue to hide behind the HSE which will wield the knife on behalf of Fianna Fáil, the Green Party and the Progressive Democrats.

Real savings need to be made and can be made by ending all State subsidies for the private for-profit health sector, reining in those consultants who profit from both the private and public systems, cutting bills through the use of generic drugs and the establishment of a State pharmaceutical procurement and distribution company.

The Government could also cut massive salaries and allowances at the top of the HSE, including €16,000 per month for an adviser to HSE chief, Professor Brendan Drumm. This massive salary and allowance is disgraceful and indefensible in any circumstances. In the current economic situation, it is criminal. People are struggling to survive and make ends meet, yet the Government allows such salaries and allowances to continue.

Meanwhile, the Government and the HSE are preparing to cut services for patients and the pay of front line health care workers. If they proceed in that way, the damage to our public health services will be catastrophic and will exceed the damage caused by cuts in the 1980s. It is now time for strategic decision-making to be taken out of the hands of the HSE and placed where it belongs — with the elected representatives of the people in this House. There must be such political accountability. Any revised service plan and budget for the HSE must be placed before the Dáil so that the Taoiseach, the Minister for Health and Children and their colleagues can be fully accountable.

Equally importantly, the Government must listen to and take on board the constructive proposals of all parties. They need to listen to those of us who have been elected to serve the needs of the people. We all have a responsibility to those who elect us.

In the absence of real accountability and a Government that listens to the people, especially those who use the health services we have the disgraceful decision to scrap the national carers' strategy. The revenue saved as a result of services provided by our carers is huge. Across the country, dedicated people are looking after family members in the home with inadequate support from the State. In my own county of Kerry, there are almost 6,000 carers. However, continued lack of adequate support will lead to worsening health for both carers and cared-for, resulting in much greater health care costs to the State.

I would also like to draw the attention of the House to the discovery by my colleague, Deputy Caoimhghín Ó Caoláin, that a range of health and community projects in disadvantaged areas, including 120 announced by the Government last December, is now in jeopardy as the Department of Finance is set to block the funding. We need answers regarding those commitments. These are projects in disadvantaged urban and rural areas across the State, which were to be funded by the RAPID and CLÁR programmes and administered by the Health Service Executive. The announcement of the projects was made just before Christmas by the Minister for Community, Rural and Gaeltacht Affairs, Deputy Ó Cuív, and the Minister of State at the Department of Health and Children, Deputy Hoctor, who said that €4.6 million would be made available for the 2008-09 scheme. This was to allow elderly people to be able to live independent lives.

All Members of the House welcomed the intended programme. The 120 projects range from a drop-in centre in Cavan town to a meals-on-wheels service in Dublin 12, from a bus project in Cork city to the refurbishment of an Alzheimer's Society facility in Drogheda. All of these are worthy projects and would have contributed greatly to the needs of the individual older people concerned. In many cases also, their family members would be given some respite from constant care, particularly where people are suffering from conditions such as Alzheimer's disease, which places such a demand on carers.

My own county is among those badly hit by the proposed withdrawal of funding. Projects with a projected investment cost of €1.2 million — funded by a combination of CLÁR and HSE inputs — are under threat. They include programmes to improve services and community support for older people based in community centres at Lixnaw, Knocknagoshel and Listry, as well as the Coomnassig centre in Sneem, Caherciveen social services centre, Portmagee social services, Duagh resource centre, Glencar care of the aged and the Glen social centre in Ballinskelligs. All those centres in isolated rural areas require Government support. Also at risk are plans to improve child care and family support at the Scartaglin child care association and the tele-medicine centre in Faranfore.

The overall cost of the proposed joint CLÁR and Health Service Executive programmes was to come to €8.9 million. It was also included in the provision of day-care services development in Castleblayney, County Monaghan, and the upgrading and equipping of ten day-care centres for older people in County Donegal.

The Health Service Executive has apparently been required to re-submit all these capital projects to the Department of Finance. There is a general expectation in the sector that the funding will be withheld. I reiterate Deputy Ó Caoláin's appeal to the Minister for Finance, Deputy Brian Lenihan, not to axe any of these projects which are based in disadvantaged areas and are especially important in enhancing the health and quality of life of older people. The Minster should also reflect on the fact that while withdrawing the funding may represent a small short-term saving, in the long run it will increase the demand of those concerned on the health services, their GPs, hospitals and, ultimately, represent an even greater draw on the Exchequer. It is far better and makes more economic sense to provide those services which will improve the quality of life for the people affected, therefore improving their health and lessening their dependency on direct provision from the health services.

This is only the latest in a series of blows to the health sector across the country. It is one which will inflict more hardship on those least able to cope with it, especially older people. The overall impact of the health cuts in Kerry has already been dramatic. The Health Service Executive has announced planned cutbacks of €4.5 million which will devastate an already overburdened and under-funded service. It will have a serious impact on patient care, particularly at mental health facilities in the county. The Government's imposed cuts in staffing and beds stand in stark contrast to the private health industry continuing to enjoy massive tax breaks.

Among the proposed cuts is €1.2 million to be removed from mental health services in Kerry. This will include bed closures and staffing reductions at the acute psychiatric unit at Kerry General Hospital. The Health Service Executive has implemented these cutbacks without properly consulting the staff's union representatives as required by the Labour Court. Last week, I tabled a series of parliamentary questions on this but have not yet received a reply as they have been referred to the parliamentary affairs division of the Health Service Executive.

There are two psychiatric wards at Kerry General Hospital which, at night, are staffed by three nurses. It is proposed to reduce this to two, a ridiculous and ill-thought decision considering most psychiatric admissions take place late at night. Psychiatric nurses at Kerry General Hospital have one of the most demanding jobs in the health service. To attack them in such an underhanded way and against the spirit of the earlier Labour Court rulings requiring consultation is repulsive.

I have also asked that a full health and safety audit be carried out in the acute unit to assess the likely impact of the cuts on both staff and patients' safety. People are appalled that such miserable cuts are being made to front line services while the Minister for Health and Children continues to defend the tax breaks available in the private-for-profit health sector.

The threatened withdrawal of the promised CLÁR and Health Service Executive funding for services for the elderly comes shortly after the Government decision not to publish its long-promised national carers' strategy. This will affect up to 160,000 family carers whose work in the home saves the State hundreds of millions of euro every year. The decision is in direct breach of the Towards 2016 agreement. It also reneges on the commitment in the programme for Government to "ensure a national carers strategy focusing on supporting informal family carers in the community will be developed by the end of 2007".

It is extremely short-sighted. Even with the current desire to save money, any scaling down of the carers' schemes will exacerbate existing problems, have economic consequences for carers and lead in the long term to greater dependency on direct provision by the State. Instead of making real savings, the miserly cutbacks will only create a vicious circle which, in the long run if people's health disimproves and they require more direct care from the State, will add to the costs of the health service. This is assuming that even such basic provisions survive the current onslaught on the existing services.

This illustrates the extent to which health spending and the health services are inextricably linked to the overall state of society. It is no mystery that those on lower incomes tend to have poorer health and, therefore, to be more dependent on the health services. It is also true that people's lifestyles in what they eat, drink, whether they smoke, whether they use illegal or legal drugs and the extent to which they engage in physical exercise also affects their health.

People have a responsibility for their own health and lifestyles but society must create an environment which encourages people to live in a healthier manner. Unemployment, low incomes and poor accommodation contribute greatly to poor health. The lack of sporting and other recreational amenities prevents people from engaging in healthy pursuits. The current economic situation has impacted and increased these negative factors.

It is all the more important that in the current economic situation the State does not make matters worse by implementing cuts that will, on the one hand, contribute to a worsening of people's health and, on the other, impost actual cuts in the health service itself. The first contributes to an increased demand on the health service while the second further increases the difficulties of adequately addressing those problems when they do arise.

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