Joe Carey (Clare, Fine Gael)

The Minister for Health and Children, Deputy Harney, in introducing the Nurses and Midwives Bill before this House two weeks ago was at pains to point out that nursing and midwifery are the cornerstones of our health service and that Irish nurses and midwives have long enjoyed a fine reputation, both at home and overseas. She went on to state that this Bill is a key component in the construction of a system of governance and accountability for the health services which has the public interest and patient safety as the focal point. Those were fine words, indeed, noble sentiments, but unfortunately, straight from the manual of spin and doublespeak. I must ask how the Minister can reconcile these statements with the fact, according to the INMO, that we have lost 1,900 nursing and midwifery posts since the imposition of the public service moratorium, how she can reconcile these statements when none of the 1,600 2009 qualified graduates have been offered a post in the Irish health care system and how she can reconcile these statements when 1,064 hospital beds have been closed and are unavailable.

It is all very well to enact legislation on governance, but what type of chaotic skeletal health care system is the Minister trying to govern? No amount of window dressing will allow the Minister escape and dodge the fact that in her many years in charge of the health services in this country she has actively presided over the creeping introduction of a business-model based health system for the Irish people.

It has become clichéd but anybody who has been in our hospitals recently will have experienced Irish nurses and midwives under severe pressure trying to provide a most necessary service as they struggle to do the jobs of two or three. When their colleagues retire or go on maternity leave or sick leave, they are not replaced, all because of the public service embargo put in place by the Government. Increasingly, they are working in an environment where quality in the delivery of care is really secondary to the issue of finance, despite what the Minister might say.

From talking to nurses and staff working in our health services, morale has never been so low among staff, everywhere within the service and in every role. The public service recruitment embargo has undermined the value of their contribution to the health system in the country.

End of Take There is no doubt that science and technology and matters of governance and regulation are thriving in medicine. However, the Minister and Government should never think that because they have all the tools such as legislation, degree-led education and new corporate bodies, that this is the whole package; humanity and empathy for a patient's position are needed as much now as any time in the past. The Minister must take cognisance of the universal fact that the more prescriptive one becomes, the more one dilutes these characteristics. This is a balance she will need to continuously address.

When the Minister talks about governance and best practice with regard to nursing and midwifery, I suggest she considers the Mid-Western Regional Maternity Hospital which serves not just Limerick, but also Clare, north Tipperary and parts of north Cork. The hospital delivered 5,463 babies in 2009. One of the 5,463 babies born in 2009 in the hospital was my daughter Alma Maye Carey. My wife, Grace, gave birth to Alma on a bright summer's morning on 15 June last. Coincidently, five days later, a young fellow called Fionn Plunkett was born to very close friends of ours, Tadgh and Catriona Plunkett. Fionn's birth was followed by Saoirse Fitzpatrick who is the second grandchild of my constituency secretary, Kathleen Fitzpatrick. I will not leave out little James Buglar, the son of my personal assistant, Paul and his partner Shula. It could be said we kept the maternity hospital in over-drive for the month of June 2009 and there must have been something in the water in late 2008.

I pay tribute to the midwives, nurses, doctors and staff based in the maternity hospital in Limerick for their professionalism. My experience of childbirth and that of my wife was made so much easier by these wonderful hard working people. One of the consultants based in the hospital was in touch with all the Oireachtas Members from the mid-west early this year. He wrote:

The infrastructural situation at the hospital has become very depressing - it is now very close to something that could justifiably be described as a shambles. Shabbiness, over-crowding and a general inadequacy of facilities is the routine experience of patients from the moment they arrive in the car-park until they leave again and as they progress through almost every clinical area in the hospital. The term 'public squalor' comes to mind. Were it not for the fact that we have a very good core of permanent staff who reside in the region, who are very committed to looking after their own community and who take great pride in their work, things could be very much worse.

These and other problems have been caused by a lack of strategic planning, poor governance structures and chronic under-funding. There is a plan to re-locate the hospital to the Dooradoyle site, but this is not being progressed because no political decision has been made. The disempowering and centralised nature of the current HSE structures means that there is no local decision making of any description. The maternity hospital has an annual budget of €18.5 million In comparison, the three Dublin maternity hospitals have budgets of between €62 million and €65 million per annum - they do about 8500 deliveries each annually. In other words, the Dublin maternity hospitals have about 350% of the Limerick funding to deal with about 150% of our deliveries (they each have their own labs, management, financial and human resources set-ups, which is hardly an efficient use of national resources).

I read this letter into the record of the House in order to make the point again that all the legislation in the world with regard to governance and best practice cannot mask the fact that the Government, of which this Minister is a part, presides over many fundamental cutbacks which are affecting both patients and those working on the front line of public service, in this case our nurses and midwives.

There is a fine veneer for public consumption but little attention and in many cases deliberate attacking of the structures that would create a proper public health service. This is driven by a specific political ideology as presented by the Minister for many years, the Boston versus Berlin model. However, in the meantime, even the Boston model has now incurred changes with President Obama's reforms and yet in Ireland, under the stewardship of the Minister, we are happy to continue on down a road of health care provision that is in the process of being abandoned internationally.

The governing structure as proposed by the Minister in this legislation is at odds with the Minister's assertion of having the public interest and safety foremost in her mind. The current board consists of 29 members, 17 of whom are elected by nurses and 12 of whom are appointed by the Minister for Health and Children. The new board will have 23 members, 15 of whom are appointed by the Minister and eight elected by the professionals. The eight members of the new board are supposed to represent each discipline of nursing and midwifery. This, on the face of it, represents a slimmed down quango. However, I do not agree with the shift in balance between elected representation and ministerial appointment. The fact that the board, as envisaged by the Minister, is not allowed to comment on the environment within which nurses and midwives work does not indicate best practice for either nurse or patient, in my view. The fact that there does not appear to be any provision whereby the board has some advisory role to service-providers on staff shortages, physical environment, poor quality or unsafe conditions, is at odds with the Minister's stated intentions in relation to public interest and safety.

Our party spokesperson on health, Deputy James Reilly, asked the question last week about the subtle but important distinction as to the manner of how this new board is to be appointed and the independent powers at its discretion, in contrast to those that apply to a body such as the medical council. I have noticed a similar distinction in much new legislation over the past 12 months. The Minister for Finance and the Minister for the Environment, Heritage and Local Government, immediately spring to mind, now to be joined by the Minister for Health and Children, in that much more power and influence is being transferred to the Minister's office.

It is also interesting to note it seems quite likely that most costs associated with this new board will be met by nurses and midwives through increased registration fees. It brings to mind the establishment of the Teaching Council a number of years ago whereby the teachers of Ireland pay an annual subscription to this body with little discernible benefit accruing to them. In essence, the project has become a money-making exercise dressed up in the clothes of professionalism and advancement of standards.

I pay tribute to the superb work of the nurses working in Ennis General Hospital. Despite all the cutbacks and budgetary constraints as a result of the policy to centralise all acute services in the mid-west, the nursing staff at the hospital have remained at all times ultra-professional and dedicated to delivering the best possible service. The decision by the HSE 12 months ago, under the direction of the Minister for Health and Children, Deputy Mary Harney, has allowed the balance of health care provision swing towards the private sector.

There is much evidence that many Clare people who are lucky enough to have medical insurance are now opting for the Galway Clinic as their hospital of choice, even for acute services. This is an appalling indictment of the Government's failure to provide basic health care for its citizens.

The HSE's administrators have stripped Ennis General Hospital of services and moved us along the road to a commercially-based health care provision in Ireland, where what really counts is the size of one's wallet. Many Clare patients have been diverted to the Mid-West Regional Hospital in Limerick in recent months, where staffing embargoes and increased patient numbers are creating significant difficulties. I have witnessed at first hand the chaos in our so-called centres of excellence where people are stripped of all dignity and placed on trolleys and chairs for hours and days. No new facilities or extra patient space has been provided at Limerick Regional Hospital to deal with the additional workload despite all the promises made in this House. It is even difficult to park a car down there.

At Ennis General Hospital, I have been outraged at the ongoing situation with regard to CT scanning services. There has been a stream of conflicting information coming from the HSE concerning this much-needed facility. Last January, we were told that staff recruitment difficulties were resolved and that operations would be up and running without delay. Then we learned that services had been suspended again following the departure of a temporary radiologist. The latest news is that this vital service is now at last working again, seven months after closing. It is vital that this service is developed and opened up to outpatients.

Some weeks ago, I met with staff working in Ennis General Hospital to brief myself on the current situation in that facility. The under-investment continues apace, as does the agenda to close services and centralise. The endoscopy unit promised under the reconfiguration of services has still not been delivered, while the promised geriatric beds are not there either. The policy continues to be to cut whatever costs money and replace it with nothing.

I refer again to the roll-out of BreastCheck to County Clare. I first raised this matter here in May 2009 and since then I have raised it a further eight times. The latest statement from the HSE is that BreastCheck will be made available via a mobile unit in the grounds of Clare County Council in Ennis this September. These are more words, however, and there is a sense that we have heard all of this before. What we need now is action. The roll-out process should be fast-tracked and prioritised. The handling of this issue has been nothing short of a scandal. How can anyone have confidence in our health service when the administrators cannot roll out an essential programme such as BreastCheck on time and efficiently?

At this juncture, we need an overhaul of the country's health care system. Fine Gael has such a plan called FairCare, which will fix our broken health care system. Only then will we be able to adopt 21st century health care, where patients come first and not cost savings, and where everyone can have confidence in their health care system.

This week, fears were expressed that cardiac services in Ennis General hospital are under threat. The Minister for Health and Children should attend the House to make a statement on the long-term plans for cardiac services at that hospital. Yesterday, a very committed consultant, Mr. Terry Hennessy, who is based in Ennis, said he wants to see the services being upgraded there. Mr. Hennessy rubbished claims that cardiac services were under threat. Nonetheless, the Minister should make a statement to this House on the matter.

I welcome the main provisions of this Bill and look forward to the Minister, Deputy Harney, addressing the concerns I have raised.

See this speech in context