Jan O'Sullivan (Limerick East, Labour)

I commend Deputy Reilly and his Fine Gael colleagues. It is very important for us to debate this motion tonight. There is a great deal of pain, suffering pain and concern within communities around the country because of the numbers of people on trolleys, waiting for operations and because of the numbers losing their services, including those with disabilities and the elderly who are losing the home help hours and the aids and appliances they need to live their daily lives in some type of comfort.

This is not a mirage, rather it is the reality we all know as public representatives, because people come into us every day with these issues. People are waiting in some cases, years, to have procedures carried out. Admittedly some of them are not on the waiting lists about which we have statistics, because they are waiting to get from the GP to the outpatients' department before they see a consultant who will then put them on the list. Some three months after that they start to be counted.

There are many problems in the health service and that is not accidental. I have a reply here from the new head of the HSE, Mr. Cathal McGee, which acknowledges that €1.3 billion was cut from the Executive's allocation in 2010. That has to come from somewhere. As the HSE is such a cumbersome organisation, the way in which it implements such cuts is to bludgeon. It is literally a question of cutting front line services, by and large. We have not seen the backroom reforms and other measures that might have alleviated some of the pain.

I am sorry the Minister is no longer here, but she read out a list of costs that the Fine Gael motion would embrace. However, all Fine Gael is doing is seeking to maintain front line services in the various hospitals that are listed as examples and ensure there are no further reductions. The Minister has effectively conceded that all that money has actually been taken out of the service. The motion is simply asking that the existing front line services be maintained. Therefore the Minister, in her contribution, has effectively made the case for the fact that this is a very important motion and that real pain is being experienced.

She also made the argument very strongly for the type of reform the Labour Party has been talking about since 2001. She referred to the figure of £2 billion that was being spent on the health service in 1995, I believe. In the Labour Party document for 2001, we had a figure of £5.5 billion as the amount being spent on the health service at the time. We said that to produce the universal health insurance reform we were proposing the cost would go up to £7 billion. The present figure is around €15 billion – it went up more or less to €16 billion, but has come back down yet we have not had the reforms. Therefore we have this loss of service, and all these waiting times because we have not had reform.

All we had was the setting up of the HSE, which was a setback to reform, in my opinion, rather than an improvement. It is such a centralised monolithic organisation that it makes it very difficult for anybody to achieve reform in that context. The Minister has effectively admitted defeat in what she said in her speech. The cost of the health services are not high relative to other European countries, although it represents a high proportion of the amount of tax being taken in. However, we have not had the reforms to allow the money to be spent efficiently to provide the front line services that other European countries can achieve on similar GDP percentages.

The Minister has therefore acknowledged that she has not reformed the health service and that we are spending a considerable amount on it but are not getting value for our money. I am particularly concerned, on reading today that the number of people on trolleys is 420. I have the figures here for the various hospitals all over the country, and it is 33 in the Mid-west Regional Hospital, in my constituency. Our region is supposed to be the shining light as regards configuration for the rest of the country, yet our main hospital has 33 people on trolleys today.

The highly respected former Fianna Fáil councillor for many years and former chairman of the health board, Mr. Jack Bourke, with whom I served on Limerick City Council, was quoted recently in the media as being appalled at the whole situation when a family member attended the hospital's accident and emergency department. He was not complaining over the treatment but about the conditions in the accident and emergency department in Limerick and the number of people waiting. The attempt to reconfigure in Limerick was meant to include a critical care block, which has not yet started. It was meant to include many day services in Ennis, Nenagh and St. John's as well as other diagnostics and services in the smaller hospitals. On paper it looked quite good, but unfortunately it has not been delivered. One of the results of this is that 33 people are on trolleys.

I should like to quote Mr. Paul Burke, the person who is implementing reconfiguration and who is very committed. He is a very fine clinician, somebody I respect enormously, and I know he has tried very hard to make reconfiguration work. I am quoting from the most recent edition of the Medical Independent, where he says:

One area of agreement that is common to all sides of the debate is the impact of the staff moratorium.

A 1.8 per cent decrease in the numbers of people with private health insurance – equivalent to 42,000 people – in the 12 months to June 2010 has increased the demand on public health services, including acute care.

Combined with the moratorium, this leaves consultants in a difficult position when trying to deliver a workable process of reconfiguration.

"More than the funding itself, the big difficulty has been the moratorium and our resulting ability to effect change," said Mr. Burke.

"We could have done a lot more, much more quickly, even if we were working in a budget-neutral situation. But for example, when we closed the in-patient surgical wards in Ennis and Nenagh, there were a number of staff there who were either redeployed or took early retirement and under the moratorium, we didn't get those retirees WTE.

"So then when I said, 'We want to develop things more quickly here' in terms of getting more nurses and a greater pool to draw from, when I went looking for these people they were gone, thanks to the moratorium.

"So yes, this hospital [Limerick] has become busier and there is greater pressure on staff."

Mr. Burke explained that Limerick has taken a "double-hit" in terms of staffing pressures because of the moratorium.

"There would be the usual, natural loss of jobs because of retirement and so on, but because a number of people said, 'Well, I'm not going to move to Limerick at this stage' and took early retirement, there were a large number of people in our region who would have made that decision, rather than somewhere where there were no changes occurring, and in that sense, we took a double-hit because of the moratorium."

I read that out because I wanted to make a case this evening for the moratorium to be substantially reviewed. It is causing untold problems and that is an example of somebody who is genuinely committed to reconfiguration, and who is finding the moratorium is making it almost impossible to achieve the Government's policy in this regard.

We also saw reports during the summer whereby HSE west and other regions found themselves in the ridiculous position of having to take on agency nurses in particular along with other health care professionals, at an extra 40% to 50% of the cost they would otherwise have had to pay. I strongly argue that this needs to be addressed.

Another point I wanted to make relates to the insurers. I got a reply to a parliamentary question which said that by the end of 2009 some €41 million was owed in insurance charges to HSE west, and a further €2.5 million was owed to St. John's Hospital in Limerick.. That is appalling inefficiency and if collected would make up the kind of money that is needed. My final point is about those crutches. I do not accept the argument to the effect that it is not cheaper to reuse crutches. There are plenty of materials that can hygienically clean articles such as crutches. I urge the Minister to rubbish whoever told her it was not cost effective to reuse crutches.

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