Seán Crowe (Dublin South West, Sinn Fein)

Setting aside the merits of the Bill, it is regrettable that it comes before the Oireachtas at a time when we face a deepening financial crisis which is having serious and far-reaching implications for our health care system. The main concern is that the most vulnerable people in our communities are those who suffer the most.

My party colleague, Deputy Caoimhghín Ó Caoláin, pointed out that many of our citizens who wish to access the general medical services scheme cannot do so because of the exclusivity of the current arrangements. However, despite the obvious need for change, some in the medical profession want to see the retention of the status quo. This is unethical and untenable as clearly there are too few GPs overall and too few GPs who have access to GMS contracts which allow them to treat medical card patients.

Our health system is failing people throughout the State and nowhere is this more clearly illustrated than in my constituency of Dublin South West. For many years Tallaght hospital has been rarely out of the news, unfortunately for all the wrong reasons. I note in a joint statement issued today that the Minister for Health, Deputy James Reilly, announced a series of initiatives to reform and modernise the governance structures of the hospital. While I welcome the potential of this announcement, the Minister must also address the years of under-funding of Tallaght hospital which still has a proven track record in providing quality care in the face of almost insurmountable demands and having to function with wholly inadequate resources. Its management has consistently advised on the staffing and other resources required to rectify obvious imbalances and any restructuring of the management structures at the hospital will make little or no difference if the resources deficit is not corrected to ensure Tallaght hospital operates properly.

Since it opened in 1998, Tallaght hospital has become the busiest hospital in the State. In 2010, its accident and emergency unit treated 93,000 people. Recent figures obtained from the HSE show that it sees more emergency department attendees, treats more in-patients, and sees in excess of 30% more patients in its outpatient department than the next busiest hospital. Despite this, it has the fewest numbers of consultant doctors of the four Dublin teaching hospitals and there is also a shortfall on the requisite number of consultants. This was identified in the hospital review conducted by Dr. Maurice Hayes in September 2010 when he inquired into the issue of radiology and the scandal of unread reports and X-rays. He reported that relative to other Irish hospitals "the degree of under-staffing in Tallaght hospital in 2009 was substantially greater than in the other sampled hospitals".

Tallaght hospital is funded by the HSE to supposedly service a population area of 350,000 when in reality it must service a population of up to 500,000 people. A breakdown of Dublin hospitals' annual financial allocations yields startling figures, with Tallaght hospital's allocation set at €176 million, compared with St. James's allocation of €220 million and a €200 million allocation for St. Vincent's. This equates to €800 per person in St. James's, €727 in St. Vincent's and €350 in Tallaght.

Having a properly functioning acute hospital depends on appropriate health service provision in primary care and in continuing non-acute care beds. It is clear that tremendous challenges face Tallaght hospital and these are further exacerbated by the shortage of GPs servicing local communities compared to other similar areas. For example, if one compares Galway city and the Tallaght urban areas, both have similar populations of more than 70,000 yet Galway city has more than 40 GPs compared to 26 GPs for Tallaght. This is significantly below even our poor and low State-wide level of provision and this needs to be examined.

The absence of an out-of-hours GP on-call system means people have nowhere to turn except Tallaght hospital's accident and emergency unit. This was touched on by other speakers during the debate. People complain about patients turning up at accident and emergency units but if they have no alternative that is where they will go. Fettercairn, which is an area in my constituency, has a population of 7,000 people but no GP service is available. This is a scandal in what is supposed to be a modern country. Where do people go? They go to their local hospital.

In addition to this, the provision of so-called "step-down" beds for patients who have completed their acute care treatment is very poor in the Dublin south-west region when compared with other catchment areas. This compounds the problem of, to use the awful expression, "blocked beds", adding to long waits for accident and emergency unit admissions and elective procedures which tie up 50 of Tallaght hospital's 640 beds at any time. We also have the added pressures that will result from the imminent closure of the St. Brigid's Nursing Home in Crooksling which for decades provided highly specialised care for high-dependence patients who suffer from very debilitating illnesses. It has 89 patients at present and not 80 as was stated in the statement issued by the HSE. Of these, 65 are high-dependence patients and it is proposed to move them to another site. However, it will not be suitable for high-dependence patients and another crisis in the system will ensue.

Good management and governance are crucial in ensuring patient care but progress can be achieved only if adequate resources are put in place so the hospital and its staff are able to provide the necessary care which is essential for the general well-being of our citizens. As the medical board of the hospital stated, it is not possible to deliver optimum safe care with continually diminishing resources and steadily increasing patient activity.

My party supports the Government's commitment to provide, during its term of office, free GP care for all and this is something we have long advocated. However, like much that has been promised, there is very little tangible evidence that the Government is making good on its pre-election pledges. This was highlighted by the Minister of State with responsibility for primary care, Deputy Róisín Shortall. While the Minister of State has acknowledged that there are what she termed "blackspots", such as Tallaght, where there is a shortage of GPs, this can be addressed only if effective measures are put in place to improve the present unacceptable situation. Good planning and good implementation of an effective primary care strategy is needed to ensure that all communities are served equally and that every citizen has access on the basis of need and within reach of where they live.

I came up with a solution for the situation in Fettercairn. A Polish doctor, who is a consultant in Tallaght hospital, was willing to work in the area but because of the crazy rules in the medical system on access to medical cards he was not allowed.

An audit was carried out on the patients in a hospital in Limerick with regard to their needs and background. We need to look at similar hospitals in Dublin to see why people are coming to the accident and emergency units. This Bill only addresses one aspect of the problem of primary care delivery. The system is flawed in so many ways and people's worst fears about December's budget are that things can only go from bad to worse.

I remember going to a launch concerning primary care, hospital care and access to doctors in the south west of Dublin. Where was it held? In Fettercairn. I do not know if others can see the irony in launching a primary care programme in the specific when there is no doctor operating. I look forward to hearing the comments of the Minister of State in responding to the debate. I hope the positive elements of this Bill will have a positive effect on patients who have no option but to go to the accident and emergency unit.

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