Michael Moynihan (Cork North West, Fianna Fail)

I welcome the opportunity to contribute to the debate on the Health Service Executive's plan for the health service for 2012. As public representatives, Members interact daily with the HSE and health service on behalf of constituents. We also do so in our family roles.

I will address a number of issues. Home helps provide value for money in providing services for people who need help in their own homes, primarily elderly people. Since being introduced on a structured basis, the home help service has delivered major benefits for patients, their families, the wider community and, by extension, the State. Home helps have achieved great success in keeping people in need of assistance in their own homes and local communities. For this reason, any reduction in the home help service should be carefully targeted.

Delays in processing medical card applications have been raised in a number of forums in recent weeks. In many cases, those who are forced to wait for medical cards have been diagnosed with serious illnesses. Having been informed by their general practitioner or consultant that they have an entitlement to a medical card, they are encountering serious difficulties in securing their entitlement. The system used to provide medical cards needs to be challenged and taken by the scruff of the neck, so to speak. Those applying for medical cards tend to be on the lowest incomes and are, therefore, highly vulnerable. Public representatives, whether Members of the Dáil or Seanad or local authority councillors, are being contacted by a large number of people. We have seen at first hand people who have been diagnosed with serious illnesses and must have a medical card if they are to pay for their medication. Not only must they deal with their illness and the financial burden of their diagnosis but they must wait for long periods to receive a medical card. The Minister should give a commitment to address blockages in the system. He should issue a directive requiring that problems in the current shambolic system be ironed out.

In recent weeks, I had reason to speak with a hospital consultant who informed me that in his 25 years working in the health service he has never seen circumstances as bad as they were in recent weeks. He noted that whereas budgetary issues are usually not a major theme in January, he has been forced to cancel more day and theatre procedures than at any other time in his career. He asked me to raise this issue in the House. It is not possible to have all diagnostic procedures and other treatments carried out in the primary care sector. There is a fundamental need for hospital services to be backed up in every way possible and to ensure accident and emergency services and admissions are properly resourced. He was genuinely concerned about his patients and what he saw around him and was not making a political point, good, bad or indifferent. The situation is difficult and challenging at the moment.

Over the years Mallow General Hospital has provided a huge service to the people of north Cork and beyond. In any assessment of Mallow General Hospital, it always has been said that it is one of the most efficient hospitals. It is the first point of call for many people. In downgrading services or amalgamating services into centres of excellence or whatever, it is vitally important we acknowledge the contribution hospitals, such as Mallow General Hospital, have made to the State over the years.

It is vital that Mallow General Hospital is protected because in Cork, everything is being centralised into Cork University Hospital and other places. When elderly relatives of mine go to Cork University Hospital, it is chaotic not only inside the hospital but outside it. Any attempt by the HSE, the Department of Health, the Minister for Health or the Government to downgrade any of the services in these communities would be a retrograde step. It would have disastrous consequences not only for the HSE delivering the plan but in regard to the fundamental issue of money.

In recent weeks, there has been huge concern about the preservation of community hospitals. It could be a case of penny wise and pound foolish. Over the years these community hospitals provided even more services. By and large, they take in acute medical cases who need long-term care and assistance while the nursing homes take the other people. There are three community hospitals in my local area - Macroom, Millstreet and Kanturk - all of which have provided a huge service. Those three centres have been commended by HIQA on the care they provide. In the first instance, we must consider the residents of those community hospitals who are attached to their communities in a very significant way. They also have family support in their communities and can be visited by friends and neighbours.

The policy always has been to accommodate the acute medical cases. All but one of the patients served by the 38-bed Macroom Community Hospital are maximum or high dependency, meaning that most of them could not be cared for at home or even in the standard nursing home facilities. In the most recent inspection report on Macroom Community Hospital, HIQA stated:

Many factors contributed to the residents' quality of life. Relatives and friends visited the centre regularly and there was a sense of warmth and familiarity between staff, residents and relatives. The centre had a homely atmosphere where residents were encouraged to be independent and residents were encouraged to remain in contact with family and friends. Residents' health needs were overall well monitored and met.

To close Macroom Community Hospital would scatter these patients all over the community and their connections, which were rightly highlighted in the HIQA report, would be shattered. This would add to the congestion in the regional hospitals or lengthen the nursing home waiting lists. Likewise, Kanturk Community Hospital provides excellent and essential care.

Over the years, the communities have been hugely supportive of these three community hospitals. They have raised funds for the day centres or for enhancing their facilities. I suppose the communities take ownership of these hospital. The biggest difficulty with State institutions, no more than the issues in regard to the EU, is that we must bring the people with us. Communities should take ownership of their hospitals, schools and so on. It is vitally important that the contributions people have made to maintain these hospitals and the fund-raising they have done is acknowledged and maintained.

Patients in St. Joseph's Community Hospital, Millstreet, commended it. There have been huge advances in creating a better environment in that hospital. Pope John Paul II said that anyone of goodwill and good sense must agree that a society must be judged on how it treats its weakest members. It is vitally important we remember that when we reflect on the ethos in the community hospitals and the good work being done in them. We must commend them. The Department and the HSE should tread carefully and should look at the excellent work being done in these facilities and not take a blunt instrument to them.

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