Michael Colreavy (Sligo-North Leitrim, Sinn Fein)

I have a good deal of understanding for the predicament the Minister and her colleagues are in as she tries to grapple with the crisis in our health care system. In this regard, the Minister was handed a poisoned chalice by the previous Government. I am not sure, however, that the Minister and her colleagues are aware of the real fears Irish people have as they contemplate the future. I am sure that Government backbench Deputies are aware of what is happening to our health care services because they are hearing about it in their clinics. Nonetheless they seem to have adopted a Trappist vow of silence and are not reflecting the views of their own constituents.

Not alone is the health system in crisis, but it is also an apartheid system. We still have the awful phenomenon where ability to pay can determine the speed of access to health care services. That is an apartheid system which is simply not good enough. Sinn Féin seeks to create a democratically accountable, national health service that is responsive to the diverse needs of the population as a whole, and that is flexible enough to provide the highest quality care appropriate to individual needs. However, we currently have a health care system that is in crisis and there is very little leadership. We hear much talk of change but see no evidence of it on the ground. In addition, there is very little accountability and only vague promises of change to resolve the myriad problems that are arising.

In the constituency I represent, Sligo Leitrim North, there was an outcry when breast cancer services operating to a very high standard at Sligo General Hospital were withdrawn. There must be a re-examination of the cancer control strategy. We still have ill people from Donegal, Leitrim and Sligo travelling to Galway and back, which is not a good service. The policy must be revisited and one of the key aspects of it must be access to the service. There is a lack of stroke service facilities at Sligo General Hospital, which was promised but never happened. We were promised a mammography service would be restored to Sligo General Hospital by the end of last year but that has not happened yet. There have been myriad resource and staff cutbacks for acute hospitals. Staff in hospitals may not be telling the Minister this but they tell me that when someone is sick, is on maternity leave or retires, staff are not replaced. The staff are beyond stretching point.

Our Lady's Hospital in Manorhamilton has an excellent regional rheumatology service. Two consultant rheumatologists provide an outstanding service and relieve many patients of severe pain. One is going on maternity leave and cannot be replaced because of the staff embargo. Waiting lists of one year will extend to two years and no human can say that to leave someone with acute arthritic pain for two years without a consultant is a good service. It is a disgraceful service and we deserve better.

There are threatened cutbacks to longstay nursing homes throughout Sligo and Leitrim and real fears that nursing home beds will be closed because, allegedly, the nursing homes cannot provide a gold standard service due to lack of finance or human resources. People who should not stay home will do so because the gold standard is not available in public hospitals.

The most insidious of all is the threatened reduction in the number of home help hours. It is the most effective and best value service in the range of health care services. Home help hours have been reduced and non-replacement has also been threatened with regard to critical front line staff who will retire in great numbers at the end of this month. We do not yet know the impact. The public dental services are virtually non-existent in the area.

The CEO of HIQA was invited to attend a meeting of the Oireachtas Joint Committee on Health and Children two weeks ago and acknowledged the growing challenge of ensuring quality while slashing expenditure in public health care services. At some stage HIQA and the people must say that enough is enough. If health care was a passenger aircraft, we would have been called in long ago by the Irish Aviation Authority and grounded due to safety concerns for passengers. I refer to the shambles that surrounds the centralisation of processing of medical card applications. People who are desperately in need of medical cards must wait months instead of weeks for eligibility decisions. In the meantime, they cannot afford to pay a GP, they cannot afford prescriptions and other essential medical needs. An increasing number of people are marginally outside the eligibility guidelines. People with chronic illnesses are being turned down and it is a mathematical calculation used with no reference to illnesses.

Several years ago, I heard my party colleague, Deputy Caoimhghín Ó Caoláin, speak about death by 1,000 cuts in health services. The cuts are getting deeper and the wounds are fast approaching the point of no return. There is an alternative to this. Sinn Féin promotes a new universal public health system that provides care for all, free at the point of delivery on the basis of need alone and funded by general, fair and progressive taxation. That can still be done. There must be a fundamental reorientation of the health system to adopt a central focus on prevention, health promotion and primary care, including mental health care. Ultimately, we must eliminate the underlying social and structural causes of ill-health and premature death, such as poverty and inequality. We need a reorientation and roll-out of the promised primary care centres throughout the State on an accelerated timescale. Decisions about acute hospitals are being made on the pretence that primary care has improved. That is fiction. Decisions on cutbacks in acute hospitals made in advance of improvements to primary care only reduce the choice and increase the timescale for sick people getting into hospital when they need it.

Has the Minister of State wondered why thousands of people entitled to receive public health care in acute hospitals pay increasingly big bucks for private health insurance? The reason is that they do not trust the public health care system. They feel the public health care system will not be there for them and their families when they need its services. People prefer to see money invested in health care and the education rather than to increase the income of greedy financial gamblers and zombie banks. Quality health care is a labour-intensive industry and cannot be done on the cheap. People would not mind paying fair taxes for a quality, one-tier health care system, provided it is delivered fairly, efficiently and effectively. Health care needs will increase over the coming years and decades. It will not decrease because we have an increasingly elderly population. Access to quality health care is a right, not a privilege that can be withheld at the whim of Government, the troika, the EU or anyone else. We cannot continue to deliver a quality service at bargain basement prices. There must be a baseline, below which we cannot go. We have fallen below the baseline.

See this speech in context