Michelle Mulherin (Mayo, Fine Gael)

In response to Deputy Colreavy, not a day goes by that the enormity of the tightrope being faced in the delivery of health service is not starkly clear to me and the Minister of State, Deputy Lynch, the Minister, Deputy Reilly, the Minister of State, Deputy Shortall and the Minister, Deputy Fitzgerald, who are involved in this area. They hear a large number of stories and have much with which to contend. There is also the human side of wanting to give a service to people, which is overwhelming.

We know the system is crying out for reform and efficiencies. Aside from our economic crisis, the most pressing area is health because we cannot choose when we become ill, are dying or have a disability. It is a time we would like to think help is available and the State is there for us. Illness does not discriminate between those from poor or wealthy backgrounds. People want the service to be in place. It is important that we reform the system. It is the most difficult area and one which frightens me.

The Minister, Deputy Reilly, has made a clarion call which he wants to follow through on. Let us be under no illusion. There are many vested interests who do not want anything to change and do not want to address efficiencies, and we know why. People do not want to change job practices and so on. These realities are faced every day. The system will not change overnight but if we steer the ship in the right direction it is to be hoped we will end up at the right destination, which is the objective.

The talk is about efficiencies, reform and so on. If one looks at how sub-areas in the HSE are trying to react, one will find efforts are being made in local areas. I can speak for my area in particular. There is a district hospital in my town which is considering closing beds because of a lack of staff. A solution which has been applied in St. John's Hospital in Sligo is being considered. The hospital might bring in home helps to help with cleaning, which would alleviate staff to support nurses and keep beds open. I am very hopeful that will happen. Unions have to be very responsible in encouraging people to be flexible and responsive so we can deliver health care under the constraints that exist. Nobody is losing his or her job, people are being asked to be flexible.

In terms of efficiencies being achieved, since this time last year there has been a reduction of 70% in the number of people waiting on trolleys in Mayo General Hospital. The national average is 20%. All the efficiencies, green lights and health statistics have brought the hospital into the top five list of efficient hospitals in the country. I commend the hospital manager, Charlie Meehan, the HSE manager, Frank Murphy, and the staff and management who are working together to achieve efficiencies through the reconfiguration of medical and surgical beds, increasing the number of day cases and a more efficient use of step-down facilities.

There are also plans in the pipeline which, it is to be hoped, will come to fruition to extend the renal dialysis unit and build a cystic fibrosis unit. There is also what I believe is a unique initiative, the lean academy. People working at management level in multinational companies in Mayo work with hospital management on the leaner and more efficient delivery of services. We are getting the know-how and expertise from people in multinational companies who give their time voluntarily to try to achieve efficiencies.

There comes a point when people hit a wall. The reality is that even if we are achieving efficiencies we are contending with a moratorium. At some point soon we will have to consider replacing front line staff. We can have all the fine structures we want but if we do not have nurses to look after people in bed we will not have a service. Without a doubt, anybody speaking truthfully would say it is a problem. The problem is the economic crisis in the country. The patient has to be of paramount interest and has to be what motivates us, and there should be an alarm bell when that is not happening.

There are many ways in which services can be delivered and they are being explored. Just because they are not under the traditional heading of how services should be delivered not mean they cannot be delivered in another way. It is a serious challenge. There are delays in people in getting approval from exemptions to the moratorium, ranging from a year to 18 months. If we are serious about exemptions they should be delivered.

The fair deal package is unsustainable and we have to consider other ways of allowing people to be cared for in their homes. People should only need to go into homes for medical reasons and should be supported in their old age, no matter what disabilities they may have. It would be a lot cheaper to give incentives to people to give up work, stay at home and still get a stamp.

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