Liam Twomey (Wexford, Fine Gael)

The solutions are far more important at this time. In the time I have been involved in politics I have seen some progressive changes in the health services and I work with the dedicated public service to which Deputy Nulty referred on a regular basis. Even in the decade I have been in politics, the problems with the use of computers and IT in the health service have not been addressed. We still have a hopeless implementation policy for the use of information technology in the hospital sector. For instance, I cannot get blood test results via broadband, but must continue to get them via an ISDN line because the HSE does not want to use broadband to transfer information from the laboratories to doctors' surgeries. I cannot send an e-mail to hospital consultants but must send faxes or letters. These would be considered ridiculous by most businesses, but that is what is happening.

There are continual problems with the care of the elderly and how we will address it in the future. That was an issue a decade ago and remains an issue. In these more difficult times, it requires us to be very conscious of what we are doing because we need to look after our elderly people who can no longer look after themselves. Access to hospital services is still poor and is inconsistent across the country. People in the south east wait four years to see an orthopaedic surgeon and three years to see an ear, nose and throat surgeon. However, patients in other parts of the country will wait longer for different types of services, for example speech and language services. If we could not sort out these problems when we called ourselves the richest nation in the world, we will certainly have trouble sorting them out now that we are in such difficult financial times.

Access to primary care and mental health services will also be a problem. As Deputy Browne is aware, St. Senan's Hospital, which was a Victorian institution, was closed as we are trying to move services for people with mental health problems into the community. There is a need to destigmatise people with mental health problems and treat them as normal members of the community who should not feel they should be locked up when getting treatment for those problems. All health care is moving away from the acute hospital setting and mental health should do so also.

I know that Fianna Fáil's Private Members' motion tonight concerns small schools. A large number of people in the public sector undoubtedly feel that an attack is being made on them, but that is not the case. There is an agreement with the public sector unions to implement the Croke Park agreement. There is a need to implement that agreement in order to protect services in the future and we must implement it quickly. There is no Croke Park agreement for the service users, students, patients or pensioners. It is very important that all public servants, including doctors, nurses, teachers and politicians, work together to ensure the service users we are looking after get the best possible service. That is the point some members of my party are making about the Croke Park agreement. It is not about getting rid of it and having strife with people who work in the public sector which would be pointless. It is about implementing the Croke Park agreement in order to deliver the best possible service we can in the worst financial times the country has ever experienced. Everybody acknowledges that public sector workers have taken pay cuts of 15% to 25%, which is a significant hit in households dependent on the income that derives from the State.

There is urgent need to make changes and we need to review everything. Hospital theatres lie empty at night and some hospital consultants are not actually working. We are paying those consultants €160,000 a year and they will openly admit they have no work to do because they have no access to theatres. In recent years we made major changes to how hospitals are administered and run. We may need to review some of those changes to see if they remain fit for purpose. Many of those changes were made because we were pouring money into the health services without any necessary regard to how that money was being spent. Undoubtedly a significant portion of that money was poorly spent. We structured our health services in a way that may not work well in these more difficult times. We meet people all the time who know we can make our health, educational and other public services work better. That spirit of co-operation will remain, but we need to get down to working on this issue, which is far too important for the people involved.

I see great potential in what the Minister for Health, Deputy Reilly, proposes. He talks about the money following the patient. Many of those who contributed to this debate spoke about specific concerns in their areas. Deputy O'Donnell spoke about the Mid-Western Regional Hospital. I visited that area six years ago when there were plans to close the hospitals in Nenagh and Ennis. At the time it was quite obvious that the Mid-Western Regional Hospital would have problems dealing with this extra workload. The Deputy is correct in pointing out that hospital has below the national average number of doctors, nurses and allied health-care professionals considering the throughput in the hospital, and it was clearly going to run into problems. This happens in a number of hospitals. Many people might not understand that hospitals such as the Mid-Western Regional Hospital and Waterford Regional Hospital have similar workloads to St. Vincent's University Hospital, which has 1,200 more staff than either of those regional hospitals.

The staff complement in Waterford Regional Hospital is 2,700, representing a significant difference for these hospitals. One cannot simply compare these hospitals in an absolute sense because St. Vincent's University Hospital carries out a good deal of specialised work not carried out in the other two hospitals. However, by and large, much of the work done in all three hospitals is similar. These are the issues the Minister, Deputy James Reilly, is considering now. He is trying to find efficiencies in the health service at present.

There is a need to make other changes for the future. There is a need to ensure that we focus on health promotion, health prevention and health screening. We must try to catch disease before it gets to people. Previously we used to discuss high blood pressure and diabetes. However, these diseases are now being overtaken by a condition called metabolic disease. This is made up of diabetes, high blood pressure, obesity and high cholesterol. Vast numbers of the population are affected by all of these illnesses at the same time. Vast health resources will be required in future to look after patients and we must plan for the explosion that will occur in this country in the coming decade or 15 years. Otherwise, there will be an even greater crisis in our heath service than that which we perceive at the moment. There are problems now and there will be problems in future. Unfortunately, because of the financial crisis we are making significant cuts and these will hit front line services. There will be reductions but I believe that we have a great opportunity to change things. It will not be perfect.

Deputy Browne will remember his former party colleague, Charlie McCreevy, who stated that he would not put any more money into health because putting money into health was like pouring money down a black hole. That is not correct but the point he was making was that health services will consume as much money as one wishes to put into it. In these limited times we must try to get the best possible outcomes for the money we are putting into the health services and we continue to put a significant amount of money into health.

I wish to make some remarks about private health insurance. The genesis of the problems with private health insurance today dates back to meetings of the Joint Committee on Health and Children in 2005 and the position of the then Minister, Mary Harney, on risk equalisation and the way in which the structure of community rating was set up in the country. The then Minister, Mary Harney, chose to believe there was no problem. No more than she ever expected that we would be in the position we are in today, the genesis of many of the problems we face in private health insurance now date back to that time when we did not deal properly with the private health industry and the provision of these services to people.

Many people believe that there is no accountability when a patient goes to hospital with VHI cover. The bill is simply sent to the VHI. We do not know what people are being charged for or how much they are being charged. I understand the receipt one receives from the VHI is considered unacceptable to the auditors in the European Union because it does not provide the clarity required.

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