Patrick O'Donovan (Limerick, Fine Gael)

I welcome the opportunity to speak on this topic, in which there is much interest. There is concern in various sectors about the development of health services and associated policies. I will restrict my remarks to three areas that do not get attention and in which I have a personal interest - carers, orthodontic care and childhood obesity. I have raised the latter with the Minister previously. I represent a constituency in the midwest and while there has been negative criticism recently about acute services in the midwest, the vast majority of services in the midwest are operating very well. I have had the misfortune from a family point of view to have to use the acute services in the Mid-Western Regional Hospital and the ambulance services in the midwest region. We are very fortunate to have the Mid-Western Regional Hospital in Dooradoyle, County Limerick, along with the support services available. One cannot understand the impact of the health services or the work people do until it comes to one's own door. On 29 November 2010 I was working as a primary school teacher and within an hour of taking the roll of children in my care, I was sitting in the back of an ambulance with my father, who had experienced a number of strokes and heart and lung related problems. That day changed my life and the life of my family. It left us with someone in permanent need of care.

Many of these discussions forget the carer. It is not just the life of one person that changes with this sort of incident, where someone's independence is removed. It also affects the person who looks after these people, in many cases the partner, spouse or wife. I had no real understanding of the work carers do until I started to live with one. It is a difficult, silent role and it goes unnoticed. The reason is that carers are withdrawn from their daily lives and contact with the outside world and their lives suddenly change. Their lives revolve around the people they care for, as they are there 24 hours a day, seven days a week without a break. The hours provided by the State, not-for-profit organisations or profit-making organisations, in looking after the person and giving the carer an hour to collect the pension, go to the shops or just get a bit of downtime, are invaluable. It would be easy to say that home care packages and home help cost the State a certain amount of money but we cannot put a monetary value on it unless one experiences the impact the removal has on a person's life. I understand the country is in dire financial circumstances, as has been well enunciated. For the people who built the country and on whose backs the country was founded, it is a sad reflection on where we have come from and where we are going that we must examine the services available to a group of vulnerable people who have lost the right to have a say because, in many cases, they are unable to exercise the franchise.

There has been much talk about the community hospital network in this country in recent weeks. It is very easy to throw out the idea that hospital care and care of the elderly within the community hospital network is expensive compared to private nursing homes. Examining it on the basis of the number of patients and the amount of money going into each sector, is a fair comparison. However, when one peels back the money and looks at the patient or resident, many of them have complicated medical needs and have been discharged from acute general hospitals. They are in need of ongoing care, including rehabilitation, physiotherapy, occupational therapy, speech and language therapy or intensive care following a stroke or serious head injuries. In my area, we talk about bed numbers, trolley numbers and the occupancy of beds while there is a network of community hospitals around the country that are not being used to their true potential. There is a temptation to look at them only in terms of longstay beds when, as the Minister said, the best thing for community hospitals is to focus attention on getting the person back to independence or semi-independence and capable of returning to the home, with ongoing care from the State services. This should include home care packages in order to restore someone's dignity. The loss of someone's dignity is something that cannot be quantified. It leaves a huge mark on a family when it happens.

I refer to orthodontic care of children. It is a shame the Dental Act was passed in 1985 and allowed persons to be appointed as dental technicians to clear the waiting lists but it has not been advanced. The legislation has been passed but we have not made regulations that allow it to be rolled out. We can contrast what is happening in Ireland with Wales, Bulgaria and other European countries. We are light years behind them because reforming the Dental Council has not happened fast enough, there is no chief dental officer and we need a joined-up strategy on how this will be delivered.

One can talk about the cosmetic element of orthodontic care and it boils down to a cosmetic function for some people but it is a huge problem for young people of 14 or 15 years of age. It is not the only problem because there are complicating factors. Young people are exposed to all sorts of peer pressure and families must spend thousands of euro every year to try to avoid waiting lists to get braces. The Minister and the Minister of State have responded to me on this point and are conscious of the efforts required but it needs to be prioritised, particularly for families struggling to make ends meet. The cost of braces and ongoing care can be between €10,000 and €13,000 and people cannot afford this crazy money.

I refer to childhood obesity. We have a national advocate in the Road Safety Authority in the person of Gay Byrne, who took on, without fear of control from Government, politics or State agencies, the need to drive down the number of people being killed in road fatalities, which has worked successfully. We now need to consider the appointment of a personality outside politics and the public arena who young people, in particular, would have an appreciation and respect for to drive a national campaign in this country to address the massive issue of obesity.

It is like a timebomb waiting to explode in this country in terms of the illnesses that are being stored up such as diabetes, obesity-related cancers, heart disease, asthma and others. For a health service developing in the future, one of the largest problems we have buried beneath the carpet waiting to cause huge problems for the Exchequer and the long-term ongoing health needs of the country is obesity. If I could make one proposal, it is that the Government consider the creation of a post of national obesity advocate to drive national policy and the implementation of same, and hold the Government to account.

In five years time we should be able to say we have achieved something and are taking the issue seriously, as is happening in the United States . I again thank the Minister for the opportunity to speak today. The implementation of the health service plan is dear to all our hearts. Much has been said in the past 24 hours and if the Minister takes it on board we will have a much stronger and more vibrant health service.

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