Dara Calleary (Mayo, Fianna Fail)

I welcome the chance to speak on a number of issues around the HSE health service plan for 2012. I will begin by considering the whole area of medical cards. All of us in our constituency offices are dealing with the unbelievable backlog that has arisen whereby an anticipated and targeted 15-day turnaround is now close to 15 to 20 weeks. While the staff in Finglas are doing a very good job in very difficult circumstances, I want to give an example of what we are dealing with. A constituent of mine, an elderly gentleman, through diabetes was forced to have a leg amputation, although he was lucky enough to have a good family around him. He submitted a medical card application last September. I checked the details with my office earlier today. Since September, we have exchanged 20 pieces of correspondence with the central processing unit's client registration office about this gentleman. On five separate occasions, his family and ourselves submitted information that had been previously submitted and then once again requested. This man is missing a leg and is dealing with consequences of that as well as being diabetic and suffering from other conditions. Yet, we cannot sort out a medical card for him.

Everybody in the House probably has similar stories as to what is happening in this regard. With a local office, at least there was some element of local intervention in such a case. Under the Croke Park agreement, I have always felt there should be a core of staff who would move into areas where there are shortages, demands and pressures, such as in this case, to address backlogs before moving away to another office - we would almost have a small army of people to address backlogs in given areas. None of us can stand over a system that waits five or six months to issue a medical card to a person with diabetes. The plan anticipates that 100,000 extra medical cards will be issued this year, which is probably inevitable given the economic circumstances. If the delays continue as at present, what system is in place to deal with this extra avalanche of applications that will come during 2012? The HSE attended the Committee of Public Accounts and made all sorts of commitments. The proof will be in the pudding. I ask that urgent attention is paid to this issue.

There are many ambitions and aspirations within the plan in regard to care for the elderly. Again, the plan often contradicts itself, as the Minister in his public statements often contradicts himself. He said at the health committee that community nursing homes with less than 50 beds are not viable, despite the fact this would include the majority of such homes in the country. We are cutting back on community nursing homes and the number of beds within them. The fair deal is apparently funded until the end of March. What happens beyond that date? If a person cannot get a community bed, he or she may not be able to afford a private bed. We are cutting home help hours and home care packages.

What message is being sent out to elderly people who may need a bed, perhaps temporarily, or may have to make the choice to move into a home? There are so many different messages. We are cutting every kind of supply to them. Many Deputies have spoken about the role of community nursing homes and community hospitals. The fear among all Deputies and the community generally is that many will close because of the policies the Minister seems intent on pursuing. Before this plan was published, I questioned him on several occasions on this model he has of money following the patient. What does that mean for community nursing homes and district hospitals which do not have the necessary throughput of patients because they are going to the general hospitals?

I pay tribute to the management and staff of Mayo General Hospital who have put enormous work into transforming the services and the standard of delivery at the hospital in recent years. We have a hospital we can all be very proud of. However, it only works, and the standards and transformation only work, on the basis of having very good step-down hospitals in Ballina, Belmullet and Swinford and having community nursing homes across the county where people can be stepped down into beds instead of having them occupy beds in the general hospital. There have been 70 bed closures in the district hospitals and the community nursing homes since last September. How can the management of Mayo General Hospital continue to step people down to beds that no longer exist? This will put the pressure back on the general hospital, waiting lists will increase and we will be back into the same ring-around.

Deputy Conway spoke about joined-up thinking. There is no joined-up thinking when one cuts off the funding to feeder hospitals. I come back to my earlier point. This all fits clearly into the model in terms of addressing backlogs in our major, general hospitals. However, the model the Minister is pursuing of money following the patient will cut the legs from the ability of the feeder hospitals to form part of that model in time to come.

I have spoken previously in the House about services at St. Joseph's Hospital in Ballina. I understand the Minister is involved in putting together a plan to save beds through the use of home helps in the hospital, although I gather this is still subject to union approval. I ask everybody involved to knock their heads together in order to protect the beds there. I have not seen anything proposed in regard to the psychiatric unit at the hospital or, indeed, psychiatric services generally in Mayo.

Deputy O'Donovan spoke earlier about the need for a national champion on obesity, and he is right that we must have such a person. Far more fundamentally, however, we need a national conversation or debate about mental health. We need people to stand up and say that they may have a mental health condition. I pay tribute to the many people whom we have seen come out in recent weeks and months to say they have had depression. Mental health is the same as physical health. As a country, we are great at running to people when they get physically sick and great at providing support, talking to them, praying for them and so on. However, we are still stand-offish and reluctant to talk about mental health as an issue.

Mental health is the number one challenge facing this country. When one considers the rates of suicide and depression, we have to put it out there and start talking about it. To be fair, the Minister of State, Deputy Kathleen Lynch, has done a good job ring fencing money and positions. Again, however, the issue of joined-up thinking reappears in that the senior Minister does not get it. Some 400 extra positions have been ring-fenced for mental health teams throughout the country, which is great and something we all welcome, but how many people are retiring or announced yesterday their plans to retire by the end of February from mental health services?

We were able to run to get Mr. Paul Appleby sorted out and put a package in place for him to wait on to finish his work. Surely, the 400 positions could be brought forward to make sure there are no gaps in our mental health services when that investment is going to be made later in the year in any case. It would be a shame to think the investment and the genuine commitment on the part of the Minister of State, Deputy Kathleen Lynch, would be undermined by someone failing to knock heads together in regard to sequencing retirements and appointments across the service.

The Minister, Deputy Reilly, when he was on this side of the House, was a great man for throwing every kind of abuse, indeed, much personal abuse, at the former Minister, Ms Harney. I do not see that much has changed since he came into office except that he is not as voluble as he used to be. I genuinely wish him well. Never mind the political issue, health is an issue that affects us all. However, mighty mouse, as he was when he was on this side of the House, is kind of quiet now as he deals with the realities of being Minister and having to deal with the issues.

I am willing to give him a chance in regard to this plan. I emphasise that it is his plan. I love the reference to the "HSE health service plan". The HSE is in the control of the Minister now. It is his body, his creation and he intends during 2012 to dismantle it and put up a James Reilly version. I will give him a chance on this but next year he had better deliver on the targets. We must see reform that involves better services and better access for people. We would then see the colour of his money before he starts to bring in his new, Dutch, one-size-fits-all system that has been promised to all as the nirvana of health care. However, the more one looks into it the less realistic it is.

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