Michael Healy-Rae (Kerry South, Independent)

I thank the Whip of the Technical Group for allowing me the opportunity to speak on the health service plan. I wish to quote:

No one knows more about the changes that need to take place in the Health Service than the experts on the ground ... and they are the managers, staff and their representatives who deal with the day-to-day realities of hospitals, health boards, support services, outpatient clinics, day care and other facilities.

We are now in an era of rapid development in health care and increasing consumer awareness. To deliver the service we need in the 21st century, we need a new way of working together, a way to cross the dividing lines and pool our resources...

Each local issue that is resolved, each short-term goal reached, is a solid advance in the journey toward a high-quality service for all who receive health care and treatment, and genuine job satisfaction for those who deliver that service.

These are not my words, but come from a document published by the former Minister of Health and Children, Deputy Martin, in 2001. These words give the sense that everything will be fine, but alas not much has changed since 2001.

Nobody will ever but have the highest praise for the front line staff of our hospitals. One need only read the letters page of any newspaper to see praise rightly heaped upon these doctors and nurses. Everyone seems to be very happy with the service in our hospitals, once there are admitted. So where is the problem? Every day we hear of long waiting times at accident and emergency departments throughout the country, people on trolleys, long waiting lists for procedures to be carried out and morale among staff at an all time low.

It must be asked, therefore, what is wrong with our health service and why does it not work for the benefit of those it is trying to serve? Having listened to the speakers from all sides the problem, I believe is not as complex as HSE managers make out. I put it simply with the acronym BEDS. I use this term because it is what everyone around this country is telling us and it also stands for better early diagnostic services.

We need a better community health service. County Kerry has a network of excellent community hospitals, in Caherciveen, Killarney, Kenmare, Dingle and Listowel with one which remains to be opened in Tralee. These community hospitals, working with the local GPs, can provide a great service to their locality. A few extra beds in these facilities used for non-critical medical conditions would immediately relive the pressure on our bigger hospitals. GPs, who have spoken to me on this subject, have informed me that many procedures could be carried out by the GPs themselves if they had access to these facilities. All community hospitals should be able to boast of having digital X-ray and video-conference links to their general hospitals in order to enable staff in the wider community to have direct access to consultants and specialists in whatever field may be necessary to carry out a proper diagnosis and treatment schedule.

However, community hospitals will have to provide a wide range of services for all ages from the youngest to the oldest, including child and family clinics along with physiotherapy, occupational therapy, speech therapy, psychiatric clinics, breast-care clinics and other carers' supports as required. Along with the upgrading of our network of community hospitals, further goals must be put in place for our general hospitals. The feeble excuses offered for recent ward closures include staff retirements and maternity leave, both of which are well within the bounds of forward planning and should have been flagged earlier so that action could have been taken to deal with the situation.

A new approach will need to be agreed with all managers on admittance to hospital. There needs to be co-operation between all hospitals whether they are community or private so that wherever a bed is available it should and must be availed of. The provision of these community services is the first step in ensuring a health service of which we can and should be proud. It is only by working from the bottom up that any progress will be made.

When the Minister for Health was in opposition he used to berate the then Minister for always claiming an issue about which she was asked was a matter for the HSE and not her responsibility. No Minister for Health who is asked a question in this House should hide behind the HSE - the buck stops with the Minister. I would like to see the Minister adopt a more responsible and hands-on approach when dealing with questions.

The issue of medical cards was raised earlier. There is chaos with medical card processing at present. I compliment in a special way the people who are working on trying to process the cards here in Dublin. I am not pointing any finger of blame whatsoever on them because they are dealing with thousands of applications. However, I have a problem with the policy of dealing with applications from all around the country in a central location. We had excellent staff dealing with medical card applications throughout the country. Local representatives and doctors had direct access to the people dealing with the applications and public representatives had direct contact as well. We knew the names of the people working on the processing of the cards.

However, a policy was introduced to centralise the processing of the cards with chaos resulting. There are people who have repeatedly sent in information by registered post only to be told afterwards that there is no record of the application. I have the PPS numbers of people to prove this fact if the Minister or anyone else wishes me to back up the claim. The Minister of State is aware of this and would have encountered the problem herself as would the Minister, Deputy Reilly. Constituents are being driven to the point of distraction when it comes to applying for a medical card. I place no blame on those involved in the processing of them as they are simply overwhelmed. We should go back to the system we had in place for dealing with medical card applications county by county.

I wish to highlight the position of carers. What has happened recently whereby carers' hours have been slashed and cut is wrong. The people providing care for elderly people in their homes save the State thousands of euro every week. If these people were not being cared for in their homes, they could end up falling and then they would end up in a community hospital or in an acute bed in a general hospital. Keeping elderly people at home is better than having them as patients in a hospital.

Orthodontic delays should be addressed, especially procedures that young people wish to have carried out. We are all aware that when a young person is developing and if they have a problem with their teeth, it is preferable for it to be dealt with at a young age because as the young person gets older it is more difficult to deal with the problem. There are considerable delays not only in my constituency but throughout the country. I wish to see the matter being given the consideration it deserves.

There are certain situations in hospitals such as that prevailing at the community hospital in Dingle. I appreciate the Minister will officially open Dingle Community Hospital tomorrow and to turn the sod for the new community hospital in Kenmare. Progress has begun there. It is ridiculous to have a new community hospital in Tralee with the doors shut, to be paying security guards to mind it and having wards in the magnificent hospital in Dingle which I visited recently. I compliment everyone on the great work they carry out there and in all our community hospitals. However, it is nonsensical and penny-wise and pound foolish to have massive infrastructure in place but not to open the beds.

Deputy Neville spoke about suicide prevention. I believe no one in the House or in the country has not been touched or affected by suicide and if it did not involve a family member it may have been involved a friend. Sadly, we have all had these experiences and in my case it has occurred in the recent past. Resources must be pumped into the issue of suicide prevention to ensure that everyone will talk about the problem. Ultimately, there is a critical timeframe whereby if a person is in danger and if there is intervention, talk and openness, that person may be taken to a better place and what they might have considered today they would not dare consider at another time.

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