Joan Collins (Dublin South Central, People Before Profit Alliance)

I am pleased to be able to contribute to this discussion because it is an issue on which there has been significant debate. Much attention has been given to the issue of health services and the Government has made much of its commitment to primary care services and to reducing the demand for acute hospital services by developing community care.

I would like to point out one example of how far there is to go in this regard and I base my remarks on information provided to me by the Irish Heart Foundation. I am sure the Minister and Minister of State must be aware of this information but we need to put it on the record to make people aware of the situation and of how far we need to move to solve the problems within this particular community. Stroke is one of the main causes of acquired disability and up to 50,000 people with disabilities resulting from stroke live in the community. Survivors should have access to physiotherapy, occupational therapy, clinical psychology, speech and language therapy and nutrition and dietetic information provided by both hospital and community-based stroke teams.

In 2008, the Irish Heart Foundation's national audit of stroke care indicated the almost complete lack of stroke rehabilitation services. The audit showed that putative rehabilitation was only available to one-in-four patients or was delayed beyond the point at which it was most effective; continual care and long-term recovery programmes were haphazardly organised or did not exist; the quality of care was determined by chance, location and a haphazard combination of circumstances; and too many survivors were left with unavoidable and unduly prolonged disability. In 2010, the foundation showed that the direct cause of stroke to the economy amounts to €557 million per annum. Of this, as much as €440 million, almost 80%, is spent on nursing home accommodation. Less than €7 million is spent on community-based rehabilitation, which is barely enough to pay for one physiotherapy session per each of the 50,000 stroke survivors. At least one out of every six nursing home residents has had a stroke. The lack of rehabilitation services means that we are failing the survivors of stroke and as a result, people who with the right care and support could live independently require ongoing care. This is an issue that must be examined and addressed, but it cannot be addressed with the huge cuts we face in the health area.

Respite care is also a significant issue, particularly for young people in a respite home in Dublin where staff will have been cut from nine in 2010 to five by the end of February. This will leave five staff struggling to provide 24-hour respite care seven days a week to 27 families. They do not have the capacity to do that. These areas of the health service are being cut right across the board and the situation is not getting any better. The same is true for the home help service, which is already very thinly spread. The proposed cuts to this service of 4.5% will soon have the service on life support. This reduction of 4.5% will mean that 5,000 fewer people will receive home help than in 2008, a cut of 2 million hours from then.

I fail to see how we can make progress with these and other services. The ones I have mentioned are just the few that came to mind when I thought about my contribution to this debate. How can we change this when there is to be a cut of €2.5 billion in funding over three years and a reduction of staff of 8,700? This reduction in staff has affected primary and community-based care in particular. Home help hours will be cut by 500,000 in the plan. The IMO and midwives say that 10% of public health nurses will leave under the early retirement scheme. We face a chaotic situation. I was very distressed recently when people came to my office in Crumlin seeking my intervention to get them the surgery they need, a hip replacement or to find out why they are waiting so long for this care. It is a terrible state of affairs when people must come in to ask their Deputies to write to hospitals for them. It is terrible that people feel they must come to a Deputy because they are not getting the care they need from the hospitals.

I was also horrified recently to hear from people who came to me about the difficulties they are having with regard to their loved ones in hospitals waiting for places in nursing homes. They are having difficulty finding nursing home places and have been told by the hospitals that they will now be charged €1,000 a day for the hospital bed while they are waiting for nursing home care. That is wrong. It is horrific that people whose loved ones are already in a stressful situation waiting for nursing home care, and who through no fault of their own cannot get that care due to lack of space, face this. Then we see that beds in public nursing homes are to be reduced by 500. It is horrific to think of where we must start from and get to with our health service.

Talk of reform is just talk and our historically underfunded, unequal, two-tier, consultant dominated system has never been fit for purpose. It will be less fit for purpose after these cuts. The task of creating a properly funded public health system, with an emphasis on primary and community care and with free, equal access at all levels, can only be achieved when we have a Government which puts people before the profit of these consultants and many private hospitals.

The Minister's health plan will not deliver what is needed in the community, and there needs to be a complete change of tack on how we deliver our health service both in the community and in hospitals.

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