John Paul Phelan (Carlow-Kilkenny, Fine Gael)

I am glad of the opportunity to discuss health funding. It is the first health debate in which I have participated since being elected to this House. I want to make a couple of points to the three Ministers in the Department of Health. In our current economic crisis, most publicity is placed on the difficulties facing Ministers in the Department of Finance. The job of Ministers in the Department of Health, however, is an onerous one and it is all the more difficult given reductions in expenditure across the board. I wish them well in what is a very difficult task.

I wish to comment specifically on a couple of areas concerning the HSE's national service plan for 2012. I echo what was said earlier by Deputy Paul Connaughton who welcomed the extra funding for mental health services. The inclusion of additional funding for the mental health sector is highly appropriate given the economic crossroads we are at and the commitments given by Fine Gael and the Labour Party in opposition. Increased funding for this sector has been found at a time of great difficulty to ensure services can be improved across the country. There has been a change in emphasis in the past ten years in how mental health services are delivered. Thankfully, more services are delivered outside acute hospital facilities nowadays. Extra funding will help in this regard.

I agree with Deputy Tom Fleming's point on increased funding for autism and primary care centres across the country. Many people present at acute hospital facilities who could be treated closer to where they live. They need not become involved in the acute hospital service. I welcome the additional funding for primary care.

The service plan provides for a reduction in cancer funding. In my region and others, there has been centralisation of services in the regional hospital, which will result in some savings. Hopefully the impact on the delivery of service will be positive. In response to the debate, perhaps the Minister of State can refer to colorectal screening, an issue that has been raised with me. The HSE, the Department, the Minister and the Minister of State are anxious that this can be rolled out in 2012. Are there concrete proposals for when it will be rolled out?

Care of the elderly is close to my heart. We saw harrowing scenes in Laois where proposed closures of public beds for elderly people led to protests before Christmas. There is the prospect of a significant reduction in public geriatric beds. It is not something I support. I refer to the policy pursued by the previous Government in promoting the private provision of nursing home beds. It is without doubt that the provision of beds is necessary in dealing with the number of elderly people who require residential care. I urge the Department and the HSE to do everything in their power not to close 555 public beds in the coming 12 months. When 75% of the health funding is spent on pay and pensions, it is unjustifiable that savings from the other 25% lead to elderly people and their families becoming involved in protests. I have regard for the people involved in my local hospital, St. Columba's Hospital, Thomastown, County Kilkenny. This fantastic public facility provides a home for close to 100 people. There is no private facility in the region that can match it. We need to ensure these public facilities are retained. Whatever savings are made in the overall health budget, I ask that we ensure elderly people are kept in these facilities. For many people, these facilities are their homes rather than just a hospital. They live there and build bonds of friendship and affection with fellow patients and staff.

I welcome the initial steps taken by the Minister and Minister of State in the overhaul of the HSE. We often speak of the economic difficulties passed by the previous Government to the current Government. One of the unmitigated disasters passed by Fianna Fáil and its friends of various colours in government over the past 15 years is the HSE. When first proposed, the HSE was in a very different form to the form it has taken in the years of its existence. We have a bureaucracy that is not delivering a proper service across the country.

In the response to this debate, the Minister of State can provide information on how the HSE will be further overhauled in the coming months. As a Member of the Seanad, I remember discussing legislation and hearing that savings would be made because the HSE would deliver a unified service across the 26 counties. Instead, we saw the creation of extra levels of management and bureaucracy and decisions being taken out of the hands of local decision-makers and centralised, with the result of mass frustration. This applied to public representatives like me and the general public but also those involved in the service. People in the south-east region used to make decisions for the south east but they now have their hands tied behind their backs because of an extra series of management levels created above them. They cannot look after the service in the local area.

Over the years, there was a problem with the delivery of funding for health services in the south east. The region consistently lagged behind the rest of the country in capital expenditure. There have been welcome announcements about the provision of accident and emergency facilities in Wexford General Hospital and St. Luke's Hospital in Kilkenny but the south east receives less capital funding per capita and substantially lower current funding per patient treated. That is unacceptable and is not part of what we were told the HSE would be. We were told there would be the same level of care and the same level of funding across regions of the country. This has not been delivered.

I am not sure funding for rural GPs comes under the HSE national service plan. I welcome primary care centres but GPs in rural areas operate alone or in practices with one other GP. There are proposals to reduce substantially the funding for GPs and this will have a serious impact on the delivery of vital health care services in rural areas. Perhaps the Minister or Minister of State can comment on this in response to the debate.

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