Mick Wallace (Wexford, Independent)

The general nature of the plan is difficult, given that so much money is being cut from it. It will be very difficult to provide the same services with fewer people. A strong unknown element is involved. It must have been difficult to plan for how many people were going to avail of the opportunity to avoid pension cuts. It appears that 3,500 people will leave the medical profession, a figure made up mostly of nurses and midwives. Front line staff seem to be getting a hammering more than others.

One of the priorities for 2012 is to deliver the maximum level of safe services possible. How will that be achieved in a maternity unit if there are not enough midwives to deal with the number of women coming in? Given that we have a rising population and there are more births every year but fewer midwives, I do not know how things will work out. I would not like to be a woman going into hospital not being sure how many midwives were available. I have never had such an opportunity.

I heard there will be a review of the situation when the HSE knows exactly how many people are leaving. It is clear that extra people have to be recruited to certain sections, especially midwifery. I do not see how the State can take a gamble on not having enough staff on the floor to deal with patients.

The Government's plan to treat patients at the lowest level of complexity and provide services at the lowest possible unit cost is fair enough. The policy of keeping more people in their homes is good and I agree with keeping people out of hospital if they do not need to be there. However, I am surprised that home care support hours were cut. The carer's allowance has come under threat through the welfare system. This is a backward step. The Government is right to start working towards more home care but I do not understand how it can cut home care services through changes introduced in the budget.

The Law Reform Commission made recommendations on Monday. It stated that HIQA should be given additional regulatory and inspection powers to ensure that appropriate legal standards are in place for undertakings providing professional home care. It seems the Health Act 2007 does not empower HIQA to set comparable standards as it does in other areas for the provision of health care in a home setting.

Most older people would rather stay at home if at all possible. If I were 80 years of age I would rather be in my home then go into an institution. Having said that, it would be inappropriate for the State not to be able to guarantee the quality of home care provided for older people. The general philosophy behind how we care for our older people needs improvement. Many other countries would put us to shame in terms of how they look after their older people.

In countries in the east and even as close as Italy older people are revered for having done so much throughout their lives and given so much. They are treasured, hugely respected and far better taken care of. We need to examine how we approach the care of the elderly and how we feel about them in society. We need to value them a lot more.

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