John O'Mahony (Mayo, Fine Gael)

I am glad to contribute to this debate on the health plan for 2012. I wish the Minister, Deputy Reilly, and the Ministers of State, Deputies Shortall and Lynch, well in the mammoth task they have been given, to reform a health service in the middle of the greatest economic recession this State has known. The Minister is trying to reform a system - some would call it a monster - where there are thousands of good and dedicated people working in front line and management who, on many occasions, are just as frustrated with the service they deliver as are politicians and the public at large.

Deputy McGrath referred to the number of reports and the medical card situation. All, or at least 99.9%, of the reports were produced by the Government of which he was part. I agree with him on the medical card situation. It is difficult because of the overwhelming number of applications from people who qualify for cards. It was not a good idea to centralise the system but that decision was also taken by the previous Government.

The Minister, therefore, has inherited a system which was set up at a time when there was plenty. When problems arose money was thrown at them without anybody examining what the problem really was. Layers of bureaucracy were added that complicated delivery of service rather than reorganising and improving it. In addition, in this year's plan the Minister must factor in the reduction of staff by some 3,700 at the end of this month. According to some stories I hear, the difficulty is that in many cases the wrong people are retiring. Perhaps I should say the people who are crucial to the ongoing delivery of the services are retiring. This is why the 2012 plan will be particularly difficult and challenging but it is the most important plan that has ever been delivered by a health service in this State.

It is only natural that most of the time it is the problems and bad stories that make the headlines. There are also many good stories and good things happening in the health service in recent weeks and months. In my constituency, Mayo, our general hospital has come in closer to budget than most hospitals throughout the country have, even as it improves services. For example, the number of patients on trolleys in 2006, at the height of the Celtic tiger era, was 2,285. The number on trolleys in 2011 was 599. That is still too many but it is a 400% improvement on what it was. This has come about because of greater flexibility, better use of resources, better organisation and changes in work practices. I compliment the chief executive officer in Mayo General Hospital, Mr. Frank Murphy, and the hospital manager, Mr. Charlie Meehan, who have improved services in many areas. An example is renal dialysis where all patients in County Mayo will get their treatment in the Mayo General Hospital rather than having to travel to Galway. A new MRI scanner has been added, with the help of massive local fund-raising. It is crucial, however, that good and efficient management is rewarded rather than punished. In other words, the line should not be taken that since such great savings were made last year the same can be done again next year.

For the overall delivery of an efficient health service the role of the district hospital is crucial. In County Mayo we have three: Swinford, where a magnificent new extension was officially opened in July by the Taoiseach; St. Joseph's Hospital, Ballina; and Belmullet District Hospital. In order to allow the acute hospitals to run efficiently it is vital that beds are maintained at the district hospitals so that patients can be transferred or stepped down from the acute hospital, in our case Mayo General Hospital. I compliment the Minister for the allocation of a special fund to allow front-line critical services to continue in a safe manner. This is happening in Swinford where there had been a threat to 12 beds. This has now been removed. It is crucial that the same should happen in St. Joseph's in Ballina which has similar difficulties.

I turn to the Minister's proposals to organise every acute hospital into a set of hospital groups so they can be managed efficiently and as co-ordinated units. The Minister stated that for far too long some hospitals have tended to work in isolation, not working with others or taking a team approach. Mayo General Hospital has always had a close relationship with University College Hospital Galway and it is critical that this relationship is allowed to continue in the new groupings. Ideally, any hospital network should provide a full range of services up to three-quarter level, with the exception of the super-regional or national specialties. Mayo General Hospital has been fortunate to have been part of such a network with UCHG as the regional centre. An increasing level of its services are provided on a outreach basis in Castlebar. Systems have been developed around that relationship, for example, in ICT and laboratory work. There are established and developing clinical relationships, most recently in the case of breast cancer services. It would be difficult and costly to dismantle such arrangements and provide equally good substitutes.

The linkage of Mayo, Sligo and Letterkenny hospitals would be a combination of relatively equal-sized hospitals, with roughly similar numbers of beds in general specialties. It is not clear that a network or regional arrangement has actually worked in that north-western region as the experience appears to be that where additional specialties were provided at Sligo General Hospital the tendency has been to seek to have similar services in Letterkenny. It is also unclear whether patients from mid to north Donegal have seen Sligo General as their hospital of choice.

The organisation of hospital services should take account of geographical relationships and the natural flow of populations. Apart from the border areas, County Mayo people travel to Galway as a regional centre when a service is not available locally. It is also interesting to note that regional bodies in tourism and other such areas tend to link counties Mayo and Galway. It is unclear why it would be in the interests of the Galway-based regional hospital services to lose County Mayo from its immediate catchment area. The presence of the university and related medical academy in Galway is also a strong reason why Mayo General Hospital should work closely with UCHG.

There are many other points I would like to address but I do not have the time to do so. I refer, for example, to the €35 million which has been allocated to mental health services. This is most welcome because more than any other service it has suffered the most in funding in recent years. I urge the proposed directorate for mental health services is appointed immediately to ensure the €35 million funding can be rolled out where it is most needed.

The difficulties with medical card applications was raised by other Deputies and it is one which I have raised many times too. I accept these are largely due to overwhelming demand and commend the Minister of State, Deputy Shortall, for her efforts in recent weeks to streamline the application process. Bottlenecks in systems such as those at the Passport Office previously were replicated in the medical card unit. It is important these are sorted out. People go through enough trauma with a medical condition without having to send their medical information to the unit three times in respect of an application.

The most fundamental job of the Department of Health is the reform of the health services. From the greatest challenges come the greatest opportunities. With people working together, a good health service can be delivered. This year will be crucial to that.

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