John McGuinness (Carlow-Kilkenny, Fianna Fail)

That does not mean a Government cannot and should not take a deliberate decision on it. It is about good governance and respect for taxpayers' money.

If one wants an example of a total collapse of how a system is administered, one only need look at how the medical card system is administered at national level. Deputy O'Mahony claimed the last Government was responsible for this. This and the last Government should not be directly blamed for the administrative errors that occur in the medical card system. It lies with those who administer it. It should be part of the standard of good practice that one would apply in any system, yet the HSE has failed in ensuring those who need medical cards get them in a timely fashion.

We can all give examples of the difficulties experienced. I know of one applicant who was approved for a medical card last week which was followed days later with a GP card. Both of them are in date but the individual does not know to which one he is entitled. I know of other cases where medical card applications have been lost or the applicant has been asked to apply on three different occasions for the same card. It is not correct that such a system should be allowed continue. The administrative errors in the system need to be corrected and the Minister must ensure some humanity and compassion in its operation.

It is unfortunate that whistleblowers who speak out to ensure improvements in the system for service users often if not always become the victims themselves, broken and out of a job. Recently in the House, I raised the matter of an incident in Kilkenny with the Minister of State, Deputy Shortall, in which a psychiatric patient was locked out of a facility and was forced to sleep out in the rain. The nurse who complained about this treatment now no longer works in the facility. The first investigation into the incident was in-house and all subsequent investigations continued to uphold its findings. Instead, someone from outside the HSE should have investigated the incident to ensure it never happens again and that the whistleblower's rights were protected and he or she did not suffer any consequences for his or her actions.

Senior nurses have come forward to tell me their fears that the psychiatric and community services in which they work are going to collapse and will not be able to continue beyond a particular time and date. They have made their views known within the service and have asked for the necessary changes to be made in the interest of patients. Those changes have not been implemented, however, and one of the nurses in question is now on sick leave. That is a terrible indictment of the organisation. I urge the Minister of State, Deputy Shortall, to respond to those who want to improve the services for the sake of patients.

I ask that a review be carried out of expenditure on home help packages. By supporting people in their own homes, we can prevent them from occupying hospital beds that might be put to other uses. That is worth doing.

We must review Graignamanagh in County Kilkenny in terms of providing a primary care unit for an urban centre with a large population and rural hinterland.

Anyone who looks for services in Graiguecullen in County Laois, which borders County Carlow, is told to go to a different county. I have repeatedly urged the local administrators to put in place a package to facilitate those who need services at that location. They should not be penalised just because they fall between two stools. I appeal to the Minister of State to work with the local HSE office or general administration to ensure services are improved and extended in that area, as in most other parts of counties Carlow and Kilkenny.

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