John Browne (Wexford, Fianna Fail)

I am pleased to have an opportunity to speak on the motion tabled by the Fianna Fáil spokesperson on health, Deputy Billy Kelleher, and to express my concern about the health services.

Before the last general election, Deputy Reilly had all the answers. He travelled the country, visited every county and constituency and made every possible promise that could be made. In my own county of Wexford, he promised many changes to the health services, improvements to Wexford hospital and better mental health services. He undertook to deal with just about every issue on the cards at the time. He was the expert in the health service area and had all the answers and solutions.

The Minister's promises have not been fulfilled. The health service is on course to run a deficit of €500 million this year. This is due to the Minister's failure to prepare a proper budget. He presented a false Estimate last December, failed to implement necessary legislation on drug pricing and bed designation and his other targets were never achievable. He got rid of the HSE board, to great fanfare, and we now do not know who is running the health service. When he got rid of the HSE board I understood the Minister would take over complete control of the HSE. That is why I was amazed when, last week, he made an attack on the HSE and told it to get its house in order, even though a significant number of directors of the HSE are officials of his own Department and the Department of Children and Youth Affairs. Do these officials not follow the same philosophy and ideals as their Ministers? That cannot be the case, as the Minister is criticising them and asking them to get their house in order.

Savings of €124 million in drug payments were envisaged through a new pricing agreement with the industry but pharmacists, doctors and consultants did not think the target was achievable. The Minister spoke about replacing expensive drugs with generic medicine but I recently read that generic drugs are almost the same price as their branded equivalents. Perhaps he will clarify how he plans to save €124 million with cheaper drugs because it does not seem to be happening. He also proposed to increase private income by €144 million, of which €75 million would come from private patients in public beds. As Deputy Kelleher has pointed out, however, the CEO of the HSE, Mr. Cathal Magee, has indicated that it will not be possible to deliver on this target. Clearly the Minister was pulling figures out of the sky. Agency costs were to be reduced by 50% but, again, Mr. Magee has stated that the target is completely unrealistic. When the Minister and his departmental officials presented their budget last December they put forward figures that nobody in the health service believed could be achieved.

People are waiting as long as five years to see a consultant in Waterford and Wexford general hospitals. The orthodontic service is a shambles and people are waiting years just to be assessed for hip operations, let alone be admitted to Ardkeen or Kilcreene. There are also significant waiting lists for eye operations.

The medical card system is a disaster and Deputies spend a large proportion of their time trying to secure people's rights to cards. People who are below the income threshold or who previously held cards are now finding it impossible to get medical cards. In fairness to the staff in the medical cards unit, they are very helpful and respond promptly to our inquiries. Whether because of a lack of staff or delaying tactics on the part of the Minister, however, medical cards are taking too long to process. I suspect the delaying tactics come from a desire to save money.

I recognise that mental health services are dear to the heart the Minister of State at the Department of Health, Deputy Kathleen Lynch, and she has been helpful to my own county in providing funding for services. I ask her whether the €35 million budgeted for mental health services continues to be ring-fenced for this area. I have been informed by sources within the HSE that it has been suggested in recent days that part of the €35 million investment in mental health services should be diverted to offset overruns in other areas. I ask her to confirm that the 414 staff promised for mental health services will be recruited at the earliest opportunity. From what I have been hearing about mental health services in my region, I am concerned that money may be siphoned off for other parts of the health service. That would be disastrous because, as the Minister of State will be aware, the service has changed significantly in recent years and people have moved with the reforms recommended at national level. It is important that the process of change is maintained. The closure of St. Senan's hospital in Enniscorthy became an emotive issue but the ancillary services that have since been put in place are excellent. We need additional services for the south-east region and, I am sure, the rest of the country. Mental health services in Waterford need to be upgraded because they are now serving the entire south-east region. I am sure the Minister of State will fight to ensure the money is ring-fenced.

The Minister has spoken about the importance of the fair deal scheme for the elderly in our communities. I recently received a letter from a nursing home in Wexford which has not admitted a single patient through the fair deal scheme. It now has seven empty beds but it has been informed by hospital management in Wexford that the funds required to release patients to nursing home care are not available, even though a considerable number have been approved for funding. This is another broken promise from the Minister. The fair deal scheme is not working in the south east because the funds have not been made available for it. The old subvention system worked reasonably well but the fair deal scheme was to be the answer to all the problems in terms of caring for the elderly. We must continue to fight for the rights of elderly people because the lack of funding has been a bone of contention in the south east for the past two years. Between eight and ten patients in Wexford hospital could be transferred to nursing homes with vacant beds rather than holding up beds through no fault of their own. Gorey hospital had eight long stay beds for older people but they are now being transferred to St. John's hospital in Enniscorthy. St. John's is a new hospital with excellent facilities but it is already overcrowded and the transfer of patients from Gorey means there will be no room for fair deal patients.

There are many difficulties in the health service at present and it is important that the Minister comes clean on the issues that have arisen. The estimates he gave in the budget are clearly incorrect and will never meet the needs of the health service. He needs to fully explain the reason his budget was underfunded and what he is going to do to provide additional funding. The Minister for Public Expenditure and Reform is calling for cuts in the running costs of the health service but this can only mean the closure of wards and reductions of services. In this day and age, that is not good enough. I ask the Minister to come clean and deal with the issues as quickly as possible.

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