Séamus Healy (Tipperary South, Workers and Unemployed Action Group) | Oireachtas source

A number of key criteria must underpin the provision of a proper health care service for the people. A quality service must be delivered on the basis of medical need. We must have a service that is democratically accountable and controlled. The delivery of the service must be transparent. The service must be delivered in a fair manner devoid of political interference. There must be real and meaningful consultation with stakeholders and local communities. The Bill does not fulfil these criteria.

In fact, if it goes through as it is, we will lose the opportunity to reform the system and, in particular, a situation where there is no democratic accountability and no democratic control of the health service. As we all know, the HSE was established by Fianna Fáil to specifically avoid accountability - accountability to this House, stakeholders, local communities and those interested in the delivery of health services. What we got was a bureaucratic monolith which was operated from an ivory tower, with absolutely no contact with stakeholders and local communities, and intent on avoiding such contact and consultation.

The old health boards were certainly not perfect. However, from the point of view of democratic input, they were far ahead of the undemocratic HSE we have today. At least, elected public representatives were represented on them, as well as staff representatives and ministerial nominees. Meetings were held regularly and they were transparent, open and public, and could be accessed by both stakeholders and local communities. We also had local health committees at which local councillors in every county could make their views known to the health boards and ensure their voices and those of their communities were heard. We now have a situation where even parliamentary questions on health matters cannot be responded to in the House and are referred to the HSE, from which we receive no satisfaction. While we have this opportunity, we should ensure there is proper reform, democratic control and accountability, not just to the Minister, the House or stakeholders but also to local communities.

There is a further problem in that there is no meaningful consultation or negotiations between the HSE, stakeholders and local communities in furthering any of its initiatives or plans. I have been through a number of such plans, including the so-called reconfiguration of hospital services in the south east and the closure of the acute psychiatric unit at St. Michael's Hospital in Clonmel. The fact is that the HSE has absolutely no interest in consultation or negotiations. It decides what it wants to do and drives a coach and four through everybody - stakeholders, staff and local communities. It does not want to listen and has no intention of listening to stakeholders. That simply has to change. We should even go so far as to ensure there will be a legal obligation on the health service to consult stakeholders, local communities and staff.

In regard to the situation on the ground, staffing levels have been decimated by cuts in numbers and funding; there is a moratorium on the employment of staff; some 2,500 additional staff reductions are proposed in the next year to 18 months; and there is the proposed reduction in the budget by a further €2 billion in the next two years. All of this puts huge pressure on staff who are already working above and beyond the call of duty and each of whom is now doing the work of two or three individuals. In these circumstances, there is no doubt that, despite their very best efforts, things will go wrong. I have huge sympathy for staff who are unfairly placed in this position. Last weekend, for example, in my local hospital, South Tipperary General Hospital, there were 26 patients on trolleys in the accident and emergency department, side rooms of the accident and emergency department and the corridors of the hospital. Six of the patients were left beside the vending machines in the atrium of the hospital. As I said, this was despite the best efforts of staff who were working above and beyond the call of duty. It is a disgrace. The reductions in staff numbers and the moratorium have to be reversed because they are totally unacceptable. The service the public is getting is not and cannot be described as a quality service while these cuts are taking place.

It is a pity the Minister has left the Chamber. I call on him specifically to fulfil the commitment he made to the committee of the Community Hospital of the Assumption in Thurles which met him in November 2011 and again in April 2012. He gave a commitment that he would reopen the 22 beds which had been closed in the hospital. His Fine Gael colleague from north Tipperary gave a similar commitment just before Christmas. I ask the Minister to immediately reopen these beds and ensure provision is made for this in the HSE West service plan.

I refer to the question of medical cards. As I have said in the House previously, the centralisation of the medical card system was a complete shambles and remains so. In particular, the issuing of medical cards to applicants on medical grounds is at an unacceptable level. By way of parliamentary question, I brought to the attention of the Minister a situation where an applicant had been awaiting a medical decision since last September. It is not unusual to find such cases every day. It is taking too much time for medical applications to be dealt with.

I concur with Deputy Billy Kelleher who indicated, correctly, that, in respect of medical applications in cases involving persons suffering from a very serious illness such as cancer, whereas medical cards had been granted automatically in the past, this was no longer the case. Moreover, the most insensitive of letters are being sent to applicants and their representatives. This must change. The Minister must intervene to ensure this happens.

We must take the opportunity in this Bill to ensure we will have a democratically accountable and controlled health service which will operates through consultation and agreement.

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