Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I move:

That Dáil Éireann agrees that the 2014 National Service Plan of the Health Service Executive is inadequate to meet fully all of the growing demands being placed on the health services and that the lack of sufficient resources will not be in the best interests of patient care and this is already evident in accident and emergency departments.

I wish to share time with Deputies Keaveney, Browne and Cowen.

The reason I put down this motion is quite clear. The last three Estimates that have been presented for the HSE service plan have been inadequate in providing funding to maintain the services in a manner that is safe for patients and that allows front-line services to provide the care that they want to give to patients not just in accident and emergency departments, but also in ambulance services, acute hospital setting and care for the elderly. Looking through the HSE service plan, it is quite evident that it does not have sufficient resources to ensure that we can deliver services to the people who need them. Time and again, we have listened to eminent professionals - senior clinicians, front-line staff - saying that they simply cannot maintain safe services in emergency departments in our broader hospital system throughout this country. That is why we decided to put down this motion.

I would like to put on the record my distaste at the decision by the Government not to allow for a full debate in the plenary session of this Parliament on the HSE service plan. That was signalled by the Government last week. This was in Government time. Fianna Fáil decided to table a Private Members' motion, and then the Government decided that it would pull the six hour debate on the HSE service plan tomorrow. That will deny many Members in this Chamber the chance to contribute to the debate on the HSE service plan and the lack of services that will flow from it. The Government has decided, in an arrogant way, to remove any form of debate from this Chamber on the HSE service plan. The Minister knows as well as I do that Private Members' time only allows for three hours of debate this evening and tomorrow evening. Due to Standing Orders, a large number of Deputies will not be able to make a contribution. The HSE service plan deserves scrutiny because it outlines the blueprint for spending in the year ahead. We already know in January that services will be cut back in 2014 and as we get to the end of 2014, as happened in 2012 and 2013, we will see a cut in services that are primarily targeted at the most vulnerable in our society, so that we can live within means.

The Minister has said that he has his spending indicators on a monthly basis right through the year, but since he has taken charge, every year there is panic by August, cuts in September and pain in October for many people whose services have been withdrawn. This is why we have put down the motion tonight. More importantly, the Government has decided to withdraw six hours of debate tomorrow which would have allowed Deputies on all sides to make a meaningful contribution, to go through the HSE service plan for 2014 and to highlight their concerns and the deficiencies in it. The deficiencies are quite stark, and it is not just me, the Fianna Fáil spokesperson on health, saying this. The director general is also making the same point. He said that it would not be possible to meet fully all of the growing demands being placed on the health services. He also said that, in particular, some service priorities and demographic pressures may not be met. We already know that this is a sanitised version of what the director general wanted to say, but when the HSE service plan was submitted to the Cabinet by the Minister, his colleagues jumped up and down and said that they had to politically sanitise the director general's statement. The director general was saying quite emphatically that the funds being presented for the Estimate in October were not sufficient in any way and it would not be possible to provide a safe system of health in this country. This is why we believed it was appropriate to have a debate in Private Members' time, but also for all Deputies to be able to contribute to the debate on the HSE service plan in this Chamber tomorrow for six hours. It was a shameful decision by the Government, the Minister or the Chief Whip, or all of them.

For a number of years, expenditure and savings in discretionary medical cards were itemised in the HSE service plan. However, there is no reference in this year's service plan to discretionary medical cards. When I put down a Dáil question recently to the Minister of State, Deputy White, he was clear in stating that there is no such entity as a discretionary medical card. I cannot understand how there can be no such entity as a discretionary medical card, because we have been debating the issue for some time in this Chamber, and the Minister has been contradicting the fact that there has been a targeted attempt at removing and reducing the number of discretionary medical cards in the system. Now we find that they do not exist at all and there is no such entity, but there is such an entity. Over 90,000 people had discretionary medical cards at one stage, and I can assure the Minister they are a very important entity to those people who rely on them to deal with their illnesses and disabilities.

I know what is happening. The Government wishes to erase the word "discretionary" from its accounting practice. It wants to be able to reduce the number of discretionary medical cards awarded every year. Great play has been made by the Minister about the fact that many of the people who had discretionary medical cards are now moving towards being awarded a full medical card under the Health Act 1970. That may be the case, but many more people should be qualifying for discretionary medical cards because of the precedents that were set over many years. These are precedents that were based on basic humanity and decency, and on assisting people through a very difficult time in their individual lives or in their family lives, dealing with financial issues and also sickness, disease, disability and so on. Erasing that word shows that there has been a fundamental change in policy regarding discretionary medical cards. People will be let sink or swim. If they qualify under the financial guidelines of the 1970 Act, they will get a medical card, but if they do not, then the other aspects of their circumstances will not be taken into account. I believe there is a targeted approach, and the fact that it is not mentioned in the HSE service plan and the fact that the Minister of State claimed that there is no such entity as a discretionary medical card, is an indication to me that there has been a major change in policy on this issue.

Whether we count them in the accident and emergency department, or in the corridor outside the emergency department, or in the ward where it is not in a designated area, there were 410 people on trolleys today in our hospitals. I remember in the past when the Minister would be apoplectic with rage and indignation on this side of the House if we had those figures. He said it was a central tenet of his stated policy to eradicate waiting times in emergency departments and to reduce dependency on trolleys in emergency departments for excessive hours.

That was the Minister's stated policy.

Most criticisms I level at the Minister are reasonable and I heartily endorse all measures he introduces with which I agree. In adjudicating his efforts to address the problem of people waiting on trolleys, however, one need only examine the figures for January. More important, recent data show a 2% increase in the number of people on trolleys in 2013 compared to 2012. The Minister's policies have led to a reversal in this area.

The special delivery unit established under Dr. Martin Connor created some impetus and resulted in a brief respite in terms of the numbers on trolleys. However, recent developments indicate that the unit is quickly losing momentum for a number of reasons. The embargo on recruitment to front-line services continues and staff continue to operate under serious pressure. Furthermore, the HSE decision to reduce the number of people who can access long-term residential care and respite care means patients are being kept in hospitals for longer than is necessary. Having repeatedly stated that a person should only be in hospital if he or she needs hospital care, the Minister should know that this is the wrong approach. Many of those who are in hospital should be at home or in step-down facilities. The absence of a determined effort to increase capacity in after care indicates that the Minister is not prioritising step-down facilities, home care packages, home help supports and so forth and his policies in these areas are not having the desired effect.

Senior clinicians, consultants in emergency medicine and representatives of the Irish Emergency Medicine Trainees Association have pointed out that patient safety is being jeopardised daily in our emergency departments. The Minister appears to dismiss these concerns as if clinicians are making them up. I have met and listened to the concerns of nurses, doctors, non-consultant hospital doctors, janitors and members of every other profession working to make our emergency departments function under extremely difficult circumstances. I suggest that rather than dismissing their concerns, the Minister should listen to those who assist the people who are admitted daily to our accident and emergency departments. They will tell him that there are major problems with the system. If he chooses not to believe them, he need only examine the Irish Medical Organisation's trolley count figures for January, which show we have a major problem in our emergency departments. The provision of care in emergency units is a key aspect of the Minister's policy on the Health Service Executive.

Having read through the HSE service plan, it is clear we must wait for the detail of the regional plans because the meat will be in the provision of services at local level where the impact of cuts will be felt in services for the disabled, elderly and others.

When I raised the issue of general practitioners with the Minister previously, he stated that global comparisons show that Irish GPs are well paid. He also denied there was a crisis in primary care and general medical practice. I beg to differ; there is a major problem in primary care. If, as the Minister claims, general practice is a lucrative area, why do many general practitioners view boarding an aeroplane as a career option? The answer is that they have been left with no choice. I am not advocating directly for general practitioners - the issue at stake is primary care, another central plank of the Minister's mission statement both as an Opposition spokesperson and a Government Minister. He has failed in the past three years to pursue a meaningful policy that will have a significant impact on the provision and expansion of primary care. He speaks, for example, about the roll-out of primary care centres. This is tinkering at the edges because the bottom line is that general practices, one of the critical components of ensuring the delivery of primary care, are under serious stress. If the Minister does not wish to listen to the concerns of general practitioners, he should listen to their patients who will soon find it more difficult to see their general practitioner on a same day basis and may have to wait for one or two days for an appointment.

While the motion is welcome, it should be taken in conjunction with the six hour debate promised by the Government for tomorrow. It is shameful that the debate will not take place because the Government could not be bothered to listen to the views not only of the Opposition but also of Deputies on the Government back benches.

See this speech in context