John Browne (Wexford, Fianna Fail) | Oireachtas source

I too welcome the opportunity to contribute to the debate on this motion regarding the Health Service Executive. I agree with Deputy Kelleher's comments in regard to the Government's decision to withdraw the six-hour debate tomorrow on the HSE service plan, which would have provided more Deputies on this side of the House, and on the Government side, with an opportunity, to have an input into the service plan for 2014.

It appears to me that the Minister and director general of the HSE are poles apart in that while the director general has outlined the amount required for the provision of services in 2014 the Minister is not willing to make available the necessary funding to provide all of the services required to meet the needs of people throughout the country over the next year. As stated earlier, this was clearly spelled out by the director general when he stated: "It will not be possible to meet fully all of the growing demands being place on the health services." While the HSE national plan has been published, we have not yet had sight of the plans for the regions. The executives of HSE south would normally by this stage have explained the cuts and reductions to services in 2014 to the people on the ground. It is strange that this has not yet happened. I encourage the Minister to ensure that the service plan for HSE south is made available as quickly as possible.

While many issues are, perhaps, dealt with in the small print they are not set out in the overall detail of the HSE service plan. The Minister will be aware that the provision of speech and language therapy for children is one of the great scandals of recent years, with children waiting two and three years for services. I recently received a letter from a constituent, a mother of a child who is two years and eight months old, cannot speak and has many other problems, for whom she recently applied to the HSE for an assessment of needs in terms of his development. The response from the HSE was that her child may not obtain services for a year or 18 months, which caused her great concern. In my constituency of Wexford, as I am sure is the case in every other constituency, there are delays of two and three years in respect of speech and language service provision. The letter from my constituent goes on to state that she was told by the HSE that if she has the child privately assessed by a psychologist, this assessment will not be accepted by HSE south. It is strange that a psychologist's report, paid for by a parent, is not acceptable to the HSE. I ask that the Minister make available funds for the provision of speech and language services for children throughout the country.

I wish to raise the issue of the ambulance service, which is creaking at present but not only in my constituency. The Minister will be aware that throughout the country we have had major problems with the ambulance service. We have a situation whereby there is not enough manpower and vehicles are not in the appropriate condition. There have been many cases where gardaí and ordinary people have taken people to hospitals because the ambulance service has been delayed or has taken so long to come to meet the needs of the patient. I gather €130 million will be spent on the ambulance service in this country in 2014. Scotland is a comparable country but £240 million will be spent in Scotland on ambulance services during 2014. The ambulance service needs a leg-up and extra resources but I do not see this anywhere in the HSE service plan. Perhaps when representatives from the HSE South come to explain their services there will be an increase in money, but I doubt it.

The discretionary medical card is one of the major ongoing issues within the system. People come to our clinics on a daily basis suffering from cancer and other serious illnesses. It is practically impossible to get a discretionary medical card nowadays. There has been a major change in the attitude of the Minister and the HSE in this area. The Minister for Health, Deputy Reilly, is a general practitioner. I have had situations where a GP has put on the relevant medical letter "end-of-life situation". Yet we must fight, argue and make representation after representation to get a medical card for such a person. That should not be the case. It is a shame and, as Deputy Kelleher has pointed out, nowhere in the HSE service plan are discretionary medical cards mentioned.

Mental health was touched on by Deputy Keaveney. We all bought into A Vision for Change. As the Minister is aware, the old St. Senan's Hospital in Enniscorthy closed down. The walls have come down and nice new buildings have been built, which we welcome. Many people were sent home to the community. However, in recent months many of the nurses and staff who were working in the community have been withdrawn into the residential care houses because of a lack of staff. This is a genuine area of concern. People were very good at providing outreach services in the community. Now, we find that the staff are being withdrawn and the people in the communities are left without visits from the community nurse. The scheme had been so successful.

A Vision for Change was one of the enlightened decisions taken by politicians in this House and there was buy-in from all sides. It has been implemented by this Government. However, there is a lack of funding in mental health services at present. This was one of the major planks of the programme for Government. I remind the Minister that he said he would ring-fence €35 million annually from within the health budget to develop community mental health teams and services as outlined in A Vision for Change. That money does not seem to be coming on-stream despite the fact that the Minister of State, Deputy Lynch, has said on several occasions that the money is ring-fenced for extra staffing. However, the extra staff are not being provided. Now we have a situation whereby the nurses who were working in the community are now being withdrawn to the residential areas.

There is an issue with accident and emergency departments. A new accident and emergency department is being built in Wexford General Hospital. I understand an extra ten staff will be required to open the new accident and emergency department, which is coming near fruition. Will the Minister indicate whether an extra allocation of money will be made available to provide the extra ten staff for Wexford hospital? Will we see what has happened in other parts of the country, that is, new buildings remaining closed for months or years? I call on the Minister to ensure that the essential extra funding is made available for the new building at Wexford hospital.

We have long waiting lists at accident and emergency departments. People are on trolleys. As Deputy Kelleher said, the numbers increasing on trolleys in recent weeks are alarming. They disappeared for a while but we now have over 400 people on trolleys. We have a significant increase in the numbers on trolleys in Wexford hospital. Waiting lists are soaring at the hospital, they have increased by 57% in a year. Certain areas of the HSE service plan have not been working in 2013 and certainly will not work in 2014 when one considers the dramatic reduction of funds to be provided by the HSE.

I emphasise to the Minister the importance of the fair deal scheme. The fair deal scheme worked reasonably well. However, now when I inquire about the scheme or make a new application, I am told to send in the application but that the officials do not know when I will get the money. This means a significant number of people are taking up hospital beds when they could be out in the community and in nursing homes under the scheme. It is essential that extra moneys are made available for the fair deal scheme. Nursing Homes Ireland has stated clearly that the service plan is projecting a reduction of 939 persons to be supported by the nursing home support or fair deal scheme in 2014. That is a substantial reduction. It is not a wise decision for the fair deal scheme not to continue as heretofore.

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