John Browne (Wexford, Fianna Fail) | Oireachtas source

I welcome the opportunity to speak on the Bill before the House. One could say it is another health Bill and another speech from the Minister on what he intends to do but after three years he has done nothing to improve the health services to the general public. We still have overcrowding, patients on trolleys, a lack of nursing staff and a reduction in the number of medical cards available to people, yet the Minister would ask Members on all sides of the House to support this Bill.

We believe in a strong public health system but this Bill, which is part of a process to abolish the HSE, undermines the public health service. It effectively transfers the HSE budget back to the Minister. If we had a capable Minister we would not be concerned about that but to transfer the budget to the Minister, Deputy Reilly, is putting politics back into the health services.

The legislation provides for the funding of the HSE and its successor through the Vote of the Minister for Health from 1 January 2015. The HSE Vote will be abolished and a new financial governance structure will be introduced. The Minister has not yet explained or outlined that new governance structure to the House. It follows on from the enactment of the Health Service Executive (Governance) Bill in July under which the HSE board was abolished and replaced by a directorate. Judging by the budget presented to the House in December, the directorate did not bring about any great improvements on the funding or the way the quality of care was to be administered to the public.

The Government says its legislation will enable new funding arrangements to be put in place as part of the wider restructuring of the health service and the ultimate implementation of universal health insurance. For a number of years before he came into office, the Minister talked about the Dutch model. He is not talking about any model now because the Minister for Finance and the Minister for Public Expenditure and Reform, Deputy Howlin, have rubbished the Minister's intention to introduce universal health insurance. We are still waiting on the White Paper, and we are still waiting to know what it will cost per patient. The Department of Public Expenditure and Reform signalled recently that it could be an exorbitant charge of up to €1,600 or €1,700 per annum, which would be outside the remit of the ordinary person in this country. The Minister should bring forward the White Paper as quickly as possible. He needs to explain what he intends to do regarding universal health insurance and whether it is dead in the water, so to speak, because that seems to be the position in terms of what is coming out of the Department of Finance and the office of the Minister for Public Expenditure and Reform, Deputy Howlin, in recent weeks.

The Minister has done a good deal of talking about the improvements in the health services but in my county we still have people on trolleys, a lack of nursing staff, young people waiting between 18 months and three years for speech therapy, overcrowding, a reduction in the grants available for the elderly, a reduction in the amount of money available for respite grants, and serious reductions in other areas. Recently, the Minister implemented the hospital groupings designed to deliver improved outcomes for patients. Under the old HSE system, Wexford and the south east were amalgamated under Carlow-Kilkenny and Wexford-Waterford, and Cork was the main hospital service in the south east. Wexford has been transferred now to what is known as Dublin East in which there is a large number of hospitals including St. Vincent's University Hospital, the Midland Regional Hospital, St. Luke's General Hospital in Kilkenny, our own hospital in Wexford, St. Michael's Hospital in Dún Laoghaire, and Cappagh hospital. A number of other hospitals have been mentioned that will now cater for Dublin East. I do not know whether that will improve the quality of services because I am aware that on a daily basis people were finding it very difficult to get into hospitals such as St. Vincent's before we ever came under this new grouping. There will, therefore, be serious problems in the ability of Dublin hospitals to provide for a large area of the population in the south east. Wexford has a population of 140,000 and when we consider that Carlow, Kilkenny and other areas will feed into the hospitals in Dublin, it will put major pressure on the hospitals in Dublin to provide services in an adequate way.

The Minister needs to spell out what the new legislation will mean in terms of money because the HSE certainly spelled out very clearly in its 2014 service plan that there would not be adequate money to meet the needs of the public.

What one might call the south-east service plan was presented to local Oireachtas Members last Monday week at Wexford hospital, where we were told the hospital's budget was to be reduced by €3 million for 2014. This hospital got kudos in 2013 for being one of the most efficient hospitals in the country but, as a result, we now find its budget has been reduced. One would expect that if a hospital was in the top ten of efficient hospitals in the country, it would be rewarded, not penalised. Unfortunately, however, that is what has happened. We find ourselves €3 million down for 2014 and we are also told there will be no increase in funding for home help during 2014, despite the fact that the Minister points out regularly that we are an ageing nation and that there will be huge demand for services for older people. Extra home help would mean fewer people staying in hospital for longer and would enable them to return to live in their own homes. That has not happened and it certainly will not happen given what the Minister is suggesting for the future.

The old HSE, which the Minister is now abolishing under this legislation, is only eight years old. Its thousands of workers delivered a very good care service in every community and provided a wide range of facilities. It was only really beginning to bed in under the old system but the Minister has now decided we are going to have a new system, one he will be in control of. This is bringing in politics. We see regulators being appointed in every other area to take powers and decision making away from Ministers, but here, under this legislation, the Minister is taking all powers back to himself. He is going to have a major input into the political running of the health service while he is in power, whether that is one year, two years or longer. The Minister is becoming the godfather of the health service. He is going to make all of the decisions. He is going to call in the HSE, as he did in December last year, and say that, politically, this or that is not a good idea and that he is going to make sure the HSE changes it.

In the area of responsibility of the Minister of State, Deputy Kathleen Lynch, I would like to remind her that, in Wexford, St. Senan's psychiatric hospital was closed and the people bought into A Vision for Change. We got some new buildings on the grounds of St. John's hospital and we were promised further new buildings and services for people suffering from mental health difficulties. I remind the Minister of State that she promised a significant number of extra staff, particularly for Wexford and the south-east region, because of the way the staff of St. Senan's and the Waterford psychiatric hospital implemented A Vision for Change. I would ask the Minister of State to ensure the extra nurses and staff who were promised are made available as quickly as possible. I know some of them have come on stream, which we appreciate, but we need further nursing facilities in that area.

I was told recently that when the HSE visited Wexford to announce the service plan for 2014, it denied what is happening, namely, staff who had been in the field providing services on an outreach basis have been brought back into the mental health houses because of lack of staff in that area. That is a pity because the nursing staff out in the field have been providing an excellent service for those who suffer from mental health problems. They do not need to be in institutions. They are living at home and to have the nurse call is a very important part of keeping patients at home in a family and community environment. I ask the Minister of State to ensure there will be adequate nursing staff out in the field to provide these services.

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