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

I welcome the broad thrust of the first two sections of the Health (Miscellaneous Provisions) Bill 2014. The Government, however, has taken the interpretation of “miscellaneous” to a whole new level in section 3 which covers charges for people who depend on provision of accommodation by the HSE or agents on its behalf. Fianna Fáil has no difficulty in supporting the first two sections but section 3 leaves much to be desired because of the lack of consultation and discussion with the various stakeholders involved.

The Department of Health stated this is not a revenue-raising measure. The Department, however, also told me last year that it would not have a budget deficit of €500 million. I must advocate on behalf of people who have the view that section 3 will put charges on a statutory footing that could be increased at a later stage. The broader issue of this should have been discussed with the Disability Federation of Ireland and other stakeholders who have concerns about these measures. While the measure contained in section 3 tightens up a lacuna in section 19 of the Health (Amendment) Act 2013, it should have been put out for discussion among the stakeholders involved. Not doing so is regrettable. When we talk about giving people with disabilities a voice in society, the very least we should do is listen to them when such a measure that directly impacts on them is brought before the House. Section 3 does impact on people with disabilities.

The Minister stated the Bill’s main objective is “to protect the public by promoting high standards of professional conduct and professional education, training and competence among registrants of the designated professions”. We welcome this streamlining and the advances being made in the regulation of professional medical bodies, as well as them being open to the need for the public to have full confidence in such regulation. There is also the need to ensure continual training and education in these professions, as well as sanction in the event of codes of conduct being breached.

For a long time, some of our professions may seem to have had a vaulted position in society and been considered above the law. Critically, as people take more ownership of their health needs, the quid pro quois that the medical professions must be obligated to respond in ensuring adequate safeguards are in place to ensure the appropriate conduct of their members. This also applies to education and continual learning because of the advances taking place in medicine in general.

As we are dealing with miscellaneous provisions in this Bill, I want to raise another broader issue, one to which we have referred on several occasions as did the former Minister for Health, of medical professionals who have been declared bankrupt such as pharmacists, for example. A commitment had been given that this issue would be addressed. I cannot understand why a pharmacist, if deemed bankrupt, cannot practise. I can understand the pharmacist being debarred from the business aspect but not from practising. Discussions were meant to have taken place to address this particular issue in the short term. Will the Minister inform me how the Department is dealing with this matter? The professionals involved are highly qualified and are meant to be used more in the provision of community-based medical care. This is an area that needs to be examined and the former Minister for Health said he was of like mind with others who raised this issue.

This Bill highlights the complexity of our health services and the number of health care professionals delivering care in our communities. This leads to challenges, particularly for administration managers and policymakers. As we see health care evolve and become more complex in many ways, equally we need to ensure there are simple and transparent ways for people to bring about complaints and not to be afraid to do so. Organisations overseeing the medical professions must also not be afraid to be seen to acting on complaints. Most people who have a concern or complaint about a medical professional will want it ventilated and investigated. For many years, many health professions swept complaints under the carpet which has led us down some unfortunate pathways in some incidents. I hope the norm will be the investigation of people’s complaints. This will enhance the integrity of health professionals as they will stand up to scrutiny and adjudication by their peers. This will ensure the public has full confidence in all health care professions.

Returning to section 3, the Bill provides that statutory contributions are payable by recipients of residential support services who, while maintained, are not directly accommodated by or on behalf of the HSE. Being maintained by the HSE means the cost of food, utility bills and other household essentials are met by the executive or its agents. However, the Department has no estimates available of the numbers likely to be affected by this measure. I find that a little strange. The Minister claims no extra costs or no extra charges will be incurred but it will still affect people involved as this provision will be placed on a statutory footing when this legislation passes. It would be nice to know how many people could be affected. The people most likely to be impacted are older people and those with physical, mental or intellectual disabilities or care needs who are living in accommodation provided by housing authorities or local authorities and who receive residential support services from the HSE or its agents.

That is a critically important point because moving services into the community will become more prevalent in future. I have genuine concerns that increased charges will arise. In some nursing homes people did not receive the full range of treatments they required such as physiotherapy and other supports. The Department of Health, the HSE, HIQA and others must monitor the situation to ensure people receive their entitlements and the necessary supports to address their health needs. In some cases there is no clear oversight or lines of obligation for the provision of ancillary care services.

I recently spoke to a person in a nursing home who informed me that consultant geriatricians seldom visit nursing homes. We still have a long way to go to develop proper community services where the care professionals go into the community and meet their patients in their home as opposed to the reverse always being the case, which requires people to traipse in and out of hospitals continually. I accept such an approach requires resources but it would also free up resources if people did not have to visit hospitals continually. We should change the traffic flow and get health care professionals into communities. That should be easily done in the context of nursing home care as patients are in a defined place. I heard recently that it is very difficult to get a GP to visit a nursing home out of hours. I accept that is a challenge but we must put a strong emphasis on addressing the situation as such cases turn into emergencies requiring an ambulance and a visit to an accident and emergency department. That is not good for the individual or for the system as it ties up scarce resources in an already challenging environment. That is an area about which I have concerns.

People could be discouraged from opting for care in the community rather than in a residential setting. The financial contribution required could discourage some people from moving from a residential setting to a community setting. The Disability Federation of Ireland is concerned that the situation could adversely impact on those accessing respite care services for a period, which would place an extra strain on carers. It is estimated that family carers provide vital, unpaid support to people with disabilities in their homes every day, thus saving the Exchequer considerable sums of money. Periods of rest and time to oneself can be rare occurrences for family carers but it is essential for many family carers to maintain their health and well-being, therefore enabling them to continue to provide care to a loved one at home. The amounts that could be charged could push people with disabilities further into deprivation or back into institutions, as they would no longer be able to afford to live or socialise in the community. The view was expressed to me by disability advocacy groups. It would have been preferable to have allowed time in advance of the Bill coming to the Dáil for discussion between stakeholders and the relevant sections in the Department, the HSE and others on their concerns about the impact of the proposed changes. Their concerns could well have been alleviated or in some way addressed in the legislation.

The national disability strategy and the Disability Act established a new framework for disability services with the aim of supporting equal participation in society for people with disabilities. If they are paying higher charges, however, they will not be able to afford to participate. What I say is not a reflection on the Minister of State, Deputy Lynch, or the office she holds, but we all know what will happen once a charge is introduced. There is an inevitable creep in the system which continually creeps in only one direction. Charges are seldom reduced. It is a concern for many that once a charge is statutorily introduced, the contributions sought could increase incrementally over a period. Most people with disabilities face considerable challenges in terms of personal development, job opportunities and financially. In the context of the Bill, we would oppose anything that would place further burdens on them. The miscellaneous provisions outlined are varied and disparate and it would be remiss of me to allow the Bill to be introduced without highlighting the issues of concern.

On the broader issue of health and the challenges facing it, the Minister of State is aware of the recent figures on waiting lists for outpatient appointments. Those who are on waiting lists for urgent procedures are being told they will be seen within 22 to 24 months for knee replacements and hip replacements. The challenges are considerable. Budgets are set at the start of the year. The Chamber is known for its latitude in many ways and the Acting Chairman, Deputy Catherine Byrne, is particularly known for her generosity in that regard. We must be honest about the health service. We cannot pretend we can give everything to everyone in the State and that it will not cost them anything. It is probably time for political parties and people in general together to come up with an honest approach to the health service. The proposed model for universal health insurance was not workable. Even those who drafted it must have known deep down that it was merely designed to get the Government over a particular hurdle. We have gone past that stage and we now face a situation where the health service is unsure of the funding model that underpins it. The notion that we can have a health service that will limp along, unsure of which direction to take, which funding model will underpin it or the principles that govern it in terms of who can access it, who will pay for it and who can get it are key components of an honest and timely debate on the direction of the health service. We cannot have a situation whereby this time next year we will have another budget deficit of €500 million and pressure on care professionals, especially at the coalface of the health service.

Nurses protested about patient safety outside a hospital in Galway recently and there was another protest in Limerick. Nurses elsewhere have expressed considerable concern at the impact of the cuts on patient safety. Nurses are health professionals whose obligation is to provide care in a safe, meaningful and efficient manner. We must listen to them when they say they are unable to do that. All the governance and structures in place stand for nothing if the Government does not support them in terms of resourcing them to ensure they can comply with their own high standards, the high standards expected of them by others, and the high standards the public deserve. The key issue is to ensure front-line services, in the context of some of the people proposed to be governed under the Bill, can operate in a safe environment. The Minister of State, Deputy Lynch, referred to oversight by HIQA and others. From time to time HIQA must observe the pressure on front-line staff in emergency departments. Nurses in Galway are being given assistance to cope with work related stress. That is how difficult health care professionals find the situation on the front line. In the context of best practice, continuing professional development and oversight, we must ensure professionals operate within clear defined guidelines and maintain very high standards.

It is critical that we support them when we ask them to do this. When we ask them to do so in legislation they are under an obligation so they should be helped with resources and supports. That is a debate for another day but it seems to me that everyone in this Chamber pretends he or she has the solutions to the challenges that face us in the area of health. We do not have all the solutions but we need a collective observation on the health system we seek, how it will be funded and the services it will provide. Who pays for health care and who receives it? Will everyone be entitled to universality or will contributions vary depending on a person's resources and needs? Will we encourage private health insurance? Is private health insurance integral to the public system or is it separate?

Nobody has all the solutions but producing a document prior to an election is merely pretence - and that applies to all parties. Five-point plans, seven-point plans and key lines throw health services into upheaval yet we expect a service to be delivered. This is not good enough as 100,000 people work in the health sector and 4.3 million people depend on it in various ways. We cannot simply lead the health service into a cul-de-sac and reverse out when we find it is blocked because that is not a sustainable way to deliver health care in this country. Even the best will of the professionals governed by this legislation, other legislation and various overseeing bodies does not allow them to operate properly in this environment.

GPs and nurses are under pressure to deliver in the community primary care setting, as are front-line staff in the emergency services. These are all key areas and we must respond quickly and collectively to the cries for support and help. Many nurses already need help to deal with work pressure and GPs are leaving the country in droves. I am not exaggerating - this is the reality of what is happening outside Leinster House. I know the Minister of State is not immune to this observation as she sees this every day. This matter must be addressed quickly.

The budget will be published on 15 October and it will outline some form of funding until the end of this year. I hope it will give us a chance of making it to the end of 2015 with a reasonable financial package that is realistic, achievable and sustainable, as opposed to the pretence that was offered last year and in previous years. I could go back further but such arguments are for another day.

We can speak of statutory registration, regulation, oversight and insisting on the appropriate behaviour of health care professionals but this must be done in the presumption that such professionals will be supported in their duties with proper and fair resources.

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