Finian McGrath (Dublin North Central, Independent) | Oireachtas source

I am grateful for the opportunity to speak on this new legislation. I welcome the fact the Minister of State is in the Chamber to listen to the views of various Members. We all have one thing in common, despite some political differences, which is that we all want a quality health service with standards and professionalism. We should all unite in the debate on funding for the health services. I strongly welcome any important debate on our health system, in particular on reforming our health service. The Bill is about standards and professionalism. These words jump out at one when one reads the legislation. We must make them real and meaningful and relate them to people's lives. We have a long way to go with regard to standards, professionalism and resources.

The number of people on trolleys in accident and emergency departments increased by 158 in August. This is appalling and not good enough. It is not acceptable.

How can we talk about standards and professionalism when this type of activity takes place on the front line in our accident and emergency departments? That is a key part of this debate as well. The Minister of State should not come into the House and say everything is fine, the economy is booming and growth is back in business when there has been an increase of 158 of patients lying on trolleys in hospitals in August. It is time to get real and bring in the resources and reforms we all support.

We need to stuff the tax-cuts brigade until we help the sick, the elderly and the disabled. That is a debate that will go on in coming weeks regarding the budget. In any economy in any civilised society that was ravaged by recession and rampant greed where resources are slim, one must give it to the neediest. That must be a key aspect if one is in here today addressing health issues. That is a tough decision for the Government. It can throw out tax cuts to the wealthy and yet it cannot find the extra resources and finances to look after the sick, the elderly, the disabled and our senior citizens on trolleys in hospitals such as Beaumont. That must be challenged and these are the kinds of tough decisions that need to be made. These are important key elements of this legislation.

The main purpose of the Bill to subsume the Opticians Board into the Health and Social Care Council. It makes certain amendments to the Health and Social Care Professionals Act 2005 in the interests of efficiency and to ensure consistency with the legislation governing health regulators. It also amends the Health Act 1970 to ensure 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. That is what is going on in this legislation. There are positive elements to it and I would also be very constructive regarding the Bill.

The Health and Social Care Council, which I will refer to as the council, is an independent regulator established to protect the public by promoting high standards of professional conduct, education, training and competence among registrants of 12 designated health and social care professions. That is what the council is all about. The objective of the council is a key aspect regarding the build-up and debate on the health service. The objective of the council is to protect the public by promoting high standards of professional conduct, education, training and competence among the registrants of the designated professions.

To date, six registration boards have been established for the professions of social worker, radiographer, dietician, speech and language therapist, occupational therapist and physiotherapist. It is planned to have all these 12 boards and the registers established by 2015. I welcome that six have already been established which is a positive development. I hope we achieve that target by 2015.

When one looks at the details of it, one finds we are talking about professions such as social worker. We now have a crisis with dysfunctional children and children at risk and yet we also have a problem with social workers. We need people to be involved in these front-line services. We all know there are waiting lists but we have to prioritise kids' situations. In particular abused children and children at risk need to be at the top of the political agenda.

The Minister of State should not come in here and tell us the economy is achieving 5% growth if the Government is not going to look after those vulnerable children. If one does not intervene when they are between four and ten years of age, they will all end up in Mountjoy Prison, robbing taxi drivers in Cork or beating people up in the streets because their dysfunction and abuse was neglected when they were between the ages of four and ten. Most sensible people, whether one is a social worker, an education psychologist or a backbench politician, will say that is the reality. Therefore the social workers have to be given priority.

An issue that has come up in recent days is the scandal of the shortage of positions and children on waiting lists for speech and language therapists. This is something we have to deal with. Children should be given these services as a right. If it means more tax, so be it, but one has to pay for the services.

I would like to broaden the debate because I mentioned social workers and speech and language therapists, and there are also occupational therapists. There is also the broader issue, which is the main part of the Minister of State's brief, and that is the issue of disabilities. We need to ensure we have high professional standards for all children and adults with a physical or intellectual disability. We have examples of good practice in the State as I know from first hand from my experience of my family situation. There are some excellent service providers in the State doing an excellent job, but we also need to plug the gaps and give those, who do not have them, an adequate service.

For example, many people do not realise that the census in 2011 recorded 595,355 people as having a disability, equivalent to 13% of the population. At least one in ten adults of working age of 15 to 64 has a disability. Disability increases sharply with age. Just 5.4% of children under 15 have a disability compared with 38% of those over 65 years. This is linked into the debate about the standard and professionalism of this debate on the whole council issue.

Some 68% of people who use disability services are not satisfied with the level of control they have over their own lives. I accept this is about to change and that debate is going on and hopefully it will change. Some 40% are also dissatisfied with the quality of services being provided. The 60% I mentioned earlier are satisfied and, in fairness, they are getting a good service which I commend. However, if we are talking about reform, change and resources, we need to focus on the 40% who are not satisfied.

Some 13,655 applications for disability allowance were turned down last year, which represents a refusal rate of 55%. The Minister of State might say they are trying it on. The reality is that 58% of the appeals were later accepted. My point is that these people should not be punished or penalised for their disability. Almost 4,000 people with disabilities were in need of social housing in 2013.

This goes back to the issue with speech and language service. More than 32,000 children remained on waiting lists for speech and language assessments and interventions at the end of 2013. In 2013, some 15,830 people were waiting for assessment by an occupational therapist, with 2,500 waiting for more than a year, including 1,900 children. I am giving the facts and the reality. We know we cannot do it overnight, but we should prioritise certain issues.

We also have to face the reality that many people with disabilities have also been caught, particularly over the four or five years of austerity and they experience higher rates of poverty, for example. That is a figure that has been ignored - people with disabilities in poverty. Families where the head of the household is not at work due to illness or disability have the lowest average annual disposable income in the region of €21,492 - an 11% drop since 2010. Individuals who are not at work due to illness or disability endure some of the highest levels of consistent poverty at 17.6%. This overshadows the national figure of 7.7%.

Some 48.5% of people not at work due to illness or disability are at risk of deprivation, in contrast to the national average of 26.9%. This means that they struggle with the cost of adequate clothing and heating and cannot afford to eat a meal with fish or meat every second day. That is the reality. I am bringing this into the debate because we are talking about standards, professionalism and the work this council will do to upskill and ensure that standards are met.

Just 24.5% of people with disabilities have completed third level education compared with 38.7% of the general population. Some 16.3% of people with disabilities aged between 15 and 49 have completed no higher than their primary education, compared with 5.1% for the general population of the same age.

Included within that figure are people with intellectual disabilities but there also are people with a physical disability who are extremely bright and intelligent. I again refer to my experience as a councillor on Dublin City Council. In 1999, our target was to try to get the figure of staff with disabilities up to 5% and I remember we exceeded that target in one year. It showed that a lot of talented people in IT and in administration who had a physical disability came into work in Dublin City Council and made a massive contribution to the city of Dublin and the development and running of Dublin City Councils services.

My point is that Members must be radical, creative and compassionate and must show leadership. Only 20.7% of people with disabilities aged 15 and over are in employment, while the equivalent figure rises to 50% for the general population of the same age. The unemployment rate for people with disabilities stands at 30.8%, which is significantly greater than the current figure of 11% for the general public. There also of course have been the hits in budget 2014, including a 15% cut to the weekly invalidity pension, a reduction of €5 million in expenditure on the supplementary payments, cuts of €44 per week to jobseeker's allowance, the abolition of the telephone allowance and seeking of €2.1 million in savings through exceptional needs payments. These issues affected people with disabilities and I raise them because they are important and because one must go back to standards and to the work that is set out.

I will return to the detailed provisions of the legislation, which makes reference to amendments to the Health Act 1970 in respect of statutory contributions. The Bill aims to ensure that statutory contributions are payable by recipients of residential support services who are maintained, though not directly accommodated, by or on behalf of, the Health Service Executive, HSE. Being maintained by the HSE means the cost of food, utility bills and other household essentials is met by the HSE or its agents. While there are no estimates available of the numbers affected, this group is likely to comprise older people and people with physical, mental or intellectual disabilities or care needs who are living in accommodation provided by housing authorities or local authorities or who receive residential support services from the HSE and its agents. Residential support services vary greatly, based on client need, and may include care assistance, supervision, house-parenting, psychological and nursing services. I urge the Minister to give priority to these services in the build-up to the budget.

I note the figures for the waiting lists for residential places, day places and respite care are not very big and consequently, they could be targeted and dealt with effectively. A radical Minister for Health could solve this issue pertaining to residential and day care because I read recently that in some places, the numbers were 300 to 340 and while there was a big figure in the region of 1,100, these still are issues we can attempt to solve. I urge the Minister, as well as every party in the Dáil, to prioritise these people. Examples of good practice are available, as are examples of high standards. Moreover, as the Minister of State, Deputy Kathleen Lynch, is aware, there also are examples whereby some of these service providers during the bad times really maintained services against the odds and managed their money sensibly. I have seen some outstanding services and people availing of some of them did not mind paying a contribution for respite in order to pay for the poorer families in respite. Some chief executives of such services took a highly inclusive approach with the parents. I happen to be a parent of a daughter who is in the Prosper Fingal services, which has a young team of staff who, although they are nailed to the wall, are doing a fantastic job against the odds. My point to the Minister of State is that examples of good practice are available. They should be given a leg up and, where possible, there should be a focus on these issues and the delivery of the services. This is an important point.

The Department of Health has stated that the new system is not intended as a revenue-raising measure, which I welcome. It is understood that most of those affected already are contributing towards their maintenance and accommodation costs. Under the Health Act 1970, the daily contribution will not exceed 80% of the maximum daily rate of the State pension (non-contributory). The Bill provides for waivers in certain circumstances, including to avoid undue financial hardship on the person concerned or his or her dependents. These are the positive aspects of this legislation and are the issues about which Members must agree on a commonsense idea and must decide to adopt it. I will support this and make no apologies for so doing. However, as part of my support, I urge the Government and the Minister to focus on the priority issues. They should not come into this Chamber every second day like the comedian who came into the Chamber earlier, namely, the Minister for Finance, Deputy Noonan, who was telling jokes about the economy. The bottom line is if the economy is growing, that is fine but one must focus on providing services. Moreover, the State must prioritise its money and it is easy to jump up and down stating one wishes to give tax cuts to those people and further tax cuts to those who are well off. Any humane, sensitive and compassionate Government must first acknowledge it is aware that people want this and that everybody needs a break. It should accept the point about middle income and low-paid workers who, God knows, have suffered enough in recent years. However, there are certain times in life when one must make tough decisions and they must be to support the weaker sections of society. This must be the entire theme in respect of this legislation today.

I refer to the details in the legislation providing for the dissolution of the Opticians Board. The section looks at the dissolution of the aforementioned board, the transfer of staff, transfer of property and liabilities to the council, preservation of contracts, pending legal proceedings and preparation of accounts. I am a little concerned by the section pertaining to the transfer of staff and a red light has gone on in this regard but perhaps the Minister of State can deal with it later. It provides that every person who, immediately before the relevant day, was a member of the staff of the Opticians Board is, on the relevant day, transferred to, and becomes a member of, the council’s staff. I welcome this provision. Moreover, a person transferred under this section is entitled, while in the council’s service, to be employed on conditions of employment no less favourable than those to which that person was entitled immediately before the relevant day. The previous service of a person transferred under this section with the Opticians Board is to be counted as service for the purposes of, but subject to any exceptions or exclusions in, certain Acts, including the Redundancy Payments Acts, the Protection of Employees Acts and the Unfair Dismissals Acts.

As for the number of people affected by these issues, I believe there are no estimates available of the number of people likely to be affected by the changes proposed in the Bill. The Department has stated: "Unfortunately, the HSE does not collate information at present in a manner which facilitates quantification or reliable estimation of the numbers likely to be affected by the amendments in Part 3 of the Bill". This is also an issue Members must watch because this pertains to standards, effectiveness, accountability and reform. Members should remember they all were elected in 2011, when all promised reform following the shenanigans, everything that had gone on and the way in which things happened. On the doorsteps, all Members promised reform. My point to the Minister of State today is that part of reform is about being realistic. Anyone working in the health service will say that one cannot effect reform without money. As for those Members who come into this Chamber and state that expenditure in the health service is out of control, they do not realise but must understand that the health service is a service; it is not a private company or business and things change overnight. For example, last nights "Prime Time" programme highlighted the question of those families affected by hepatitis C. Those concerned need a drug to keep them alive and I believe the figures quoted were for more than €300 million. However, the bottom line is Members must pull back and must ask what, as a country and as a society, are the priorities. The point I make is that when one has limited resources, one must give them to the priority cases. Although this will not be popular with some people, I must state that I was shocked by a recent poll in The Sunday Business Post. I was having a go at the tax-cut brigade and my position was that were a few extra bob available, they should be put into services. I thought I would get hammered but in the aforementioned The Sunday Business Postpoll, when asked, 61% of people stated that were an additional few million euro available, the money should be put into services and the resources should be provided. The Minister of State, Deputy Kathleen Lynch, also should focus on this point that support exists in this regard. Everyone accepts she is trying to do this internally and people are aware that in their hearts, those who work in the health services are trying to provide a quality health service.

People are also aware that there must be reform, efficiencies and accountability and that they cannot spend their lives slagging off the medical profession, including doctors and consultants. I acknowledge so doing might sound good in the newspapers.

However, I have a major concern in light of the €100,000 or so of taxpayers' money that is given over to training each young doctor in UCC, NUIG, UCD and so on, when, as soon as their training is complete, so many end up going off to Australia or the United States to work. It might not be popular to mention Cuba in this Chamber - colleagues seem to have gone mad lately in their support of the US - but what happens there is instructive. When I visited the country some years ago I met a group of medical students who told me how, after finishing their training, they were obliged to give two years service to poor communities in the villages and mountains, providing GP, midwifery and a range of other services. On another occasion, in a pub in Havana, I met another gang of medical students who were working, during their summer holidays, with the poorest families and communities.

This is a country that has been hammered by the embargo imposed by the bully boys in the US. I do not know what the Americans are up to, but I wish to God they would leave the Cuban people alone. However, that is another debate. The point of this example is to show what is happening in a very poor country that is being tortured by a US embargo. I attended a disability centre during my visit there and saw the disability provision that operates from cradle to grave. Every child with an intellectual disability is guaranteed a service from day of birth to day of death. We have far more resources than some of the countries already providing the type of modern, accessible and progressive health service our citizens deserve.

I welcome the Bill and the measures it contains. When it comes to health service provision, we should take a cross-party approach. The universal support for the NHS in Scotland was very evident during the campaign leading up to the independence referendum. I am very sorry for the voters for whom the result was a disappointment, but I was pleasantly surprised to see that all parties were committed to protecting the NHS. Some even spoke about how to make a better NHS. I would like to see a united approach in this country which acknowledges that there are certain things in life which we as a society and country must protect, namely, a good-quality health service and a good-quality education service. One can build a country and a society from those foundations. If we look after our sick, elderly and disabled, we will have a better country and a better quality of life for the people who live here. The Minister for Finance and his departmental whizz kids might not agree, but early intervention will, in the long term, see substantial savings in the provision of health services. I referred earlier to children being raised in very dysfunctional and violent families. We must intervene early in such circumstances and prevent their ending up in Mountjoy Prison some years down the road.

I hope the Minister of State takes on board the points we have made today. I urge her to keep fighting in the coming weeks for people with physical and intellectual disabilities. These people deserve services as a right, not as a charitable act. The parents of children with disabilities pay taxes and are entitled to a service. Nobody complains about the cost of sending little Johnny to the local national school, but there is plenty of whinging when parents of children with disabilities are looking for speech therapy and other services. We must break down that mindset. I welcome the legislation, but urge the Minister to give consideration to these issues.

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