Seán Fleming (Laois-Offaly, Fianna Fail) | Oireachtas source

I thank my colleague, Deputy Kelleher, for tabling the motion on the underfunding of the national service plan for 2015. When he launched the plan on Thursday, 27 November, the HSE Director General, Tony O'Brien, said the additional funding "will not...be sufficient to fully address the increasing demands being placed on our hospital system, in particular the growing waiting lists for elective admissions.” This is an indictment of the national service plan 2015. Mr. O'Brien said the plan does not meet the needs for 2015. Enough said. It is no wonder we will be back with a Supplementary Estimate in the coming days for 2014, as we will be for 2015. While the Minister might say otherwise, evidence from the HSE Director General will contradict him, and I accept what Mr. O'Brien says because he is a straight talker.

On budget day in October, when the Estimates were published here, we pointed out the black hole of €460 million in the Estimate for the Department of Health, comprising the magical, increased revenue of €330 million and drug procurement savings of €130 million. The HSE has proved itself incapable of delivering the savings required in the drugs procurement budget and it should be removed from the HSE and given to the Government's Office of Government Procurement. One national office is getting increasing strength and ability in national procurement. It is so good that it is causing flack at a local level because small, local suppliers can lose out. It is getting the best price for the taxpayer and that is what is needed in this situation. The expertise needed is available in the Office of Government Procurement, not in the HSE. The job of the people in the HSE is to deliver health services, and they should not be doing a job that can be better done by another State agency, such as the Office of Government Procurement.

At last week's meeting of the Committee of Public Accounts, I was shocked to hear the HSE intended to spend a lot of money next year on a patient identifier number system. It is a disgrace and I ask the Minister to reconsider it. Given that everybody in Ireland has a PPS number, why does the HSE want to invent another system? It should attach the PPS number to existing files. The Revenue Commissioners have everybody's house listed in the local property tax system. Practically 40% of the population have medical cards with a number from the HSE. Yet the HSE proposes to spend millions of euro on a new IT system for a new numbering system for everybody in the country. Will the Minister tell the people in his Department and the HSE, who should be working to deliver health services, to leave the job of identifying people by number to those who do it best, namely, the Department of Social Protection, which already supplies the PPS numbers? People will have a PPS number, a patient identification number and a medical number. It is nonsense. Each person should have one number. The Minister should ask his staff to hand over that operation. I was shocked to hear that the HSE does not have a patient identifier number. The Department should not need to spend money on it.

There are 2,200 people on the waiting list for the fair deal scheme and although the Minister said there was an average waiting time of 14 weeks, I find cases of people waiting up to 20 weeks. What people do not understand is that this is not 20 weeks after a person applies but after he or she has gone through the full assessment process. After a person's application for payment has been approved, he or she is told he or she must wait 14, 16 or up to 20 weeks. It does not take 14 to 20 weeks to get a payment. Imagine if a person applied for a social welfare payment and when it was eventually approved he or she was told it would be paid in 14 weeks. It is unacceptable. One of the reasons for the delay is the 850 delayed discharges in hospitals.

I welcome the recent announcement that the HSE will convert the former Mount Carmel Hospital into a community hospital to help alleviate the problem. I can give the Minister two more suggestions to further alleviate it, of which the Minister will be aware. Abbeyleix District Hospital in County Laois is a community hospital which the Minister is running down. With a tiny investment, it could take 50 people. However, it is not taking new patients except for respite cases. The same applies to St. Brigid’s Hospital in Shaen, Portlaoise. With a small investment, it could take 30 or 40 people. I ask the Minister to consider those to help solve the problem.

I have come to the conclusion that the delayed discharge is not just a financial decision but a HSE policy. Although some people will say there is nowhere to discharge these 850 people, I believe there is a policy in the HSE and the acute hospitals to keep them in the beds because when they are full, they can stop new people from coming in through accident and emergency. In the past month, I have visited two accident and emergency departments in respect of a person aged well over 90, in very poor health and suffering from an illness. When the person's family suggested that the hospital should keep the person overnight, there was pandemonium. The hospital staff said there were enough people sleeping in the accident and emergency unit that night and that with 12 people in the wards they could not take in any more people. They wanted to send him home.

A few weeks later, the same patient ended up in Naas General Hospital, and when I visited, one could not get in the door of the accident and emergency unit. There were beds in both sides of the corridor backed up to the front door of the accident and emergency unit, head to toe. One could not get through the place. There was no room to wheel a bed or a chair in an emergency situation. Old and young sick people were lined up, head to toe, on trollies on both sides of the corridor, never mind getting into the unit. The nurses were right to take to the streets two or three weeks ago to protest what was happening in the hospital. It was unsafe and unfair on the staff, never mind the loss of dignity and medical care that should have been provided to the patients. It was not the fault of the nursing staff, but the physical infrastructure was far too small.

In some parts of the country, orthodontic treatment does not exist at school level. In County Laois in the midlands, a child is lucky to be assessed by sixth class and might wait until the age of 16, almost finished secondary school, before receiving any treatment. Killeshin is in south County Laois on the border with County Carlow. While the children in County Carlow will be assessed in fourth class and receive treatment before they leave primary school, down the road in Killeshin national school, the children are in a different county and region. Did nobody tell anybody we have a national HSE? It still operates on the basis of county boundaries. Even more bizarrely, children in Carlow who happen, for family reasons, to attend the school in Killeshin in County Laois, will not receive orthodontic treatment because they are going to school in Laois even though they are from Carlow, where everybody else can get the service.

The situation regarding the income limit of €900 per couple for medical cards is farcical.

The Health Service Executive uses that figure of €900 when it suits it and disregards it when it suits it. In the cases to which I refer the people were applying for discretionary medical cards. I had a case in the past week where an elderly couple were told their household income was over €900 and therefore they do not get a medical card. They applied for a discretionary card. They looked at their legitimate outgoings as part of their medical expenses and they came in below €900, at €850. They were told that because they were above the basic figure they will now disregard the €900 when it comes to an application for a discretionary medical card, but they implement the €900 ceiling when it comes to a medical card application. I hope the Minister will fix that.

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