Dara Calleary (Mayo, Fianna Fail) | Oireachtas source

I thank my colleague, Deputy Kelleher, for giving us the opportunity to raise this issue this evening. We should not be debating this here because it should not have happened. There was notice, as there has been for many years, that January would be difficult. I am prepared to accept that the Minister took the necessary steps but that they were not implemented. That is a big problem, if the plans he put in place were not implemented. We are entitled to answers and the 600 people who last Monday week found themselves on trolleys are entitled to know why the Minister’s wishes were not implemented by either the HSE or by the Department.

The management of the HSE must answer why it is presiding over this situation, and seems relatively comfortable to do so, in the hope that we will move on to another debate and that if waiting lists or some other issue comes up it will deal with that. We will be here again in January 2016 and further Dáileanna will be here in 2017 and 2018 discussing this problem because of the time of year, unless there are fundamental changes in the attitude and ethos of HSE management on this issue. It has to stand up and take responsibility, as do senior officials within the Department. They must take responsibility and stop leaving the present Minister, or any future Minister, hanging out to dry for their failings and lack of willingness to implement policies.

We must have a proper system of primary care. General practitioners, GPs, are at the base of any proper system of primary care. They have never been under as much pressure as they are now. There is the lure of foreign climes, to which the Minister has referred, and the lure of more regimented health systems offering much more money. Young GPs are seriously tempted by that.

There is the difficulty of getting GPs to attend in rural areas. The notion that the rural practice allowance seems to be a bonus that the HSE will offer, depending on the candidate for the job, rather than being a standard offering for a rural practice is typical of the HSE’s attitude to GPs. If we are to have a proper primary care system which will allow us to avoid many of the incidents Deputy Kitt referred to and that have happened in hospitals over the past two weeks, GPs must be at the core of that system but the administration within the health system must give them the proper respect and resources. A properly resourced GP facility can do many things so that people do not need to go to emergency rooms. Proposals have been made for some time for them to deal with a range of conditions, such as haemochromatosis. Pharmacists are also an under-utilised resource on everybody’s main street that can work and get involved in primary care, with proper facilities, which would save people having to go to the emergency room at any time of the year but particularly now.

We must examine the administration practices of consultants and hospitals that allow hospitals to have the same work practices as other workplaces and shut down for two weeks. Everybody is entitled to their holidays and should be allowed to take holidays. Monday a week ago was the return to work day and many releases from hospitals that had not been signed off were suddenly signed off and the problems improved considerably throughout that week. That is ridiculous. People working in hotels would not be allowed to take leave over Christmas because it is one of the pressure points in the year. If administration and leave policies are playing a role in this problem they too need to be changed for next year and we cannot have those allowances in the system. We are not dealing with manufacturing an inanimate object but with people in a very distressed state. We have all seen cases like those referred to by Deputy Kitt. They are real people whose families are very distressed at what is happening.

I support Deputy Kitt’s remarks about the policy which has continued for some time of forcing services out of small hospitals into regional hospitals. Galway is an example. The nursing staff in Galway are phenomenal, as are all the nurses. They spoke today of the frustration at services being withdrawn from small hospitals from Letterkenny to Limerick and everything being put into the regional hospital in Galway whose campus is too small to deal with it all. That too results in the kind of problems that happened last week.

The problem in Mayo General Hospital was exacerbated by several issues but at one stage last week four ambulances were stalled outside the accident and emergency department with patients in them because there was no room in the accident and emergency department or the hospital for those four patients. The already poor ambulance service was hit by having the four ambulances parked up. Patients received some initial consultations in the ambulances. There needs to be a different approach to this problem. The notion that the emergency planning force for this did not meet, even though everyone knew the problem would arise, is like having a guard dog that cannot bark.

We need to have a properly resourced emergency planning force. I welcome the interesting decision to appoint Liam Doran as co-chairman of the task force. He has laid out that his solution to this problem involves extra staff and extra beds. I wonder whether his appointment by the Minister represents a somewhat tacit endorsement of that policy. I know there are many other issues in this area. The central involvement of Mr. Doran in this process must represent some sort of endorsement by the Government of the appointment of extra nurses and the opening of extra beds as part of the solution. Where will the budget for that come from during 2015?

Last year, the lack of funding for the fair deal scheme resulted in a reduction of more than 1,000 in the number of people receiving fair deal packages. We discussed the delays in getting approval for the fair deal scheme on Private Members' business well before Christmas. As a result of these delays, people who do not necessarily need to be in our main hospitals are unable to get into nursing homes. I understand extra money was allocated in the budget, but is that money being spent? What is the timescale for reducing the delays in processing fair deal applications in order to ensure there is space within the system at the beginning of February, when admissions tend to spike, or in the event of a flu outbreak? If there are 600 people on trolleys, it will be more difficult to deal with a major outbreak of some sort of winter disease.

I would like to make similar point about community care packages, which were the subject of a ministerial intervention before Christmas. Why do Deputies, Senators and other public representatives seem to have to go to war with local health officials to get community care packages and home help hours in place? After the need for such services has been signed off on by general practitioners and other professionals, the system seems to make people wait. It forces patients to stay in hospitals instead of giving them the supports they need. Very few people want to be in hospital. When they face a choice between being in hospital and being at home, they want to be at home. As I said at the outset, unless we are serious about primary care, such people will not have an opportunity to be at home.

I think the system has many questions to answer. Many plans that may or may not have been put in place were not acted on. This serious situation needs to be resolved. As a result of this ignorance and unwillingness to act, more than 600 people were treated in an undignified fashion last Monday week. It is totally unfair on our nursing staff, doctors and consultants, who are doing their level best in incredibly difficult situations, to have to face this problem every January. It seems that when we present this problem to them every January, it is debated in the news and it sucks up the attention of programmes like "Liveline" before the media coverage moves on. It comes again the following January. We should resolve to do something different this January so that we will not be discussing major waiting lists in emergency rooms throughout the country in January 2016.

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