Séamus Healy (Tipperary South, Workers and Unemployed Action Group) | Oireachtas source

I welcome the opportunity to speak on the Health Insurance (Amendment) Bill 2015. The Bill raises the question of equity of access to health services in this country. We currently have a two-tier health system where ability to pay is key to timely access to services but what we need is a system based on medical need and which is free at the point of delivery. That concept is becoming more widely accepted and should be at the core of the delivery of our health services. Professor Brian Nolan of the ESRI said recently that the two-tier system is now widely regarded as problematic from an equity perspective. In the same vein, Ms Suzanne Quin, senior lecturer in social policy at UCD said that a policy which enables those who can afford it to access alternative paths to what they see as being a more comprehensive, superior quality and faster service is hard to justify on grounds of social justice while Dr. Samantha Smith of the ESRI said that health services should be delivered according to need.

This is an enormous issue for our health service. We need a service based on medical need which is free at the point of delivery. Related to that is the provision of health services as close to the patient as possible, the funding of those services and their quality. The provision of health services as close to patients as possible should be a key priority. All services should be provided locally to service users where possible. I accept that specialist services always have been and will continue to be necessary and that patients will have to travel to regional centres and specialist hospitals to avail of them. However, 95% of services can and should be provided locally in local general hospitals such as South Tipperary General Hospital.

I wish to refer in particular to the provision of inpatient acute psychiatric services in County Tipperary. The decision to close the service was taken by the previous Government through the former Minister of State, Deputy John Moloney, while the implementation of that decision was carried out by the current Minister of State at the Department of Health, Deputy Kathleen Lynch. That decision and subsequent closure was made against the advice of advocates, general practitioners, consultants and the entire mental health community in County Tipperary.

We now have a situation where there is no inpatient acute mental health service in the whole of County Tipperary. People in the south of the county must go to Kilkenny for services and those in the north of the county must go to Ennis.

The inpatient service in Kilkenny is the one I know best and it is particularly dysfunctional. South Tipperary patients are being absolutely disadvantaged in having to travel to Kilkenny for the service. The service should be and could be delivered locally. I have regular contact with families who tell me it is very difficulty to get admitted to the inpatient services in Kilkenny. When a person is admitted, there are questions around early discharge and follow-ups are not carried out by the same consultant. This is unacceptable. A strong case can be made for inpatient services to be provided in Tipperary. Will the Minister examine the situation again and put in place, as requested, a small inpatient unit for the county? Eight or ten beds would be adequate.

The community-based teams are not staffed properly. They are deficient, in particular, in respect of paramedical staff, physiotherapists, occupational therapists and social workers. Despite the best efforts of the staff, who provide a good service, they are hampered by the lack of fully-staffed community-based teams.

Will the Minister provide additional funding and staff for the general hospital service? In particular, I speak about South Tipperary General Hospital. The hospital has lost about 20% of its budget, which is about €12.5 million, and approximately 100 staff members. As a result, members of staff are working under huge pressure on a 24 hour basis. They have done tremendous work, given the hospital is running at a capacity of approximately 120%, but the situation simply cannot continue. Staffing levels need to be urgently addressed and, in particular, additional nursing and support staff need to be put in place.

The lack of funding and resources creates a particular problem in the accident and emergency unit. People are on trolleys for long hours and often for longer than 24 hours. The service urgently needs to be sorted out. We were promised an additional ten step-down beds. These beds are urgently needed to address the difficulties in the accident and emergency unit. We also need to open additional beds in the hospital to cater for the overflow from, and difficulties in, the accident and emergency unit.

The hospital needs capital development. A phase two development for the hospital is on the books. I urge the Minister to provide the capital investment required for the phase two development of the old part of the hospital. The new endoscopy, surgery and theatre services provided a number of years ago were an excellent development and are working very well but the older part of the hospital requires urgent attention and capital funding. Will the Minister make moneys available for the phase two development of South Tipperary General Hospital?

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