Michael Colreavy (Sligo-North Leitrim, Sinn Fein) | Oireachtas source

One of the hallmarks of a decent republic is that the people can access quality health care when they need it, irrespective of age, geographical location or ability to pay. Unfortunately, we do not live in such a republic. It can be informative to look at the OECD 2014 health at a glance report for 2014. Many people do not know that Ireland is below the EU average number of doctors per 1,000 people. We have 2.7 compared to the EU average of 3.4. The number of hospital beds per 1,000 people is also below the EU average. We have four compared to the average of 5.2. However, the notion is out there that somehow we have plenty of resources but they are being badly used.

There were 12,683 beds in the system in 2013. As far back as 2006, hospitals were operating at close to 100% capacity and a recent OECD report confirms that is still the case. There is no other word for this but "dangerous". The accepted and researched wisdom is that any hospital with a greater than 85% average occupancy increases the risk of harm for patients, including the risk of hospital-acquired infections. It is easy to say the resources are there but are not being used. The real problem is that the necessary frameworks and infrastructure are not in place. There have been repeated cuts to the service and when that happens, it is no wonder there is bleeding.

The main issue with emergency departments in acute hospitals is that there have been continual cutbacks to budget, staff numbers and bed numbers. In addition, lack of access to beds in community nursing homes creates a delay in getting people out of hospitals. Another factor is the bureaucracy, red tape and delay involved in accessing home care packages under the home support scheme. It makes no economic sense or health care sense to keep people who could and should be looked after at home in acute hospitals simply because administration has to work its magic before a home care package can be organised. Part of the problem is what is referred to as bunker management. We have a bunker called acute hospital services and a bunker called primary and continuing care services. Occasionally a head will pop up over the bunker but more usually, and particularly following a succession of cutbacks, each bunker will jealously guard what it regards as its budget.

There is nobody standing between the two bunkers or seeking to demolish the bunkers and demanding that the money follow the patient and that what is right for the patient must be done. If continuing care service is more appropriate for a particular patient in a particular set of circumstances, that is where the patient should go and he or she should go there now. We should not have two or three weeks of form filling and a series of approvals, leading to interminable delays. While that is happening, people are lying on trolleys in emergency departments or having to join waiting lists for outpatient and inpatient services. It is disappointing that the best we can apparently do to try to resolve the current emergency department problem in acute hospitals is to threaten the waiting list for planned admissions. People who might already have been waiting for three years between outpatient consultation and inpatient admission will be told they must wait three months, six months or 12 months longer so that we can solve the problem in emergency departments. Is that a decent service in a decent republic? Does it amount to the provision of quality health care to people when they need it, irrespective of age, geographic location or ability to pay? No, it does not.

In regard to the length of hospital stays, Deputy Liam Twomey spoke about Chinese walls in hospitals. Unless it is the Great Wall of China, a Chinese wall is usually made of paper. The Government has had five years to take down those Chinese walls but has not done so. Why do we not have smooth administration within our hospitals? Why is the focus still not on the patient? There should be no Chinese walls. Members opposite speak as if these matters are beyond their control. It is within the Government's control to effect change; in fact, that is its job. Why was that not done over the past five years? Ministers can blame the hospitals and the professional bodies, but the fact remains it is the job of Government to change what it considers to be wrong. If Ministers cannot or will not do so, they should not be in office. It is very simple. We must get rid of the Chinese walls, if they are the problem, but the Government cannot continue to impose cutbacks while blaming those walls for the failure to create the infrastructure that is necessary to provide an effective service.

Ministers frequently make the charge that Sinn Féin Members criticise what they consider to be wrong but never present solutions. In fact, we have presented the Government with solutions, including a way to approach delivery of a quality health service in this country. The challenge for Government is to take on board the suggestions we have put forward. Unfortunately, on the basis of its so-called amendment to our Private Members' motion, it is clear that, once again, the Government is running away from taking effective action.

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