Fergus O'Dowd (Louth, Fine Gael) | Oireachtas source

I welcome this debate. Taking up the points of the last speaker, Deputy Pringle, I agree entirely with what he said about people needing proper home care packages and proper home help.

It was brought home to me not so long ago by a 78 year old lady who gave me a call and told me that she had a half hour per day home help to look after her husband who was 82, had dementia and was doubly incontinent. She was in extremisand had no help at home. I went out to visit her and obviously she is doing her best but bedlam is the best way I can describe the home. Everything was all over the place because her poor husband was unable to behave in a manner that one would call normal behaviour. The place was absolutely upside down. I got in touch with the HSE about that and they increased home help hours. It is a serious issue. People who are looking after people suffering from dementia are fighting a losing battle in terms of the age at which they are interacting with their spouse or family member and also with the lack of care and support they are getting. It is entirely unacceptable in the present day that we do not insist on a bill of rights for people who are suffering from Alzheimer's or dementia. The support services should be there as a right to those families.

I had another case of a family where the lady had Alzheimer's and was up and down the stairs 24/7. She never rested and was constantly moving up and down. Her husband and daughter - who could not work because of the medical situation - could not get her a proper location in the community where she could be looked after. The lack of support for community organisations that provide dementia care in places like Dundalk and Drogheda is entirely unacceptable. They should never have to come to politicians to get the service they absolutely need - it should be there as a right. We need to look at the Alzheimer Society's proposals for a bill of rights for people who are suffering from Alzheimer's and dementia. It is a fundamental issue that we must address because it will be an increasing problem in our society.

When one knocks on doors people talk about people on trollies. It is a huge issue for families and individuals who suffer greatly, not because they are not getting medical care and attention but because of the proximity of other patients and because of the distress that the often elderly patients are in when they are in the corridor. Most of them are people of advanced years. There will be more and more people living longer in our society and needing care. An awful lot of them should never end up in hospital at all. The reason they end up there is because there are no interventions before they get that far, like the family I spoke about earlier. There is inadequate home help for these families. If somebody has a disability and does not have proper and adequate home help, it means their illness will become more acute and more interventions and hospital treatment will be needed. Proper home care is one of the ways forward.

The other way forward concerns our ambulances and medical staff. When paramedics come to a home they should have the capacity to use the very best modern technology and telemetry to communicate directly with the individual concerned. Obviously the person's consultant may not be available but they could interact with an equivalent consultant. If somebody is very bad with asthma, has a chronic attack of some illness or if a problem with their heart is distressing them in the middle of the night, they would not need to go to hospital if they could be reassured medically on the spot and if the people in the ambulance service could give them the medication that is directed. If we upskill our ambulance staff and improve the technology that our ambulances use, we can keep people at home. We all know that if one has a pain in one's tooth at 9 o'clock at night, it gets worse as the hours go by and one gets really concerned about it. Similarly if one has a very bad headache it is not as acute during the day. There are strategies for keeping people out of acute hospitals and meeting their immediate medical needs without any further distress being caused by hospital admissions.

The debates here on health are always excellent because on all sides of the House we experience the same issues with our constituents. Since the health boards were abolished, the only forum that politicians have is debate in the House with the Minister or in the health committee. A new interaction should and could take place. We are all in different HSE regions. We used to meet in the health board and I see some of my former colleagues in the HSE here. There should be meetings, at least on a quarterly basis, held between all the Deputies for the particular area, Members of the Oireachtas and HSE staff - both acute hospital staff administrators and community care staff. Those meetings should have a public dimension to them. One should be able to challenge those professionals as to why things are happening or not happening and they should have the opportunity to tell us as politicians what we should be doing and what we are not doing. That debate which happened in the old health boards was very positive. I never saw a good reason to abolish the health boards because I found they were excellent and kept everybody on their toes, including politicians and HSE staff. If we go back to having a quarterly interaction, which is not unreasonable, there could be a quarterly plan for acute hospitals and community care and a meeting in a public forum to ask for a report or talk about what happened. That is constructive and would increase efficiencies and the transfer of knowledge of which there is a deficit in this House at times.

We meet lots of people who feel they need assistance to apply for medical cards and we have dedicated lines for this. I had an experience yesterday of communicating with the medical card hotline. The issue concerned a lady who unfortunately has cancer. Most of her stomach and half of her bowel was gone and she was being told she was not entitled to a medical card. She applied for a discretionary medical card and part of the reason she was turned down was on financial grounds. That is appalling and disgraceful. When people are suffering from very serious illnesses like cancer and are in treatment, finances should not enter into it at all. There is an issue here about a human being who has an illness which will more than likely kill the person. The important thing for them is to affirm their worth and importance as an individual and their entitlement not to be distressed by all this paraphernalia and bureaucracy. It is a disgrace that this is still going on. There has been a lot less of it in the last year but it is beginning to start up again. Whatever instructions are being given, if somebody has a very serious illness, particularly cancer, and if they cannot eat, why the hell should they have to ring me to get their medical card? They should not have to do that; they should have it as a right. It needs to be addressed and it would be a very positive and constructive thing to do.

The other issue I wanted to talk about was the quality of care in our nursing homes. We are talking about the health service. We spent an absolute fortune on what we call the fair deal. There is a very significant number of people in nursing homes who should not be there at all. I return to the earlier point, which was also made by Deputy Pringle, about proper home care packages and integrated home care. If we had the proper community services for them, they would not need to be in a nursing home. This is not a pejorative comment. If one is ambulant, able to walk around and not in a bed 24/7, one should not be in a nursing home for social reasons. In many cases people are in nursing homes for social reasons. If people can be kept in their home and given all the support they need, it would be far healthier and far better. That is the way forward.

I have 21 seconds left and I will return to my primary point. If there was interaction between the political representatives of the Oireachtas and the HSE executive on a regional level in a public forum, we could get to the bottom of a lot of the problems that we cannot really get to the bottom of in a debate like this. It could be a question and answer session - I am not looking for statutory powers or anything like that.

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