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

This is a welcome and timely debate. I fully agree with the motion. If we can all sign up to changes and if we can sign up to a ten-year plan or a plan of whatever length in terms of the cycle of change, I do not have a problem but the changes I would like to see would not take ten years. They would not take ten days, if we attach the importance to them that we should.

The HSE is an unaccountable organisation. It is accountable only to the Oireachtas committees and to the Minister for Health. There is no accountability, to me and every other Deputy in the Louth-Meath Cavan-Monaghan area, other than by written request or by meeting an official. Given the significant controversies that are arising, as we see in Cavan hospital, and as we see regularly in Our Lady of Lourdes Hospital and in County Meath, etc., we ought to go back to the system of accountability of the HSE at regional fora of Members elected to the Oireachtas. That would be useful. Such meetings should be held quarterly, where one could receive reports into the care provided by hospitals in one's region and could also raise, directly and publicly, the issues that arise as a result of those concerns. That is something that is missing in the formula in terms of accountability. If one could bring in before the regional Oireachtas Members the officials of the health board in a transparent accountable way and hold them to account for the issues that arise, it would be constructive for both sides. One needs that creative tension between the administrators of the health service and the public representatives. It would be a two-way process because the administers would be able to clearly identify to us directly the changes that they believe are necessary as well.

Does it take somebody to be dying to get a medical card? That is the question I must ask today. In the past week I have had contact with two constituents who are terminally ill. One of them has serious cancer and most of their bowel and stomach has been removed. The other person has terminal heart disease and will be dead, the person tells me, probably within six months at the most. In both cases, their income is higher than the limit for medical cards. Both of them have been kindly turned down by the HSE medical card appeal system for a discretionary medical card. It is a shame and a disgrace that somebody who is terminally ill should be deprived of the comfort of the concern of the community. Such people should be given a medical card if they are terminally ill, regardless of their income. It would recognise their importance as a human being. It would recognise their battle to live as long as they can in the best way that they can. It is a shame and a disgrace that constituents are telephoning me with those concerns in the past week. I note, from listening to other Members in the Oireachtas, it is not unique to my good self. We need to look again at the discretionary medical card applications. The HSE needs to be much more empathetic towards families and the seriously ill. It is unforgivable and unacceptable that the current system prevails.

The other element missing in the health service is advocates for the elderly, for those who are terminally ill and for patients who are in hospital about whom families have concerns. One telephones the hospital and leaves a message and perhaps the call will be returned or perhaps not. One talks to the liaison staff and maybe they will or will not be sympathetic to the point one is making. What we need in the HSE are advocates whose full-time job is to deal with the bureaucracy for and on behalf of the patients who lie in those beds who are not getting the treatment that their families feel they need or who need to be in hospital and are not, and who will be accountable to the patient and families. I recognise and welcome the work that the patient liaison staff do but I am not convinced that they are on the side of the patient. What we need is a clear, absolutely committed and fully funded advocacy service that will reach out and meet the needs of those people.

Never is this more important than when people have dementia. I and every Member of this House are aware of people who suffer from dementia, the problems in the families and in the homes, and the fear that people outside of the immediate family have about getting involved. It is like the way cancer was treated many years ago. People do not know what to do or what to say. We need to reach out much more to people with dementia and to the families who support them. One should not forget the family gives day and night support, 24 hours a day seven days a week, to keep them in their home. If anything must change in society, it is the way we treat people with dementia and the way we interact and support the families who are caring for people who have that illness. In particular, I welcome the nomination of a representative from the Alzheimer Society of Ireland to the Seanad. I do not know whether it was Fianna Fáil. Whoever made the nomination, it is a welcome place where the person can articulate views on what should be done in this area. I would fully support such concerns and views.

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