Marc MacSharry (Sligo-Leitrim, Fianna Fail) | Oireachtas source

First, as our senior spokesperson and Deputy Cahill have noted, Fianna Fáil supports this Bill. It contains some good measures with many more to come. However, while the Ministers of State are present in the Chamber, I will use the opportunity to raise a number of other issues. First, I wish to raise the issue of arthritis services for children in Ireland, which are in a bad state. I gather there are precisely 2.5 whole-time equivalent rheumatologists in Ireland. That is the second worst provision in the European Union. Given the prevalence of the disease, there should be five to six rheumatologists for a population of our size. Although the World Health Organization recommends waiting times for children of no more than six weeks, the current waiting time for a child in Ireland with arthritis is a staggering two years and four months. Essential appointments for children are being cancelled regularly due to the consultant paediatric rheumatologist being called for on-call emergency treatments in Crumlin hospital. On foot of the cancellation of these essential appointments, many children who are on what are highly dangerous drugs are not being viewed with the frequency required to give them the optimum care and treatment plan that is needed. In essence, what is needed is an increase in the number of paediatricians and, in particular, an increase in the number of rheumatologists here in Ireland. In addition, I note this service is only provided for in Dublin. While Manorhamilton is a centre for arthritis and related matters in north County Leitrim, it is an adult-only service that children cannot attend. What is required to avoid children being obliged to make long journeys or to have such long waits is to have a regional locum clinic for this condition visited by the appropriate paediatric rheumatologist. As I noted, the WHO recommends six weeks whereas in Ireland, a poor service is being delivered at present with waiting times of two years and four months. Clearly, children who are obliged to wait for so long while suffering from such an acute illness could be irreparably damaged. As they are growing, they obviously need ongoing care of a specialist nature and children in Ireland are being failed at present.

I also wish to raise the issue of home help hours, which has become an issue in all Members' constituencies. All Members are aware the cupboard is bare in terms of resources but it is about the management of what is being done. Older person services are covered under the social care division, which in turn is a division within the community care area. The Ministers of State opposite may be able to find out the name of the national lead in this regard but I understand, and anecdotal evidence certainly confirms, this individual is directing nationally that all help hours are to be reduced. Moreover, the direction is not to go over a certain amount regardless of the level of needs or dependency. I ask the Ministers of State to look into this on a national basis because this is what is coming back anecdotally from the social care professionals throughout the country.

In addition, I refer to the many people who wish to be cared for in their own homes and who are surviving quite well there with the appropriate level of home help hours. The reductions arising from the new directive that appears to be coming down from the aforementioned lead person in older person services, which is under the aegis of the lead person for social care, will mean these people will not be able to cope. In turn, this will put more pressure on the nursing homes throughout the country and as Members are aware, there is a shortage of nursing home beds with an ageing population and in turn, that will put even more pressure on the acute services. Moving on from that, the winter initiative in effect means that patients being discharged from hospitals are receiving priority over those who are already receiving home help in their homes. This will put further pressures on that scheme and there should not be such a prioritisation at the expense of people who already are being cared for in the community.

As I do not wish to be seen as merely moaning without at least suggesting some solutions, I will reiterate a suggestion I made as a Member of the Seanad and in the Dáil earlier in this term. Costings should be carried out on the partial abolition, at least, of the means test on the carer's allowance. To my mind, everyone has a relative, be it a sister, a brother, an aunt, an uncle, a father, a mother or a grandmother, for whom a family member would be more than capable of caring in the home with the benefit of the carer's allowance. This would enable that person to keep the relative in his or her home. In addition, one could ensure the person was in receipt of a medical card. To add further to this point, even if home adaptation grants were required for that purpose, it still would be a fraction of the cost when compared with the average weekly cost of a nursing home, which is between €800 and €1,600 per week depending on the part of the country and whether they are public or private, which is a colossal amount of money. To go further, the cost of an acute bed per day is approximately €1,000. Consequently, these figures certainly justify carrying out a costing on this proposal and being prepared to push the boat out to ask whether there is a better way to keep people in their homes. Clearly, that is where people would like to remain and if there are family members who are in a position to care and to do this, why do we not at least examine the potential to give such people the carer's allowance, as well as some additional supports? To my mind, a cursory glance suggests the large amount of money that could be saved, not to mention the pressure that would be taken off what is a small number of nursing home beds. Moreover, from listening to the spokesperson for the emergency medicine practitioners in Ireland, Mr. Fergal Hickey, all Members are aware of the difficulties being experienced in respect of bed numbers in acute hospitals. He suggests, for example, that 300 people die every year because not enough beds are made available for people on the acute side and I ask the Ministers of State to take this on board as well.

My colleague mentioned the drug Orkambi. I cannot stress enough the importance of making this drug available to patients throughout the country who are suitable for treatment. Orkambi is a game-changer. By changing the game, we can equally reduce the burden on the State in terms of caring for these patients when they become more ill because Orkambi is not available to them. Young people have passed away in every constituency. In my own constituency, in particular, the late and courageous Gráinne Golden and her family, her sister Aisling and mother Terri, have been exemplary in promoting the need to make this available. Former Senator John Crown and I brought forward a suggestion in the previous Seanad to the effect that rather than people being obliged to fight, through Joe Duffy's "Liveline" and other means, to get access to certain life-saving cancer treatments and drugs, it should be the case that the Government opts out of the provision of a drug if the cost per life saved is not justifiable. We had the ipilimumab crisis in terms of skin cancer some years ago. Orkambi is no different. We can change the lives of these young people and their families. As I said, if it is merely down to pounds, shillings and pence, we can also remove some of the burden on State because if people are not treated with this drug, they will become a greater burden down the line.

All politics is local, as Tip O'Neill famously said. I do not want to lose the opportunity to comment against the backdrop of a Minister of State perpetrating a charade whereby he sought to have an additional cardiac catheterisation laboratory facility put in place in Waterford where, from a clinical point of view, one is not needed. There is an existing lab there and cardiac care is available. In addition, there is also a motorway to Dublin. There is good proximity to Cork, where there are many cardiologists. The position in the north-west of the country is somewhat different. Indeed, I must give the analogy of two maps I came across lately - one showed the road network in 1729 and the other was for the motorway network in 2016. These maps which mirror each another. Indeed, many of the acute health services are the same - north of a line between Dublin and Galway and west of Mullingar, or, for want of a better expression, the greater Dublin area, there are no cardiac catheterisation laboratory facilities. If one has a heart attack in that part of the country, one has a lesser likelihood of survival than somebody in Dublin or, indeed, Waterford who suffers a heart attack. Prior to the election, the Government announced that there would be a cardiac catheterisation laboratory in Sligo to serve the north-west region. Deputy Tony McLoughlin can confirm this in the event anybody in the House has a short memory. We are anxious to know when we will move to a position where tenders will take place and these services will be available so that the people in the north-west have the same possibility to survive as those equal citizens from other parts of the country.

We have had an issue with follow-up mammography, in respect of what a pre-election promise was also made. As the Minister will be aware, cancer services were stripped out of the north-west in what, quite frankly, was a shameful act by a previous Government. In fact, my own party was in government at that time. It was the wrong decision then and it remains equally wrong today. Follow-up mammography for those ladies who require it was promised prior to the election and now it seems what we will have is a truck visiting for two weeks per annum to facilitate only those women who, thankfully, have been five years clear of cancer. That is all that will come.

In terms of other capital plans that also were announced, one which dates back to 2010 is a new 90-bed facility in Sligo University Hospital, formerly Sligo Regional Hospital. I wonder how much the rebranding cost. Perhaps that money could have been better placed in upgrading the facilities that have been promised by successive Governments over the years. There is a 90-bed facility somewhere in the mix and I would very much like to see an update on that. That hospital serves a population in the region of 280,000 and we are interested to know when precisely that will be up and running.

I refer to a new 21-bed facility at the existing mental hospital. Currently, there is a facility where, no matter what their complaints, people are all put together in wards. In terms of its practice, it is almost medieval. There is a 21-bed facility in the mix somewhere in the capital plan within the HSE but rumours abound that the priority of this Government is only the national children's hospital and that everything else will be placed on hold as a result. We would like to get some clarification on that issue also.

Finally, I ask in connection with waiting list times throughout the country. I touched on the position regarding rheumatologists and, specifically, the need for more consultant rheumatologists to be appointed on the children's side. In the context of psychology and psychiatry, the waiting times for children with issues are beyond a joke. In some instances, the waiting period is a couple of years. In others, it is many months. This is simply far too long for people to be obliged to wait. I appeal to the Minister. While I appreciate that we are discussing the Health (Miscellaneous Provisions) Bill, which my party will be supporting, and rather than waste the time that was available, it was important to highlight some of the genuine needs of the north-west and, indeed, children throughout the country. I would also ask that the Minister would reminisce upon and embrace some of the pre-election promises which the people of the north-west have waited far too long to see fulfilled.

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