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

This important Bill makes significant amendments that afford the Minister additional ways of ensuring that no sum of money received by victims of medical misadventures in compensation as part of a new deal will be included in any assessment of means under the nursing homes support scheme. The scheme is expensive and has existed for a number of years and there are significant problems with it. For example, I receive complaints from people in nursing homes or their families to the effect that, although they agreed to an overall package before entering a home, many elements were not included. Clarity is needed as regards what is being offered and paid in these deals. A person signs a list of items when entering a nursing home, but homes often ask for extra money subsequently, which can eat into the small resources still in the pensioner's hands after paying for the fair deal. This has a significant and adverse impact on many pensioners. Pressure is placed on them to pay for additional items that should have been included in the deal and of which they may never be able to avail. For example, someone who is bed-bound because he or she cannot move a leg or arm due to a medical condition might have to pay for entertainment and other activities that he or she cannot even attend or participate in.

As the Acting Chairman knows, a question about home help has arisen in our constituency. In many cases, the home help system in County Louth is not working efficiently or well. I am still receiving complaints from people who have applied for home help services or whose home help hours have been cut. What is the point in cutting people's home help hours when the alternative is a nursing home at a much higher cost to the State and a significant reduction in the benefit derived by being supported to live independently in one's own home as best one can regardless of one's medical condition? This is a concern and I am not satisfied that the system is working to everyone's benefit. For example, I fail to see the advantage in offering an elderly person half an hour per day of home care over a week, which is often the case. By the time the person who comes to the home can get anything done, it is already time to go. In such a situation, the advantage that someone's carer might otherwise have - going out, taking a break, doing a bit of shopping, getting a breath of fresh air or having a little bit of a social life - is not available. This must be addressed in respect of people with significant adverse medical conditions. The transparency of decision making in the HSE concerns me. I have tried to communicate with the HSE and get a better understanding of what is happening within it as regards home help, but I have failed.

The question of respite care also arises in our constituency. Some people can get respite care from the HSE in institutions, but a significant number in our constituency cannot get any. This is because no spaces are available. They have intellectual disabilities and the respite care previously afforded them by the St. John of God services in Drumcar is no longer sufficiently available. I am concerned about this. We have held a number of meetings about it, including with the Minister, but the situation remains unresolved. The key benefit of respite care is that it keeps people out of long-term care and gives families an opportunity to do things that they would not otherwise be able to do. When adults suffering mental disabilities have nowhere to go, it is unacceptable that the funding provided to the St. John of God services cannot be broken down to identify how much of it is for respite care. This is an emerging need across the country, with a large number of families encountering problems in getting respite care because the congregated settings principle has ended. While I welcome the fact that funding is now going towards resourcing adequate and proper homes for long-term patients in the community, people who need respite care are not being considered and nothing is being made available to them.

I welcome other aspects of the legislation, but I wish to make a point about cataract operations in County Louth. A constituent told me this week that the private waiting list is four weeks long. If he could come up with the money, which he cannot, then he could have his cataracts dealt with in four weeks. Instead, he must wait 18-24 months to attend the Mater hospital. This is unacceptable. If he availed of the facility to go north of the Border, his operation would be almost twice as expensive as it would be in the South and he would be expected to pay the difference. The State covers £1,184, which is the listed price for a cataract operation, and the price in the North is £2,198. The State is obliged to ensure that people get their operations in time, but one must come up with the difference if one goes to the North or else suffer for a further 24 months.

Notwithstanding the Bill's good elements, problems continue to exist in our health service. The HSE needs to be made more accountable, particularly to Members of the Oireachtas, in how it operates. My colleague, Deputy Fitzpatrick, referred to being a member of the health committee. I am not a member, although I have tried to become one. Unfortunately, I was turned down. Obviously, I do not qualify with my interest in health. I would love to make the HSE accountable on a regional level to Members of the Oireachtas. When an Oireachtas Member was a member of a health board, one attended its meeting every month and could raise and get an answer and action on any acute care or community care issue affecting one's county. Now, we cannot meet the people in question. They hide behind e-mails. Notwithstanding the fact that, the HSE has a good communicator in Mr. Dermot Monaghan, who is exceptionally capable and helpful. However, it is impossible at times to contact other people further down the line. I would like the HSE to be accountable to Members on a two or three-county basis. It keeps reorganising itself and I do not know what dance it is doing in what counties at present, but it is not accountable. People run and hide from us and the public suffers as a result. I would like to see more accountability to the Oireachtas, notwithstanding the efforts of the health committee. Deputies and Senators would meet the HSE executives from each group of counties - I believe our group used to comprise Louth, Meath, Cavan and Monaghan - on a quarterly basis.

They would go through issues of concern for only those areas and I should make it very clear that it would not be about taking up issues outside the brief. They would have to give due notice of questions and copies of reports. That would make them much more accountable and much less likely to provide bad health care.

I am familiar with the case of a person who died a very tragic and appalling death while in care. The family feel the same. The inability of the HSE to provide an independent investigating team indicated the following problems. An investigation was established that did not include medical people so the family could not accept the result. A doctor who worked with the HSE met another specialist in a second investigation but the doctor resigned from the committee - I am told it was because of work pressures - and the investigation ceased. I am thankful that in the past two weeks an independent private company has begun to investigate this appalling death. I welcome the investigation, which will be professional, thorough, full and fair. Nevertheless, the HSE cannot and should not investigate itself and attempts for it to do so are wrong. The HSE needs a body separated from the executive in every respect, with a field of specialists available to investigate tragedies, health mismanagement and deaths that could bring serious concern to the public. The family I spoke of has been waiting four years for accountability in respect of the death of its relative. If such an separate and independent process could be put in place, such people would not have to wait that long. That process should be professional in doing its work. For families to get closure in the event of tragic deaths like this is very important for the people in question and the State. There should be independent analysis of what happened and how it can be prevented from happening again.

I welcome the changing of some previously prescription items to being available over the counter with a medical card. It is a very positive move that will alleviate medical problems for people who need creams or different products. Not every person with a medical card will need them but some will. If the product was not on the list in the past, they could not afford the medication. I welcome that change.

I am still amazed by the number of people who continue to smoke. Many of them are very young. I might see them walking across the street and I would say "Hey guys, you know that in 20 or 30 years you will probably be in your graves". That is what I say in my head and I do not actually say it do them. How can one miss all the health issues associated with smoking? Anything we can do to stamp out the evils of tobacco, with all the additional powers being vested in the Minister to make new and better regulations on tobacco packaging, should be welcomed.

I thank the Ceann Comhairle for the freedom to deal with a range of issues. I will deal another time with 900 complaints made to HIQA four years ago. I gave the information to the Garda and received a report on it recently. I probably do not have enough time to deal with it today. I welcome the Bill and the changes proposed. The Minister of State is listening and I hope the Department will hear what I say. We will raise these questions and issues again.

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