Mattie McGrath (Tipperary, Independent) | Oireachtas source

I defer to Dr. Harty and his experience. I have some limited experience of dealing with GPs and of watching very harrowing cases where we have seen the HSE and its legal advisers drag families through the courts for years, sometimes decades, and have then admitted liability on the steps of a court. Huge awards have been paid and trauma and stress have been inflicted on families in situations which were totally outside their control and unfair. I welcome the Bill as an effort to deal with this. It has been harrowing to hear statements on the news of a loved one who has fought sometimes for ten or 15 years. It is serious. The State Claims Agency needs to be reformed. If there is clear knowledge and legal expertise that says something happened, without admitting total liability, it must settle these cases. There must be humanity. In many areas, the HSE lacks humanity and the human touch.

Deputy Harty compared the insurance costs and legal claims when he started to those today. There seems to be no holding back. The figures for 2014 and 2015 as well as the anticipated costs for 2016 were quoted. The money is phenomenal. One would need a computer to tally it. It has trebled between 2014 and 2016. I am involved in a community involvement scheme and the insurance has increased from €50 per participant to €150; it has trebled. Lo and behold, when we got a cheaper quote, the insurance company told us it would match it. It is nothing short of a racket. I have said it here before. The insurance industry is an extortionist racket and legalised robbery. It could not be called anything else. Insurance companies tell customers if they get a cheaper quote they will match it, but first they give a shocking quote to a voluntary group that cannot afford it.

We are trying to attract young GPs. We have lost our best and brightest. It takes a village to rear a child. A person who studies medicine has to work and study very hard. Many ordinary, middle-class people - the new poor, as I call them - do not get grants, and their families have to put them through college. Then we lose them all as they go abroad because of the abject, dire conditions in which they are expected to work in public hospitals.

Rural GPs suffer loneliness and lack of support. We fought it in Bansha for years. If there is no doctor, there is no village. Those in the larger practices have the support of colleagues and others if they get sick. It has been 40 years since the GP contract was updated. A group of doctors had to break away from the Irish Medical Organisation, IMO, because the IMO is a cosy cartel, as in so many other areas of health administration, including the Department and the HSE. It is completely out of control. There is no understanding, interest, passion or vision to look after the ordinary people, ensure we have GPs, put some bit of respect and manners on the insurance industry and ensure there is some bit of humanity regarding settling claims and not dragging people to the courts for years. Nobody is accountable, that is the problem.

In 1983, Mr. Paul Kelly, the boss of Console, employed himself as a GP. Where were the checks and balances on him? Did he have indemnity insurance? I would love to know. It is a pity he did not have it in a charitable organisation either. We can see gaping holes. This is where we are left. I recently saw a case on television in which a fitness to practice committee was examining a case in the west in which a consultant did not know the difference between an ankle and an elbow. There is some difference. A vet dealing with an animal that could not tell him or her where it had a pain would know, but this guy did not know the difference between the ankle and the elbow. I wonder who employed him and what insurance cover he got. How could someone like that be insured? He could not be insured. How did he get through the system? How was he employed in a hospital? There are question marks all the time and I am sure there are many more instances.

Notwithstanding the powerful work that goes on in our hospitals and in GP practices and that is being done by front-line nurses, it is the HSE we need legislation for. We need legislation to get rid of it, to stand it down. It has cannibalised itself and is totally dysfunctional and unable to react to any situation, because there is not a shred of accountability. When I put down a parliamentary question to the Minister, it is referred to the HSE for an answer. It is a joke. Two former Fianna Fáil taoisigh promised me they were going to disband the HSE, but it goes on and works away and it is not accountable or made adaptable.

Last weekend, I met a woman whose two daughters went to work as nurses in Australia. Representatives of the Bon Secours Hospital in Cork went to Australia to entice them to return to work in that hospital. They returned, yet we in Tipperary cannot get them. They travel from Tipperary to Cork every day and will not work in South Tipperary General Hospital because it is bedlam. This morning nurses would not attend at the hospital because they could not cope. Trolley numbers have increased 220% this November compared to last November. Think about the front-line staff. We have ward managers, floor managers, bed managers, linen managers, hygiene managers and food managers. We nearly have yard managers. We have everybody to manage but nobody to work. The lunatics are running the asylum. We see what is going on in Portlaoise hospital. Ordinary, dedicated, passionate people who have taken the hippocratic oath to work to cure people are not supported. They are hindered, blindfolded, restricted and blackguarded by senior management. Most the time, they do not even have blankets or pillows to lie on the trolleys. If we saw it on television happening in a Third World country we would have collections. We have had collections to send food out those unfortunate people, but we have it on our doorsteps. There is no explanation for it. It should not be happening.

I salute the GP practices for the work they do. It is a tough job. They have to make decisions after a ten, 15 or 20 minute consultation. I recently brought the Minister for Health, Deputy Harris, to two GP practices in Clonmel, the Mary Street Medical Centre and the Western House Medical Centre. They have fabulous experience there. They have six or seven doctors with 20 or 30 years of experience each, totalling hundreds of years of experience. They have made huge investments in diagnostic equipment and they have medical insurance, which costs them a fortune. The HSE has a two-year waiting list for a simple ultrasound diagnosis. However, because of bureaucracy, the HSE will not allow patients to be diagnosed in these GP clinics, which have links to colleges and people in university hospitals to read the X-rays and scans. Instead, they must send their patients to the accident and emergency departments to further overcrowd them, for fear they are not bad enough, and wait a minimum of six months. It could be done in these GP clinics for a fraction of the cost and it would take away the pressure from the accident and emergency departments. How can we get this through to the HSE? We write to, telephone and make other contact with the HSE. The Minister and I visited another clinic that had extensive diagnostic equipment, some of which I did not even understand. Although this clinic could do the same, it must send its patients to accident and emergency, where they go into a packed ward and wait hours or even days on trolleys before meeting a junior doctor. I mean no disrespect to the people working there. These junior doctors are much less experienced than the GPs and are tired from working 20 hours shifts. Although this is supposed to be outlawed, they are working 20 hour shifts and are going around like zombies, but are expected to make decisions. The diagnosis could have been done in the calm and relaxed atmosphere of the GP clinic. The GP clinics I deal with are very warm, friendly places. However, this would involve the loss of a little bit of the imperial control of certain management systems in the hospital. This is what it is all about: control and egotistical power trips for promotions.

When the consultants retire, which they are entitled to do, they contract their services out to the HSE for weeks, if not months, afterwards. It is a rotten, disgusting racket and it should be stopped.

The HSE should not stop this because it is not serving the public or the sick. It is self-serving and it is shameful.

We have a hospital in Cashel on which €18 million or €20 million was spent after it was closed. There is not a patient inside it notwithstanding the bedlam 15 miles down the road in Clonmel. We cannot put a patient in it, even though the Minister, Deputy Harris, visited recently at our request to see what was going on. It is state-of-the-art but it is office after office. There are suites of offices and what is being done in them could be done in any office in any part of the country. There are plenty of them so let hospitals be used to treat people. I have asked the Minister about it and I asked the Taoiseach about it last week. HIQA will not allow it to be used because there is no lift. We had a perfectly good bed lift which I was in twice as a patient. However, in the upgrade, the planner of which I would love to know, the bed lift was removed for fear we would put a patient into it and interfere with their grand, powerful headquarters with its colour-coded tiles, armchairs and wall-mounted paintings. "We could not have patients in here; this is for us", they say. There is something rotten in the state of Denmark and there is something rotten in the state of the HSE. It is totally dysfunctional and we cannot use the facility. HIQA says that because we have no lift, we could not evacuate in the event of a fire. HIQA is cited because we do not have this, that or the other. I have told the Minister to sell it to the Bon Secours. He should put it up for sale to some private company that would come in, work it as a hospital and treat people rather than to have it as an emporium-style headquarters for officialdom. It is beyond a joke. We had St. Luke's psychiatric hospital for years and it served the people. It was closed down and one third of it is now offices.

I support the Bill but we need a great deal more legislation. We have to look at a lot more than persecuting GPs. By all means, they have to have insurance but we need to keep control of insurers. Insurance companies are watching this tonight and rubbing their hands with glee because they see money and slot machines. We must support the GPs and ensure, of course, that they have insurance, but we also need to have insurance at reasonable prices.

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