Brendan Smith (Cavan-Monaghan, Fianna Fail) | Oireachtas source

I welcome the opportunity to make a brief contribution on this report as I have to go back to a committee meeting. I compliment Deputy Róisín Shortall. My party colleague, Deputy John Brassil, and Deputy Michael Harty were members of the committee. The committee put in a huge amount of work over a considerable length of time, which showed their commitment and knowledge of the whole area of health. It is an ambitious programme and a challenging one to fund, but it has to be realisable for the good of the people of this country.

Far too often, we hear about the need for structural change, etc., but part of the structural change is implemented and then the other commitments that were made in advance of those changes are not implemented. In too many instances in this country, we have had the removal of services from the smaller general hospitals but we were told that the ambulance service in those regions would be upgraded to ensure that no delays occurred in transferring patients to the new centre, if one wants to call it that. The Minister of State will be aware of the concerns we have in the Cavan-Monaghan area in regard to the ambulance services. Many years ago, when some services were removed from Monaghan General Hospital and transferred to Cavan General Hospital and Our Lady of Lourdes' Hospital in Drogheda, we were promised the ambulance service would be upgraded. Not alone would the fleet be upgraded but the paramedics working there were to be upskilled and would take on new responsibilities. In some instances, that has happened. When it has the most modern facilities and vehicles and highly qualified paramedics, the ambulance service can make a significant difference to the patient in need of treatment. However, far too often, we are coming across instances of undue delays in ambulance response times and the issue needs to be addressed.

The Department of Health will not be able to convince people of the need for structural change and the transfer of services from one location to another if the public is not confident that the structural change promised will be implemented. Those resources have not been given to the ambulance service to ensure the services that personnel working in the ambulance service want to provide are effective on an ongoing basis. I have had correspondence with the Minister for Health with regard to some instances in County Monaghan. The delays that occurred were deplorable and, sadly, some people who may have been saved if there had been intervention at the right time have passed away. That is an obvious source of terrible grief, anguish and concern for those families. However, those families who lost loved ones as they did not get the response from the ambulance service in time have said to me repeatedly that unfortunately they cannot bring back their family member but that their concern is about saving someone else in the future. I will speak to the Minister of State another time about some of those instances. However, it is essential that the ambulance service is upgraded if we are to have meaningful reform and structural change.

I have not had an opportunity to refresh myself on the contents of the Sláintecare report this morning because I have been at committee since early morning. The report is both good and ambitious, and it should be realisable. That should be the concern of all of us who are privileged to be Members of this House. However, my recollection of the report is that there is very little mention of the potential for co-operation with Northern Ireland. All of us in this House are influenced by where we come from. In the worst of days of North-South relations and British-Irish relations, particular initiatives were put in place. What is called the Ballyconnell agreement goes back to July 1992, when the co-operation and working together, CAWT, partnership was introduced between the trusts in Northern Ireland and the North Eastern Health Board and the North Western Health Board, as they were structured at the time, to provide services for those regions on a cross-Border basis. That particular initiative has been very successful. I recall over the years from my early days making representations that some services were delivered from the then Omagh General Hospital to Cavan General Hospital and Monaghan General Hospital. At the minute, some ENT services are provided by the hospital in Coleraine.

In providing services on this island, we have to assess the capacity for elective surgery on all of the island. For instance, in the area of ENT, with which I am familiar, that level of co-operation exists but needs to be upgraded. However, surely there are other areas where we have to identify potential for greater co-operation. I welcome the fact that paediatric cardiac services are provided at Crumlin hospital for children from Northern Ireland. We are too small an island to be living in isolation and in silos. We must have increased co-operation. We know the Brexit challenges that are coming down the road. We have to plan on the basis that health care on this island should be delivered, where possible, on a cross-Border basis. I am talking about elective surgery and access to emergency departments on both sides of the Border. Some of my constituents in Cavan-Monaghan live nearer to the South West Acute Hospital in Enniskillen than Cavan General Hospital. We have to ensure that there is increased co-operation at all levels. It would be farcical if there was spare capacity in the South West Acute Hospital in Enniskillen while we were not able to treat in time the patients needing such services on our side of the Border.

I believe I am accurate in saying that not enough emphasis has been placed on North-South cross-Border co-operation in this Sláintecare report and if there is any review or further analysis of the report then this is an area I would like to see revisited if at all possible.

Like some of the rest of us here in the Chamber, the Minister of State represents a very rural constituency. There is increasing concern among rural GPs over their inability to attract support staff or indeed other GPs. I know that the age profile of GPs in my counties of Cavan and Monaghan is quite high. Some of the GPs with what might be considered good practices say to me that there is no hope of those practices continuing when they retire themselves. This is a very worrying prospect. Speaking in his professional capacity as a GP, Deputy Harty has spoken here about the need for proper supports for the primary care sector so as to ensure that people have access to a proper service at the appropriate time. GP and primary care have to be resourced properly. We need to give urgent consideration to how we can attract more GPs, particularly to rural communities.

With regard to care for the elderly, I welcome some of the developments and indeed some of the facilities that the Minister of State and I have visited together. These are very good and provide a very good service but in too many instances delays and pressures arise over getting people in. One particular initiative was taken many years ago in my home county of Cavan and it may even have crossed into Deputy O'Rourke's native Leitrim. It was called "boarding out" and was targeted at elderly people who lived alone but were still somewhat independent. These were people who did not need to be in a nursing home but were nonetheless unable to manage living at home on their own, particularly those in remote areas. Provision was made under this scheme that four or five people could go to live in a "boarding-out house", as it was called, with adequate care and attention provided by the people running the facility. The older people could then lead independent lives: they could go down the town or down the village and they became part of the family. That scheme was very successful for many years in County Cavan but is currently being run down. The cost to the Exchequer of such a scheme was substantially less than the costs that would have been incurred had those people been placed in nursing home care. I know people who lived in these kinds of boarding-out houses for many years. They were semi-independent and were able to go down the town or go out to football matches with a family member, or whatever else; they were also cared for and all of their needs were met in a family home setting. We should be pursuing initiatives like this which would ease the pressure on both public and private beds. Perhaps the Minister of State could have a chat with me about this. The bottom line is that, as well as providing proper care - I am not talking here about care delivered below the standards that we all want to see - the cost to the Exchequer was considerably lower than that of a person going into a nursing home.

To conclude, I would also like to stress that the whole area of home support, an excellent service, needs additional funding and we cannot wait for the re-organisation of the health service to provide this. We need additional supports as soon as possible.

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