Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I am glad to have an opportunity to contribute to this very important debate on the issue of investment in healthcare. There are many facets to it and many demands because it is demand-driven. I have raised this issue on numerous occasions. Every year after the budget, the question has always been to ask the Minister for Health to indicate whether the budget allocation for his Department is sufficient to meet the requirements for the next 12 months. It is a simple, straightforward question and the answer is always "Yes". However, as we come to the end of the year, the answer becomes a little bit faded and not as clear as it was before. Suddenly we hear condemnation of the Government, that it has not done things according to the plan, that it has fallen down on the job and is to blame and so on and so forth. This is despite the fact that a considerable investment is being made on annual basis here, comparable to that made in any other country in Europe. In fact it is considerably more than in many countries.

It now falls to us to ask the simple question. We need to put our ducks in a row. We need to find out exactly where the cost increases are coming from. That requires a certain person, when drawing up the Estimates, to be able to identify the potentials in every area and to be able to put that into a package that is readily available to the Minister when the allocations are being agreed upon. Without that we will always have the same problem of running after the cart, as it were, and all the time trying to catch up from a position of being behind the curve. This simply does not work. In private industry, if somebody is given the job of projecting the cost for the next 12 months or the next two years or more and they do not do it in accordance with the request they have to find a job elsewhere.

We have to admit that we need a correct assessment of the costs at the time of the budget. That includes everything. There are prime cost sums in every other sector of life that are provided for and priorities are determined. The sooner we get to that stage and rely on it, the better for everybody concerned. This would eliminate the continual harangue about how bad the services are and how everybody is under pressure as a result and how no one gets the level of care they need. We either cost it properly and effectively and we then deliver on that or we continue this same circuit on an annual basis. It does not work.

I remember, as will the Ceann Comhairle, when the old mental health facilities were closed down. Everybody said that it was a great idea, which it was. It was essential that it happened. There were people in some places who had spent up to 20 years in the same room upstairs and had never seen the light of day in all that time. However, the problem was that when the facilities were closed down, we did not make alternative provision. As a result of that, we have a greater number of people living on the streets and a greater number of people who are incapable of functioning in today's challenging society. That is in respect of child and adult mental health services and indeed general health services. The list goes on forever and we have all dealt with it on a daily and a monthly basis and it keeps coming back up again.

Some years ago we also discussed the need for more home care. This is an absolutely wonderful idea. Some of us had experience of the daycare services in County Kildare. They worked extremely well. Of course it meant that the patient had to go to daycare service, which they wanted to do, anyway. They wanted to mix with other people and be part and parcel of society and get the same care that they would get there as if they went to a hospital. It still works very well in County Kildare but it is limited.

The problem was that other people sold the story that care would be better in the home. Of course it would be but it cost an awful lot more and nobody ever said that. The Ceann Comhairle and I pointed this out on numerous occasions. It is logical that it would cost more. The most important element here is that it does not matter how many carers we have. With an increasing population and an increasing demand, it takes time to travel between point A and point B. With the increase in traffic on the roads and the increase in population, it takes longer to travel between point A and point B, so it is more expensive, as we anticipated it would be We need to address this issue. We either want it one way or the other way but we need to provide the service. We have to think about the most appropriate way to deliver the service and we have to do it soon.

There is an increasing demand for child mental health services for all the reasons we all have talked about. It is wrong that children who have mental health problems are put on the long finger in terms of attending to their needs. This has been going on for years. I am not blaming any Minister, it is just a fact of life. We need to get the show up and running and to deal with the issue. This applies to all counties. It requires an accurate costing at the outset and it requires putting the show on the road and into operation. I think that can be done but we have to first identify the costs. If we do not, we are going to be disappointed because there will be overruns.

I am tired and sick to my back teeth of hearing about cost overruns in the health service. It is a question of identifying what the real costs are in the first place and then delivering on them. It will be an improvement to the health service because the providers are under the cosh, as it were, all of the time. They are under the microscope and they face continuous criticism that despite more money and more staff the service is not as good as it should be. Whatever the other issues are, we need to deal with that as a matter of urgency. A couple of years ago, I read a report by an official who had the temerity to put on paper her observations of mental health issues and the number of cases referred to hospital over a two-year period. What shocked me at the time was that children as young as eight were being referred to hospital for self-harming and attempting to commit suicide. That is a sad situation that should not be allowed. In our constituency clinics we can observe the children who come in with their parents. Without being an expert at all, it is easy to notice the child who is in difficulty. If it is that obvious, the child should have been attended to long before it becomes obvious to a passer-by. We need to concentrate our efforts on this.

The children's hospital is notorious for being one of the largest cost overruns ever. Many people say that it is the greatest waste of money ever. I say that it is not. That is what is required in today's competitive society. For many years, we have been working with old fashioned systems that are no longer applicable in the present demanding world. If we can deal with this, we can silence the constant criticism and ease the pressure on the people who are trying to provide the service and are doing the best they can in the circumstances but we also have to commit ourselves to the actual identification of the spend.

The oldest trick in the book as we know - I used to do it when I was in opposition, strange as it may seem - is to predict an overspend by allegedly identifying an actual cost in the beginning. If that is pitched low enough, it can be adjusted as needed and as meets the demand in order to exaggerate what is needed to provide a reasonable service. I think we have sufficient funding in the system and it is consistently sufficient to be able to do the job to a far greater extent than we are doing it, but it needs considerable operational review.

I have spoken in the House before about the layout of accident and emergency departments. I spoke previously in the House about delivering a patient to an accident and emergency department. The accident and emergency department was crowded with people who had alcohol and drug addictions. They are correctly entitled to their treatment and should get it. That is the appropriate place in the whatever room is available in that particular institution. However, they should not have to sit on the seats that are around, two at a time with a blanket thrown over them waiting, and the people behind them who are in pain and obviously in need of attention, have to wait until these are all cleared. I can understand people having to wait for somebody ahead of them. However, they should be in the area where the specialty is available to deal with the situation; that is good organisation.

On this occasion, I was told I could not park in various locations. My obvious question was, "Where do you park, if you bring your person who is not ambulant into the reception area?" The answer was nothing - just blank silence and that should not be. We have to make the comparison with a private hospital because there should always be a certain amount of competition between the two. We need to have the two, one to take the overflow from the other as necessary. We need to have good solid reliable services. In the private system, people can go to the set-down area right outside the reception area, drop the patient off, go into the reception area, find a seat, come back out, take the vehicle away down into the car park directly underneath and go back up in the lift to reception again. The patient does not need to drag themselves or to be dragged by somebody else from one place to another and be told, "That's not really the place you're supposed to be." We need better organisation and delivery by a long shot.

I know the Ministers have made unannounced visits to hospitals, which is a good thing. As they will know, in the old days we were all on hospital visiting committees. We had a very difficult job to do; nobody liked to see us arriving on the scene. We did some things that needed to be done at the time without any fuss and without waiting for any report. It was never a question of asking for a report on something and then six or ten months later we might see some action on it. It was done the next day, within 24 hours. That is another lesson.

I could go on forever and I am sure the Ceann Comhairle could go on for at least as long, but I do not intend to so do. I ask the Ministers not to lose sight of the objectives and not to take criticism too seriously because there will always be criticism. However, one issue needs to be determined and that is the amount of money required to run the hospital services, the community care services and all the services for a year. Giving it a year at a time would make a huge improvement in the delivery of services.

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