John McGuinness (Carlow-Kilkenny, Fianna Fail)

I thank the Cathaoirleach Gníomhach for facilitating the time for me to contribute to this Bill. I appreciate his helping me out.

When I look at the Bill and see the different approaches being taken to corporate governance and accountability, I am happy to support it. These types of reforms and changes, and a lot more, are necessary. I will go with the content of the Bill but a lot more needs to be done to make the HSE accountable and transparent and to ensure public trust in the health services is restored. We can only do that by taking action and living by the word of the legislation.

In my world of business, what gets counted gets done. For far too long, we have had a lot going on in the HSE that was neither counted nor being done. Any of the changes that were suggested were suggested off the cuff. Reform was introduced but without drivers of reform - in line with the legislation and the changes that are necessary - to direct and change, there was no change. That is what has happened over the years. Legislation and actions have been taken in good faith but were never implemented in full.

One only has to look back over the parliamentary questions asked every day the Dáil sits to see what TDs are asking about. They are asking about medical cards, delays in delivery, appointments not being filled, people on waiting lists waiting far beyond an acceptable time limit, complaints within the health service, the delivery of capital programmes and so on. As long as those questions are being asked, the Minister can be sure that the services, the capital spend and the accountability and transparency that we all talk about are not being delivered in the counties, the regions or nationally. That is an undeniable fact.

People will measure this by the delivery of services. When older people are in hospital beds waiting to be discharged to go home, their families are given a care plan. They are told they will be looked after from Monday to Sunday and these are the hours they can expect. However, as soon as they are in the family home to be looked after they find out that none of this is true. They may get a fraction of the hours they have been promised. That is not acceptable. Even more perverse is the fact that the families, I would say, are conned into believing they will get the services, but they do not. This puts massive pressure on families who want to contribute to the care of their loved ones. They will put in the hours themselves but are restricted in what they can do and need support. These families should be supported. They should be told exactly what they are going to get. I would love to know where the thousands of hours that have been allocated to the services for the care of people at home are all gone. I do not see them being implemented or used in counties Carlow and Kilkenny. I just see a stream of people coming into my office complaining, not that they have not got hours but that they have not got the hours they were promised when they were taking their loved one home. Nor have they received supports such as hoists and wheelchairs and other provisions that would make life easier for them and their families at home. I ask the Minister to take a serious, deep look at what is happening in regard to the delivery of those services. What is happening to those hours?

The other theme that runs through health services is the ambulance service. You cannot talk about the health service without talking about the ambulance service. I have met some of the ambulance crews and paramedics in the headquarters in Carlow. There is capital investment going on there. Patients, drivers and paramedics tell us stories of turning up to a scene, a house or a random location two or three hours after a call was made. For three hours, whatever happened to cause the ambulance to come has been waiting to be dealt with. A gentleman wrote to me recently to say a man had a heart attack on Patrick Street, Kilkenny. The ambulance was so delayed that people rang the Garda. Hours later, the ambulance came, only to find that gardaí had taken away the heart attack victim. That is not uncommon. In another location in Kilkenny two ambulances turned up. I witnessed it myself. What kind of service is that? What kind of waste is that? Where is the governance and transparency there?

I spoke to a lady yesterday who was on a trolley in St. Luke's hospital in Kilkenny for two days. The past two days were particularly warm, yet she was on a trolley in the corridor with the heating on at full blast. There was no way it could be turned down. Her requests fell on deaf ears. That is a small thing but what does it tell the public about an organisation when it disregards complaints that are made? What householder would not turn down the heat if they were conscious of the cost of heating, let alone the effects of it in a confined space?

In terms of money being spent, SOS Kilkenny is a fine organisation. It celebrates 50 years in existence on Thursday. It was delighted when told it would have an extra €1.6 million in its budget. It has not been paid yet. Where is that money? Why has Teac Tom, which provides services as a matter of urgency to those who are mentally challenged, not got the €50,000 it was promised? It is nickels and dimes in the context of the €26 billion or €27 billion the health services get.

In regard to planning in the health service, why has it not planned for endometriosis and the care of women affected? Why has that not been planned, staged and developed so that we do not have that kind of debate we had last night and instead, the difficulties women face are dealt with? I spoke with a group of women regarding the vaginal mesh issue. They could not get a pathway to care. It is shocking that we allow the citizens of this State to be treated in this way. We should be to the fore in the delivery of services to people who need them, particularly when we are looking at an overall budget of €26.9 billion or whatever it is.

Regarding the infrastructure within the HSE, Castlecomer District Hospital, for example, is a leading light in the delivery of care for those of a particular age who are in most need. It has to fight for the funding. The entire upstairs of that building is empty and could be developed. Fire requirements and so on must be fulfilled but it could be done in this modern age. We are not even taking the best model in the class. We are just ignoring the best model and moving to private sector care of the elderly.

A state-of-the-art hospital is being built at Thomastown. It is a wonderful facility. I would like to see more public facilities and hospitals caring for the elderly. I would feel a little bit more comfortable in that setting than in a private sector setting. The recent exposé on television has frightened the life out of those who are in care and those going into care and the families involved. We have to restore trust and it is only through action, investment and delivery that we can do so.

In regard to IT investment and an organisation of the size of the HSE asking for money, I go back to my original comment that what gets counted gets done. What has changed in relation to the IT systems? Do they now talk to each other? Is IT taking up every piece of spend in the HSE? Do they know what they are asking for in terms of where that money is going? Should they get it? In other words, is the budget real? Is it based on fact? Should we go back perhaps to zero budgets to make sure that whoever asks for money, whatever hospital or organisation, must provide an appropriate plan that it will be delivered within budget and on time.

The message I want to leave with the Minister is that care of the elderly and the marginalised is paramount in my politics and my response to people.

I want the direction of the HSE to change in order that it will be fully inclusive of all services that are being delivered to the marginalised and elderly.

Complaints relating to hospitals should be answered by the manager of the relevant facility. Too many complaints are being totally ignored. Instead of learning from them, they are covered up.

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