Jerry Cowley (Mayo, Independent)
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Question 86: To ask the Minister for Health and Children if her Department will provide adequate funding for the transport needs of older and ill people requiring essential hospital investigations and treatment; her views on whether the funding required by her Department to the Health Service Executive west needs to be increased in order that the old and the ill can get to hospital for appointments; if her attention has been drawn to the fact that lack of funding by her to the HSE west is putting the emergency ambulance service in jeopardy by underfunding as the money supplied to run the HSE west ambulance service has not kept pace with the increased transport demands of ill and older people; when adequate funding will be provided to supply ambulance transport to persons who need it; and if she will make a statement on the matter. [35619/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The role and purpose of the ambulance service is to provide a clinically appropriate and timely pre-hospital care and transportation service. Pre-hospital emergency care and transportation services are provided as an integral part of the continuum of care for patients.

The Department of Health and Children has been advised by the HSE that there was a significant growth in demand for patient transport services in the west between 2004 and 2005. The ambulance service in that region has prioritised the provision of transport to oncology patients, dialysis patients, patients with acute lower limb injuries and transplant patients for one year after the operation.

The HSE has advised my Department that it examines all requests for patient transport services on a case-by-case basis, taking account of individual needs. The HSE's national ambulance office, in conjunction with the primary, community and continuing care directorate and the National Hospitals Office, is arranging for a comprehensive review to be undertaken of all non-emergency transport needs of patients. It will include an examination of the service delivered nationally and make recommendations for its future development. The group will also be tasked with developing proposals on how best to support patients who have to travel to access specialist services. One of the key outcomes for the group is to complete a needs analysis and strategic plan for a national patient transport scheme, to be finalised by the end of 2006. Subsequently, it will plan the migration to a separate role, which would be implemented on a phased basis from 2007.

Jerry Cowley (Mayo, Independent)
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I thank the Minister for Health and Children for her answer but the question I asked was would she provide enough money to the HSE west to bring ill people to hospital appointments. Patients requiring leg treatment will not get transport unless their leg is falling off from trauma but not if it is falling off from gangrene. I know of an elderly lady on a pension, whose family has a strong history of bowel cancer, who must have a check-up every year. She is expected to get her own transport home after being administered an anaesthetic. Does the Minister know that people on pensions must travel from Belmullet to Galway city, almost the same distance between Dublin and Galway? Can she imagine a pensioner in Dublin having to go to Galway for a hospital appointment at his or her own expense? Does this make sense? It is a scandal and outrage. How can the Minister stand over it?

Will the Minister provide enough money to the HSE to provide essential transport for those older people who need it? How can a pensioner pay €110 each way for a taxi to travel from Achill to Galway to have a pacemaker checked? It is my job as a Deputy to raise this matter in the House. I am outraged that the Minister has not responded to my specific question. The Minister has given so little moneys to the HSE west that it is now facing a €3.9 million deficit which is threatening the provision of emergency services. Does the Minister condone this situation? Why will she not provide additional moneys? What good is a review to a lady who must have her pacemaker checked but must borrow money to get a private taxi to do so? She, along with many more, deserves more. The categories of patients referred to by the Minister have been in place since March. What about those with cardiac failure, liver failure and other diseases?

Mary Harney (Dublin Mid West, Progressive Democrats)
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Deputy Cowley is always outraged. Every time I reply to his questions, I get the same response. Last year, the HSE received an extra €1 billion, a 10% increase in resource allocation. I do not divvy up these moneys as autonomy and authority for them are vested in the HSE as a result of an Act passed by the House. It is the HSE's responsibility to use that money to provide for the transport needs of patients on a priority basis.

I want the HSE to examine alternatives to the traditional ambulance transport to hospital facilities, particularly where long distances are involved. We must be innovative in how we transport people to hospital. On some occasions, it may be possible to transport the medics and the diagnostics away from Galway city and closer to where the patient lives. If the case referred to by Deputy Cowley is common, it may be more cost-effective to bring the doctor and diagnostics closer to Belmullet. I accept the considerably long distance between Belmullet and Galway. The number of people receiving transportation in the west has gone up by 48% in two years and the cost by 51%. An extra ten crew members have been added. There has been an increase from three ambulances on a 24-hour basis to nine and 13 additional ambulances have been provided for the region.

I accept challenges and deficiencies arise in how patients travel for treatment. Earlier, in response to Deputy Lynch, I pointed out more must be done on a community level, particularly for patients with particular chronic illnesses. They are all required to come to the regional hospital for treatment, a model not used in other countries. It does not suit Ireland's circumstances. It is neither cost-effective nor suitable for patients' convenience. That is why one of the priorities this year will be to beef up community-based services that can provide greater supports to patients and minimise the need for them to enter the acute hospital system.

Jerry Cowley (Mayo, Independent)
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It is not fair for the Minister to throw it back on the HSE. She claims it is up to the HSE to prioritise resources. On 1 July 2005, the assistant chief ambulance officer for the region, Paddy Duffy, informed me that "transport is provided on a discretionary basis on having resources to do so".

Mary Harney (Dublin Mid West, Progressive Democrats)
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That was July 2005. It is now almost 2007. Much more money since then has gone into the system.

Jerry Cowley (Mayo, Independent)
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More recently, the chief ambulance officer, Ray Bonor, informed me: "I would like to see all applications for transport for the elderly supported, but the financial resources to do so are not available." The Minister should read my lips. "Demand always exceeds our ability to supply certain services; this is a common problem throughout the health service". The HSE is willing and able to provide transport for these unfortunate pensioners if the Minister will only provide the funding.

The Minister is failing in her responsibility by not meeting the needs of these older people who have done so much for the State. In their autumn years, they simply require that they be able to visit the hospital to have their pacemakers checked. It is disgraceful that the Minister refuses to provide the HSE with the resources to provide the necessary transport. I would resign if I were in her shoes. Those categories that are covered, including dialysis and oncology, are already oversubscribed. As the population ages, there is an increased need for dialysis and a greater incidence of cancer.

The HSE is willing and able to provide transport for any impoverished elderly or ill person requiring hospital investigation or treatment. It is scandalous, in one of the richest countries in the world, that it is not able to perform this essential service because of a lack of money. The Minister should resign if she cannot even ensure patients can travel to their hospital appointments.

Seán Power (Kildare South, Fianna Fail)
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It is another opportunity for Deputy Cowley to protest.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Unlike Deputy Cowley, I am a full-time politician totally devoted to health reform. In addition to his parliamentary role, the Deputy is a practising GP with a large practice in the west. If he does not mind me saying so, he sometimes confuses those two roles. I am sure what he is saying will sound great on local radio tomorrow but the reality is that this country's increase in expenditure on health care in the last ten years, including in the western region, has been greater than that of any country in the developed world.

It is also the reality, however, that there are deficiencies and problems. One of the tasks I have assigned to the HSE is to look at innovative solutions to these difficulties. There may well be different ways of providing patients with their necessary treatments either closer to home, by means of doctors attending centres closer to where patients live on an outreach basis, or through the provision of modes of transport other than ambulances. In most countries ambulances are used only where they are necessary and there may be other modes of transport more suitable in the situations to which the Deputy refers. Other forms of transport are already in use in some areas.

Our priority is to ensure services are available as closely as possible to patients' homes so long as this can be done without compromising the high quality of provision for patient safety. If a person is obliged to make a round trip of 220 miles for a check-up, even on an annual basis, we should explore whether there is a better way of proceeding.

Séamus Pattison (Carlow-Kilkenny, Labour)
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The time for Priority Questions has expired and the remaining questions will be taken in ordinary time. I remind Members that under Standing Orders, supplementary questions and responses to those questions are limited to one minute.