Dáil debates

Wednesday, 6 February 2008

The following motion was moved by Deputy James Reilly on Tuesday, 5 February 2008:

That Dáil Éireann,

noting the failure of the Government to implement the recommendations of the Pollock report;

recognising the serious deficit in isolation units and the shortage of specialist cystic fibrosis staff;

noting the failure of the Government to secure funding for the implementation of the recommendations of A Vision for Change;

acknowledging that mental health services remain chronically understaffed, under resourced and inaccessible, and

noting the imminent threat to critical frontline hospital services in the north east;

calls on the Government to:

deliver on its commitment to develop adequate cystic fibrosis services;

fulfil its promise to implement the recommendations of A Vision for Change;

request an urgent report from the Health Service Executive on any proposals to reduce frontline services throughout the country;

to ensure that, at a time when an additional €1 billion was allocated to the HSE, frontline services are not further reduced; and

fulfil its commitment to deliver an additional 3,000 public-only hospital beds.

Debate resumed on amendment No. 1:

To delete all the words after "Dáil Éireann" and to substitute the following:

welcomes the significant revenue investment of €6.78 million since 2006 for the development of cystic fibrosis services nationally, the resultant improvement in services and the plans for further significant capital investment during 2008 and beyond to improve hospital facilities, including isolation facilities, for these patients;

welcomes the unprecedented level of funding being invested in mental health and commends the Government for the allocation of €51.2 million since 2006, which represents a third of the additional resources required to implement A Vision for Change over the stated 7-10 year period;

notes the assurances by the Health Service Executive that no decisions have been taken to reduce frontline services in the north east and that in progressing the reconfiguration of services in the region, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place;

acknowledges the improvements in frontline accident and emergency services over the last three years and in particular the overall reduction in the number of patients who were awaiting admission to hospital from an emergency department over this period;

welcomes the cumulative increase in funding for health services of €4.3 billion provided by the Government to the HSE over the four years 2005 to 2008 and notes the substantial improvements in services which have been provided as a result; and

welcomes the progress made since 2001 in providing on average over 1,600 additional public acute beds and endorses the commitment of the Government under the Agreed Programme for Government to provide a further 1,500 additional public acute hospital beds under the co-location initiative, and through the national development plan."

—(Minister of State at the Department of Health and Children (Deputy Jimmy Devins)).

7:00 pm

Photo of Mary UptonMary Upton (Dublin South Central, Labour)
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I welcome the opportunity to speak on this motion this evening. It is an incredible indictment of the Government, of the Department of Health and Children and the HSE that it is left to the courage of a young patient to get a promise of some action regarding the treatment of cystic fibrosis, a condition that claimed 30 young lives in 2007. It is not as though the HSE is not aware of the problem. Management boards of hospitals, the Department of Health and Children and the HSE are all in key positions to make changes, so why has there been stalemate for so many years?

This evening, I simply want answers to the following questions arising mainly from the reply given by the Minister of State last night. According to the Minister of State, 44 additional staff to deal with cystic fibrosis, CF, patients have been appointed throughout the country. Where exactly are they located? What positions do they hold? What are the terms of their appointments? Have the posts for the 37 promised staff actually been advertised? What exactly are the posts and where will they be located? I want no more fudge, but some simple facts.

I wish to comment on the provision of facilities in St. Vincent's Hospital. I want to declare a personal interest in this saga and I can vouch for the appalling conditions to which vulnerable young adults were and are exposed in wards where CF patients are treated. I can also vouch for the dedication and professionalism of the staff there. Any progress in the provision of additional isolation units in St. Vincent's Hospital is welcome, but I remind the Minister of State that there are between 18 and 25 CF patients at any one time at this of year in the hospital. Approximately another ten are awaiting beds there. Can the Government at least plan for the seasonal needs of CF patients? Otherwise, we will all be back again this time next year with Joe Duffy leading the attack again.

Can the Minister of State confirm that the promised units in St. Vincent's Hospital will be ring-fenced for CF patients? Why is not possible to provide further prefab space for additional units? I understand that this can be done if the will is there to do it. Will the units proposed for St. Mark's ward and St. Camillus's ward in the hospital be en suite? This is not clear from any press statements I have seen. When can we expect that CF patients will be admitted directly to wards without the trauma of lying on a trolley or sitting on a chair in the accident and emergency ward, often for days, surrounded by other unfortunate patients with a variety of infections? What plans are proposed for other centres around the country?

When will newborn babies be routinely screened for CF as occurs for other conditions and in other countries? Why is it that only one CF lung transplant has been carried out in the Mater Hospital to date? What exactly is the arrangement between the Mater Hospital and Freeman Hospital in Newcastle regarding lung transplants? How many transplants were carried out in 2006 and 2007 in Newcastle on Irish patients? What is the commitment from the hospital in Newcastle to the Government on behalf of CF patients in Ireland? What is the financial arrangement between the Department of Health and Children here and Freeman Hospital regarding transplants for CF patients?

I want to highlight the need for a co-ordinated and unified approach to the management of CF patients post-transplant. A single centre of excellence is needed where all aspects before and after transplants can be carried out. Cystic fibrosis does not go away just because one is lucky enough to get a transplant. Very specific challenges have to be addressed for post-transplant cystic fibrosis patients. That facility is not available in this country at the moment. It is split between the Mater and a centre of excellence at St. Vincent's, each with a specific speciality than can be delivered effectively. However, the two have to be combined for the sake of cystic fibrosis patients.

Where is the national reference microbiology laboratory that was recommended by Pollock? This is absolutely crucial, given the changing and rapid environment in which micro-organisms are affecting cystic fibrosis patients, literally almost on a weekly basis. The most up-to-date facilities and services are needed to ensure the best treatment for those bacteria. What about the national register and the need for committed funding? This happens on a year to year basis and it is no way to provide a reliable and ongoing service. There must be a long-term commitment, providing money to ensure the register can be updated. We are very much dependent on ensuring we have the correct number of patients on that register. To do that the money must be made available to allow people to get on with that job.

Paediatric services are just as much in need of quality facilities as the adult units. What provisions are being made to upgrade these facilities in Crumlin, for example? When will the HSE provide replies to parliamentary questions that contain some real information.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Hear, hear.

Photo of Mary UptonMary Upton (Dublin South Central, Labour)
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I can paper the walls of my office with the numbers of non-replies I get from the HSE, containing absolutely no information.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Or misinformation.

Photo of Mary UptonMary Upton (Dublin South Central, Labour)
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Either a senior counsel is needed to interpret what they contain or there is absolutely nothing in them. It is time we got real factual information. That is why this evening I am posing those very specific questions. I want facts, not fudge, because we have had a great deal of the latter but no substance and no content. That is my basic reason for asking the questions in the manner I have, so that I may at least have some facts to relate back to the many people with a very important interest in this life-threatening disease, in the country that has the highest incidence of this disease in the world.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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I thank my colleague, Deputy Mary Upton, for sharing time.

Like Deputy Upton I do not believe five minutes is enough on the issue of health. I will speak tonight on the whole area of hospital acquired infections. I would like to speak, as well, on childhood diabetes, which I have raised numerous times in this House, and the lack of treatment facilities and care in Cork despite all the rhetoric from the Government. The parents of children as young as 18 months are handed an orange and a syringe and told to practise with them and they will be fine. Then there are the consequences into adulthood for the children concerned and the poor health they will finally end up with as a result of the neglect of Government in a time of boom.

I listened today to the debate on the economy and every Government speaker told the House we were the envy of the world. I accept we are when it comes to the economy, but people who admire us for this are appalled at what we have done with that boom in terms of services. The health service is just one of those areas.

I want to talk about hospital acquired infections. Most people are aware of MRSA, but there are several others. I will talk of my experience in this regard, as no stranger to hospitals. During my lifetime I have been in hospital every second year, on average. I attended a meeting recently of people who had lost loved ones through MRSA. It should never happen, but when it does it is as if it has not occurred at all. There is no admission of guilt and no traceability. We have traceability in the food industry, but none when it comes to our loved ones who die from hospital acquired infections. I keep hearing about the Department's plans. Several reports have been published about cleaning hospitals, and doctors and nurses cleaning their hands, but what is really needed is a campaign to allow patients to be comfortable while challenging people to wash their hands, without them feeling threatened as a result.

In the main, medical staff are good people whose entire focus in life is on treating patients and ensuring they get better. When will we install in hospitals clean rooms where the staff change into uniforms from their day clothes and go to work and, when finished, change back into their street clothes and leave? On any day of the week in Cork hospitals one may see medical staff leave at 1 o'clock to do their shopping and come back without changing their clothes. I have witnessed this in hospitals. When are we going to get real about infection control? I have seen filthy toilets being cleaned extensively and the same cleaning utensils being used on wards. When will we accept that infection is carried, not just by patients, but by people treating them and those who are in and out of hospitals? When will something be done about it?

The Minister for Health and Children abolished health boards and employed more staff. In effect, the only thing she did was to remove the people's voice from those boards because the elected representatives knew the everyday concerns of the population. She produced an executive that was at arm's length, she said, because of excessive interference. Arm's length usually means out of one's grasp and out of control. When are we going to return to the health boards? When will we allow the people to have true control over their health service?

Photo of Chris AndrewsChris Andrews (Dublin South East, Fianna Fail)
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I want to share time with my colleagues, Deputies Finian McGrath and Michael Lowry.

I thank the Ceann Comhairle for the opportunity to speak on this issue. I am glad this motion has been brought before the House because it gives us the opportunity to take stock of the measures that have been taken in the provision of health services. The motion refers to a number of issues, including cystic fibrosis and mental health. This public debate must seem like a double-edged sword for those suffering from cystic fibrosis and indeed mental illness, and their families who carry much of the accompanying difficulties and hardship. On the one hand, this debate gives voice to those who are suffering and ensures the issue stays top of the agenda. On the other, it must be very difficult for those families and individuals listening to various experiences of hardship. It is therefore a double-edged sword, but on balance it is a good way to raise these issues.

I heard Deputy Upton refer to Joe Duffy leading the charge. My impression, as a new Deputy, was that the Opposition was supposed to set the agenda. I did not realise that the media were setting the agenda——

Photo of Mary UptonMary Upton (Dublin South Central, Labour)
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The Government is supposed to deliver.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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There would have been no need for it.

Photo of Chris AndrewsChris Andrews (Dublin South East, Fianna Fail)
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——and then the Opposition would do their bidding. Clearly this is where we have arrived at and I suppose that is for the Opposition to deal with.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I have been campaigning on mental health for 15 years.

Photo of Kathleen LynchKathleen Lynch (Cork North Central, Labour)
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There would have been no need for a young woman to have been on the radio.

Photo of Chris AndrewsChris Andrews (Dublin South East, Fianna Fail)
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The issue of cystic fibrosis is a priority for the Government. Additional funding of €6.78 million has been spent on the services since 2006 arising from the recommendations of the Pollock report. This helped in the appointment of 44 additional staff throughout the country. Before Joe Duffy and even the Opposition were aware of the issue, the Taoiseach and the Minister for Health and Children——

(Interruptions).

Photo of Chris AndrewsChris Andrews (Dublin South East, Fianna Fail)
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——together with the HSE, met the Cystic Fibrosis Association of Ireland last September to discuss infrastructural deficits. Therefore, we are well aware of the difficulties. There is no magic wand. There is a long way to go. The built infrastructure has serious deficits which are being addressed. We have come a long way in terms of the multidisciplinary teams that are required and we will continue to prioritise not only cystic fibrosis but also mental health.

Photo of Finian McGrathFinian McGrath (Dublin North Central, Independent)
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I thank you for the opportunity to speak on this important and urgent debate on our health service and particularly cystic fibrosis patients. I commend the cystic fibrosis patients and their families on their courage and dignity. I thank people such as Dara Crowley, Orla Tinsley, Paul Dempsey, Philip Ahern, Charlie Gallagher, head of the cystic fibrosis unit at St. Vincent's Hospital, Gerry McElvaney at Beaumont Hospital, Dr. Murphy at Tallaght Hospital, Godfrey Fletcher and all the families in the cystic fibrosis association for their hard work and efforts in recent weeks.

I have met cystic fibrosis patients and have visited them in hospital. I know the issues and I understand the hurt and pain. Yes, they are being treated badly but this is changing.

During the election campaign I read and was strongly influenced by Sam Smyth's great article on cystic fibrosis. When elected I included cystic fibrosis services in my agreement with the Taoiseach. It is in section 5 of my agreement and is something on which I am determined to deliver. We need a dedicated unit at St. Vincent's Hospital and we need it as soon as possible. I agree that cystic fibrosis patients have waited too long. However, we also need an interim solution which I have been pushing behind the scenes. I thank all the cystic fibrosis families who telephoned my office with constructive ideas and plans.

I welcome the temporary solution to fast-track six beds for St. Mark's ward at St. Vincent's Hospital within weeks and an extra eight single rooms which will create a total of 14 single rooms available for cystic fibrosis patients. In my constituency I warmly welcome the extra €2.5 million for Beaumont Hospital which operates as a regional centre in providing services to people with cystic fibrosis. Gerry McElvaney and his team are doing an excellent job and I know the northside parents welcome this extra cash investment. This is leading to improved isolation and infection control facilities together with enhanced outpatient facilities for cystic fibrosis patients attending the hospitals. I am also meeting the chief executive of Beaumont Hospital on this and many other issues.

The battle has begun for these services. We will know in two years if we have won the war for these patients. I do not make any false promises but I give a commitment to try to deliver first class services to our patients. I will not take any lectures or old guff from editorials in The Irish Times accusing me of backstairs political deals on the cystic fibrosis issue. I gave a promise to help cystic fibrosis patients and I put it in the deal. All I want is that the deal be implemented as soon as possible. Politics is about delivering and if I can deliver to people I will be satisfied with my efforts.

On the broader issue of health, the hidden story in this year's budget was that despite budgetary constraints €16.2 billion is being spent in 2008, an increase of €1.1 billion on last year's provision, an extra €50 million of this is going to the disability sector and €35 million extra to cancer services. I urge all Deputies to support the cystic fibrosis patients.

Photo of Michael LowryMichael Lowry (Tipperary North, Independent)
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Last Sunday night I met with the Tipperary cystic fibrosis organisation and heard heart-breaking stories of neglect and the failure of our health system to respond to genuine needs, problems with accommodation and facilities and problems with staffing levels. In the mid-west region the following concerns need to be addressed in the short term. The first is the provision of necessary, fully equipped ensuite bedrooms for cystic fibrosis sufferers in key adult and paediatric units in Limerick, Waterford, Cork and in the central unit in St. Vincent's Hospital, Dublin. This would prevent the risk of cross-infection that is of such danger and critically affects the survival rate of people with cystic fibrosis. Extra specialised training staff in cystic fibrosis care are badly needed, including an urgent need for the posting of a second cystic fibrosis nurse in Waterford Regional Hospital. In the home domiciliary care area we need a dedicated cystic fibrosis home nurse and a dedicated cystic fibrosis physiotherapist to cater for the mid-west area.

Cystic fibrosis patients should be automatically entitled to a medical card and their families should be entitled to a carer's allowance that is non-means tested. It is a disgrace in 2008, having all the information we have on the condition, that this policy has still not been initiated. Cystic fibrosis sufferers should not have to report to accident and emergency departments on the occasions when they need hospital care as they should not be subjected and exposed to the infections and viruses in those departments.

A national screening programme at neo-natal level should be initiated for the detection of cystic fibrosis. An early diagnosis and the correct treatment from birth would mean much better living prospects for cystic fibrosis patients.

I call on the Minister to initiate a national debate on the issue of presumed organ donation along the lines of the proposed UK model as outlined by Gordon Brown and the highly successful Spanish model that is currently in practice. While I acknowledge that many issues in this area need to be teased out and that the subject should be handled with extreme sensitivity, all parties can see the benefit of such a move to sufferers of many diseases.

In general terms the health service has been burdened and stymied by vested interests within the system. The time is long overdue for a Minister for Health and Children to establish as a first principle that patient need is paramount and that the welfare of patients is a first priority. I believe the Minister, Deputy Harney, has the courage, conviction and determination to tackle the vested interests within the health service and I will support her in her efforts to force and implement change.

Photo of Margaret ConlonMargaret Conlon (Cavan-Monaghan, Fianna Fail)
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I wish to point out some stark facts and offer a basis on how to move forward to improve our health service and especially to tackle the unacceptable threatened diminution in services. Spending on health has increased by 370% during the last decade, seven times the rate of inflation, yet the HSE in the north east is running at €26 million over budget and the Cavan-Monaghan group has a deficit of €9 million. How is this happening?

The Department's allocation is based on an approved service plan. Heath spending increased by 7% this year. Why is the HSE not running a service in the north east that provides high quality patient care within its budget? The memo leaked last week indicates that discussions to stem this deficit are taking place and the axe will wield on frontline services. There is no mention of cuts at administrative or managerial level. Nationally, there are 2.5 administrative staff for every doctor in the health service. The number of grade eight workers, such as managers, accountants and IT personnel, between late 2005 and 2007 increased from 521 to 713. I realise there is a need for support staff. However, evidence presented to me suggests that many of these are surplus to requirements.

The fundamental issue here is accountability of the Health Service Executive. We must hold this body to account. The crucial point that must be kept in mind at all times is that the HSE is seemingly wasting or misspending or misapportioning public money. One euro out of every €4 of tax for every man and woman is spent on health. I call on the Minister for Health and Children, Deputy Harney, to claim back accountability for this expenditure.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Hear, hear.

Photo of Margaret ConlonMargaret Conlon (Cavan-Monaghan, Fianna Fail)
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As TDs we must be able to see, query and demand to know where and how our constituents' and taxpayers' money is spent and why frontline services appear to be regressing rather than progressing. I have been assured and have been telling my constituents that a new regional hospital will be built and that no services will be removed from Monaghan hospital until a safer, better and more appropriate alternative is in place. I accept the Government amendment as a pledge in this regard and I will play my part in ensuring this happens. If we lift the flawed logic that the HSE is employing for the proposed reductions in services we see carts before horses everywhere. Money has been spent on a high quality treatment room and it threatened the service. Our coronary care unit which has a higher record of safety and better outcomes than most other facilities throughout the country was also threatened. We lost two casualty consultants and there has been a definite change for the worse in the level of service provided, and certainly no replacement with a safe or superior alternative.

The leaked document stated that the changes are dependent on many factors, including improved home care packages. I ask where the HSE proposes to get the €9 million it would require to put these packages in place. If Monaghan hospital is taken off call, the risks greatly increase as people have further to travel to access medical care.

It seems the HSE is making it up as it goes along and it is constantly changing the goalposts. In November I attended the official opening of a newly refurbished ward costing €5 million. I said then that the facilities were as good as could be found anywhere in Ireland and Britain. How, therefore, can the HSE justify a reduction in frontline services to the people of my constituency after opening a totally refurbished ward? I ask the HSE one simple question, what are the people of Monaghan to do when they fall ill? The HSE is now a professional master at changing the goalposts on many issues. There is never a plan B or an alternative. There seems to be a lack of logic and joined-up thinking.

I call for a wholesale audit of the HSE from the top to the bottom of the organisation at financial, managerial and human resource level. We must identify the black holes that swallow up millions of euro which should be prioritised for frontline services. We must have an independent audit of the management of taxpayers' money. We must streamline management and administrative processes. I suggest as a starting point that we need to undertake an audit to ascertain the current position and how many support staff we really need. It seems bizarre that we amalgamated so many organisations when the HSE was created and did not restructure the support staff at the same time. This is where the savings must be made, not on frontline services. There must not be any diminution of services until this audit takes place. We must call a halt to the current crazy situation where the bloated HSE is allowed to expand and become even more unwieldy. I call for a halt to that.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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In that case, the Deputy should vote for the motion.

Photo of M J NolanM J Nolan (Carlow-Kilkenny, Fianna Fail)
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I welcome the opportunity to speak in this debate. We all recognise there are difficulties and shortcomings. Indeed, the Minister acknowledged the shortcomings in the area of the treatment of cystic fibrosis patients. Having spoken to them, I know there is no Member of the Oireachtas who has not been lobbied in recent weeks, particularly since this debate took place on radio. There is an urgent need for single rooms in our hospitals for cystic fibrosis patients. I am glad the Minister has given a commitment that urgent short-term measures are being put in place in St. Vincent's hospital in Dublin. The HSE, for all its faults, has given a commitment that it is fast-tracking the development of a ward adjacent to the main cystic fibrosis unit in St. Vincent's, which I welcome. However, it will take time. Why is it only now that the HSE has become alarmed at the shortcomings in the treatment of cystic fibrosis patients?

International comparisons show that Irish cystic fibrosis patients are at a greater disadvantage than their counterparts in Northern Ireland and the UK. It is important that this debate has become public because something is being done, albeit belatedly.

This debate also concerns the health service in general. It would be wrong only to be critical. While there are areas of serious deficiency, we have made much progress over the years. Reference was made in this debate to the fourfold increase in funding in the budgets between 1997 and 2007 and the capital programme has increased by three and a half times in that period, from €167 million to over €580 million. Our spending is almost 9% of GNP, which compares favourably with other countries in the OECD area.

The health services are making progress and people are living longer. As a result, there will be greater demands on the health service, and the HSE and the Department of Health and Children will have to come to terms with that positive development. Life expectancy for women is now 80 years and for men it is 75 years, an increase of five years for both men and women since the 1980s. The rise has been very rapid since 1999 in particular and life expectancy in Ireland now exceeds the European average, which is positive.

Our lifestyles have changed. Various factors are involved and Ministers are to be commended for this, particularly the former Minister for Health and Children, Deputy Micheál Martin, whose ban on smoking in the workplace was unique in that he found it very difficult to get that legislation through the Houses, in particular past some of his parliamentary colleagues. We now have an excellent infant care service and infant mortality decreased by 35% between 1999 and 2005. The rate of heart disease as a cause of death has decreased by 42%, which is also a result of improved lifestyles. I welcome the initiatives in various Departments to improve this further. Cancer survival is improving. Five-year survival rates for breast cancer are rising at one of the highest rates in Europe, which is positive. Some 40,000 cancer patients were discharged from public hospitals in ten years, an increase of 70%.

The situation is not all bad. The HSE has a job to do and I encourage the Minister in this regard. The small-minded swipe by the Opposition at the Minister, Deputy Harney, with regard to her trip to the US was unbecoming of the members of the Opposition. It distracted from what is a serious debate. I wish the Minister well.

Photo of Niall CollinsNiall Collins (Limerick West, Fianna Fail)
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I welcome the opportunity to participate in the debate. It is important we should have as much debate as possible on the provision of health services, particularly given the large budget administered by the HSE. I agree with the previous speakers with regard to their comments on cystic fibrosis and mental health sufferers. However, I will confine my comments to dealing with some of the positive aspects of the health service. Debates sometimes become clouded by focusing on shortcomings and misgivings, but it is not all doom and gloom.

I congratulate the Minister, Deputy Harney, and her team of Ministers of State for their commitment to their job. It is not an easy area and issues often arise which are not of their making or that of their predecessors but which go back many years. We must place the health service in the context of developments since the foundation of the State and through the 1960s, 1970s and 1980s when investment was not made because the country was not in a position to invest in capital and current health service budgets. Given this history, the health service is coming from a deficit position or a standing start.

Debates on the provision of health services often go back to the old health board versus HSE argument and focus on whether the situation was better when there were eight health boards and health board meetings were held once a month. We debate whether we should reverse engines or whether the situation was better then than now — I do not believe it is.

My constituency is served by a number of hospitals in Limerick city. Eight consultants were recently appointed to the Mid-Western Regional Hospital and the Minister for Education and Science, Deputy Hanafin, officially opened the Children's Ark, which is a full-time teaching facility. A number of public representatives were involved with a deputation from the maternity hospital and plans are afoot to provide a new maternity hospital on the grounds of the Mid-Western Regional Hospital, which is welcome and positive for the area. The Mid-Western Regional Hospital does not have the physical capacity to cope with the throughput with which it must deal. Both medical and non-medical professional staff within that area work under extremely pressurised conditions. The HSE and the Department of Health and Children are examining the situation with a view to relocating to the Mid-Western Regional Hospital campus. They have outlined a construction timetable for that and are working through a planning phase of the programme. I urge everybody involved in the HSE and the Department of Health and Children to keep the process on track.

Previous speakers referred to the HSE's annual budget, which is €16.2 billion. I wish to outline some of the areas which I find to be quite positive, particularly concerning services for the elderly. We are awaiting legislation in this regard but €110 million is being provided to cover extra costs that will arise this year under the new long-term residential care scheme which was announced by the Minister last year. The purpose of the new scheme is to equalise the level of State support provided to individuals in public and private nursing homes. It also aims to make private long-term residential care affordable and anxiety-free thus obviating the necessity for people to sell or mortgage their homes in order to pay for nursing home care. No one currently in long-term care will be financially disadvantaged by the scheme.

An extra €25 million is being allocated to increase community services provided to older people. It will also allow for increases in a number of home care supports, home help hours and day respite places. These services, which have seen a major investment in recent years, are designated to help older people to live in their own homes. The policy is to build up sufficient home and community-based care so that less than one in 20 people over 65 will be in residential care.

Photo of John O'DonoghueJohn O'Donoghue (Ceann Comhairle; Kerry South, Ceann Comhairle)
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The Deputy's time has expired.

Photo of Niall CollinsNiall Collins (Limerick West, Fianna Fail)
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It is not all doom and gloom in the health service. Comments were made about the administration side of the health service and while that may be true, it should be remembered that successive national wage agreements have had an effect. There is an industrial relations bargaining process and practices have built up which are not easy to root out. We have recently seen the conclusion of talks with the consultants' body and I congratulate the Minister for sticking with that difficult process which has now come to an end. The home page of the Irish Hospital Consultants Association website is still urging its members not to apply for any of the new positions. That is the difficult environment in which we live but I congratulate the Minister for sticking with that difficult job.

Photo of Mary WhiteMary White (Carlow-Kilkenny, Green Party)
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I welcome this debate and the opportunity to highlight the plight of approximately 1,100 people in this country who suffer from cystic fibrosis. In the short time allotted to me I want to deal with the question of CF. From under the Blackstairs mountains in rural south Carlow I bring my own stories of the experiences of people I know whose lives are defined, tormented and curtailed by this condition. I do not come to this debate with pat phrases, smart statistics or vapid statements of earnest goodwill. My party's credentials on this issue are strong. The Green Party was the only one that acknowledged cystic fibrosis in its recent election manifesto.

Not far from where I live, a brave young man whom I know well successfully underwent a transplant in Newcastle, which gave him a new life. A few miles further down the road from my home another young man made history by becoming the first Irish patient to have a double lung transplant. I phoned his mother today to know how he was and he is doing fine. In my own family, three children of a cousin have cystic fibrosis. Across the water in my husband's family, another tiny family member has been diagnosed with the condition.

I am pleased to hear the Government's reiteration in its proposed amendment to the motion that it plans significant capital investment in the area of cystic fibrosis services during 2008 and beyond to improve hospital facilities and isolation units. This investment is so vital because the level of services, the risk CF sufferers are exposed to due to a lack of isolation units, and the ensuing low life expectancy of Irish cystic fibrosis sufferers — a life expectancy which is over 20 years shorter than those in the United States — are totally unacceptable. It is also unacceptable in a wealthy country like ours that specialist, isolated care is not afforded to those young people for whom the dice is loaded from the outset.

Seven cystic fibrosis sufferers died over Christmas in Ireland. Recent media coverage of the issue has provoked anger but we should not have to wait for radio and television coverage of our deficient services to kick-start us into action; we should already be busy implementing the recommendations of the Pollock report. Some facts give us hope that the services required for cystic fibrosis sufferers will be delivered and that their needs will be prioritised. The appointment of an additional 44 staff to deal with cystic fibrosis sufferers across a number of hospitals is welcome, as is the knowledge that funding for the recruitment of a further 37 is available. I know the Minister will get them working quickly.

Recently opened facilities in St. Vincent's Hospital for the ambulatory care of cystic fibrosis patients, which provide for segregation for improved infection control, are also greatly welcomed. The additional beds for respiratory-cystic fibrosis patients in the St. Camillus wards will also go some way to helping them.

I return to the case of a neighbour and constituent of mine whose parents told me today that while their child was small the doctors and nurses treating him in Waterford Hospital's paediatric unit were superb. The problem, however, was the fear of catching infection in Dublin. Investment in hospitals in the capital city and around the country for sufferers of cystic fibrosis must be accompanied by well-planned and co-ordinated infection control so that these investments are not undermined. There is now the political will to implement and deliver the necessary services and comforts for cystic fibrosis patients. This issue will not be forgotten — not while I can breathe and act on behalf of those who cannot breathe because of cystic fibrosis.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I wish to share time with Deputies O'Dowd, Catherine Byrne, O'Mahony, Joe Carey and Kehoe.

Photo of John O'DonoghueJohn O'Donoghue (Ceann Comhairle; Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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I wish to deal with the area of mental health services. On 24 January 2006, the expert group on mental health policy, established by the Department of Health and Children, published a new national mental health policy framework, entitled A Vision for Change, which was subsequently adopted by the Government and the Health Service Executive. It proposed significant changes and improvements in mental health services and a true movement of services into the community. Regrettably, since the launch of A Vision for Change there has been little or no action to implement it. Two years later, mental health service users and providers are still struggling with an outdated, fragmented and severely under-resourced system.

Mental health and related services remain the areas most neglected by the Government, thus leading to multiple infringements of the human rights of those at risk of mental health problems. There remains a widespread unavailability of psychological and social interventions as complements to medication, denying the right to the most appropriate and least restrictive or intrusive treatment. Ireland still has a high rate of hospitalisation for mental health problems due to limited community-based services. This conflicts with the right to treatment in the least restrictive environment. Specialist mental health services such as those for people with eating disorders or brain injury, remain generally unavailable outside Dublin, while access in the capital remains very limited.

A Vision for Change explicitly stated that a minimum of an additional €25 million was required annually for a six-year period to allow for the implementation of the mental health services expansion and improvement objectives as outlined in the policy. I have repeatedly asked the Minister of State about the investment. He informed me that €25 million was made available in 2006 and 2007, yet no extra money is being made available in the third year of a six-year programme.

Photo of Jimmy DevinsJimmy Devins (Minister of State, Department of Health and Children; Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Sligo-North Leitrim, Fianna Fail)
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It is a seven to ten-year programme.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Some €25 million was to have been made available in the first six years of the programme, which the Minister of State launched with aplomb, yet he is now neglecting it.

8:00 pm

Photo of Jimmy DevinsJimmy Devins (Minister of State, Department of Health and Children; Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Sligo-North Leitrim, Fianna Fail)
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The Deputy knows that under A Vision for Change, a seven to ten-year programme is envisaged.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Some €25 million was promised in 2006 yet only €17 million went towards developing the priorities set out in A Vision for Change. In 2007, only €10 million was allocated to the programme. The remainder was hived off by the Health Service Executive to cater for its deficits elsewhere. Was the Minister of State informed that was happening? Perhaps he will deal with that. While being interviewed on "Prime Time", he was unable to answer how much of the €50 million was spent on the mental health services and the development of A Vision for Change. Is this what we should expect from someone who has primary responsibility for the area? The Government cannot pretend that it did not know the funding allocated over the past two years for the development of the mental health services was not delivered. Blaming the HSE is not an option, as the Minister of State has political responsibility for ensuring the taxpayer's money is spent according to Government policy and he has failed in that regard.

In January the Irish Psychiatric Association published a report entitled, Lie of the Land, which revealed that money released by the State from assets in the mental health service was not being ring-fenced for reinvestment in the psychiatric service. A Vision for Change stated explicitly, as did two reports going back to the 1960s and accepted by various Governments, that resources, both capital and revenue, should remain within the service. According to the Irish Psychiatric Association, numerous countrywide examples of diversion of psychiatric services assets from the HSE include St. Canice's Hospital, Kilkenny; St. Dymphna's Hospital, Carlow; Clare mental health services; St. Stephen's Hospital, Glanmire; Donegal mental health services; Laois mental health services; Longford-Westmeath mental health services; Mayo mental health services; Sligo-Leitrim mental health services; Cavan-Monaghan mental health services; Wicklow mental health services; Tipperary south mental health services; Limerick mental health services; Louth mental health services; and Kerry mental health services. Did the Minister of State know the HSE was diverting these assets resulting in a loss of mental health services? This is explicitly contrary to his stated policy but obviously this was done with his acceptance.

Why will the report into his examination of this issue be limited to the past two years, given it has been Government policy to ring-fence funding for psychiatric services since 1984? Resources raised from the sale of surplus psychiatric hospital land should be reinvested and developed in the mental health services. This approach should include the disposal of all assets associated with psychiatric hospitals since that time. When does the Minister of State expect to receive the report? When will it be publicly available?

In 2006, 3,000 children and adolescents waited an average of 15 months for assessment, with a number of families waiting as long as four years. In 2007 waiting lists were even longer, with 3,598 children awaiting assessment, one third of whom had been waiting for more than 12 months. In 2008, with no money allocated for the implementation of change, the position can only worsen. A Vision for Change recommended 100 inpatient beds nationally for children and adolescents in five units comprising 20 beds but there is no sign of this happening.

Photo of Jimmy DevinsJimmy Devins (Minister of State, Department of Health and Children; Minister of State, Department of Education and Science; Minister of State, Department of Enterprise, Trade and Employment; Sligo-North Leitrim, Fianna Fail)
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A total of 80 additional beds are being provided, which is a 200% increase.

Photo of Dan NevilleDan Neville (Limerick West, Fine Gael)
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Last year, the Minister of State allocated €4.5 million for the implementation of the 1995 report recommendations. This year, the same amount has been allocated and, therefore, no progress will be made on the implementation of these recommendations.

I refer to the issue of suicide. The Minister of State allocated €4.5 million to suicide prevention this year with 500 people dying by suicide last year, while the Government allocated €44.3 million totally inadequately for the prevention of road traffic deaths, of which there were 338 last year.

I attended a serious presentation recently by Professor Paul Mullen on his work in Victoria, New Zealand, in the forensic mental health area. He is absolutely totally opposed to locating Thornton Hall hospital beside a prison. He said it was one of the worst decisions the Government has made. The hospital is a therapeutic institution while the prison is a custodial institution. The hospital, where the treatment and cure of patients must be the objective, will be stigmatised by its location beside a custodial institution, designed for the containment of people. Due to its location, it is inevitable the regime and the culture of the hospital will become custodial rather than therapeutic. I ask the Minister to revisit that decision. Land is available at the present site of the Central Mental Hospital. A total of 43 acres are available, of which only 20 are required to build a new state-of-the-art hospital.

I have received various replies from the HSE to parliamentary questions. I asked what had happened to the €50 million allocation for mental health services and the HSE replied it was allocated towards the development of A Vision for Change. However, we know that was not the case because of a Freedom of Information Act request by the Mental Health Alliance, which established this. I have no confidence in the replies of the HSE to parliamentary questions because the officials are not answering our questions. They give us a vague overall outline, which is misrepresentative.

I refer to cystic fibrosis. I acknowledge the services for sufferers of this disease in Limerick. Isolation wards have been provided courtesy of J.P. McManus and his allocation committee under the chairmanship of John Harty. Private contributions by this organisation have made this possible.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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I support the motion fully and, in particular the reference to "the imminent threat to the critical front line hospital services in the north east". Mr. Finbarr Lennon, consultant general and breast surgeon in Our Lady of Lourdes Hospital in Drogheda, held high office advising the North Eastern Health Board when it was in place. He referred in a letter dated 11 December 2007 to another letter he wrote during the general election campaign on 19 June 2007 in which he expressed his concern about the failure of the management authorities at all levels to appreciate the impact and consequences of the current workload and the throughput of cases in the hospital in Drogheda. Mr. Lennon indicated that in his opinion the situation was "very unsafe" and he called for a fundamental reappraisal of the current strategy being pursued by management regarding acute hospital services in the region. He stated:

I have just completed another difficult on-call duty weekend, which has confirmed to me the utter folly of the current management strategy of attempting to increasingly direct all the regional emergency workload into Drogheda, when it clearly is woefully short of basic resources, capacity and some vital expertise. In my opinion there is no expectation that the hospital can cope no matter what interim structure or working arrangements are put in place. It is abundantly clear to the vast majority of front line healthcare staff, including local management staff, that the Teamwork Transformation projects have and will inevitably fail. This is due not only to the fact that the present plan is unrealistic but also because many vital front line staff have been excluded by design from the "so-called consultation process". Their medical and nursing experience and advice has been largely disregarded by the planners and decision makers.

I have not come across any healthcare colleague in this region who will say that there has been any significant improvement on the ground within any of the three hospitals in Drogheda, Dundalk or Navan in the past 18 months. Central management's policy of using and depending on external experts and on hand-picked selective advisors to push its agenda has been most unwise and has resulted in peer conflict, dismay and anger throughout the hospital service.

From my perspective as a senior consultant with some management expertise I see no merit in the current course being pursued. There is no interim solution short of a new regional hospital. Until such is in place it seems to me that the only safe option is to maintain and resource the three local hospitals to a level sufficient to deliver a safe stand-alone twenty four hour general acute medical service. In my view it is also prudent at this stage to reconsider and maintain a safe twenty four hour acute general surgical surgery service in Navan. As things stand there is a perception that both Navan and Dundalk are being deprived of the basic resources necessary to cope with their respective workloads.

The HSE at this juncture should revise its medium term objective for the next two years and concentrate on ensuring all three hospitals are made clean and safe.

Photo of John O'DonoghueJohn O'Donoghue (Ceann Comhairle; Kerry South, Ceann Comhairle)
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The Deputy must indicate the source of his quotation, to whom it was directed and the date.

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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The source of the letter is Mr. Finbarr Lennon, consultant general and breast surgeon in Our Lady of Lourdes Hospital, Drogheda.

Photo of John O'DonoghueJohn O'Donoghue (Ceann Comhairle; Kerry South, Ceann Comhairle)
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To whom was the letter directed?

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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It was directed to Dr. David Vaughan, chairperson of the medical board in Our Lady of Lourdes Hospital, Drogheda, and was circulated widely. I understand the Minister for Health and Children and officials of the HSE received copies. However, they have done nothing about the matter and the hospital is facing an even more serious crisis. It is appalling, shameful and disgraceful.

Photo of Catherine ByrneCatherine Byrne (Dublin South Central, Fine Gael)
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I want to take this opportunity to voice my concern about the appalling state of cystic fibrosis services in this country. As a parent, I count myself lucky to have five healthy children who go to school, play sports and live independent lives. However, some parents are not as lucky. In my constituency of Dublin South-Central, I recently met a brave but distraught mother with two young children aged three and six who suffer from cystic fibrosis. She stays at home to look after them on a 24-seven basis while her husband works hard to support them. She cannot avail of basic services such as child care, a crèche or even a playschool because her children would not receive the care and attention they require. When I asked her how she copes, she told me she does the best she can because she has no choice.

This Government has failed thousands of parents by not providing the necessary basic services which could help cystic fibrosis patients to lead a normal life. It is sad to think this debate has come about because two brave young people suffering from cystic fibrosis felt they had no option but to highlight to the media the lack of services and the problems they face on a daily basis. I know the Minister for Health and Children does not have a crystal ball but I hope to God she has vision because that is what is needed. Why are cystic fibrosis patients required to contact a radio programme or write to The Irish Times before the Government will act? If it was not for the courage of these people, I doubt we would be debating this issue now. Their voices were heard loud and clear by those who listened to "Liveline" or read the newspapers.

The Minister needs to take action before more people die unnecessarily. Cystic fibrosis is Ireland's most common life threatening inherited disease, yet after 11 years the Government has not even started to help suffering patients who struggle on a daily basis. More than 1,100 people have cystic fibrosis in Ireland, the highest proportion of patients per head of population worldwide. Unbelievably, the average life expectancy for a person with cystic fibrosis in the Republic of Ireland is 21 years, whereas only an hour away in Northern Ireland people are living to the age of 33 and beyond. Ireland is at the bottom of the list when it comes to cystic fibrosis and caring for people.

Unfortunately, this Government operates on a knee-jerk basis. Suddenly, 120 isolation beds for cystic fibrosis patients have received approval in St. Vincent's hospital. These beds have been promised for the past ten years and we will have to wait until 2010 before they are in place. The Minister is only paying lip-service to the crisis. She must take responsibility and improve the service as a matter of urgency. I call on her to implement the recommendations of the Pollock report to give people hope and the chance to lead a full and active life.

Photo of John O'MahonyJohn O'Mahony (Mayo, Fine Gael)
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I am grateful for the opportunity to contribute to this Fine Gael Private Members' motion highlighting major inadequacies in our health service and I commend Deputy O'Reilly for his sustained efforts to better the lot of patients in our hospitals. I want to concentrate on the plight of cystic fibrosis sufferers. The fact that improvements for cystic fibrosis sufferers are dependent on a deal between an Independent Deputy and the Government reveals the bizarre manner in which health services are provided in Ireland and suggests shades of a banana republic.

In many ways, the 1,100 cystic sufferers in the Republic of Ireland, including the 39 in County Mayo, have been the forgotten patients in our health service. It is sad that as well as having to cope with inadequate services, these patients and their families had to undertake a national media campaign to get their plight and the lack of services on the agenda. We can only imagine the turmoil in the lives of these people as they try to cope with their need for constant care and treatment while having to fight in public for what should be their right. They are torn between their admiration and appreciation for the nurses and doctors, who give them such great care in impossible and sometimes dangerous circumstances in unsuitable hospital wards, and their frustration at the neglect by the Government over the years of services for cystic fibrosis sufferers.

This morning, I spoke with a parent who was in Mayo General Hospital with her daughter, a cystic fibrosis patient. In between bringing her other child to school and collecting her at 2 p.m. she had to be in the hospital. While she was at pains to praise the commitment from the doctors and nurses on the frontline, she also criticised the lack of isolation units in the hospital, the fact that adults have to be treated in the paediatric ward, the danger of cross-infection and the impossible demands placed on the half-time nurse allocated to cystic fibrosis sufferers in the hospital. The other big fear that cystic fibrosis sufferers and their families have is that even if the Pollock report is implemented, the facilities already in place will be centralised, thereby making a normal life impossible for anyone in the affected families.

I received an e-mail from the parents of two children with cystic fibrosis, one of whom is eight years of age and the other who is 20 months. The first child was diagnosed within 48 hours of birth and the other was confirmed as having the condition within a month of blood tests being taken after their birth at Mayo General Hospital. In so far as comparisons could be made with cystic fibrosis cases which attract publicity, these two children have led straightforward lives with few enough complications. To date, the second child has been hospitalised on one occasion for intravenous antibiotics while the first child has, on average, been hospitalised thrice yearly for the same procedure since they were five. Both children receive the normal routine care that is associated with the condition.

The needs of people with cystic fibrosis has attracted much publicity and this was particularly evident in the run-up to the recent general election. Everyone involved knows about the necessity of isolation wards and en suite facilities. However, Mayo has only one cystic fibrosis nurse who, like all normal people, needs to take annual leave. Unfortunately, a void appears when she is on leave. Earlier this year, one of the children I mentioned earlier was hospitalised when the nurse was on leave and the nurse who normally takes on her duties was ill, with the result that the service was disrupted.

Apart from the needs of Mayo General Hospital, other issues need to be addressed. We are continually told about the dangers of cross-infection, yet the parents of these children are not provided with any option other than hospital visits for their care. If Professor Drumm and the HSE are genuinely serious about reducing the dependency on hospitalisation, why can the role of the community nurse and the local GP not be integrated into the care of those with cystic fibrosis? At this stage, the parents simply feel that no one cares about them. A bell should have rung two years ago when the second child was born but it did not. The child's condition had to be recorded and the penny should have dropped that they were the second with the condition to be born into the family. The child's parents were and are devastated but they have received no consideration.

Photo of Joe CareyJoe Carey (Clare, Fine Gael)
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I strongly support the motion and compliment Deputy Reilly on bringing it forward. The plight of cystic fibrosis sufferers and their families has been completely ignored by successive Fianna Fáil-led Governments. The Pollock report was published three years ago and then simply placed on a shelf and forgotten. Three years is a long time in anyone's life but for a person suffering from cystic fibrosis it is an eternity. The Government's attitude to the Pollock report sums up its overall attitude to cystic fibrosis. Those in the Republic who suffer from this condition have a life expectancy that is ten years less than their counterparts in Northern Ireland. This is a damning indictment and unless the Government changes its attitude, it will remain so.

I recently met representatives of the association which represents cystic fibrosis sufferers in County Clare. The group has a number of questions to which it requires answers. First, when will a cystic fibrosis specialist consultant be appointed at Limerick Regional Hospital? This appointment has been promised for many years but nothing has happened. Second, when will the two additional nurse specialists be appointed at Limerick Regional Hospital? Third, when will additional adult isolation units to cater for the requirements of cystic fibrosis patients be built at the Mid-Western Regional Hospital, Limerick?

It is simply not acceptable that patients, particularly those with cystic fibrosis, should be obliged to travel long distances in order to avail of specialist facilities. The level of specialist resources is limited. While I welcome the proposed provision of 14 new rooms at St. Vincent's Hospital, this progress must be mirrored outside the Pale. A key recommendation of the Pollock report is that adequately staffed, fully equipped cystic fibrosis support centres be located throughout the country. What is the state of play as regards this recommendation?

I am asking that a cystic fibrosis specialist unit similar to the unit for children built, with the assistance of money donated by J. P. McManus, at Limerick Regional Hospital be developed for adult cystic fibrosis sufferers at the same location. Why is it that during Ireland's so-called Celtic tiger boom, private money was used to build the facility to which I refer? The Government must use the fruits of the Celtic tiger to provide facilities for adult cystic fibrosis sufferers.

I recently spoke to the parent of a young boy from County Clare who sufferers from cystic fibrosis. He informed me that he was going to purchase an apartment in Belfast in order to avail of the services available in Northern Ireland, which are far ahead of those on offer in the Republic. One must own a house or residence in Northern Ireland to gain access to the services there. This man is being forced to do this in order to prolong the life of his child. He informed me that one thing cystic fibrosis sufferers do not have is time.

It is time the Minister took action in the interests of the people concerned who are crying out for help and for the Pollock report to be implemented. I commend the motion to the House.

Photo of Paul KehoePaul Kehoe (Wexford, Fine Gael)
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I support the motion. We are discussing cystic fibrosis and the need for psychiatric assistance for young people. I wish to refer first to cystic fibrosis.

The campaign relating to cystic fibrosis has been highlighted on Joe Duffy's "Liveline", in national and local newspapers, on local radio stations and on "Prime Time" and "The Late Late Show" in recent weeks. The Government has failed to implement the recommendations of the Pollock report. All the Minister, Deputy Harney, and her numerous Ministers of State need do in respect of this matter is examine what is happening in Northern Ireland and other European Union countries and consider the facilities that are available for cystic fibrosis sufferers in these jurisdictions. As Deputy Joe Carey stated, the one thing cystic fibrosis sufferers do not have is time. The Government has been in power for ten years and has failed to provide assistance for cystic fibrosis sufferers.

I listened with interest to the comments made by Deputy White who has been totally whitewashed. It is amazing that she stated she was satisfied that adequate funding would be provided for facilities for cystic fibrosis sufferers in the coming years. I assure the Minister of State, Deputy Pat the Cope Gallagher, that if Deputy White was on this side of the House, she would be shouting loudly at Members on the Government side. I am jealous that her party is in government. However, I have standards and would not like to be in government just for the sake of it. That is the position in which the Green Party finds itself.

On psychiatric facilities, particularly those for younger people, I was visited by a parent at my clinic last Saturday. Deputy Collins stated that, in the context of the health service, everything was not all doom and gloom. I invite him to visit my clinic, which lasts one and a half hours, next Saturday. I will even pay for his train or bus journey or perhaps he may wish to drive to Enniscorthy. I will provide him with examples that everything relating to the health service is all doom and gloom. I have no doubt that he was provided with a lovely script by the Minister for Health and Children, Deputy Harney. As the Minister was not present to read her script, she gave it to the Deputy who did a fine job of reading it into the record. The people of County Limerick will be very proud of him. However, those within the health service who face real difficulties will not be too happy with him. He is a yes man and afraid to stand up and be counted.

I commend Deputy Conlon for what she said. However, I must ask if will she vote with the Opposition or the Government. I have no doubt that it will be the latter.

A 15 year old girl in the children's ward in Wexford General Hospital has been waiting four weeks to be transferred to a child-adolescent bed in a psychiatric hospital in Dublin. I accept that the Minister of State will not be able to provide an answer this evening but perhaps he or an official from the Department of Health and Children might indicate at a later date the number of child-adolescent beds available throughout the country. If he could communicate further with me on this matter, I would be grateful. I have been informed that there are eight such beds. I do not want to believe that is the case. If there are only eight child-adolescent beds, it is a matter of shame for the Government which has been in power for ten years. What should I say to the parent of the child to whom I refer? What would Deputy Collins say to the individual in question? He is of the view that everything is okay but I am not.

I have attacked the Green Party in recent weeks and will continue to do so because its members have no standards whatsoever. I commend the motion to the House and congratulate Deputy Reilly on bringing it forward.

Photo of Pat GallagherPat Gallagher (Minister of State, Department of Health and Children; Donegal South West, Fianna Fail)
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I welcome the opportunity to conclude the debate on behalf of the Government and the Minister for Health and Children, Deputy Harney. It has focused on developments in cystic fibrosis services and mental health services, in particular. Many points were made in respect of general health issues and local concerns. From the contributions of my colleagues, the Ministers of State, Deputies Devins and Hoctor, and statements made by the Minister, it must be clear that the Government is committed to building services for people with cystic fibrosis and mental health services and that we are ensuring actions are taken to meet that commitment.

On Thursday afternoon last the Minister dealt with these issues at Question Time, when many of the same points were raised and debated. There is no discourtesy intended to the House or the Opposition in the Minister being away on official business this week. Her trip was organised by the Department several months ago in response to specific invitations. Fine Gael, as is normal for official business abroad, accorded the Minister the facility of a pair for the week. I acknowledge the co-operation of Deputy Kehoe in this regard.

The substance of the debate is the most important aspect. In that context and since the publication of the Pollock report, the Minister and the Government have made available almost €7 million in additional funding for the development of services for cystic fibrosis sufferers. This has led to the recruitment of 44 new specialist staff across nine hospitals and we look forward to 37 further staff members being recruited with the funding available. It is acknowledged that, as the recommendations in the Pollock report are being implemented, these new staff are beginning to make improvements to services.

The Minister and the Government have made the correct funding and policy decisions in response to the Pollock report. It is now about implementation. We all want to see new facilities put in place at hospitals like St. Vincent's in Dublin as rapidly as possible. None of us finds conditions for cystic fibrosis patients acceptable.

This and previous Governments have wanted to see a fast pace of capital developments, once political approval has been given for funding. This is not confined to capital works for cystic fibrosis services but goes across the board, and beyond health too. We know there are legal and technical constraints on the speed of capital works, but the Minister, the Government, and the HSE management are determined to ensure capital funding under the national development plan is used rapidly and efficiently for the strategic purposes decided at political level. The HSE has assured the Minister it now has the capacity to make full use of its significant capital allocation.

In regard to cystic fibrosis, St. Vincent's Hospital and the HSE are acting in accordance with the public and political desire to see as fast a pace of capital development as possible. We are certainly making progress and I am confident the new dedicated facilities at St. Vincent's for cystic fibrosis patients will be put in place quickly, and that innovative ways of making the earliest possible progress this year will be implemented, as the Minister of State, Deputy Devins, outlined last evening. This will result, for example, in a total of 14 single rooms for cystic fibrosis patients by the end of the summer.

In regard to mental health, it is not the case that many sites have been sold by the HSE since A Vision for Change was adopted by Government, with the capital receipts supposedly lost to mental health services. The only property where a transaction has been completed is St. Loman's in Dublin and the €38 million involved will contribute to funding mental health capital developments under the national development plan.

New developments will include, for example, a new acute psychiatric unit at Letterkenny General Hospital. The HSE has informed me it expects to have the design work completed so as to be able to go to market for construction tenders by the end of this month.

The Government and HSE are fully committed to implementing A Vision for Change. This report and its acceptance by Government in 2006 is a major milestone in the development of mental health services. The Government has given priority to the area in funding decisions and in the appointment of my colleague, Deputy Devins, to the area as Minister of State.

I assure the House he is determined to ensure funding allocated by Government to mental health is actually used fully for mental health services.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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It has not been.

Photo of Pat GallagherPat Gallagher (Minister of State, Department of Health and Children; Donegal South West, Fianna Fail)
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What happened last year, where funding was not fully used for mental health developments, is not to recur, and this has been made clear to and is accepted by all concerned.

As in all areas of health, we are making progress in mental health. For example, admissions to Irish psychiatric units and hospitals are continuing to decline from 25,985 in 1997 to 20,288 in 2006 — a 22% decrease. The introduction of the Mental Health Commission has also been a significant step forward for patients.

All the Ministers involved in health and the whole Government are determined to keep up the daily work to continue to make measurable progress across all areas of health.

Photo of Jan O'SullivanJan O'Sullivan (Limerick East, Labour)
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Was the Minister of State told the money was not spent?

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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I wish to share time with Deputy James Reilly.

Photo of John O'DonoghueJohn O'Donoghue (Ceann Comhairle; Kerry South, Ceann Comhairle)
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Is that agreed? Agreed.

Photo of Seymour CrawfordSeymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank my colleague, Deputy James Reilly, for giving me the opportunity to again discuss the important health issues regarding lack of services to the disabled, those with mental health issues and those with cystic fibrosis etc. In the few minutes available I will speak specifically about the real cutbacks in the north east.

The Minister for Health and Children and Professor Drumm have given many commitments that no services would be removed until as good or better services become available. In recent weeks, however, two consultants have been removed from Monaghan General Hospital as well as beds, so the treatment room there can no longer give the same full service. This in turn means patients will have to go to Cavan, Drogheda or even Dublin. These are patients who in the past were dealt with perfectly well and safely in Monaghan General Hospital.

Mr. Finbarr Lennon, senior consultant, with full knowledge of the north east, has clearly stated that Our Lady of Lourdes Hospital in Drogheda is incapable of dealing with its present numbers and is currently unsafe. Yet the Minister, Deputy Harney, and Professor Drumm insist on carrying on with the implementation of the Hanly report under the guise of the teamwork operational programme, which Mr. Lennon argues is unworkable.

At this late stage I beg that the Minister, Deputy Harney, preferably in the absence of Professor Drumm, sit down with the elected Members of the north-east region to work out a realistic way forward. Surely the Minister can no longer oversee the wanton waste at management and other levels within the HSE while services are being wound down at all the five hospitals in the north east.

I am glad to hear my colleague, Deputy Margaret Conlon, making a statement in the House. I know if she is to carry through on her contribution, she will vote with us on this side.

Medical cards are being removed because of a lack of finance in the north east and even being refused for seriously ill patients. The last straw in mismanagement was when the President recently opened a facility in Monaghan for the adult handicapped. Although it had been built for two years by Mr. Dan Rogan and the Association of Parents and Friends of the Mentally Handicapped, no staff was appointed to run the centre. In that context, the only three available beds for respite of young handicapped are now in the process of being removed.

We do not expect to have a Beaumont or Blackrock Clinic type of hospital in Monaghan but we deserve to be treated as human beings and be guaranteed, as the Minister promised, that services will be retained until better is available. I have no wish to see the HSE running over budget but I humbly suggest that it is not the closure of Monaghan General Hospital or taking it off call that will solve the problem in the long term. We need a real reconfiguration of management and administrative structure.

The former Minister responsible for health, Deputy Michéal Martin, organised 150 reports and inquiries, with 115 of these costing €32 million. We have no costings for the others. How many reports and inquiries has the current Minister instigated and at what cost?

The Indecon report on pharmacists, sponsored by the Government, was brought in but completely ignored. In a reply last night on the pharmacist issue, the Minister indicated her wish to find a way of reaching new arrangements, adapting what has been a traditional process to arrive at a revised pricing arrangement. The Minister has no arrangements as such with the pharmacists and it is a disgrace.

Photo of Terence FlanaganTerence Flanagan (Dublin North East, Fine Gael)
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Hear, hear.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I thank everybody in the House who contributed to this debate, as these are very important issues. I welcome the members of the Cystic Fibrosis Association of Ireland in the Gallery who have come from Rush. I know it took much effort on their part to be here. Every time these people go out they are exposed to more infection, so I appreciate their being here.

We discussed cystic fibrosis last night in the Chamber. It is clear we have the highest incidence of this life-threatening illness in the world, with more than 1,100 cases in the country. We have the worst prognosis in western Europe, with people suffering from cystic fibrosis in this country dying ten years younger than their counterparts in the UK or even up the road in Northern Ireland.

There are many reasons for this, which we discussed last night, such as lack of neonatal screening, proper homecare support, isolation beds for treatment in hospital and isolation facilities when those suffering from the disease attend accident and emergency departments. There is also a lack of a specialist centre in St. Vincent's.

The main reason for the problem is a lack of isolation rooms and the danger of cross-infection. We have no reference laboratory in this country funded by the State, although there is one working on a voluntary basis in Tallaght. That is run by Dr. Philip Murphy and financed by the Cystic Fibrosis Association of Ireland. It is the only lab capable of checking and growing different species of a bug called cepacia, which is very often fatal for people with cystic fibrosis. Once people have contracted this bug, they are no longer considered eligible for a lung transplant because the outcome is not as good. The lab should be funded by the HSE so the burden of funding can be taken away from the Cystic Fibrosis Association of Ireland. This will protect patients from the bug but if they are unfortunate enough to contract it, we can check for the multiplicity of antibiotics that must be used in combination to treat it successfully. Most labs in the country do not check for that bug.

We need neonatal screening and high-frequency oscillating vests, which are applicable to certain people with cystic fibrosis. For them, it could save significant amounts of money for physiotherapy. We require proper home support. These are brave young outspoken people, and all they are asking of the Minister and this State is to be given a fighting chance against this life-threatening illness. I ask the Minister to commit tonight to delivering the service to these people within a real deadline, unlike other commitments in the past. It is particularly disappointing that 82% of sufferers have not seen any significant improvement since the Pollock report was published three years ago, that they are still exposed to cross-infection and that the too little, too late approach continues with talk of 14 rooms in St. Mark's ward by the end of the summer, while we wait almost three more years for a dedicated unit at St. Vincent's. It is not satisfactory, particularly when there are 18 patients with cystic fibrosis in St. Vincent's and ten more on the waiting list, making a total of 28. Plans are no substitute for action and promises do not save lives, only service does.

I told the Minister of State last night that there is a company in Tyrone which can build modular units in four months and has already done so at various sites around the city for the Department of Health and Children. Will he use the unspent money to engage these contractors to build these modular units, particularly at St. Vincent's and at the other sites, as promised by the Minister, in Galway, Limerick, Cork, Waterford and north Dublin? That is the solution. There should be no more reports or experts. The Minister should just do this and give these young people a fighting chance.

Mental health patients are treated in atrocious conditions, particularly in St. Ita's where 23 people on the male admission ward and the female admission ward are cared for in an open dormitory in conditions similar to those that existed in Romania under Ceausescu. These patients are in an open ward. This is 2008, not 1908. The building was built over 30 years ago as a temporary measure and I have nothing but admiration for the doctors, nurses and care staff who work there. It is a credit to them that there has not been a serious injury or fatal incident in the hospital. It is unbelievable that 23 patients are treated in an open ward with 3 ft between the beds. A lady there was nearly smothered by another patient who came back from day leave.

People are infuriated that the delay is connected with the psychiatric unit at Beaumont. This was promised over 20 years ago and was built but then used for the overflow from the medical wards. The attitude was that the psychiatry patients could wait. Planning permission was granted in 2004 for a new building and it went out to tender in 2005. How many millions of euro were spent on that planning application? A co-located hospital is to be built on part of that site rendering that planning permission null and void. People who are mentally ill go to the back of the queue because they are the least important to the Government. That is how it treats the most vulnerable people in our society.

It is galling that people who live in Artane and Killester have to drive by Beaumont Hospital to the far end of the peninsula at Portrane to seek treatment in a Dickensian building. We want the money that will be realised from the assets of the psychiatric institutions ring-fenced for psychiatry and mental health, and the money promised for the implementation of A Vision for Change used for that purpose, not to meet daily costs. Above all, I want to see a deadline for a completion date for a psychiatric unit in Beaumont Hospital. That is the least my constituents and those of Dublin North-East expect.

Last night I alluded to the terrible cutbacks taking place all over the country and the failed and broken promises of the Government, particularly the Minister for Health and Children. First, they said there would be no cutbacks, then that cutbacks would not hurt patients, then they introduced a raft of cutbacks and delayed operations, which continues. According to an article in last night's Evening Echo, nurses will be asked to take six weeks' unpaid leave. The HSE is €370 million short. Every time it plans to save money it does so at the patients' expense. There is never a question of increasing efficiencies within its bungling burgeoning bureaucracy.

We do not have the capacity to meet the demand but we can resolve this in two ways, one, reduce demand by instituting preventative care in the community through general practices. A national body test would prevent illness or pick it up early and make major savings. Every euro spent on prevention would save €20 on treatment. This could be achieved through one-stop shops in the community where there are groups of general practitioners with nursing staff, physiotherapists, X-ray and ultra sound facilities, rooms for visiting consultants to see patients, and endoscopy, the camera that examines the upper and lower bowel. That can be done in the community, keeping people away from hospital. The Minister should bring the service to the people where they want it in comfortable, familiar surroundings.

There are more people like Susie Long and the waiting list for a colonoscopy remains several months in many parts of the country. More people will die through Government inaction. Real action can keep people out of hospital and would not cost a great deal. It would be much cheaper to do this in the community.

The second part of this action is to increase the capacity of the hospitals by two mechanisms. We need more beds. Even PA Consulting, commissioned by the Government, reported a few weeks ago that we need 1,200 beds and we will need many more if we do not change the way we do business. That is the purpose of the preventative early intervention course in the community. The 57,000 bed-days lost in the Mater and Beaumont hospitals last year alone are equivalent to a 150-bed hospital. Moving those patients into the community would free up the equivalent of a new hospital. That could be done within six months.

There are people in private enterprise who are planning to build nursing homes. They only want to know whether the patients will come and they will deliver. Patients should not be stacked in nursing homes. There should be physiotherapy, occupational therapy and speech and language therapy so that the patients can continue their rehabilitation close to their families and loved ones and eventually go home.

Last night, the Minister of State, Deputy Devins, who was here earlier tonight but has left, said he was disgusted that Fine Gael would raise the issue of the absence of the Minister for Health and Children, Deputy Harney, from the country during this debate. He said that her trip was organised several months ago, as the Minister for State, Deputy Gallagher, also said. If that is so, why does it not appear in Iris Oifigiúil, which informs us of where Ministers will be when the rotas are being drawn up? It is not there. No major event is taking place. This is a fact-finding mission. We are up to our gills in reports and we have experts coming out our ears. The Minister has gone to study cancer services, having brought a new cancer expert into the country. We do not need more experts or reports, we need action and leadership.

Deputies:

Hear, hear.

9:00 pm

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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I will tell the Minister of State, Deputy Devins, who is not here, what disgusts me: that people with cystic fibrosis die ten years younger than they do 50 miles up the road; that Beverly Seville Doyle, a 39 year old, died alone in a toilet in an accident and emergency department; that psychotic patients cannot get secure beds and put themselves and others at risk; that the people of Dublin North and Dublin North-East are treated on an open ward with 22 other patients and very little dignity, at great risk to themselves and staff, while private enterprise builds a co-located hospital on a site that was designated for a modern unit for their care; that 400 people were lying on trolleys only two weeks ago; that countless thousands of people are on long waiting lists for operations; that fungus grows on the wall of an old pre-fabricated building in Balbriggan where nurses take blood from mentally ill patients; and that children are admitted to adult psychiatric wards. That is what disgusts me and many people.

We need a Minister who will act. The technology and the people are available, what we lack is a Minister who is prepared to act, to show leadership, to stay here and fight for patients and put them first instead of going to the other side of the Atlantic. This week has shown yet again that the Minister is disinterested, disconnected, disengaged and has forgotten what leadership involves. We are hoarse on this side of the House shouting for action. Patients are dying waiting for it. The Minister should cut out the vacillation and procrastination, spend the money, sort out the HSE, act, build the units, give the people the health service for which they have worked so hard and paid so much tax over the past ten years. Let us not watch our bright young cystic fibrosis sufferers die ten years younger than those 50 miles up the road.

I commend the motion to the House.

Amendment put.

The Dail Divided:

For the motion: 72 (Dermot Ahern, Michael Ahern, Noel Ahern, Barry Andrews, Chris Andrews, Seán Ardagh, Bobby Aylward, Joe Behan, Niall Blaney, Áine Brady, Cyprian Brady, Johnny Brady, John Browne, Thomas Byrne, Dara Calleary, Pat Carey, Niall Collins, Margaret Conlon, Seán Connick, Mary Coughlan, Brian Cowen, John Cregan, Ciarán Cuffe, Martin Cullen, John Curran, Jimmy Devins, Timmy Dooley, Michael Fitzpatrick, Beverley Flynn, Pat Gallagher, Paul Gogarty, Noel Grealish, Mary Hanafin, Jackie Healy-Rae, Máire Hoctor, Billy Kelleher, Peter Kelly, Brendan Kenneally, Michael Kennedy, Tony Killeen, Séamus Kirk, Michael Kitt, Tom Kitt, Brian Lenihan Jnr, Michael Lowry, Martin Mansergh, Micheál Martin, Tom McEllistrim, Finian McGrath, Mattie McGrath, Michael McGrath, John Moloney, Michael Moynihan, Michael Mulcahy, M J Nolan, Éamon Ó Cuív, Seán Ó Fearghaíl, Darragh O'Brien, Charlie O'Connor, Willie O'Dea, Noel O'Flynn, Rory O'Hanlon, Batt O'Keeffe, Mary O'Rourke, Peter Power, Dick Roche, Trevor Sargent, Eamon Scanlon, Brendan Smith, Mary Wallace, Mary White, Michael Woods)

Against the motion: 58 (Bernard Allen, James Bannon, Seán Barrett, Tommy Broughan, Richard Bruton, Ulick Burke, Joe Carey, Deirdre Clune, Paul Connaughton, Noel Coonan, Simon Coveney, Seymour Crawford, Lucinda Creighton, Michael D'Arcy, John Deasy, Jimmy Deenihan, Andrew Doyle, Bernard Durkan, Damien English, Olwyn Enright, Frank Feighan, Martin Ferris, Charles Flanagan, Terence Flanagan, Brian Hayes, Phil Hogan, Brendan Howlin, Paul Kehoe, Enda Kenny, Kathleen Lynch, Pádraic McCormack, Dinny McGinley, Joe McHugh, Liz McManus, Olivia Mitchell, Denis Naughten, Dan Neville, Michael Noonan, Caoimhghín Ó Caoláin, Aengus Ó Snodaigh, Kieran O'Donnell, Fergus O'Dowd, Jim O'Keeffe, John O'Mahony, Brian O'Shea, Jan O'Sullivan, John Perry, Pat Rabbitte, James Reilly, Michael Ring, Alan Shatter, Seán Sherlock, Emmet Stagg, David Stanton, Billy Timmins, Joanna Tuffy, Mary Upton, Leo Varadkar)

Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Paul Kehoe and Emmet Stagg.

Amendment declared carried.

Question put: "That the motion, as amended, be agreed to."

The Dail Divided:

For the motion: 69 (Dermot Ahern, Michael Ahern, Noel Ahern, Barry Andrews, Chris Andrews, Seán Ardagh, Bobby Aylward, Joe Behan, Niall Blaney, Áine Brady, Cyprian Brady, Johnny Brady, John Browne, Thomas Byrne, Dara Calleary, Pat Carey, Niall Collins, Margaret Conlon, Seán Connick, Mary Coughlan, Brian Cowen, John Cregan, Ciarán Cuffe, Martin Cullen, John Curran, Jimmy Devins, Timmy Dooley, Michael Fitzpatrick, Beverley Flynn, Pat Gallagher, Paul Gogarty, Noel Grealish, Mary Hanafin, Jackie Healy-Rae, Máire Hoctor, Peter Kelly, Brendan Kenneally, Michael Kennedy, Tony Killeen, Séamus Kirk, Michael Kitt, Tom Kitt, Brian Lenihan Jnr, Michael Lowry, Martin Mansergh, Tom McEllistrim, Finian McGrath, Mattie McGrath, Michael McGrath, John Moloney, Michael Moynihan, Michael Mulcahy, M J Nolan, Éamon Ó Cuív, Seán Ó Fearghaíl, Darragh O'Brien, Charlie O'Connor, Willie O'Dea, Noel O'Flynn, Rory O'Hanlon, Batt O'Keeffe, Mary O'Rourke, Peter Power, Dick Roche, Eamon Scanlon, Brendan Smith, Mary Wallace, Mary White, Michael Woods)

Against the motion: 57 (Bernard Allen, James Bannon, Seán Barrett, Tommy Broughan, Richard Bruton, Ulick Burke, Joe Carey, Deirdre Clune, Paul Connaughton, Noel Coonan, Simon Coveney, Seymour Crawford, Lucinda Creighton, Michael D'Arcy, John Deasy, Jimmy Deenihan, Andrew Doyle, Bernard Durkan, Damien English, Olwyn Enright, Frank Feighan, Martin Ferris, Charles Flanagan, Terence Flanagan, Brian Hayes, Brendan Howlin, Paul Kehoe, Enda Kenny, Kathleen Lynch, Pádraic McCormack, Dinny McGinley, Joe McHugh, Liz McManus, Olivia Mitchell, Denis Naughten, Dan Neville, Michael Noonan, Caoimhghín Ó Caoláin, Aengus Ó Snodaigh, Kieran O'Donnell, Fergus O'Dowd, Jim O'Keeffe, John O'Mahony, Brian O'Shea, Jan O'Sullivan, John Perry, Pat Rabbitte, James Reilly, Michael Ring, Alan Shatter, Seán Sherlock, Emmet Stagg, David Stanton, Billy Timmins, Joanna Tuffy, Mary Upton, Leo Varadkar)

Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Paul Kehoe and Emmet Stagg.

Question declared carried.