Dáil debates
Wednesday, 22 February 2012
Private Members' Business
Health Services: Motion (Resumed)
5:00 pm
Joan Collins (Dublin South Central, People Before Profit Alliance)
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The reality for ordinary people is completely different from what is set out in the Government amendment. The Sinn Féin Party's proposal is far more representative of the true situation. This morning the Irish Association for Emergency Medicine issued an alarming statement on the crisis in hospitals throughout the State, with a particular focus on children's hospitals. At Crumlin hospital, in my constituency, children are waiting 12 hours on a trolley and 24 hours to be admitted to a bed. The number waiting on trolleys there has increased by 700% in the past seven years. Temple Street hospital is described by the association as "significantly overcrowded". At St. Vincent's hospital, meanwhile, 40 patients were waiting for beds yesterday morning, with 60 to 70 awaiting treatment in the accident and emergency department.
All of this is in stark contrast to the claims made by the Government about the health service. There is a crisis in hospitals in terms of access to beds, particularly in the winter, yet no account has been taken of this by the Minister for Health, Deputy James Reilly, in his plan for health services delivery. Beds must be reopened without delay, particularly for cystic fibrosis patients at St. Vincent's hospital. One such patient had to wait overnight in the accident and emergency department before being admitted. That is a terrible indictment of the health service. We all know that cystic fibrosis sufferers should not be left in an open ward or accident and emergency department for any length of time. The bottom line was that the hospital had no bed to cater for this patient. The Government amendment does not reflect reality. I urge the Minister to ensure beds are reopened in the winter.
Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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It is time the Government admitted the reality of what is happening in the health service and dispensed with the ridiculous and meaningless slogan of "getting more for less". The evidence everywhere is that as a result of the vicious cuts the Government is imposing on the health service, we are getting considerably less for less. Sick and vulnerable people, including children in Crumlin and Temple Street hospitals, are suffering as a result of the cuts. It is as simple as that. Sick children are waiting on trolleys for hours on end. The most vulnerable members of our society, those who most need to be protected and cared for when they are unwell, are feeling the effects. When there are reductions in ambulance and accident and emergency services, bed closures and reduction in the numbers of health professionals in the system, one is inevitably faced with a disaster descending on the health service. That disaster will only get worse as rising health insurance premia mean that more people will be forced to depend on a public system that is entirely unfit for purpose and being carved up in order to pay off the bankers and bondholders who have ruined the economy of the State and are ruining the European economy.
The Minister's plans to close down local accident and emergency services in hospitals throughout the State are of particular concern. I have a special interest in St. Columcille's Hospital in Loughlinstown where the plan seems to be - the Minister will not confirm it one way or the other - to shut down the 24 hour accident and emergency service at the end of March. As recently as last month, Professor John Nichols, speaking at the Royal College of Surgeons, stated categorically that the distance a patient had to travel in an ambulance to receive treatment was a matter of life and death. If local 24 hour accident and emergency services were shut down, he said, more people would die. I appeal to the Government to end the butchery of local accident and emergency departments at Loughlinstown and elsewhere and to reinstate those such as the service in Roscommon which have been closed. We must stop the cuts in order to save lives. The bankers and the rich should be made to pay for the economic mess, not the sick and the vulnerable.
Shane Ross (Dublin South, Independent)
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I agree with much of the sentiment behind the motion and understand the emotion being expressed on this side of the House. Even if one looks at the health service and the Health Service Executive in a very forensic way, one cannot justify what is happening. Looking at the figures in a cold, calculating way shows that the behaviour of those involved is unacceptable. To anybody who observes a meeting of the Committee of Public Accounts at which representatives of the HSE are in attendance, it is clear that they are simply putting out fire after fire. On every question one asks, every flank on which one attacks or criticises, they are vulnerable and wrong.
The Health Service Executive is flawed, rotten, inefficient and politicised. It is incapable of managing the problems with which it is presented and has not done so for many years. Successive Governments have also shown themselves to be completely incapable of dealing with the difficulties. The problems are absolutely manifest, but above all is the loss of faith by the public in the HSE. That loss of faith is a consequence of people's inability to access what they consider to be rightful and proper treatment because of the cuts that have been imposed. The reason for this is partly, like many semi-State organisations, the Health Service Executive has built an empire, the interest of which, in the end, is to defend and expand itself.
Anybody who has attended the meetings of the Committee of Public Accounts will have seen that the management has completely lost sight of its objective, purpose and mission, which is to look after the health of the patients of Ireland. That is not the focus of senior figures in the organisation. Instead they are focused on defending themselves and their patch. There is a great deal of evidence to indicate that this is the case, part of which is the raw figure that 16% of personnel in the HSE are administrative staff, while at the same time there is a shortage of front-line staff. An observation made by the Minister for Health, Deputy James Reilly, when in opposition illustrates the reality of the situation:
The HSE are engaged in industrious futility, running around filling out very extensive reports that are terribly important in their own minds but which do not result in an iota of improvement in care or a single new service.
Mattie McGrath (Tipperary South, Independent)
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The Leas-Cheann Comhairle has indicated that I have only two minutes in which to make my contribution. I might not be able to stop once I get going.
I compliment the Deputies who brought forward the motion. The Health Service Executive is a total disaster. We have heard so much from the Minister for Health, Deputy James Reilly, about his intention to abolish it. Instead he has merely tinkered with the board. It is an out-of-control juggernaut, a train that must be derailed. I made this argument many times to the former Minister for Health, Mary Harney. We hear about all the positive developments under the HSE, but they are spoiled by the very nature of the beast that it is the system which is simply abominable.
I walked out of a meeting with representatives of the HSE in Tipperary last week. Having been one and a half hours late in arriving for the previous meeting, they were 40 minutes late on this occasion. They have no respect for the Minister, his Ministers of State, Deputies or anybody else. Many of the senior managers are self-serving and concerned only with career building and ascending the ladder. We saw this when the health boards were amalgamated and not one job was lost. The Minister should know the situation well as a former president of the Irish Medical Organisation, in which capacity he negotiated some of the great deals for doctors and consultants. They are the only ones in the system whose pay has not been cut. Patients are waiting on trolleys, ambulance services are being cut, care homes are being closed down and so on, yet we continue to ignore the elephant in the room - consultants' pay. We are told there will be greater productivity if salaries are not reduced. That is patent nonsense. The people concerned are very eminent in their own right, but they cannot be treated like sacred cows. Everybody must feel the pain. Senior consultants are using public beds to treat private patients. A fitter and so on must provide his or her own premises and facilities. Former Minister Barry Desmond tried to abolish this practice a number of years ago but failed. Things have gotten worse since. The Minister, Deputy Reilly, acquiesced to the consultants and now lacks the moral credibility to retract that to which he agreed.
Michael Kitt (Galway East, Fianna Fail)
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The Deputy must conclude.
Mattie McGrath (Tipperary South, Independent)
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If not disbanded, the HSE will lead us into a morass. As I stated, it is made up of self-serving people who are interested in their careers rather than patient care.
Dara Murphy (Cork North Central, Fine Gael)
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A number of the Private Members' motions tabled during the lifetime of this Dáil have been positive. This motion is, however, the most hypocritical and nonsensical tabled thus far. The HSE was mentioned by Fianna Fáil Deputies eight times. However, none mentioned that the HSE was established by Deputy Martin, when Minister for Health and Children. We had 14 years of Fianna Fáil in Government during which time former Deputies Brian Cowen and Mary Harney were responsible for the health portfolio and services provided to the people of our country deteriorated. This changed when Deputy James Reilly became Minister for Health.
The Minister has through the special delivery unit put in place targets which were achieved in year one. No targets were set during the lifetime of the previous Administration. I agree that it is extremely regrettable that owing to the mismanagement and abuse of our country by Fianna Fáil we now have to take €1 billion out of the health service to restore our independence and sovereignty. The Minister for Health is to be commended on achieving his targets last year in respect of a reduction in the number of people on trolleys, a reduction in waiting times for people needing elective surgery and his development of a strong momentum towards free GP and universal care, which the people of our country voted for in such huge numbers. The Government and Minister have this month set new targets in this regard.
The creation of 1,000 new jobs in the north east was announced today. Yet we are faced again this evening with this doomsday nonsense. Week after week this Government is proving that it is able to combat and that there is a better way for our people. For Fianna Fáil to criticise the monster that is the HSE, which it created, smacks of hypocrisy and nonsense. The people are aware, as the good news continues to be announced, that Fianna Fáil is becoming more and more desperate.
Dara Murphy (Cork North Central, Fine Gael)
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They are trying to con the people that politics is the same as ever: it is not; it has changed.
Billy Kelleher (Cork North Central, Fianna Fail)
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What about St. Mary's Orthopaedic Hospital?
Dara Murphy (Cork North Central, Fine Gael)
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We will continue to change it for the better in spite of the type of rubbish we have to endure every week from Fianna Fáil, who let the people down. We will not go down the same route.
Billy Kelleher (Cork North Central, Fianna Fail)
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The Deputy did not mention St. Mary's Orthopaedic Hospital.
Dara Murphy (Cork North Central, Fine Gael)
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The new facility will open on 20 March.
Michael Kitt (Galway East, Fianna Fail)
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Deputy Murphy, please. I call Deputy Neville.
Billy Kelleher (Cork North Central, Fianna Fail)
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Deputy Murphy will be there.
Dara Murphy (Cork North Central, Fine Gael)
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Yes and happy to be there. Fianna Fáil was never there: it could not care less.
Michael Kitt (Galway East, Fianna Fail)
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Deputies, please. Deputy Neville has the floor.
Billy Kelleher (Cork North Central, Fianna Fail)
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I supported the reconfiguration-----
Dara Murphy (Cork North Central, Fine Gael)
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The Deputy never supported the orthopaedic hospital.
Mattie McGrath (Tipperary South, Independent)
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The facility is not even finished.
Michael Kitt (Galway East, Fianna Fail)
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I call Deputy Neville.
Dan Neville (Limerick, Fine Gael)
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I welcome the opportunity to contribute to this debate. I am disappointed that the motion does not mention mental health services.
Billy Kelleher (Cork North Central, Fianna Fail)
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We will be tabling a motion on it in a couple of weeks.
Dan Neville (Limerick, Fine Gael)
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Bearing in mind that one in four people will suffer mental health difficulties at some stage in their lives I would have expected mental health services to be included in a general motion on health services.
I would like to address the issue of child and adolescent psychiatric services. While the figures in respect of the number of children admitted to adult psychiatric services have reduced, it is totally unacceptable that there were 129 notifications of under-age admissions to adult approved centres last year. I know the Minister's objective is to have no child or adolescent patient in adult psychiatric centres, which are totally unsuitable. Existing adult psychiatric services are poorly resourced to deal with children and adolescents owing to the different emphasis placed on a development prospective which needs to focus on families of young people, schools and social intervention rather than on treatment of the psychiatric difficulty.
Adult services do not have inpatient facilities that are appropriate for the admission of adolescents for various reasons, including health and safety and treatment issues. Adult outpatient clinics are generally not adolescent friendly. There is also a difficulty in regard to the provision of services for 16 to 18 year olds in that they are not eligible for adult or child psychiatric services. There is a gap in respect of services in this regard. The frequent need for an urgent response to problems presented by children and adolescents leads services to deal disproportionately with adolescents at the expense of their work with young children. In other words, when adolescents present, the service must deal disproportionately with young people.
It is totally unacceptable that children must wait six months to three years for psychiatric services. With early intervention, there is a 90% chance of cure but with late intervention the patient's condition becomes chronic.
Michael Kitt (Galway East, Fianna Fail)
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The Deputy must conclude.
Dan Neville (Limerick, Fine Gael)
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As stated on a number of occasions, I welcome the €30 million allocated this year to A Vision for Change. However, appointment of a director of mental health services within the HSE is urgent to ensure that money is spent on that for which it is designated. A previous Minister allocated €50 million to A Vision for Change, only €27 million of which was spent on psychiatric services. We must ensure the €30 million allocated to this area is spent on that for which it was allocated.
Dominic Hannigan (Meath East, Labour)
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I support the Government amendment. The Government is determined to reform the health service. While this poses a challenge to Government, we will meet it. However, reform will take some time.
The Opposition motion states that our plan for reform will fail despite that we have not yet had an opportunity to complete it. Fianna Fáil knows all about failure. Its plans failed. While expenditure in the health service doubled during Fianna Fáil's time in office, it left us with an under-performing health service.
Billy Kelleher (Cork North Central, Fianna Fail)
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Which the Deputy criticised.
Dominic Hannigan (Meath East, Labour)
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We need to learn from the previous Government's mistakes. We must ensure we do not repeat them as they have been very costly to the taxpayer. The HSE needs to be restructured and this process was commenced with the putting in place of a new board and will be continued by way of the forthcoming health service legislation. Reform of the health service has also commenced. The move towards universal health insurance commenced with this year's budget, which means free GP care to long term illness claimants will commence this year. In 2013, GP care will be extended to patients who receive medicines under the high-tech drugs scheme. This will be followed by access to subsidised GP care for all. The Government's plans are ambitious but they are achievable through better use of resources.
The motion before us also deals with the north-east service plan, which takes in County Meath. While the budget for this plan is being reduced it must be recognised that investment in services continues. For example, €5 million has been provided for primary care service staff in primary care centres, such as the one due to open in Ashbourne in the autumn. This centre will provide a comprehensive service to residents in that area. It is good news for the residents of Ashbourne and for nearby hospitals as illnesses are identified earlier and treated quicker. The roll out of primary care centres in Ashbourne and other areas around the country is key to our overall health strategy. The result will be a more effective spend for the taxpayer, one that ensures better outcomes for patients.
Derek Keating (Dublin Mid West, Fine Gael)
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I also welcome the opportunity to make a short contribution to this debate. The development of primary care services is highly important and I believe it to be an essential component of the health services reform process. Moreover, it was a key issue during last year's general election. I will take this opportunity to commend the Minister, Deputy Reilly, on the manner in which he literally has taken this issue by the scruff of the neck whereas others, who were his predecessors not that long ago, considered the health portfolio to be akin to Angola.
Mattie McGrath (Tipperary South, Independent)
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Were they in the Deputy's own party?
Derek Keating (Dublin Mid West, Fine Gael)
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In a developed primary care system, up to 95% of people's day-to-day health and social care needs can be met in the primary care setting. I recently visited the soon-to-be opened primary care facility for Palmerstown and Ballyfermot. It is a fantastic facility that will change for the better the entire manner in which health care is delivered in the community. The ambition of the Minister, Deputy Reilly, is to have primary care as a linchpin for health services, including mental health services, for the young, the old, the dependent, the able and those with learning disabilities, that is, for all citizens of the State. This ambition must be supported and admired.
A key objective of the primary care strategy is to develop services in the community which would give people direct access to integrated multidisciplinary teams of general practitioners, social care workers, occupational therapists, physiotherapists and so on. Moreover, additional services, including speech and language therapy, may be provided on a sessional basis. This commitment will be achieved on a phased basis to allow for the recruitment of additional doctors, nurses and other primary care professionals. Initially, free GP cover will be extended to persons in receipt of drugs and medicines under the long-term illness scheme. Primary legislation is required to give effect to this commitment and it is expected that the new arrangements will be in place by this summer. A project team of officials from the Department and from the Health Service Executive has been established to oversee the implementation of the universal primary care strategy and I understand this project team met for the first time on 24 January. I commend the primary care concept and the new facilities, including the aforementioned facility that is coming on-stream and which will cater for Palmerstown and Ballyfermot.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I am glad to have the opportunity to say a few words on this motion and to commend the Minister, Deputy Reilly, on what is an extremely difficult job. Arguably, he has the most difficult job in the Government, which is to try to overhaul radically the health service at a time of reducing budgets. I decided to speak on this motion when I read its contents and Fianna Fáil Members have a barefaced cheek to propose a motion that mentions items such as the centralised medical card system, the introduction of which was overseen by that party just before it left office.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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Moreover, Deputy Kelleher, who is Fianna Fáil's main spokesperson was a Minister of State in that Government. This motion refers to the cut of €750 million in the HSE's funding but does not acknowledge the role Fianna Fáil played in the fact that funding cuts are taking place across all Departments. The motion also mentions the early retirement scheme and the possible detrimental effects it might have but, again, the date of that scheme was decided upon by Fianna Fáil when in government.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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This type of rank hypocrisy that passes for politics was something I thought Deputy Martin might be in a position to change.
Billy Kelleher (Cork North Central, Fianna Fail)
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Hypocrisy. I will not take lectures on that subject from Fine Gael.
Niall Collins (Limerick, Fianna Fail)
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Is the Government capable of changing anything?
Niall Collins (Limerick, Fianna Fail)
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Even with its big majority, it cannot change anything.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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The entire tenor of the motion is about criticising the HSE in particular-----
Niall Collins (Limerick, Fianna Fail)
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It cannot change anything. It tried and failed to change our policies.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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It is a pity that Deputy Mattie McGrath has left the Chamber because he was an elected representative of Fianna Fáil when the HSE was established.
Billy Kelleher (Cork North Central, Fianna Fail)
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So was Deputy Keating. He also was a member of both Fianna Fáil and the Progressive Democrats.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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Moreover, when it came to reductions in funding for the health service in the past few years, he did not vote against them.
Billy Kelleher (Cork North Central, Fianna Fail)
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Deputy Phelan should not cast aspersions on people because they were members of Fianna Fáil. Deputy Keating also was a member of Fianna Fáil.
Niall Collins (Limerick, Fianna Fail)
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And the Progressive Democrats.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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He decided to vote against the previous Government on the important issue of stag hunting.
Billy Kelleher (Cork North Central, Fianna Fail)
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Will Deputy Keating deny it?
Michael Kitt (Galway East, Fianna Fail)
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Order for Deputy John Paul Phelan, please.
Billy Kelleher (Cork North Central, Fianna Fail)
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Deputy Keating should deny it. Deputy Phelan should not cast aspersions on his own colleagues because they were members of my party.
Michael Kitt (Galway East, Fianna Fail)
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Deputy Kelleher, order for Deputy Phelan, please. Deputy Phelan has the floor.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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He decided to vote against the previous Government on the issue of stag hunting and not on funding for the health service in his area or anywhere else.
Niall Collins (Limerick, Fianna Fail)
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Deputy Hogan and Fine Gael promised to reverse that ban but now they will not.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I commend the Minister-----
Niall Collins (Limerick, Fianna Fail)
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Will Fine Gael reverse the ban on stag hunting?
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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-----who has visited three hospitals this afternoon and eight so far over the past few days, to investigate the potential detrimental effects of the early retirement scheme and with a view to making a hands-on impact on how these changes will be implemented.
Niall Collins (Limerick, Fianna Fail)
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Does Deputy Buttimer intend to reverse the ban on stag hunting?
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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He also has secured a reduced number of trolleys based on the previously mentioned figures from the Irish Nurses and Midwives Organisation. He also has managed to reduce waiting times for elective surgeries-----
Billy Kelleher (Cork North Central, Fianna Fail)
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Actually, he has not, as they are increasing.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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-----all at a time when funding for the health service, like all other aspects of public expenditure, has been reduced dramatically.
In summing up, I wish to mention three areas in particular. First, the provision of funding for public nursing homes is of crucial importance and I refer to the spectacle in recent months of particular homes-----
Billy Kelleher (Cork North Central, Fianna Fail)
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When will stag hunting be banned? The Minister, Deputy Hogan, promised that we would be chasing deer around County Meath for the rest of our lives.
Michael Kitt (Galway East, Fianna Fail)
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Deputy, we are on the health services.
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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-----potentially being closed. It is not acceptable to see people at that stage in their lives, who have contributed as taxpayers and ordinary, decent citizens, effectively being put out of their beds.
One must remember that 75% of the funding in the health service is spent on pay and pensions and not on the actual service. Consequently, any cuts must be made to the other 25%, which comprises trimming at the edges. In addition, there are significant difficulties in my own locality in respect of orthopaedic surgery and EMT specialists. It is important that such essential services, which are the cornerstone of the delivery of any health service, be protected.
Joe McHugh (Donegal North East, Fine Gael)
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In a way, I admire what Fianna Fáil is trying to do. Moreover, it is not simply trying to do this at national level, because it also is so engaged at county and town council levels. It is attempting to disassociate the past from the present. That is fair enough and is an admirable thing to do but unfortunately, the past always is a significant factorial of the present. This is the case on an individual basis in one's own life when one looks back on the past and considers how it shapes one's future. Unfortunately, I refer to the components and factorials of the past in respect of the input of Fianna Fáil's boss man, Deputy Martin, who, as Minister between 2000 and 2004, spent €16 million on reports while creating the HSE. More ironically, in 2000 he spent €600,000 on a value for money audit while creating the culture of the HSE monster that is alive and present in the world in which Members now live. As Deputy Hannigan noted, it will take a long time to sort it out.
As recently as last Friday, the HSE met in Galway to discuss the service plan for the HSE est region-----
Billy Kelleher (Cork North Central, Fianna Fail)
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When will the cancer services be restored in Sligo?
Joe McHugh (Donegal North East, Fine Gael)
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-----which ranges from Malin Head through Galway and almost to County Tipperary. After two hours of that meeting had elapsed, a Fianna Fáil participant made a sensible suggestion. He advocated that participants should break up into groups based on significant geographical parts to discuss the issues which were relevant to their respective areas. It was a sensible suggestion which basically was reminiscent of the old health boards in which there was local autonomy, local responsibility and local power over decision-making. All that was taken away from the people with the creation of the HSE monster. That is the real and present danger the Government has inherited from Fianna Fáil's past in power and its contribution. I stated that I admire what it is trying to do, which is to create complete amnesia and to suggest the past does not relate to the present. However, the unfortunate reality is that it does.
Billy Kelleher (Cork North Central, Fianna Fail)
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I remind the Deputy that he promised a cancer service based in Sligo. It has not been put in place yet.
Michael Kitt (Galway East, Fianna Fail)
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Deputy, please. I call Deputy Mulherin.
Michelle Mulherin (Mayo, Fine Gael)
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I must state that I absolutely do not agree with Deputy McHugh. In contemplating this motion, I am absolutely sickened to my stomach because I detect cynicism and arrogance.
Michelle Mulherin (Mayo, Fine Gael)
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I would like to speak on the issue of authority. Fianna Fáil may have a technical authority but it has no authority as a party to bring such a motion that decries €750 million in cuts, that calls for more funding for the fair deal scheme or that refers to recruitment embargoes.
Billy Kelleher (Cork North Central, Fianna Fail)
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I was elected to this House just as was the Deputy.
Michelle Mulherin (Mayo, Fine Gael)
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Fianna Fáil has absolutely no authority.
Billy Kelleher (Cork North Central, Fianna Fail)
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I am an elected Deputy.
Michelle Mulherin (Mayo, Fine Gael)
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The Government is trying to contend with the fall-out created by Fianna Fáil's bringing of the IMF into this country.
Billy Kelleher (Cork North Central, Fianna Fail)
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I was elected to this House in the same way as Deputy Mulherin.
Mattie McGrath (Tipperary South, Independent)
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That was outrageous.
Niall Collins (Limerick, Fianna Fail)
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The Deputy is in a strop.
8:00 pm
Michelle Mulherin (Mayo, Fine Gael)
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Consequently, we have no control over our financial situation.
Instead, in the communities across the country where there are problems with health because it is threadbare, the Members opposite are throwing oil on the fire and frightening people. That is all they can do because they do not care about the people. They would rather the whole health system was shut down, because they cannot accept that somebody else can do it better than they can. Somebody can do it with a bit of principle and somebody can try to improve this country, which is what we will do.
Michelle Mulherin (Mayo, Fine Gael)
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Their Machiavellian ways have this country where it is. It is about power at any cost. They do not give a damn about the electorate or about the health service. It is just power and they cannot get over the fact that the people have deposed them.
Mattie McGrath (Tipperary South, Independent)
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What did Fine Gael explain to the electorate?
Michelle Mulherin (Mayo, Fine Gael)
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They may be here individually, but they are collectively Fianna Fáil and this is so sick.
Kieran O'Donnell (Limerick City, Fine Gael)
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Deputy McGrath is returning to the fold.
Michael McCarthy (Cork South West, Labour)
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Allow the Deputy to speak on the motion.
Michelle Mulherin (Mayo, Fine Gael)
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They allowed the number of employees in the health service to expand to 111,500 in 2007, and now we have to deal with the fall-out. They introduced an embargo because they had to try to deal with it and now it is coming down on us again. When they got to that level of staffing in the public service, we all began to hear about the pyramids of administration. A manager had to manage three new staff and then there were people above that again and again. They introduced a recruitment embargo and an early retirement scheme that-----
Mattie McGrath (Tipperary South, Independent)
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Fine Gael broke it to hire advisers.
Michael McCarthy (Cork South West, Labour)
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Please, Deputy McGrath.
Michelle Mulherin (Mayo, Fine Gael)
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-----shows no exception for front line service workers. That is why they have made an absolute disaster of this country. We are cleaning up the mess and I am sick of going to public meetings to hear them speak out of the other side of their mouths.
Michelle Mulherin (Mayo, Fine Gael)
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They have no regard. The cynicism of them.
Billy Kelleher (Cork North Central, Fianna Fail)
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Deputy Mulherin should call down to Roscommon.
Michael McCarthy (Cork South West, Labour)
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Deputy Mulherin, without interruption.
Michelle Mulherin (Mayo, Fine Gael)
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There is hope when we do things differently in this country. Already in my constituency we have had services-----
Billy Kelleher (Cork North Central, Fianna Fail)
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Go up to Sligo.
Michelle Mulherin (Mayo, Fine Gael)
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Excuse me, I have the floor.
Michelle Mulherin (Mayo, Fine Gael)
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I have been interrupted. I would like to conclude. Psychiatric services and step-down facilities in my town have been challenged. We have been finding solutions by being dynamic and flexible, and not by throwing oil on the fire.
Jerry Buttimer (Cork South Central, Fine Gael)
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The hypocrisy of certain Members opposite never ceases to amaze me. For the period in which Deputy Kelleher's party was in government, there was a staff reduction of 2,276 in the HSE. His party has presided over the decimation of the health service. Deputy McHugh was right. Deputy Martin funked it in health. Fianna Fáil funked it. The party gave the cup of health to Ms Mary Harney because none of them wanted it. They were happy to have her out there front and centre. Deputy McGrath would not even vote against that Government on health, but he voted against them on stag hunting. He did not have the bottle to support his conviction.
Mattie McGrath (Tipperary South, Independent)
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Fine Gael promised to bring it back.
Michael McCarthy (Cork South West, Labour)
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Allow Deputy Buttimer to speak to the motion.
Mattie McGrath (Tipperary South, Independent)
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They said they would bring it back, at public meeting after public meeting.
Michael McCarthy (Cork South West, Labour)
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Deputy Buttimer is the only Member who can speak.
Jerry Buttimer (Cork South Central, Fine Gael)
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Deputy McGrath is like a duck in the Lough. He is ready to capsize.
Michael McCarthy (Cork South West, Labour)
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Stick to the motion Deputy.
Jerry Buttimer (Cork South Central, Fine Gael)
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We are spending €1.689 billion on health in HSE South in 2012. That is an extraordinary amount of money.
John Browne (Wexford, Fianna Fail)
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By how much has that been reduced?
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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What was Fianna Fáil's role in that?
Jerry Buttimer (Cork South Central, Fine Gael)
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Today we have a Minister prepared to take on the vested interests in the health service.
Billy Kelleher (Cork North Central, Fianna Fail)
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He funked them all. He is being tickled by the consultants.
Jerry Buttimer (Cork South Central, Fine Gael)
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After years of mismanagement, aided and abetted by the mutiny over there, the HSE is finally being called to a halt and we will have the creation of new directorates, which will give us-----
Billy Kelleher (Cork North Central, Fianna Fail)
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What about the consultants?
Jerry Buttimer (Cork South Central, Fine Gael)
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You might listen to this.
Jerry Buttimer (Cork South Central, Fine Gael)
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It will give us good governance and accountability. We have already replaced the board. We have announced that we are establishing a directorate, and we will see change. It will take time. It will require a buy-in and a collaborative approach. I am confident-----
Jerry Buttimer (Cork South Central, Fine Gael)
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Listen for once, Deputy McGrath. When it comes to acute hospitals, the Minister is taking a very important step in proposing a new structure that will recognise the reality that no hospital operates in isolation.
Billy Kelleher (Cork North Central, Fianna Fail)
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Will the Deputy be at the closure of St. Mary's Orthopaedic Hospital?
Jerry Buttimer (Cork South Central, Fine Gael)
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They are all part of an integrated health service. The Minister proposes that we will see an acute hospital group with a consolidated management team operated by a group CEO. What does that mean? It means we will have accountability and deliverability. It also means that we will ensure that the smaller hospitals will play a vital role in our health service.
Everybody understands why Fianna Fáil opposes the introduction of reconstituted not-for-profit hospital trusts. When in government, Fianna Fáil and its obsolete friends in the Progressive Democrats and the Green Party supported the for-profit model of collocation. Does Deputy Kelleher remember collocation? Deputy Martin opposed it in Cork because it was bad for him politically.
Michael McCarthy (Cork South West, Labour)
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Your time is up. I call on Deputy Dowds.
Jerry Buttimer (Cork South Central, Fine Gael)
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This motion shows that the Fianna Fáil Punch and Judy show continues.
Billy Kelleher (Cork North Central, Fianna Fail)
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I will say one word. Roscommon.
Robert Dowds (Dublin Mid West, Labour)
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Like the other speakers, I can hardly believe this motion is before us tonight. How can Fianna Fáil Members even think of putting such a thing on paper? This is the party that led us to the bailout by the troika and the horrendous mismanagement of the banks. This is directly why there have had to be serious cuts of €750 million to our health budget. When the Fianna Fáil Government had money, it threw it around like confetti and it was not used correctly. Deputy McHugh went into some of the detail of that a few minutes ago, so there is no need for me to go into it again.
Billy Kelleher (Cork North Central, Fianna Fail)
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I would like to know about it.
Michael McCarthy (Cork South West, Labour)
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Deputy Dowds, without interruption. You will have a chance to respond at 8.45 p.m.
Robert Dowds (Dublin Mid West, Labour)
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If the Members opposite seriously want to address the health issue, they should make suggestions as to how we can best use our resources.
Billy Kelleher (Cork North Central, Fianna Fail)
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The Deputy's party said we were not spending enough.
Robert Dowds (Dublin Mid West, Labour)
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That would be a useful function.
Billy Kelleher (Cork North Central, Fianna Fail)
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It would be a useful function if the Deputy elaborated a small bit.
Robert Dowds (Dublin Mid West, Labour)
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Alternatively, if they want to use the extra €750 million, they might at least suggest where we might get that.
I accept that in its time in office, Fianna Fáil managed to do one or two decent things, through its front person, Mary Harney. Certain improvements were made, such as the introduction of HIQA and cancer services.
Dara Calleary (Mayo, Fianna Fail)
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That was bitterly opposed by the Labour Party.
Robert Dowds (Dublin Mid West, Labour)
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However, before that there were just so many disasters. How about PPARS?
Billy Kelleher (Cork North Central, Fianna Fail)
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How about DEIS schools?
Robert Dowds (Dublin Mid West, Labour)
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We sorted that out yesterday.
Michael McCarthy (Cork South West, Labour)
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Deputy Dowds, without interruption.
Robert Dowds (Dublin Mid West, Labour)
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This sort of motion is the sort of thing that gives politics a bad name. A thoughtful proposal from Fianna Fáil would be commendable, but sadly we do not seem to have that.
I want to commend the Government for struggling to improve our health service in the very difficult circumstances in which we find ourselves. When we see the roll-out of primary care in the community and the introduction of universal health care-----
Robert Dowds (Dublin Mid West, Labour)
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-----that will indicate that we are putting in place a first class health service.
Kieran O'Donnell (Limerick City, Fine Gael)
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I am glad to speak on this motion. I would like to deal with local issues in Limerick. It is a fair comment to say that the previous Government threw money at the health service, but there was a lack of coherent strategy on how that money could be used effectively. Times are tough, money is tight and people are finding it very difficult at the moment, but the Minister is trying to bring in a new way of doing things. We have had reconfiguration in the mid-west region. There is a review under way on funding to the region.
Last Saturday the Minister visited the accident and emergency department at the Mid-Western Regional Hospital in Limerick for the second time in eight weeks. The current facility at the hospital is not adequate to meet existing needs and priority is being given to putting a new one in place. A new primary care centre is due to open shortly at King's Island on the north side of Limerick city, which is a welcome development. The HSE has put in place proper plans to ensure - despite the departure of nursing staff before the end of this month - that an excellent service will continue to be provided at the Mid-Western Regional Maternity Hospital in Limerick.
The Minister is trying to do things in a new way and operating within the constraints created by a lack of funding. However, it is not always about spending; there is also a need to do things in the right way.
Michael McCarthy (Cork South West, Labour)
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Deputy Kitt is sharing time with Deputies Calleary, McGuinness, Troy, Browne and Niall Collins.
Michael Kitt (Galway East, Fianna Fail)
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I commend Deputy Kelleher for tabling the motion. One of the major issues that has arisen during this debate is that of staffing. I was glad all my Dáil and Seanad colleagues from Galway were invited to attend a meeting to discuss this and other matters with the new area manager for counties Galway and Roscommon, Ms Catherine Cunningham. At that meeting we were well briefed on what was happening. What is sad is that in Galway alone some 113 people, 56 of whom are nurses, will be leaving the HSE this month. This is giving rise to serious problems. For example, there is an issue with the provision of public nursing services in the Connemara area.
Another serious issue which arises is that of home help services. Age Action Ireland has indicated that there has been a reduction of almost 500,000 in the number of home help hours since last year in the HSE West region. This is a massive decrease and equates to a cut of €105 million in monetary terms. Some 683 staff are set to retire across the region which is huge - it stretches all the way from County Limerick to County Donegal. The HSE West director has stated a number of key challenges have arisen and that, in the light of the reductions in staff and funding to which I refer, he is going to have a difficult job in maintaining front-line services. I am concerned about this. I am also concerned about the provision of palliative care services, as we are fighting for funding for Galway hospice.
Deputy Neville referred the provision of services for children. I have a major concern about this matter, particularly as headlines in the Irish Independent in recent weeks pointed to delays in screening and the fact that babies were at risk as a result of a failure on the part of the HSE to meet check-up dates. Some children are faced with a three year wait in order to receive vital dental treatment. In south-east Galway there is no dentist available between Loughrea and Portumna. Priority must be given to the provision of services of this nature for children.
I must refer to the shortage of nurses in orthopaedic departments. I understand HSE West plans to reduce its health budget by 5.2%. Obviously, orthopaedic services at Merlin Park Hospital in Galway have been hit as a result of this announcement. The number of beds in the orthopaedic ward at the hospital has been cut. In addition, there is a serious deficit of nursing staff in the operating theatres in University College Hospital, Galway. Patients presenting at the accident and emergency departments there and in Portiuncula Hospital, Ballinasloe will be obliged to wait longer in order to receive surgical care.
I am concerned about the number of acute beds in the psychiatric services in the HSE West region. Some 15 beds have been lost at St. Brigid's Psychiatric Hospital, Ballinasloe, a town in which there is an acute hospital. I cannot understand what has been done in this instance. However, it is welcome that a new primary care centre is to be set up in Athenry.
The HSE's national service plan refers to the upgrading of endoscopy services at Roscommon County Hospital, but that is not what the people of Roscommon were seeking. They wanted to retain the 24 hour accident and emergency department. The Minister and the Government should be providing badly needed services at such facilities.
Age Action Ireland has stated:
The loss of so many public beds and the scale of the cuts in the home help service provided by the HSE will undoubtedly be felt by the sickest of older people [and is a real cause for concern]. Without a home help service frail older people will struggle, and those requiring round the clock nursing home care will end up being admitted to acute hospitals for their care if a nursing home bed is not available.
I hope the Government will give consideration to the issues to which I refer. I particularly hope it will examine the position in rural areas. Many people who live in such areas do not have access to the services of home helps or public health nurses. Those who do not have cars are becoming increasingly physically and socially isolated as a result of the withdrawal of services. I hope the Minister will take the points I have made on board.
Dara Calleary (Mayo, Fianna Fail)
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I thank Deputy Kelleher for giving us the opportunity to discuss some of the core health issues in the House. I wish to focus on the Government amendment. I am aware that the Minister for Health, Deputy Reilly, is not a shy person and that he does not lack self-confidence, but, by God, the amendment certainly brings that self-confidence to a new level.
Kieran O'Donnell (Limerick City, Fine Gael)
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Of course, it is nothing like the motion.
Dara Calleary (Mayo, Fianna Fail)
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Everyone is aware of the serious difficulties in respect of medical cards. The amendment refers to the fact that medical cards are the subject of a review process, which is welcome. However, this fact has not been communicated, as there are still long delays for those applying for a new medical card. Surely it would not be beyond our abilities to introduce an emergency system for medical cards. Such a system would be of assistance in a particular case to which I have previously referred in the House. It involves a man who, as a result of contracting diabetes, lost a leg last September. Between my office and his family, the relevant information on his case has been sent to the central unit on six occasions. On five occasions the information was lost. We are still awaiting an indication of what has happened in our sixth attempt. It is almost March and the man does not have a medical card. No one can stand over a system which gives rise to such delays.
John Perry (Sligo-North Leitrim, Fine Gael)
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The Deputy can forward the relevant information to me.
Dara Calleary (Mayo, Fianna Fail)
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There is a need for an emergency system to cater for the needs of persons who, literally out of nowhere, have medical demands placed upon them. Surely it is not beyond our abilities to create such a system.
The amendment which recognises that there are problems raises a white flag in respect of community nursing homes. Instead of raising the white flag and announcing the closure of 800 beds across the country, including almost 60 in my home county, we should be championing these nursing homes, as we want to keep people in their local communities. We all agree that it is better for them to remain there because they can be near to their families, friends and the facilities with which they are familiar and this leads to their having healthier lives. Instead, we have been presented with a policy of centralisation in larger units in which those to whom I refer will not be given the care and attention they currently receive.
Surely it should be within the capabilities of the Government and the Oireachtas to consider how we can promote and champion community nursing homes. When I first became a Member of the House in 2007, there was a huge demand for such nursing homes, but that is no longer the case. However, we and the HSE - whatever is left of it - need to start promoting community nursing homes as being open for business. We are expecting the entire civil and public service to state they are open for business and that they want to provide services. The staff at facilities such as St. Augustine's in Ballina want to say they are open for business. However, some of the best have been closed. These beds could be reopened and paid for if people were given the opportunity to actually occupy them.
The issue of children on trolleys was raised during Leaders' Questions this morning. The figures provided by the Irish Nurses and Midwives Organisation, IMNO, by means of its trolley watch facility - this is now recognised as the Government standard - are beginning to creep upwards again. Surely, none of us would attempt to stand over the placing of children on trolleys. In fairness, the Minister is a GP and is aware of the position. He is in Cavan this evening and I hope he will have the opportunity to visit Our Lady's Children's Hospital in Crumlin in order that he might see the children waiting on trolleys. Last week I dealt with a case in which a one year old child who required emergency surgery was kept in Mayo General Hospital, Castlebar, for three days until a bed became available in Temple Street Children's Hospital. We cannot stand over what happened in this instance. This is a management issue, it does not relate to resources.
I arrived in the Chamber when Deputy Mulherin was making her concluding remarks. She stated she was sick of attending public meetings at which people spoke out of both sides of their mouths. These comments were directed at me. I do not speak out of both sides of my mouth. At the meeting in question I asked why 12 beds at Ballina Hospital were being closed when HSE West had not collected €65 million from private health insurance companies. I was not speaking out of both sides of my mouth; I was merely asking a question. Only €500,000 would be required to keep the beds to which I refer open and some €65 million remains uncollected from private health insurance companies. This amount could be used to fund a great deal of work in the HSE West region.
I applaud the Minister of State at the Department of Health, Deputy Kathleen Lynch, on securing €35 million in funding and some 400 posts. However, I have to ask why are psychiatric beds being closed in County Mayo and other parts of the country. It has been stated there is no one available to fill particular jobs, but we are going to fill 400 positions later in the year. Why is it not possible to fill these positions now? Why not spend the €35 million to which I refer and retain the services already in place, rather than taking action later in the year? I would almost bet money we will have an underspend of mental health funding this year because we will take so long to spend it. This is another question I asked and I do not think I was speaking from any side of my mouth when I did so. It was a straight question. I hope we will get straight answers to the parliamentary questions we have tabled.
The Minister, Deputy Reilly, played the ball and the man very hard. This is not my style. We want answers. He took direct personal control. He made a big deal of the fact that he is in charge and that independent directors are gone. He stated he would be in charge and he would take the hits. It is almost a year later and I am willing to give him time, but the omens are not good when we see what is happening.
Deputy Mulherin was ranting and raving about the following point. The Government has had a year to prepare for exits and retirements because it was known they would happen. Any business, organisation or voluntary organisation would conduct scenario planning. Why was it not done in the course of the past 12 months to account for those leaving?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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To take the mystery out of why the motion has been tabled, one might reflect on the fact that when the Minister, Deputy James Reilly, was on the Opposition side of the House, he gave the very distinct impression that on assuming office he would deal with all of the issues with some type of magic wand in a very short period of time. This is probably why the motion has been tabled. He certainly gave this impression not only to the Members of the House but very clearly to the public. This obviously is not the case.
John Perry (Sligo-North Leitrim, Fine Gael)
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He is getting there.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The policies and directions are not being fulfilled in the timeframe he suggested. The patient is suffering because of a lack of good politics and a lack of decisions being made. This is why the motion has been tabled.
Róisín Shortall (Dublin North West, Labour)
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Deputy McGuinness really is shameless.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The Minister also stated with regard to parliamentary questions that he would ensure the HSE would be responsible to the House when in fact one cannot ask a parliamentary question and get an appropriate comprehensive answer from the Department or the HSE. Every Member of the House acknowledges this.
John Perry (Sligo-North Leitrim, Fine Gael)
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Who established it?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The HSE and the Department should be made responsible. The buck stops with the Minister. That is what is stated and this is what we should make happen. We are entitled to the information.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Every Member of the House is entitled to the information but we are not getting it. Therefore one cannot provide the direct response or position to the client or customer one represents in one's constituency. This is not good politics and the Minister should correct it.
I attended a meeting of the HSE in Kilkenny and I must state I was shocked, because none of the information or booklets we were given on the cutbacks on every service across the board - and we expected some reductions - had one single comment on how the administrative staff in the HSE, of which we are told 2,000 do not even know their job descriptions, were to be dealt with. There was not one single line on it. However, in every line the patient suffered because of the withdrawal of services.
Róisín Shortall (Dublin North West, Labour)
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Who created the monster?
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I was particularly disturbed by the amount of money that was cut back in the area of psychiatric services. Not only was I surprised, nurses in the services for years came to me and complained privately that psychiatric services in Carlow and Kilkenny would collapse because of the withdrawal of people delivering on the front line. When on this side of the House, the Minister, Deputy James Reilly, stated he was not interested in the politics of this but that he was interested in the patient, and people believed in him.
John Perry (Sligo-North Leitrim, Fine Gael)
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He is getting there.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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It is the patient who will suffer, and the nurses have confirmed this.
John Perry (Sligo-North Leitrim, Fine Gael)
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Deputy McGuinness is Chairman of the Committee of Public Accounts.
Michael McCarthy (Cork South West, Labour)
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Deputy McGuinness without interruption.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I regret that Deputy John Paul Phelan has left the House because he referred to the medical card system. It might have been Fianna Fáil which stated we would have a national medical card application and appeals system; perhaps this was the case. However, the Government has been in office for 12 months and this is an administrative issue which affects the constituents we represent. There are examples of people who are terminally ill and cannot get their medical card renewed and therefore cannot access services.
John Perry (Sligo-North Leitrim, Fine Gael)
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That has been resolved now.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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We have examples of people involved in the health services making comments to the effect that it is being deliberately stalled for financial reasons. Why does the Minister, Deputy James Reilly, not increase the number of staff? A total of 150 people deal with all of these applications. Why not increase this number? Why not redeploy staff from places which are not that busy and ensure the medical cards which are so badly needed are delivered?
Why did the Minister, when he knows it is not true, include this in the amendment? It is ridiculous and a farce.
John Perry (Sligo-North Leitrim, Fine Gael)
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It is Fianna Fáil's system which is in place.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Deputy Perry knows his backbenchers do not believe the Minister either.
John Perry (Sligo-North Leitrim, Fine Gael)
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They do believe him.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The special delivery unit is not delivering.
John Perry (Sligo-North Leitrim, Fine Gael)
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A vote of confidence.
John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The Minister should ensure, as with the National Treatment Purchase Fund, that providing money to the special delivery unit means people on waiting lists for long periods of time get the operations they require. It is the least they deserve from a service that is supposed to deliver health services throughout the country. I call for direct intervention by the Minister. He often called for it when in opposition. It is a pity he is not present to show some respect not only for the debate but for the patient whom we are trying to serve against a system which seems to be crumbling in front of the Minister.
John Perry (Sligo-North Leitrim, Fine Gael)
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He inherited it from Fianna Fáil.
Jim Daly (Cork South West, Fine Gael)
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He inherited it from Mary Harney.
John Browne (Wexford, Fianna Fail)
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I welcome this opportunity to contribute to the debate and I thank Deputy Billy Kelleher for tabling the motion. Last Monday week I went with my colleagues, Deputies Twomey and Kehoe, to Wexford General Hospital to receive a briefing for Wexford Oireachtas Members. In the room with us were hospital managers, HSE managers and community welfare managers. I am not easily intimidated but there were so many people around the table I did feel a little intimidated by all of these managers who were there to tell us what we thought would be the factual situation.
However, the first document we received was on service plan achievements and the very first page dealt with primary care teams. It stated that in Enniscorthy, the design team has been engaged to respond to the schedule of accommodation. The same was stated with regard to Gorey. With regard to Wexford, which is one of the biggest urban centres in the county, it stated the respondents to the advertisements for primary care infrastructure have been unable to obtain GP engagement in the development and, accordingly, the Wexford local health office has been unable to progress with the development. It stated that in Rosslare, a site has been identified and accepted by the HSE but the developer is unable to obtain GP engagement.
These were presented as achievements by Mr. Healy who presented the information to us on the day. Obviously nothing is happening and nothing will happen. Perhaps the Minister will explain why there is no GP engagement in two of the areas. I understood from what he stated here that primary care is the way forward, but GPs refuse to engage in two or three areas where the HSE stated it had made achievements.
Wexford General Hospital will lose approximately 30 members of staff but those at the meeting had the cheek to tell us hospital services will not be affected. Waterford Regional Hospital and Wexford General Hospital must be taken together because they are the two main hospitals in the south east and serve a huge population area. We were told the closure of two operating theatres and 25 surgical beds in Waterford Regional Hospital would not affect services in the south east. Perhaps the Minister will explain how he will lose members of staff and close wards and surgical areas but the people of the south east will not be affected.
With regard to medical cards, we have the same problem as Deputy Dara Calleary outlined exists in Mayo. Some people have been waiting since last June or July for a medical card to be approved. The doctors in the Wexford area are very cynical about the situation. They feel it is a delaying tactic to save money. People who deserve to have medical cards, who are seriously ill and need them to get their medicines are being denied. I have tabled parliamentary questions on this matter. In fairness, if one gets through to those working in the centralised centre, they will do their best to help and support one. However, they state that because of a lack of staff, their hands are tied and they are not in a position to do anything about it.
The large management team at the meeting told us there will be a 4.5% cut in home help hours. The management states this will not affect older people, but how that might happen I do not know. When one telephones, one is told that people who have home help will continue to have the service but new applications will not be accepted.
The cuts in the home help service and the fair deal scheme must go hand in hand. We talk a great deal about taking people out of hospitals. There are a considerable number of people in Wexford General Hospital at present who would be able to leave if they got approval for the fair deal scheme. There are serious issues regarding that scheme in my county and the south east. Hundreds of patients are waiting to go into nursing homes but there is no funding within the scheme. I received a reply last December stating no money was available in County Wexford for the fair deal scheme and the only way new patients could be admitted would be if patients in the fair deal scheme were to pass away. That was an actual response I received - a disgraceful reply in the first place but also a disgraceful decision. The Minister might also explain where the money for the fair deal scheme is. Will he put money into the scheme and when will he do so?
Niall Collins (Limerick, Fianna Fail)
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I compliment the Acting Chairman on his chairing of this session which is very fractious.
Kieran O'Donnell (Limerick City, Fine Gael)
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That will win extra time.
Niall Collins (Limerick, Fianna Fail)
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Perhaps seven or eight minutes. We must bear in mind that every party in this House contributed to the state of the health services today. That applies even to the Minister of State's party. Since the foundation of the State, successive Governments neglected the health infrastructure, in both physical and human resources, and the patient suffered. It is a little rich to come into the Chamber and engage in a blame game, pointing the finger at Fianna Fáil. The Government has been in office for 12 months and it is trying to shirk its responsibility. It has not yet got into the groove of accepting responsibility but the clock will tick and eventually the penny will drop.
It is ironic that the Government questions our mandate in regard to our right as democratically elected people to table a motion and have issues which concern the public addressed and debated in this House. That is not ignorance; it is arrogance. It did not take the Government parties long to become arrogant.
John Perry (Sligo-North Leitrim, Fine Gael)
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I do not know if that is true.
Niall Collins (Limerick, Fianna Fail)
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It ill behoves anybody to come to the Chamber and question our mandate. I was elected by the public just as any Member on the Government side of the House was so elected. It is not a democratic stance to question anybody's legitimate mandate.
On the motion, HSE west has had a reduction of 5% in its budget. What has the Minister of State got against the people of Limerick and the mid-west? Deputy O'Donnell addressed local issues and I, too, will address these areas. Our share of the budget from HSE west has been reduced by 13% in the acute hospital groups around Limerick, while in the Galway region the figure has been reduced by 10%. Why are the public and patients in Limerick being more discriminated against than patients in other parts of the country? That is a legitimate question I was asked to raise.
The funding of community services around Limerick has been reduced by 5%, which is the global cut to HSE west. However, there is a further reduction of €19 million on top of that which arose from savings that had accrued the previous year. These are now being rolled forward. They were generated in good faith but now we are being penalised as a region in their regard.
I wish to raise specific issues in respect of our community hospitals. St. Camillus's was mentioned. I refer to St. Ita's community hospital in Newcastle West in County Limerick. An enormous community effort was supported by Fianna Fáil, the Green Party, the Progressive Democrats, the Fine Gael Party and local communities throughout the years. There were church gate collections and raffles. Volunteerism in the truest sense of the word helped to contribute and build the services and facilities there. There have already been 19 bed closures since last year and these are being followed by another ten. That is disgraceful. One must add to that the fact that our home help services will be reduced by 5%. We are told that everybody will continue to receive a delivery of home help service but it will be less.
The parties on the Government side promised no cuts in front-line services. They must be reminded of this at every juncture although they refer to people talking out of both sides of their mouths at public meetings. What does that promise mean? What is a front-line service to somebody who needs home help? A reduction to a person's home help service is a cut in a front-line service. The Government parties should not come back and tell us we are engaging in hypocritical politics. Those parties made this promise and the people voted for them on the basis there would be no cut in front-line services.
When will the Government give local HSE management in the mid-west a baseline staff figure? How can it expect people to manage the health services when they do not know the minimum threshold staff complement that will be available to them to provide a 24-7 service? If the Government is to take control of the HSE, as it says it will, it should empower local management to have a minimum level of staff to plan their 24-7 roll-out of service.
Limerick maternity hospital is the fifth busiest of the 19 maternity units in the country, catering for 5,500 births per annum. It was a disgrace that two weeks in succession the Taoiseach came into the Chamber and rubbished a senior obstetrician consultant in this Parliament. He rubbished him outright. As the consultant's direct employer, the Minister, Deputy Reilly, should have defended him.
Michael McCarthy (Cork South West, Labour)
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Thank you, Deputy. Your time is up.
Niall Collins (Limerick, Fianna Fail)
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He should also have defended him as a fellow medic, but mainly because he is an employee of the Minister.
James Reilly (Dublin North, Fine Gael)
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The information was not accurate.
Michael McCarthy (Cork South West, Labour)
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The time is up. I call Deputy Robert Troy.
Niall Collins (Limerick, Fianna Fail)
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The Minister has an obligation as that consultant's employer to protect his position. He highlighted a legitimate concern on behalf of the public in the mid-west and it ill behoved the Minister not to step up to the plate.
James Reilly (Dublin North, Fine Gael)
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He used erroneous information.
Michael McCarthy (Cork South West, Labour)
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Deputy Troy has five minutes.
Niall Collins (Limerick, Fianna Fail)
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The Minister should protect the people who work for him.
Michael McCarthy (Cork South West, Labour)
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Deputy Collins, your time is up, thank you. The floor is Deputy Troy's.
Robert Troy (Longford-Westmeath, Fianna Fail)
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Deputy Collins can have a minute of my time. I thank Deputy Kelleher for tabling this motion before the House and giving us an opportunity to speak on a very important and emotive debate. It affects each of us in our constituencies and it is a very emotive subject for the people we represent.
Everybody knows the best and cheapest way to run a health service is to have an effective and efficient acute hospital system that will treat patients in an effective and efficient manner, get them home and arrange home care packages to help them. None the less, we have seen plans for a 4.5% reduction in the provision of home help. This is a very retrograde step. I know from having looked after an elderly neighbour in recent years that home help managed to keep this lady out of long-term residential care for 18 months. Without that home help she would not have been able to stay out of care. That home help had a net benefit, both to her from a social point of view in that she was able to stay longer in her home setting where she had lived for 82 years, and also as a cost benefit to the taxpayer because the lady had no means. Her long-term residential care is now being met in full by the Exchequer. The Minister should consider that.
I wish to highlight the position at Mullingar regional hospital. Last year, yet again, it was the most efficient hospital outside Dublin. Now it is taking in additional patients from Roscommon hospital, which was downgraded in spite of the Minister's pledges, and from Navan. Even though the hospital has taken in these additional patients, it has not received any additional funding. Last year it took €60 million to run the hospital but this year's budget will be €56.4 million, to include an overrun of €1.9 million. What happened to the notion of funding following the patient? It is not happening in one of the most efficient hospitals in the country.
The Minister talks about the difference-----
James Reilly (Dublin North, Fine Gael)
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Would the Deputy like an answer? It is coming in.
Robert Troy (Longford-Westmeath, Fianna Fail)
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I am delighted to have that information now.
James Reilly (Dublin North, Fine Gael)
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It was introduced in orthopaedics last year.
Michael McCarthy (Cork South West, Labour)
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Deputy Troy, without interruption.
Robert Troy (Longford-Westmeath, Fianna Fail)
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I am delighted to hear that and I hope I can let the people who are affected know this. These are more than 20 people lying on trolleys tonight. In 2010, Mullingar hospital lost 1,000 bed days to delayed discharges. In 2011, the number almost trebled to 2,800. That happened as a result of the Minister's failure with the fair deal scheme. Patients are waiting months for approval under the scheme and they are taking up acute hospital beds while costing additional funds-----
James Reilly (Dublin North, Fine Gael)
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The former Minister, Mary Harney, funded the scheme for 2011.
Michael McCarthy (Cork South West, Labour)
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Deputy Troy, without interruption.
John Browne (Wexford, Fianna Fail)
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What about the funding for this year?
Barry Cowen (Laois-Offaly, Fianna Fail)
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The Minister promised to top up the funding for 2011.
Robert Troy (Longford-Westmeath, Fianna Fail)
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Deputy Reilly is in charge now.
Michael McCarthy (Cork South West, Labour)
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The Deputy should confine his remarks to the motion.
Robert Troy (Longford-Westmeath, Fianna Fail)
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The Minister has been in government for the past 12 months, in case he does not realise. Waiting times have increased by 47% for elective surgery since he took office. People are waiting more than 12 months for simple procedures.
James Reilly (Dublin North, Fine Gael)
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They waited for three to four years when Fianna Fáil was in power.
John Perry (Sligo-North Leitrim, Fine Gael)
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Fianna Fáil had 14 years to deal with these issues.
Robert Troy (Longford-Westmeath, Fianna Fail)
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They waited six months before being looked after by the National Treatment Purchase Fund.
Róisín Shortall (Dublin North West, Labour)
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I would like to respond to the issues raised by Deputy Niall Collins regarding maternity services in Limerick. It has been pointed out to him in the House and in the media that the figures Dr. Gerry Burke used originally were not accurate. That has been accepted by most people and the Deputy should also be prepared to accept that the original figures were wrong. In addition, he is being disingenuous because Dr. Burke was contacted earlier to find out what he thought about the arrangements and he replied, "Overall, I am happy with what is being planned but some further work will need to be done". The Deputy, therefore, is aware of the situation.
Niall Collins (Limerick, Fianna Fail)
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What about the 47.5 posts?
Michael McCarthy (Cork South West, Labour)
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The Minister of State without interruption.
Róisín Shortall (Dublin North West, Labour)
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Those figures were not accurate. People locally who care about the service are happy with what is being proposed.
Róisín Shortall (Dublin North West, Labour)
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The Deputy should have disclosed that when he was throwing around allegations.
Niall Collins (Limerick, Fianna Fail)
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What is the Minister of State going to do about the vacancies?
Michael McCarthy (Cork South West, Labour)
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The Minister of State without interruption. Deputy Collins should refrain.
James Reilly (Dublin North, Fine Gael)
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There are not 47.5 posts vacant in maternity services.
Niall Collins (Limerick, Fianna Fail)
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The number is 16.5 for maternity services.
Róisín Shortall (Dublin North West, Labour)
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The figure is 16 and a number of the people will be replaced.
I would like to address the medical card issue. As I said on previous occasions, I am conscious of the serious difficulties that have resulted for many patients because of the centralisation of medical card services and the level of service provided in recent times has not been acceptable. A review of the services, processes and systems in the PCRS office is under way and we hope to have an outcome from that shortly. Notwithstanding that, I have visited the PCRS on four different occasions recently, as has the Minister. Senior officials form the HSE and the PCRS have been also called into the Department on a number of occasions. We have engaged closely with the HSE to address the current position, which I acknowledge is not acceptable.
Robert Troy (Longford-Westmeath, Fianna Fail)
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It has not improved.
Róisín Shortall (Dublin North West, Labour)
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I would like an opportunity to outline the improvements that were initiated recently. The HSE has introduced a self-assessment system for all medical card holders aged over 66. The system is also being introduced for people under the age of 66 who received a medical card on the basis of means. We will have a system, therefore, under which people will be required to declare that their circumstances have not changed since they were awarded a medical card previously. It is a straightforward form and if they do that, the medical card will be renewed automatically on a self-assessment basis. In time, spot checks will be introduced but a self-assessment system has been put in place for more than 80% of people seeking medical card renewals.
The HSE is standardising eligibility periods from two to three years for people aged under 66 while the period is being extended to four years for people aged over 66. The executive is providing GPs with a facility to maintain the eligibility of vulnerable patients until their application has been completed.
The issue of staff was raised. An additional 20 staff were provided to the PCRS during January and this will greatly enhance the services available and enable the office to provide a better service to everybody. With regard to emergency medical cards, there is now a facility whereby GPs can have an urgent medical card issued without delay once they have validated the application. That service kicked in over the past few weeks. I was concerned that problems were emerging with the appeals system. However, additional staff were deployed in the appeals office, which has given an undertaking that the backlog will be addressed in the next month.
While I do not dispute there have been serious difficulties, steps have been taken and I hope within the next few weeks to provide a full briefing to every Member of both Houses regarding those changes and regarding how they can interact more effectively with the PCRS to obtain details quickly regarding the concerns of their constituents.
Éamon Ó Cuív (Galway West, Fianna Fail)
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I wish to share time with Deputy Cowen.
I hope we continue to have reasoned and analytical debates on health issues because once one goes into government, one suddenly realises how complex is the health system, the huge input of people into it and the need to work incrementally to improve services. The first thing that should be recognised is the huge improvement in health services, which has happened for many reasons, many of which are related to preventative measures. People are living longer and much of that is not related to hospital provision but to better housing, nutrition and so on. When debating people's health and well-being we should never lose sight of the extraneous factors that have a significant effect on how long they live and on their quality of life.
If we could all get more citizens to quit smoking, for example, and to moderate alcohol use, we would solve more of the health problems in the country than all the debating in the House would ever do and we should not lose sight of that factor. The Government will spend €12.5 billion on health services this year and the issue is how to obtain value for money. I pay tribute to the vast number of people who work in our health system for their commitment and dedication. The majority of health care workers do their best no matter what role they play.
I also believe, however, that as human beings we resist change in our work practices, even when it would make the job easier and flexibilities would generate a better outcome. It is human nature to initially resist change and it is, therefore, important that the Government uses the Croke Park agreement to bring about change in how health service staff work. I recall when trying to introduce change in the company where I worked that I used to often say to employees that by using technology smartly, they could make the job easier. One often was not asking people to work harder but to adopt change and new technology in order that their job would become easier and produce better results.
Greater flexibility is needed in rostering and, in particular, in the use of expensive technology. We can all work to make sure that expensive technology is used for many more hours in the week than it is used at present.
The Minister on coming into office had the great idea of introducing universal health insurance. One of the wisest things I was told by a management consultant, although I am not a big fan of such gurus, was that we were obsessed in this country with changing the structures and the names and that we would get much further a great deal faster if we tried to make the structures that we have work better. We often waste a great deal of energy changing the structures and having all the same people working under some great new structure, but what we need is to make sure that the structures in place work better.
There was a cogent argument for setting up a national health service as opposed to the health boards having regard to the idea of setting out objective service levels to which people are entitled, regardless of where they live. Setting an objective service level taking into account resources and spreading them in order that everybody would get access to an even service is the sensible way forward. An analysis of waiting times for the ambulance service will show that the waiting times vary dramatically between the old health board areas and it does not seem to have any particular relationship to the dispersal of the population but seems to have historic relationships. This should all be standardised and no person regardless of where they live should have to wait longer than a certain time for the ambulance service. That principle should apply to primary care services and to being seen by public health nurses. There should not be uneven service levels that are historic where there is over-abundance in one area and deprivation in another. The same principle should apply to home care packages, the home help service and community nursing homes in respect of which there is concern that many of them will be gathered, as it were, into big centres.
Long before the granting of medical cards to people over the age of 70 I believed that when a person reached pension age the chances of his or her income increasing dramatically was very slight. I could not understand why the health service could not follow the good example of the Revenue Commissioners in that when one is over the age of 66 and makes a tax return the Revenue Commissioners write a letter advising that there is no need for the person to make a further tax return unless contacted by the Revenue Commissioners who would only contact the person if they saw his or her name in the newspaper having won the lottery or some such thing. Otherwise, they accept the position as outlined in the tax return. The waste and worry caused in processing renewal applications from people who were 99.2% certain to have their card renewal was not worth a candle. The Minister would be much better putting the same resources into ensuring that those who have variable incomes are means tested at a reasonable frequency and get quick decisions.
I know the Minister was in Galway recently. He will know that there are a number of issues that affect Galway in particular.
Michael McCarthy (Cork South West, Labour)
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The Deputy will have to conclude.
Barry Cowen (Laois-Offaly, Fianna Fail)
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The Deputy will have to hurry up.
Michael McCarthy (Cork South West, Labour)
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I have to ask the Deputy to conclude as he is eating into Deputy Cowen's time.
Éamon Ó Cuív (Galway West, Fianna Fail)
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I ask the Minister to give me a private update on the palliative care services and orthopaedic services in Galway. He know the issues and I know them. One thing I cannot understand is what happened in Carna recently where people were given no warning; a service was discontinued and the equipment was ripped out one morning without any discussion with the local community.
Barry Cowen (Laois-Offaly, Fianna Fail)
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There are difficult issues facing this State and there were many difficult issues facing it when this Government assumed office 12 months ago. It received a massive majority and was afforded great trust in seeking to resolve our difficulties. The Government gave the distinct impression that not only would there be an easier way than the austerity of the previous Administration, on which it did a U-turn immediately on assuming office, but that it would overhaul the HSE and deliver a much improved health service.
I will allow the Minister some more time than the one year which we are talking about today but not the ten years that he sought last night. If the first year is anything to go by, we will not be enamoured by the next four either. The health service is one which from 1997 to 2011 saw improvements, as many speakers have said, in tackling cancer and improving survival rates and similarly death rates from cardiovascular disease have fallen massively. The health service had seen much capital investment across the regions such as that in my county in Offaly where there is a new state of the art hospital in Tullamore and community nursing units in Birr, Tullamore and Edenderry, which combined now face €22 million in cuts based on the service plan published yesterday. The health service saw some 170,000 people treated under the National Treatment Purchase Fund up to 2010, with waiting times having been greatly reduced or eradicated in many instances.
None of us under-estimates the various the challenges across Departments. Many of us agree with the thrust of policy geared towards meeting our commitments to close our income and expenditure deficit over the period of the next three years. Where we differ is on the specifics and the methods used to meet these commitments. We all hope that whatever methodology is used is successful. We all share the electorate's aspiration that this Dáil and even this Government will resolve our difficulties, chart a way out and attract investments for our youth. We acknowledge, compliment and congratulate everybody concerned with yesterday's announcement in Dundalk. We also acknowledge, compliment and congratulate everybody concerned with the visit of the Vice President of China to this country last week; we will now be allowed to exploit the great opportunities that exist between our two countries and we will flourish much more from that than they will. Parallel to that, we must prioritise State services to care and provide for those most in need.
Who is most in need in our society or in any society only the poor, the sick the aged and children. We in Fianna Fáil would seek to prioritise health and education. It is at that juncture that our shared aspirations evaporate. It was budget 2012 that signalled this. This Government in delivering that budget, for the first time made its own decisions and, most particularly, decided on its own priorities. Since then as further details have emerged it is patently obvious to us and to all that education and health have suffered badly. It is necessary for us to bring forward motions such as this, which highlights the crazy decisions, crazy choices and unbelievable priorities which are having such a devastating effect on those most in need. We hope the Government will recognise its errors and will recognise, as the Minister, Deputy Quinn, said, that they are out of practice and out of touch-----
Róisín Shortall (Dublin North West, Labour)
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Did the Deputy ever hear of the troika?
Barry Cowen (Laois-Offaly, Fianna Fail)
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-----and that they will follow his lead and own up to poor judgment and poor management.
James Reilly (Dublin North, Fine Gael)
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Like the Deputy's party in government failed to do for 14 years.
Barry Cowen (Laois-Offaly, Fianna Fail)
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This motion has allowed us to gauge the Minister's response to the headlines that dominate today's health service. How, for example, has he responded to the botched handling of the early retirement scheme?
James Reilly (Dublin North, Fine Gael)
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It has not happened yet and the Deputy is saying that - that is classic Fianna Fáil
Michael McCarthy (Cork South West, Labour)
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Deputy Cowen to proceed, without interruption.
Barry Cowen (Laois-Offaly, Fianna Fail)
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How has the Minister responded to having signed off on HSE service plans that will see hundreds of beds closed in acute hospitals and more beds closed in community nursing homes?
James Reilly (Dublin North, Fine Gael)
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The Deputy has learned well at his brother's feet, of that there is no question.
Barry Cowen (Laois-Offaly, Fianna Fail)
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How has he responded to the day-care waiting lists which are surging?
John Perry (Sligo-North Leitrim, Fine Gael)
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The Deputy is worse than the brother.
Barry Cowen (Laois-Offaly, Fianna Fail)
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We remember what the Minister had to say about Sligo too. He cannot hang up the phone here. How does he respond to the massive hikes in health insurance premiums? How, most of all, has he responded to the medical card renewals and the medical card processing applications fiasco?
John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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Which the Deputy's party in government set up.
James Reilly (Dublin North, Fine Gael)
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Which it centralised, by the way.
Michael McCarthy (Cork South West, Labour)
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Deputy Cowen only, please.
Barry Cowen (Laois-Offaly, Fianna Fail)
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Some of the recent responses by the Government, the Taoiseach and Minister for Health are ridiculous in the extreme-----
Róisín Shortall (Dublin North West, Labour)
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There is collective amnesia.
Barry Cowen (Laois-Offaly, Fianna Fail)
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-----and as baffling as the Taoiseach's yarn here last week about the fog in the airport. On the HSE plans, the medical cards and the botched retirement plans, we have heard the Taoiseach say that there are "contingency plans in place". We then heard the Minister, Deputy Reilly, say that there are "dynamic contingency plans in place". Then the Taoiseach went one better and said, we have "transition teams in place" but when he was told that they were not in place he said that we will wait until the next Cabinet meeting and we will put them in place.
John Perry (Sligo-North Leitrim, Fine Gael)
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What about your plans?
Barry Cowen (Laois-Offaly, Fianna Fail)
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Can the Taoiseach tell us where the dynamic contingency plan to deal with the medical cards fiasco is? Can the Minister for Health tell us where it is? Can either of them tell us where the transition teams to deal with the medical card fiasco are?
James Reilly (Dublin North, Fine Gael)
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If the Deputy comes to the meeting of the Joint Committee on Health and Children tomorrow, it will all be laid out for him.
Michael McCarthy (Cork South West, Labour)
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Deputy Cowen only, please.
Barry Cowen (Laois-Offaly, Fianna Fail)
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Let this motion be the catalyst for this Government to start walking the walk, having talked the talk for 14 years.
James Reilly (Dublin North, Fine Gael)
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Which Fianna Fáil Governments failed to do for 14 years.
Barry Cowen (Laois-Offaly, Fianna Fail)
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Let it prioritise those in need, stop pandering to the opinion leaders and spin doctors, and allow us, as a credible alternative and Opposition-----
James Reilly (Dublin North, Fine Gael)
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Fianna Fáil might suffer from the media, but the people do not.
Michael McCarthy (Cork South West, Labour)
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Deputy Cowen without interruption.
Barry Cowen (Laois-Offaly, Fianna Fail)
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-----to support the right decisions and choices. Most of all, let us be in a position to support-----
Barry Cowen (Laois-Offaly, Fianna Fail)
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-----what we recognise and what the Government will eventually see are the correct priorities. After only one year, I commend this motion by Deputy Kelleher, in its entirety, to the House.
Paul Kehoe (Wexford, Fine Gael)
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They should be repainting on Ash Wednesday.
James Reilly (Dublin North, Fine Gael)
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They are not just out of time; they are still out of touch.
Billy Kelleher (Cork North Central, Fianna Fail)
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What about Roscommon? What about Sligo?