Wednesday, 20 April 2016
Health Services: Statements
I welcome the opportunity to speak for the first time in the Thirty-second Dáil and to inform the House of the current state of our health service and, in particular, emergency department overcrowding and waiting lists, which I know are major concerns for Members.
Meeting the ever-increasing demand for health care is particularly challenging. It arises from our growing and ageing population and the development of new treatments and technologies which give people hope but which often come at a high cost. There is no doubt that our health service faces particular challenges in meeting patient demand for emergency care and scheduled or elective care. We are all very conscious that emergency department overcrowding and excessive waiting times cause distress for patients and their families as well as for the staff dealing with them. In turn, long waiting lists can exacerbate emergency department overcrowding, as today's cancelled day case elective surgery patients can become tomorrow's emergency admissions. Patients in our health service deserve to have access to necessary care within a reasonable timeframe.
With the welfare of patients, patient outcomes and patient safety in mind, a range of measures were implemented by the last Government to seek to reduce the levels of emergency department overcrowding and long waiting times. During 2015, more than €117 million in additional funding over and above the budget allocation was made available to the health service to reduce waiting times for fair deal funding, improve access to community care packages and increase hospital bed capacity. In addition, the waiting list initiative resulted in funding of approximately €30 million being provided to the HSE in order to achieve reductions in the outpatient, inpatient, day case and endoscopy waiting lists.
This year has been an exceptionally busy year so far for our health service. The HSE reported that in the first quarter of this year alone there was an increase of 6.7% in patient attendances at emergency departments compared to the same period last year. Typically, increases in attendances are in the region of 1% and in some years attendances have decreased. Despite a significant and sustained increase in patient attendances, the overall performance of emergency departments in a number of hospitals has improved. The vast majority of patients attending emergency departments nationally received the necessary care within a reasonable timeframe.
At the end of February, more than 75,000 patients who attended were admitted or discharged in less than nine hours. It must, however, be acknowledged that a number of hospitals remained in deep difficulty and patients had to wait much longer than they should have done. Approximately 20% of patients spend more than eight or nine hours in emergency departments and we must endeavour to reduce this figure every year, aiming to reach a figure of about 5% which is the internationally accepted norm.
We know that a range of factors contribute to overcrowding in emergency departments. It is not simply a matter of extra beds. Britain has no more public hospital beds per capitathan we do and has an older population but does not have the same levels of overcrowding as Ireland. While extra beds have made a difference in some hospitals, it is evident they have made very little difference in others.
We know the range of factors that contribute to overcrowding includes the following: patient attendances; the acuity of patients; the hospital admission rate or conversion rate, that is, the percentage who are seen and then deemed necessary for admission, which varies massively from about 20% in some hospitals to 50% in others; the length of stay, which again varies significantly from four or five days for the average patient stay in some hospitals to ten days in others; and factors such as flu, viruses and hospital efficiency, not to mention the weather and other environmental factors. The quality of and access to primary care and social care in the hospital's catchment area is also of fundamental importance.
Consequently, emergency department overcrowding is not just a problem for emergency departments or hospitals alone to resolve. The response has to be multifaceted and across the health service. A range of initiatives are being implemented as part of a four-pronged approach. First, a number of measures have been introduced to reduce the number of patients attending hospital by improving access to primary and community care services. These initiatives include offering a wider range of outpatient services, such as the community intervention teams and the home IV antibiotic OPAT programme, which allows some patients to avoid being admitted to hospital altogether and allows others to go home sooner, thus freeing up hospital beds. Second, GP out-of-hours services have been expanded, and while this does not reduce admission rates, it can reduce attendance rates. Third, there is improved access to diagnostic services such as X-ray and ultrasound. Fourth, there has been an expansion of minor surgery capacity in general practice.
Community intervention teams, CITs, have enabled patients to receive care in their own homes and communities which previously they could have received only in hospitals by, for example, administering intravenous antibiotics, monitoring bloods, dressing wounds and so on. These nurse-led teams prevent unnecessary hospital attendance and enable suitable patients to be discharged earlier. These services have been expanded in recent months to areas such as Sligo, Waterford and Tipperary, and there are now 13 such services nationwide. Between 2014 and 2015, there was a 34% increase in CIT referrals and the CIT-OPAT services are estimated to have reduced the requirement for hospital beds by approximately 72 beds per day. Also in primary care, minor surgery clinics have been established in 20 GP practices, with numbers to be expanded to 40 practices by the end of 2016. Out-of-hours GP services have also been expanded to alleviate some of the pressure on emergency departments, which, as I said, reduces attendances although it does not reduce admissions. A 10% increase in usage has been recorded in recent months.
The second category of measures has focused on expanding hospital capacity or bed capacity. Additional funding was provided to open 246 new hospital beds and reopen 116 previously closed beds, thus providing an additional 362 beds when compared with this time last year. That overcrowding has not reduced as substantially as we would have expected illustrates very clearly it is not a simple function of just putting in more beds - far from it.
The number of whole-time equivalent staff in the health service increased by almost 5%, or 4,000 staff, between December 2014 and December 2015. Again, this demonstrates that more staff on their own do not provide a solution to our problems. The extra staff hired include nurses, hospital doctors and consultants - we have never had more hospital doctors and consultants working in our public service - as well as other health and social care professionals. In particular, more than 800 additional nurses are on the payroll and hundreds of additional doctors were also employed in the health service last year. Recruitment of further front-line staff is ongoing but remains an enormous challenge in light of the desirability of, and growing demand for, qualified Irish health care professionals in health services abroad and also the general international shortage of health care staff.
Task transfer between doctors and nurses, which was agreed in February, is another action which can contribute to improving hospital capacity and the efficient use of expertise. Tasks that are now being carried out by nurses as standard include IV cannulation, phlebotomy, first-dose IV antibiotic drug administration and nurse-led discharge. Actions to facilitate timely discharge of patients from hospitals are a third prong of the approach to reducing overcrowding. The health service has demonstrated significantly improved performance in reducing delayed discharges throughout 2015 and 2016.
Increased funding for the nursing homes support scheme - the fair deal - has been a key action in reducing delayed discharges. In 2015, an extra €44 million was allocated to the scheme, providing an additional 1,600 places and reducing the waiting time for approval from 11 weeks to four weeks. A further €30 million was allocated to cover the cost of providing the following: 1,500 transitional care beds throughout the country, 2,500 additional transitional care placements to the year-end to enable discharges from certain hospitals, home care support to an additional 860 people, and 173 more community beds in district hospitals and community nursing units throughout the country.
In 2016 the net budget for the fair deal scheme is €940 million, almost €1 billion. This represents an increase of €43.1 million on the outturn for last year. The scheme will fund an average of almost 24,000 clients per week, which is an increase of approximately 650 on last year. As of 12 April the number of delayed discharges had fallen to 608 from a high of 830 in December 2014. There will always be a certain number of delayed discharges and these are not the same people - it changes every day. It can take time to put a home care package in place because we need to give patients the opportunity to check out one or two nursing homes before deciding where they need to go. Also, if patients are going home to a carer, it needs to be understood that the carer may need time to organise leave from work etc. There will always be a base level of delayed discharges at somewhere between 400 and 500.
To further achieve a reduction towards that number the HSE is in the process of establishing a bed bureau for the greater Dublin area. Contrary to media reports there is not a shortage of nursing home beds in the Dublin area at present.
In 2016 the HSE has provision for €324 million in home supports, including home help and home care packages. Home help assists with more routine tasks while home care packages can provide a range of services including primary care, nursing therapies, enhanced home care hours and respite care for more dependent older people who might otherwise need nursing.
Thank you a Cheann Comhairle. To ensure we start the Thirty-second Dáil in good form I wish to congratulate you, a Cheann Comhairle. This is my first opportunity to speak in the Thirty-second Dáil.
It should also be an opportunity for us to start off this new Dáil with a little honesty about where we are in terms of health, the funding of health, what we expect as a people and who should and should not pay. We should be genuinely honest about what we can deliver to the citizens.
Let us be honest: in the past five years we have had a situation where there were extraordinary promises. Of course the promises brought expectations and in all that time we have seen a failure to deliver. I have no wish to be repetitive but it is important to look back at the start of the Thirty-first Dáil in the context of the programme for Government and what was offered, promised and actually delivered. We had a situation where universal health insurance was the central plank on which our health policy would be funded. We found out some time later that the plan in itself had no funding projections or foresight and no thought was put into it in terms of how it would actually deliver universality.
Universality is something most people aspire to in this context. Certainly, we have not wish to see people being put on waiting lists based on the fact that they do not have private health insurance or because our public health system simply cannot cope with the demand that exists. Our offering in this House should be to strive towards a situation where our public health system can cater for and deal with the capacity issues that are currently blighting it. Of course that is not what has happened in the past five years. We had an obsession with putting forward proposals for funding health care that were either unsustainable or not implementable or practical, i.e. universal health insurance. The obsession in this country with structures as opposed to the delivery of services is something we have to move on from. There was a certain mindset in place. Governments and political parties had an obsession with structures rather than dealing with the real issues on a daily basis.
Whether I liked it or otherwise, in 2003 the Brennan report recommended that there would be a unitary public health system. The Brennan report stated that there should be one national public health system. The HSE was set up on foot of the fact that we had a number of health boards through the country. There was a lack of uniformity in terms of policy formulation, accountability and delivery of services. The Brennan report recommended that there would be a unitary organisation to deliver health care in a uniform way throughout the country without fear or favour or political interference. Of course, we have not had that since then. We have had the HSE, which had an independent board and was to be able to bring in its own expertise. However, it was then subsumed in the last election by the previous Minister for Health, Mr. Reilly.
He got rid of the board and started to bring the executive back under the umbrella of the Department of Health. I do not mind which way we want to go in terms of accountability, whether it is to the Minister and then the HSE or that the HSE would have an independent board. It is critical that there be a unitary public health system committed to delivering health care for people who need it.
Of course, there is also private health insurance. There is a perception that those with private health insurance are somehow luxury yacht owners in far-flung parts of the world. These are ordinary hard-working people, by and large, who take out private health insurance. They do so not necessarily out of any patriotic duty in trying to lighten the burden of the public health system but rather fear and concern for themselves and their family that they will not be able to access diagnostic services or care in the event of a difficulty. The majority of our private health insurance policyholders are ordinary, hard-working families that have taken a decision to do so in the belief that in doing so, they have a reasonable chance of accessing diagnostic services and care. That is of course the failure of the public health system. There is no confidence among people that if something happens, particularly with elective procedures, there will be access to diagnostic services and treatments in a timely fashion.
That brings me to what we should do. Many of the policy decisions made by the Minister and his predecessor did not help. For example, we had many debates in the House about free GP care for those who are under six. Of course, giving free GP care to people should be something to aspire to in here. The difficulty is that when the Minister is rationing health services and there are insufficient budgets to underpin those health services, we have waiting lists and major numbers of elderly people waiting for home care packages. They are scratching around, trying to beg an extra hour of home help here and there from the public health nurse. Choices must be made. We have a limited and defined budget and into that the Minister is trying to fit elements that he thought would be to his and his party's electoral advantage. As it stands, our GP services are meant to be keeping people with chronic illness out of hospital by catering for them in the primary care setting. At the same time, the Government has not enhanced the capacity of primary care but has undermined the structure of GP services and supports. The free GP care for those under six has been put into the mix without expanding the capacity.
This only leads to one result, which is more people being referred to hospitals. The evidence is there already. The figures for our accident and emergency departments have increased 6.9% this year alone. It is quite obvious that the pressure on our GP services is causing those difficulties. One does not have to be a GP or any form of medical professional to see it day in and day out when visiting surgeries or speaking to GPs. People cannot get same day appointments with a family doctor and must wait a day or two. That was never the traditional case in this country and a GP would always have been able to see a patient on the same day if a case was deemed urgent. People are now waiting and appointments are not taken on the same day. There is a lack of capacity in the GP service and primary care setting, with only one place for a patient to go, which is accident and emergency units throughout the country.
Policy development has been based primarily on electoral gain. Of course, it would have been very suitable for us to criticise the Government when it proposed free GP care, not only for those under six but for those under 12, under 18 and everybody else. We in the House must be honest. It is simply not sustainable consistently to pretend that the health budget delivered by the Government in the Dáil can bring all the services promised by the Government. It has never done so in the five years since Fine Gael and the Labour Party took office. The budgets have been disingenuous and, one could say, dishonest. Time and again, the Minister and his predecessor came into the House in that way. That is why we must get away from the nonsense of producing Estimates and knowing full well that they have no capacity to deliver the services outlined in the service delivery plan.
In 2014, savings were identified from cutting discretionary medical cards and €113 million was identified in probity, but there was a deficit of €666 million before we started the year. We must be honest with ourselves when we talk about Dáil reform and how we will conduct business differently in the context of a new Dáil. However, we certainly have to address how we will project the HSE budget in the context of the following year. We cannot have a situation where the Minister states that he or she is standing up to the Minister for Finance and is making a hard case for health while at the same time the HSE, which is charged with delivering public health care, says in briefings that it has no way of delivering the health care expected by the Minister and the Government because of budgetary constraints. We need to have an honest, open and accountable budgetary process in this House to provide funding.
Of course, some people will not necessarily buy into that, but at least the process will be open and accountable. All political parties and none will have an opportunity to make an input as well as prioritising and identifying key areas where they think money needs to be provided. As we all know, specific expenditure from a defined budget will cause difficulties elsewhere. However, we should at least have that honest and open debate as opposed to the spin and disingenuous efforts of the past five years, pretending that in some way budgets were sufficient to sustain services when we know they were not even demographically proofed. In welcoming this health debate, from now on we must be honest concerning public expectations. We must ensure we have a budgetary process that can underpin HSE services instead of the pretence we currently have.
The continuing inequalities in public health are a direct result of the deep social and economic divisions in our society, with the wealthier sections enjoying better health and speedier access to health care compared with the less well off. This should be intolerable in Ireland in the 21st century, yet pervasive social and economic inequality, now as in the past, continues to generate poverty and ill health in Ireland.
In health care, Sinn Féin’s primary goal is a new universal public health system for Ireland that provides care free at the point of delivery, available to all on the basis of need alone, and funded from fair and progressive taxation. As a party committed to equal rights and equal opportunities, we have on a number of occasions presented our policy priorities to achieve a system of universal health care in Ireland and have offered solutions to the crises that present every day in our health services.
One particular area of health care that deserves to be mentioned is mental health. Mental health is a key area in which successive governments have failed to provide an adequate level of service. This is despite that 644,000 people, one in seven adults, have experienced a mental health difficulty in the past year. While there have been attempts to reconfigure health spending and ensure mental health care is prioritised, we see funds earmarked to mental health spending being spent in other areas.
A number of weeks ago, I recorded my concerns that with a quarter of the 2016 calendar year now past, the promised additional €35 million to be spent on mental health had not yet been released. I also highlighted that in the absence of the means to hold the Minister, Deputy Varadkar, to account in the Dáil Chamber, I was prevented from carrying out my electoral mandate as a representative of the people.
It appears that the situation has gone from bad to worse with the threat of €12 million being taken from the additional €35 million which was ring-fenced for mental health.
This is absolutely deplorable and is indicative of a Government and senior Civil Service that is out of touch with the realities faced by so many who suffer from mental health issues. I echo the criticisms of Mental Health Reform, which rightly points out that there is no parity of esteem between mental and physical health. Sinn Féin has a plan for mental health care. Among our proposals are a commitment to increase the mental health budget in year one by €35 million, to complete the roll-out of suicide crisis assessment nurses, to reverse cuts to guidance counselling in schools introduced by the Government in 2012, to increase the number of inpatient child and adolescent beds and to increase the number of child and adolescent mental health service, CAMHS, teams.
The Trolley Watch figures provided by the Irish Nurses and Midwives Organisation regularly highlight the impact of decades of Government failure to adequately provide for the sick and the vulnerable. Yesterday, 323 patients languished on trolleys. The crisis is partly a reflection of inefficiencies within the system. Not all hospitals discharge seven days a week, for example, but in the main, it is directly due to lack of capacity in terms of staffing and bed numbers. There is also a shortage of exit packages, including the provision of home help hours and home care packages, and inadequate numbers of long-stay nursing home beds. We need to increase the number of hospital beds available in the system to move people from trolleys into wards. We need to recruit more nurses into our emergency department and acute hospital system. Many young Irish people want to become doctors, nurses, surgeons or dentists. They go to college and study for years in a system that grows more expensive by the year. When they graduate, they are faced with a health system ravaged by years of austerity, recruitment embargoes and funding cuts imposed by the Fine Gael and Labour Party Government and by Fianna Fáil before it. For too many, the choice is plain, and emigration is the result.
If we are to stem the flow of doctors, nurses and others from our health system and attract those that have already left to come home, we must commence sustained action to address the single biggest factor influencing medical migration - the toxic work environment that currently prevails. Ad hoc, half-hearted recruitment drives will not cut it. To foster and maintain a productive and motivated medical workforce, we must put credible light at the end of the tunnel for staff, showing that things will get better and stay better. This requires a commitment to ambitious multi-annual recruitment targets with revenue allocated to back these up.
As far back as the 2001 health strategy entitled Quality and Fairness – A Health System for You, there was a commitment that "by the end of 2004, no public patient will have to wait for more than three months to commence treatment, following referral from an out-patient department". We could not be further away from that if we tried. Last week, data from the National Treatment Purchase Fund revealed that hospital waiting list figures have increased for inpatient, day case and outpatient care. It revealed that an astonishing 490,500 patients - nearly half a million people - are awaiting treatment or assessment in the public hospital system. This is utterly shameful. In January, it was reported that 250 children with scoliosis were waiting for an operation to fix their spine or waiting to see a consultant. Many of these have been waiting for 15 months or more for this vital treatment. This continues to be the case. I recently learned of a child who has been waiting for rod surgery since 2014. He is only four years old and needs the rods to stabilise his spine. The little boy was due to have surgery at the end of April but this has now been cancelled again and moved to May. Without this surgery, the curve in his spine continues to progress. This causes breathlessness, infections and pressure on his heart and vital organs. I have been informed that an operation was carried out recently on a child with a 100-degree curve of the spine. That is just cruel.
New waiting time targets were introduced by the Minister for Health in mid-2015 but, rather than trying to solve the problem, he simply shifted the goalposts, extending the waiting time target from 12 months to 18 months in an effort to salve the damning statistics of his failures. No serious effort was ever made to achieve these targets, and waiting times have grown since. The waiting list crisis is one of access, capacity, funding and resources. In order to address this situation, we need to increase the capacity of the hospital system by recruiting the necessary staff, opening further beds and investing in care in the community.
What Sinn Féin advocated and what over 295,000 people voted for in the recent election was a plan to end these scandals once and for all. Our fully costed health policy demonstrates in a very pointed fashion how an ambitious multi-annual recruitment plan and, ultimately, an investment of €3.3 billion will bring sufficient capacity into our health system. The election took place eight weeks ago this Friday. We are still without a Government. No Minister has come before this Dáil to address these urgent issues or to be held to account for what is happening under his or her watch, and today simply does not tick the box. It would appear that there is absolutely no appreciation of the distress and often pain that those awaiting access to our hospital services and those on trolleys are enduring. This has to stop. Inadequate increases in the overall health spend will not hack it. The crises in our health services of which we are aware will assuredly deepen if significant additional moneys are not approved and released to tackle the serious under-capacity that exists. I urge all who will be a part of whatever Government arrangement emerges from the current round of talks to put health care at the top of their list of priorities.
I will quote an article from The Sunday Business Post. It stated: "When Dublin-based surgeon Rustom Manecksha sees a patient in the hospital where he works, he asks whether his patient has private health insurance." Does it not say it all about the state of our two-tier system that the first thing a doctor tries to ascertain is what level of insurance somebody has in order to access treatment? Under the Minister's watch, almost half a million people - 471,967 - are on waiting lists. One in ten people in this State are waiting for treatment. A total of 399,000 people are waiting for outpatient treatment, 11,000 of whom are in the Minister's local hospital - Connolly Hospital Blanchardstown. A total of 159,000 people have been waiting for more than six months and many more have been waiting for a year.
Why do such massive waiting lists exist? If we were to listen to Fine Gael, Fianna Fáil, the Labour Party and some other commentators, it is purely to do with mismanagement. It is not to do with this. It is to do with a decision taken in the past seven to eight years to inflict a punishing regime of austerity to bail out the super-wealthy. I will give the academic backup for this claim. A survey by Trinity College Dublin published last year showed that €2.7 billion has been taken out of the health service since 2009. This resulted in 12,000 fewer staff, 21,000 fewer appointments, 30,000 fewer day cases - no wonder one person in ten is waiting on treatment - and 941 fewer beds. A total of 2 million home help hours were taken out of the health service every year. In his speech, the Minister said he would maintain home help services at the 2015 level. We need to put back in what was taken out because of the bailout - a decision taken by Fianna Fáil, Fine Gael, the Labour Party and the Green Party.
The most recent figures relating to trolley watch, which is a daily routine, show that there was a 5% increase in the number of people on trolleys last year but that there has been a 99% increase since 2008. This is further confirmation, if ever it was needed, that the bailout, austerity and capitalism led to people suffering in the context of their health. I mentioned the disparity between public and private treatment. The cuts in the health service hit low and middle income workers in particular. The Trinity College survey also indicated that the €100 million cut in the drug payment scheme added to medication costs. It showed the effects of the cut in home help hours. What is particularly frightening is that it showed the different treatment for public and private patients. For example, in the Mater Private Hospital in Dublin, there are robotics to remove part of the kidney in the treatment of kidney cancer. A public patient, however, does not get that treatment but the kidney is removed. That is quite sickening. A cousin of mine died from kidney cancer so this does happen to people
It has been widely publicised in the past week that 330 deaths per year are being caused by the lack of intensive care beds. Dr. Stephen Frohlich, a consultant in anaesthesia and intensive care medicine, has stated that cuts in intensive care units are grossly unsafe for patients. People suffer every day from the cuts in occupational therapy and speech and language therapy. Linked to the housing crisis, a key problem my constituents contact me about is the waiting list for the housing adaptation grant. A person who is priority 1 is seen within five days. However, at priority 2, the wait is one year and at priority 3, in the Dublin 7 or 15 areas, it is 65 weeks.
I could go on but my time is running out and I want to mention neurology. There is a case in Dublin West of a man who had a workplace accident in 2013 and who is still waiting for an appointment with a neurologist for treatment for a brain injury. This is absolutely incredible. There are similar complaints about stroke patients and ambulance treatments, which I do not have time to discuss. We must reinvest, tax wealth in society and make the corporations pay in order that we might invest in our health service, education and public services.
As a care assistant for the past 16 years, the best education I ever got in life was working with the wonderful people I was lucky enough to care for. Sometimes the people in my care were coming to the end of their lives, while others were beginning a long and arduous journey of convalescence and rehabilitation. This gratifying work and life experience, making a positive contribution to people facing life's most serious challenges will always shape my outlook on life. Equally, I will always admire the amazing dedication of my fellow workers, auxiliary staff, nurses and doctors. I very much doubt that any Minister for Health personally likes to see people on trolleys in accident and emergency departments, struggling to get home care packages or waiting for vital operations. However, it is the result of the cruel and unjust political choices of the Fine Gael-Labour Party Government and previous Governments that we find ourselves in this perennial and prolonged crisis in our health service.
The issue I want to raise is that of home help services and the 1 million home help hours that have been cut by the Fine Gael-Labour Party Government since 2011. The Fianna Fáil-Green Party Government had already cut 1 million hours of home help to bail out the banks but the Fine Gael-Labour Government continued with the cuts, attacking some of the most vulnerable workers who look after some of our most vulnerable citizens. Those home care cuts have had a serious and detrimental effect, not only on the recipients of care but also on carers themselves. It is estimated that every year up to 75,000 people need to avail of home help services but, according to the HSE, only 21,000 people are currently benefiting from some sort of package and the number of home care hours will fall by 50,000 this year. As the Government is well aware, the demand for home care packages and home care hours is growing every year because of our ageing population. Cuts to home care packages are not, as is often claimed, a cost-saving exercise. They also serve the Government’s ideological commitment to for-profit provision by private companies. That is a policy of privatisation of public health care and home care. At present there are 50 private for-profit home care providers in Ireland. This market is worth €330 million. These are highly profitable companies that get contracts worth millions of euro per year from the HSE. On the other hand, the salaries of the care workers who actually provide the care average from €10 to €11 an hour while their employer charges over €26 an hour, more than double what the carer gets. This level of profiteering is a waste of public funding and it is it is a shame and a scandal that so many are left without care.
Professor Des O'Neill of Tallaght hospital recently described the cuts to home care as “totally bonkers and self-defeating”. He added "It will cause significant personal distress for frail older people who are prevented from being able to go home in a timely and supported manner, and will also have significant consequences for an already over-loaded hospital system." Professor O’Neill’s sentiments are shared by the majority of health and social care staff, carers and those requiring care. In an age when people would prefer to stay at home rather than have successive and needless stays in hospital, surely we should be funding home care packages as a priority. We need to respect and value the work done by care workers and carers. We need to put an end to the "care-cramming" that forces home care workers to race against the clock through unreasonable time allocations and which places those vulnerable citizens being cared for at risk of injury.
The position in respect of home care is, like those relating to many other social services - such as housing, health care and water supply - in a state of ongoing crisis. Measures urgently required are: employ more care workers in properly paid, permanent jobs with adequate training and support; stop the privatisation of our health system through expensive contracts with for-profit companies; provide medical cards as a minimum to all those receiving long-term care; abolish means testing for carers and improve their carer’s allowance payments and other supports; and publish and fund phase 2 of the national care strategy, setting out a clear plan for carers from 2016 to 2020.
Mental health was the health issue raised most with me during the election campaign in Wexford. Problems with mental health are not confined to Wexford but the county did have the highest suicide rate in Ireland in 2015. That is not unrelated to the fact that Wexford has the third highest level of deprivation in the country or that the HSE deals abysmally badly with the problem there. A person who is feeling suicidal or has any form of mental illness in Wexford after 5 p.m. or at the weekend has serious problems trying to get help. The person will eventually end up at an accident and emergency department in Waterford where he or she might get a referral and get some professional help or a space in the unit in Waterford.
We now hear that the HSE might want to cut one-third of the ring-fenced money from the mental health budget. This did not start overnight. In the 1980s, 13% of the health budget was spent on mental health services but in 2015 it was 6.2%. In 2010, the year that Wexford and Waterford mental health services amalgamated and all acute beds were moved to Waterford, the suicide rate in Waterford was 11.5 per 100,000, while the rate in Wexford was 11. The following year, the rate in Wexford had almost doubled to 20 per 100,000 and Waterford's had remained steady. Wexford has had roughly double the suicide rate of Waterford ever since. New figures from the Central Statistics Office show that Wexford now has the highest suicide rate per capitain the country. It would be hard to find a more striking example of what cuts in this area of the health service can do. They literally kill people.
I am not advocating that we reopen units such as St. Senan's in Enniscorthy. However, when it was closed, next to nothing was put in place to fill the gap.
A serious national conversation and re-evaluation needs to take place about how the State provides mental health care and how we understand mental health issues. We need to look at models that work for people and help them lead healthy and productive lives in the community. We need to take away the stigma that surrounds mental health issues. Central to facilitating this change is questioning the dominance of the medical model approach to mental health problems, the prevalence of the notion that the pharmaceutical industry can provide us with magic bullets to treat so-called mental illnesses. There is overwhelming evidence that the anti-psychotic and anti-depressant drugs are dangerous if used as a long-term solution to mental health problems and the outcomes for those who receive psychotherapy are much better.
In 2012, the Minister of State with responsibility for mental health met the former assistant State pathologist, Dr. Declan Gilsenan, the psychiatrist, Professor David Healy, and others to discuss the dangers of anti-depressant and anti-psychotic medications. Professor Healy has spent the better part of his career researching the effect of these drugs. He found that pharmaceutical companies are systematically blocking efforts to detect problems, and ghost-writing scientific articles that hide the dangers of new drugs while making it financially attractive for the psychologists and psychotherapists who they see as the real clients of their products to promote and push these products on a public that is not warned of the dangers and have little or no recourse when these professionals prescribe them a substance that has damaging and sometimes fatal effects. However, the warnings of these professionals are being ignored. The number of prescriptions is rising as are the number of people reporting mental health issues and the profits of the pharmaceutical companies.
During the general election campaign I met a woman in a pharmacy in Campile. She was alarmed at the rising level of use of drugs by young people to address mental health problems. She said there was not enough education on the matter and that drugs were seen as a fast-fix solution, but they were not working.
If it was true that the magic bullets worked and we were pursuing the right approach with these revolutionary drugs, should there not be a drop in mental illness problems? The most successful mental health programmes are ones that involve care in the community, psychotherapy and the use of drugs only in extreme cases and on a short-term basis. We need to move to something along these lines and the sooner we re-evaluate where we are going in this area, the sooner we will start to save lives, and improve the quality of lives of these in distress and the lives of those around them.
With limited time, we have to cut to the chase. If we want to deal with the problems in our health service, the starting point has to be the disbandment of the HSE. It is now very much part of the problem and not in any way part of the solution. As an organisation, it is absolutely irreformable. I do not say that lightly or flippantly. From its inception it was what Maev-Ann Wren described as a reform of health administration.
However, it did not get to the problem at the heart of our health service which is its two-tier nature. Rather than addressing that, the previous Government added to the problem by frog-marching everybody over the age of 35 into a system of private health insurance whether they liked it or not. It is not the best outcome and our citizens are paying the price. The two-tier nature of our system is at the heart of problems that see nearly 500,000 people, 10% of the population, waiting for various forms of treatment or assessment in the public hospital system. More than 10,000 sick children are waiting for an appointment in the public system.
We know the figures that 300 to 350 Irish patients die every year because of overcrowding in accident and emergency departments. That is not to mention the people who might die by committing suicide because their mental health issues were not addressed previously, the obese people and the people with heart problems and so on because of the lack of attention at primary care level. The only solution is a single-tier publicly funded public health system. It gives the best value for money and the best outcomes for patients. It is somewhat ironic that 68% of health spending on public health in Ireland is way below the OECD average of 72.7%.
That said, I believe a considerable amount of money in our system is wasted. It is not going to the front line. We are not prepared to pay our nurses, but we are prepared to pay over the odds for agencies. We are not prepared to provide public nursing home beds, but we are prepared to give away a fortune in tax breaks and handouts to private nursing homes.
We have walked away from proper services for our citizens, young and old, who are disabled. There has been an explosion in organisations providing support for citizens with disabilities - each with its own CEO, director of finance, etc., and the plethora of offices that goes with it, but the money is not going to the front line. The middlemen problem that has existed in Irish society is very much alive and well in our health services.
A recent Trinity College paper stated that disability services in Ireland paint a consistent picture of poor or non-existent implementation over several decades by voluntary and statutory bodies of the changes that are required. As a result, more than 900 HIQA inspections into residential disability services found that 93% did not comply with national standards.
I am sure the Minister is aware that in his constituency, as in mine, there is now an acute crisis in the provision of services for young people with disabilities, particularly young people with autism who are transitioning from a school environment into after-school services. There is nothing there for them. Almost 100 young people on the north side of Dublin who had been told they would get access to services such as those of Gheel, have now been told there are no places in that organisation for them. That was a high quality of care that has been downgraded into other lesser-quality care - praxis, which does not give as much hands-on training.
No parent now knows the facilities into which their young people will transition. As the Minister knows, autistic young people need routine and reassurance. Anything that falls apart in the system has a massive impact on them. It is just not good enough. We are spending a fortune on these organisations that are to the side of the HSE. They are not being checked and are not providing the services to the individuals who need them. They are costing society more without addressing the person at the heart of it and it will only get worse while this model remains.
Sometimes in periods of uncertainty comes opportunity. I believe that is the case with the health service at the moment. The new Dáil arithmetic certainly brings us uncertainty but when it comes to the health service and bringing much-needed improvements, there are opportunities to do real and meaningful things that would improve the quality of life for so many people who are dependent on the health service.
For once, it appears the Executive will be answerable to the Dáil if it wants to get through a programme of work, which is a very healthy development. No one party will have control of Government decisions and no one ideology can dominate. We will have the prospect of cross-party, evidence-based policy making, which can only be good. Some will say this will only bring stalemate, but as far as the health service is concerned I believe it represents a golden opportunity to set it on a defined path where it can become a valued public service of which we can be proud.
Currently, there is stalemate in health policy. There have been three major upheavals in the health service since the turn of the century, with different Ministers bringing different approaches. Deputy Micheál Martin brought the HSE; Ms Mary Harney brought co-location; and Dr. James Reilly brought universal health insurance with competing insurers. Each new Minister brought a new plan.
None of these has worked to deliver the quality health service that each of the Ministers claimed at the time. This constant state of flux has led to a great deal of uncertainty in the health service, along with significant change fatigue among many of the health service’s leaders, both in medicine and in administration, as well as most notably among front-line staff. There is utter frustration that the political system has not been able to address these issues, and it seriously undermines attempts to attract key staff back home. One key reason staff will not come home from the United States, the UK or Australia is because of this constant state of flux and huge uncertainty as to what the future holds. Why would any health service staff come back to a dysfunctional system when they can get jobs abroad where they are valued and they know their role and the direction of travel of the health service in which they work? While pay is one element of it, certainty about the shape and future of the health service is also critical, as well as that sense of being valued and being a key player within it. This is very much missing from our health service.
It seems that with every turn of the political cycle, the health service just gets turned on its head again. This means constant churn in the health service which very much militates against good quality care delivery. At present, the health service has no political leadership. Senior health officials are operating in what is effectively a policy vacuum. That is where there is the potential for the Dáil to play a key role. The election result should force every Member and political party to come to an informed decision, once and for all, on exactly what path we should take to develop the health service and make it one of which we can be proud.
There is actually much on which we agree and it is important that becomes the starting point. We agree that, despite significant public and private funding, our health service does not compare well with most other developed countries. Taking into account all public and private health spending at approximately €19 billion each year, we are on a par with most other European countries in health spend, yet we get very little value for money and certainly little in access to quality services or equity within it.
We all agree significant investment in primary care is vital in order that the model of care can be radically changed. We also all agree that this is in the interests of better health outcomes for citizens and the sustainability of health funding. We agree public waiting times in almost all health sectors are unacceptably high. We agree that, as a country, we are far too dependent on medication, as well as paying far too much for it. We agree access to diagnostics has to be prioritised. We agree the main chronic disease management programmes should be prioritised and implemented as soon as possible. There is so much more.
Critically, a majority of Members favour a single-tier health service which would serve people on the basis of need rather than on the current model of ability to pay. Ironically, it looks like the party that will lead the minority Government is probably the only one which does not agree we should have a single-tier health service. That may have been the case at the time of the election five years ago when there was talk about a single-tier, insurance-based health service. However, I recall asking the current Minister before the recent election whether he agreed there should be a single-tier health service but he did not quite answer it. That is a critical question. Every other political party in the House agrees we should be working towards a single-tier health service. The issue then is what is the funding model on which we should work.
If there is broad agreement across the House that there should be a single-tier health service, we must examine the best funding model to achieve this. This is the single most important decision on which the political system needs to agree. I would cite the example of Britain where, after the Second World War, the political system came to a shared understanding of what the future shape of the health service should be. Both Labour and the Tories agreed the funding model should be based on central taxation. Accordingly, they agreed upon the National Health Service, NHS. There have been many ups and downs with the NHS but it remains a highly valued public service in Britain, a source of pride for its people, even celebrated when it hosted the 2012 Olympic Games. Can one imagine holding up a tricolour and saying the Health Service Executive makes one proud to be Irish? In Ireland, there is no such cross-party agreement in place. The experience with the last Government was that, while it came up with a radical plan, it did not cost it until the final year of its term.
Then, the final bill showed the plan was unaffordable. Another four years were lost.
There needs to be political agreement on the way forward, starting with the funding model. This can be achieved through an effective cross-party health committee. We need to set out clear objectives as to what we want to achieve through our health service. There is a need to take advice and to be clear about the costings involved. There is a need to listen to experts and front-line staff. Most importantly, there is a need to ignore the many vested interests which have for so long held back Ireland’s health service. Too often, our health service policy has been dictated by some of those powerful vested interests in the health service, such as the insurance companies, the pharmaceutical industry, the private hospital system and private medical interests, meaning that very often the needs of the patient have come last.
We need to take a new approach to devising health policy. If a Government is formed in the coming weeks, we will have an opportunity to take that new approach, to work in a genuine all-party way, to use the evidence available to us, to take expert advice and start putting the patient first when it comes to designing a new kind of health service. We should not shirk that responsibility but use it as a real opportunity to do something meaningful and worthwhile to achieve, once and for all, the kind of health service our people deserve.
The Minister’s speech was informative and interesting, first and foremost because of some of the statistics outlined in it. The one figure from last year which jumped out was that admissions to emergency departments grew by 9%. While I do not have the figure off the top of my head as to what our population increase was last year, it was nowhere near even 7%. What does that say about the health of our society?
From a Green Party perspective, the first measure on which we have to concentrate when managing our emergency departments, hospital waiting lists and health service is preventing illness in the first place. We need to create a healthier environment for all our people which would see us, setting as our first task in tackling the undoubted crisis we have, reducing the number of the people having to go to hospital.
That requires us changing. It requires the Minister with responsibility for food to stop supporting at every stage processed foods that are high in sugar, fat and salt, which is good for the profits of the food processing companies but bad for the hearts and heads of the people of this country. It requires the Minister for Transport, Tourism and Sport to take what is a €100 million investment out of a multi-billion euro transport investment budget to promote the forms of transport that makes us healthier, such as walking and cycling, and to start to increase that as part of our response to the health crisis. It requires the Minister for the Environment, Community and Local Government and others to start designing communities where it will be safe to move in that way so that we start to create a healthy society. That is the first key point. Prevention is better than cure, and we must start that.
Second, regarding the statistics in the Minister's contribution, I will not cite all of them but he cited the putting in place of 343 community intervention teams. He also cited the employment of 800 additional nurses and several hundred additional doctors. He said in a range of areas there were 1,600 new nursing home support scheme places, and so on. The massive increase in investment we have seen through emergency budget provisions in recent years was cited but, as Deputy Coppinger stated, the outcome, despite all those increases in expenditure, still saw an approximate 5% to 6% increase in the number of people ending up on hospital trolleys. We are all aware of that because we all have friends and family members who have ended up in that position. The Minister's contribution was interesting and highlighted a range of public service money we are spending resulting in additional nurses, additional places and additional beds but we are not solving the problem. The fundamental question is not only the amount of additional money we can raise and can keep putting in but how we can start making sure we get value for money and ensure those nurses starting off in their career and those beds are being used in an efficient way, which means we will not see another year-on-year increase in the number of people on trolleys.
I will outline some thoughts on that from the Green Party's health policy, which the Minister or whoever will be the Minister in the upcoming Government might take into account. To start with emergency medicine, we believe we need to strengthen the paramedic service because as first responders they have a critical role. Upskilling them and giving them a real role in managing the emergency process right into the hospital is the right investment for us to make. Apologies for that mobile interference.
-----so I thank the Acting Chairman for her intervention in that regard.
The Minister set out a range of ways in which we are increasing investment in the employment of additional nurses and the provision of additional beds, but it is not having a proportionate effect in a reduction in either the number of patients going to hospital or the numbers ending up on trolleys in our acute hospital services. The question is how we can be more efficient in everything we do. We would argue that we should start with the paramedic service. We should give the paramedics a significantly increased role in how we manage the process. It is not a matter of them arriving in the hospital, queueing up and that is their business done. From what I have been told with respect to a military medical approach, we believe they could be part of a triage system where they and the local community health centres would be given a key role in trying to reduce the number of people going into the emergency departments in hospitals by being able to make decisions in the front-line, first responders process whereby a person presenting with a certain condition does not need to go to an acute emergency centre but can be treated at a local community health centre or by a local GP. That would provide some flexibility and some triage management of how we get people into hospital in the first place.
Everything in our health policy is directed towards a community health system. Every party is advocating this but the question is how do we do it. We believe that advanced practitioner nurses could provide a significant role in addition to the community health centres or community health organisations, which the Minister referenced, or community health organisations in carrying out many procedures in the community. From what I have heard from the small number of advanced health practitioner nurses on the ground, they are having a significant effect in reducing the expenditure incurred in the hospital system because they are working well in providing procedures at home. It is not easy to get such practitioners. They require high-level training. In rural areas in particular they have an even more important role. Their role needs to be combined with that of a local GP service to manage the delivery of rural health services in an efficient and effective way. We need to invest in that process as our first response to the crisis we face.
At the centre of our health policy is removing the division that exists between the primary care and the hospital-based system. While I acknowledge that the doctors among the elected Members would be better able to speak on this point, from I have been told by colleagues, it appears that GPs do not have sufficient contact right through the hospital process. It would be a better and far more effective system if it were managed through information technology or through a community-centred approach first in order that the community hospital organisations manage the hospital process rather than vice versa, and that the GP has a critical role as a patient goes through the hospital system in providing advice and being able to refer case history information about the patient. That is a role for the GP. We see the GP as the central organiser right through the system rather than this extenuated differentiation between primary and tertiary care.
We would argue also that there are a range of advances we can make in the use of digital information technology and e-health services. While there are people in the Minister's Department seeking to develop that type of technological approach to being more efficient in everything we do, it is not getting the due attention and emphasis it deserves. It is one of the ways in which, first, we can keep people out of hospital by using all these new remote sensory monitoring systems and so on and, second, manage this complex operation. It can allocate resources and patients to the right places. We do not believe we have availed of the full opportunities that exist in the advancement of e-health technology to deliver the efficiencies we need. We have an overriding fear of experimentation, going back to the PPARS example, where there is the perception that whatever a public servant does, he or she should not get caught out investing in some technological system that might not work and that it could end his or her career. We need to stop that and allow for experimentation, failure and local units to devise their own open code software systems for health care management. To use a military metaphor, the US veterans health system is one of the best public health systems in the world. One would not associate that with the American military but it is. It treats its veterans in a highly efficient, very low cost, best quality system. I understand one of the ways it does that is through the use of a range of advanced, open source, collaborative technological applications. That may seem a million miles away from the real crisis here with people lying on trolleys in hospitals today, but in terms of public policy, our job is to use our money wisely for the benefit of patients, and that requires us to be willing not to over-regulate and allow for experimentation, to stop it being a box-ticking exercise and give the health professionals the freedom to experiment and concentrate on the patient. That is what that technology allows us to do.
As this is the first time I have addressed the Chamber, I would like to thank the people of Clare for the honour of being elected to the Thirty-second Dáil.
The Irish health system is struggling to cope with demands on its services. The fundamental issues currently are a lack of bed capacity within our hospitals, a recruitment shortage of specialist nurses and therapists, a lack of morale within the health service and a lack of long-term vision for the future of our health services. The current model of health care in Ireland is not working in many areas. A new model of care needs to be developed to cope with our changing health needs which include an increase in our overall population, an increasingly ageing population and the funding of new treatments and innovations of care coming on stream year on year.
These are challenges which need to be planned for in advance, rather than being reacted to when problems arise. We must develop a ten- to 15-year ring-fenced framework for health planning that will transform our health service into an efficient and effective model of care which will respond to patient needs. Many areas of the health service are functioning very well, including medical and surgical assessment units, which are trying to take the pressure off our overcrowded emergency departments. However, these units need to be expanded in size and opened as seven-day services. The Minister referred to community intervention teams and these are making inroads in allowing patients to be discharged early from hospitals and keeping them within the community. Other services, such as cancer care and cardiology, are now of an international standard. We are delivering high quality care across specialties when given the space and resources to do so. However, our specialist services need to be protected from hospital overcrowding, so that elective procedures are not continually cancelled, thus extending waiting lists that are already long. There is a disconnect between primary care in the community and secondary care in hospital. There needs to be a new integration of care and communication between primary care and general practitioners on the one hand and specialist secondary care in hospitals on the other. This should form a new model of care where, in so far as possible, patients are looked after in their community rather than in hospital settings.
We must have active management of outpatient lists and increased shared care between chronic disease clinics and our GPs. We must embrace technology. Virtual consultations would prevent unnecessary hospital attendances, while still providing an excellent quality of care. The development of primary care teams is far more important than the development of primary care centres. Building primary care centres and centralising services in one building will not necessarily improve patient access to services or deliver better patient outcomes. However, ensuring primary care teams are properly staffed and resourced will deliver a better quality of care. The provision to general practice of diagnostic equipment and staff would also allow appropriate decisions to be made for patients in the correct and least expensive setting. Rural practices need to be supported, not undermined, as do those practices in deprived areas. Obviously many illnesses require hospital treatment and this is unavoidable. However, if we are to free up scarce hospital resources, we must endeavour to look after our ageing population and its increasing burden of age-related chronic illness, such as diabetes, heart failure, chronic lung disease, arthritis and mental health issues. These need to be managed within the community, thus preventing acute worsening of these conditions and preventing prolonged and recurrent hospital admissions.
Some 99% of patient time is spent living in the community, being looked after by GPs and community-based services, yet the hospital services consume over 90% of our health spending. This spending ratio needs to be refocused to reflect where chronic and preventative care should be provided. The Irish health services require more generalists, GPs and those who specialise in medicine for older people, who can look after chronic disease. Day care services, such as assessment units or ambulatory care units, which review patients in a timely manner, should be part of the new model of care. In these units, patients should be investigated with a view to discharging them on the same day, unlike our current model which is to admit them to hospital with a view to investigating.
I welcome the opportunity to contribute to the debate on the health services. Three aspects have to be addressed at the same time in relation to improving the service for all our citizens, namely, our hospitals, primary care, and community hospitals. Currently, our hospital works on a nine-to-five basis with consultants. That needs to be extended to working on a 24-7 basis, or at least from 8 a.m. to 10 p.m., 11 p.m. or 12 a.m., so that diagnostics and investigations can be carried out and people can get their X-rays, CAT scans and everything else at weekends as well as during the week. That would go some way to lessening the pressure on emergency departments and easing the burden.
In talking to staff and consultants in our local acute hospital in Letterkenny, I was shocked to hear the consultant explain to me that there are currently three orthopaedic surgeons operating in Letterkenny General Hospital, but they are only doing slightly more operations than were done in the 1980s - 30 years ago - when there was only one surgeon. That is a damning indictment. The reason is that they do not have access to the theatre space or theatre staff to enable them to carry out operations. Under the escalation policy in the emergency departments, for five weeks in a row the orthopaedic surgeons' elective surgery list was cancelled, even though there were available beds in the orthopaedic wards. Those beds could not be used for emergency department patients because of the risk of cross-contamination with surgical patients on the same ward, yet the beds had to lie idle and the elective surgery was cancelled. That does not do anything to address the crisis in the emergency departments; all it does is lengthen the waiting lists in the hospitals. The staff in Letterkenny believe that by using the theatre space they have and making it work hard, they could halve the waiting lists within a year and end them entirely within a couple of years. That should be the goal of any Government and Department of Health.
Within primary care, as Deputy Harty said, we need to resource primary care teams, not primary care centres, to ensure ancillary staff like physiotherapists and occupational therapists, and everything else are available to those GPs so that they can work, and to allow GPs to refer people directly into the hospital system for diagnostics, rather than having patients going in through the emergency department simply to get diagnostic scans and procedures carried out. Allowing them to be referred straight from general practice into the diagnostic system would streamline the whole process, remove people from the emergency departments and allow GPs to do the work they could and should be doing. That would tie in with the management of chronic illness, like diabetes, as well. GPs are integral to managing that process and could consult with the relevant consultants, rather than tying up hospitals with outpatient appointments, so that people can get further investigations.
Alongside that, we must invest in community hospitals and community care for our elderly people. That is absolutely vital. In my local community hospital in Killybegs, up to two weeks ago, there were five patients in that hospital who could not be released because there was no home care available. In fact, one of those patients will be in that hospital a year this June, simply because there are no home care packages available for them. The HSE is desperately trying to recruit people to provide home help and home care but cannot get them because of the system that has been allowed to develop whereby people might be offered half an hour of work a day over the five days, which is absolutely useless to anybody who wants to get involved and provide that community care. The HSE cannot recruit because of the system that is in place. Who could sign off the dole to take a job where they work seven hours a week over five days? It just does not make any sense. We need to make a career path for people to get involved in community care so that they can have a reasonable contract that allows them to be available to people. Then those five beds in the community hospital can be freed up, which will free up five beds in Letterkenny General Hospital, which will, in turn, free up the emergency department and starts things moving along.
The reason I believe this does not happen is that this actually costs money. Having those five patients move out of Killybegs Community Hospital requires an investment in the community care package for them and that also means those five beds will be taken up straight away. The five beds in the acute hospital will be taken up straight away and there is no saving for the Department of Health. When one wants to save money, one allows waiting lists to lengthen and does nothing. That is the only way to save money in the health services.
I welcome this debate. Taking up the points of the last speaker, Deputy Pringle, I agree entirely with what he said about people needing proper home care packages and proper home help.
It was brought home to me not so long ago by a 78 year old lady who gave me a call and told me that she had a half hour per day home help to look after her husband who was 82, had dementia and was doubly incontinent. She was in extremisand had no help at home. I went out to visit her and obviously she is doing her best but bedlam is the best way I can describe the home. Everything was all over the place because her poor husband was unable to behave in a manner that one would call normal behaviour. The place was absolutely upside down. I got in touch with the HSE about that and they increased home help hours. It is a serious issue. People who are looking after people suffering from dementia are fighting a losing battle in terms of the age at which they are interacting with their spouse or family member and also with the lack of care and support they are getting. It is entirely unacceptable in the present day that we do not insist on a bill of rights for people who are suffering from Alzheimer's or dementia. The support services should be there as a right to those families.
I had another case of a family where the lady had Alzheimer's and was up and down the stairs 24/7. She never rested and was constantly moving up and down. Her husband and daughter - who could not work because of the medical situation - could not get her a proper location in the community where she could be looked after. The lack of support for community organisations that provide dementia care in places like Dundalk and Drogheda is entirely unacceptable. They should never have to come to politicians to get the service they absolutely need - it should be there as a right. We need to look at the Alzheimer Society's proposals for a bill of rights for people who are suffering from Alzheimer's and dementia. It is a fundamental issue that we must address because it will be an increasing problem in our society.
When one knocks on doors people talk about people on trollies. It is a huge issue for families and individuals who suffer greatly, not because they are not getting medical care and attention but because of the proximity of other patients and because of the distress that the often elderly patients are in when they are in the corridor. Most of them are people of advanced years. There will be more and more people living longer in our society and needing care. An awful lot of them should never end up in hospital at all. The reason they end up there is because there are no interventions before they get that far, like the family I spoke about earlier. There is inadequate home help for these families. If somebody has a disability and does not have proper and adequate home help, it means their illness will become more acute and more interventions and hospital treatment will be needed. Proper home care is one of the ways forward.
The other way forward concerns our ambulances and medical staff. When paramedics come to a home they should have the capacity to use the very best modern technology and telemetry to communicate directly with the individual concerned. Obviously the person's consultant may not be available but they could interact with an equivalent consultant. If somebody is very bad with asthma, has a chronic attack of some illness or if a problem with their heart is distressing them in the middle of the night, they would not need to go to hospital if they could be reassured medically on the spot and if the people in the ambulance service could give them the medication that is directed. If we upskill our ambulance staff and improve the technology that our ambulances use, we can keep people at home. We all know that if one has a pain in one's tooth at 9 o'clock at night, it gets worse as the hours go by and one gets really concerned about it. Similarly if one has a very bad headache it is not as acute during the day. There are strategies for keeping people out of acute hospitals and meeting their immediate medical needs without any further distress being caused by hospital admissions.
The debates here on health are always excellent because on all sides of the House we experience the same issues with our constituents. Since the health boards were abolished, the only forum that politicians have is debate in the House with the Minister or in the health committee. A new interaction should and could take place. We are all in different HSE regions. We used to meet in the health board and I see some of my former colleagues in the HSE here. There should be meetings, at least on a quarterly basis, held between all the Deputies for the particular area, Members of the Oireachtas and HSE staff - both acute hospital staff administrators and community care staff. Those meetings should have a public dimension to them. One should be able to challenge those professionals as to why things are happening or not happening and they should have the opportunity to tell us as politicians what we should be doing and what we are not doing. That debate which happened in the old health boards was very positive. I never saw a good reason to abolish the health boards because I found they were excellent and kept everybody on their toes, including politicians and HSE staff. If we go back to having a quarterly interaction, which is not unreasonable, there could be a quarterly plan for acute hospitals and community care and a meeting in a public forum to ask for a report or talk about what happened. That is constructive and would increase efficiencies and the transfer of knowledge of which there is a deficit in this House at times.
We meet lots of people who feel they need assistance to apply for medical cards and we have dedicated lines for this. I had an experience yesterday of communicating with the medical card hotline. The issue concerned a lady who unfortunately has cancer. Most of her stomach and half of her bowel was gone and she was being told she was not entitled to a medical card. She applied for a discretionary medical card and part of the reason she was turned down was on financial grounds. That is appalling and disgraceful. When people are suffering from very serious illnesses like cancer and are in treatment, finances should not enter into it at all. There is an issue here about a human being who has an illness which will more than likely kill the person. The important thing for them is to affirm their worth and importance as an individual and their entitlement not to be distressed by all this paraphernalia and bureaucracy. It is a disgrace that this is still going on. There has been a lot less of it in the last year but it is beginning to start up again. Whatever instructions are being given, if somebody has a very serious illness, particularly cancer, and if they cannot eat, why the hell should they have to ring me to get their medical card? They should not have to do that; they should have it as a right. It needs to be addressed and it would be a very positive and constructive thing to do.
The other issue I wanted to talk about was the quality of care in our nursing homes. We are talking about the health service. We spent an absolute fortune on what we call the fair deal. There is a very significant number of people in nursing homes who should not be there at all. I return to the earlier point, which was also made by Deputy Pringle, about proper home care packages and integrated home care. If we had the proper community services for them, they would not need to be in a nursing home. This is not a pejorative comment. If one is ambulant, able to walk around and not in a bed 24/7, one should not be in a nursing home for social reasons. In many cases people are in nursing homes for social reasons. If people can be kept in their home and given all the support they need, it would be far healthier and far better. That is the way forward.
I have 21 seconds left and I will return to my primary point. If there was interaction between the political representatives of the Oireachtas and the HSE executive on a regional level in a public forum, we could get to the bottom of a lot of the problems that we cannot really get to the bottom of in a debate like this. It could be a question and answer session - I am not looking for statutory powers or anything like that.
Yes. I am delighted to be given the opportunity to contribute to today's debate on health. It is a privilege to be given the opportunity to contribute to a debate on health issues on behalf of my constituents of Kildare North with a view to highlighting areas in the health service where there are significant opportunities for improvement. Before getting to the main points of my contribution, I wish to set in context the points I will make. The health of the nation and the state of the health services available to the citizens always should be on the agenda of public representatives and of this House. No matter how much money is spent on the health services and no matter how good are the health professionals, there will always be a requirement for more resources for the health services. As the population ages, new medical procedures become available and new medicines are developed, the health service will always be in the spotlight and it is Members' duty to ensure it remains there.
Throughout my relatively short career in public life, I have witnessed year in and year out the adversarial approach adopted by politicians on health policy with the Government claiming it is always right and the Opposition claiming the Government policies are not adequate to address the health issues facing the country. Opposition parties must provide an effective challenge to Government policy when it is needed and the Government must defend its policies when it passionately believes they are the right ones. However, the people on waiting lists for vital health procedures will not forgive the politicians if they do not develop a new approach to the formation of health polices, namely, to have open discussions in this House on health policies in which each Deputy's input is sought and all political parties are allowed to have their say. Often the best policies are achieved by collaboration with others and all Deputies should be given the opportunity to have their input. I also believe the great work of thousands of employees in the health service must be recognised. Each day, thousands of health professionals provide invaluable care to many patients who use the health service. In the heated debates that often take place inside and outside this House on health policy and resources for the health service, their work, dedication and professionalism often get ignored. Many people who gain access to the health service are full of praise for the workers there and it is important to recognise their vital contribution and I am delighted to acknowledge their work today.
It is only fair to acknowledge the significant improvements that have taken place in cardiac treatment and the cancer care services over the past 15 to 20 years. As Minister for Health and Children, Deputy Micheál Martin brought forward health policies that had a long-term benefit for the community as a whole, as demonstrated by the cardiac national treatment services and the cancer care services. In common with all Members in this House, health is a constant issue at my weekly clinics. Access to vital health procedures is a challenge, waiting lists are increasing and securing home care for the elderly is a constant struggle for many older people. Moreover, vital services for children are starved of resources and for those who need them most, medical cards seem to be getting harder to secure. In the past week, I have come across two particular cases I believe merit mention in this debate. One pertains to a child who is on an 18-month waiting list for a vital operation to enable the child to walk. In a developed country like Ireland, children needing such treatment to enable them to walk should not be obliged to wait so long. The second case worth mentioning, albeit only because it is becoming more regular at my clinics, relates to securing home help hours or carers for the elderly. It is becoming more challenging for older people to secure home help hours and when they do receive approval for such hours, they are finding it difficult to secure the appointment of personnel to carry out the home help.
A review of information regarding Naas General Hospital in my constituency, which I am sure is typical of what is happening elsewhere in the country, highlights the need for a different approach. For instance, in March 2015, some 668 people had been waiting more than a year for an outpatient appointment in Naas hospital, which was an increase of 424 people or of 173% over the previous year. Moreover, there are 5,320 people on the outpatient waiting list in Naas hospital and there were 426 people on trolleys there during March 2016, which is an increase of 37 people or of 9.5% since March 2015. While listing off these statistics is effortless, there is a medical need, which in many cases is acute, behind each person included in these statistics. In particular, I believe older people must become more of a focus for health policy and given the projected increase in the number of older people in Ireland, it is important to put in place polices and supports to deal with this reality. In 2006, some 468,000 people in Ireland were aged 65 or older in Ireland, but by 2041, the number of people in Ireland aged 65 or older will be 1.4 million. Care for the elderly can be provided for in their own homes with some modest supports from the Government or its agencies. Older people prefer to live in their own homes and this can be assisted by providing home care packages or home care hours and making their physical environment more suitable for their needs. In Kildare, there has been a decrease of 83,346 home help hours between 2010 and 2015, as well as a significant fall from nearly €4 million to €1 million in the housing adaptation grant for older people over a four to five-year period. The lack of resources for care for the elderly, as demonstrated by poor investment in home care hours and housing grants, means older people are being pushed into care in the hospitals or into residential care, that is, pushing older people into already-strained facilities. It would be much better to facilitate independent living and to encourage people to be minded in their own homes. This reduction in the overall cost of care for the elderly would free up facilities that are needed for many other services.
As Members discuss or debate the issues regarding reform of how they and the State do their business and regarding the formation of a government, the need for a new departure in how the health services, the Department of Health and the Health Service Executive, HSE, are managed is becoming clear. I believe Dr. Ronan Fawsitt and other general practitioners, GPs, have outlined a new approach in this regard. This morning, I listened to Brendan Drumm advocate a 20-year plan based on an agreement between all the stakeholders, including Members of this House and the Minister, and I firmly believe this is the way to proceed. Nationwide, GP services are under serious pressure both financially and from the perspective of staffing. Members must understand the reason many newly qualified GPs are going away to places like Canada and so on. If it is money, structures or pressure within the services here, Members must consider how they will relieve all these factors. Consequently, a fresh approach, as well as a cross-party political approach, to health would save time and energy regarding how the health system is managed. As for country GP practices, it is impossible to get final decisions from the HSE on primary care centres, to get an extension to a community care setting or to get permission for a public health nurse in respect of a local practice. Moreover, rural GPs are under a lot of pressure regarding the delivery of a wide range of services in which they wish to get involved but cannot, due to time and pressure. Members must relieve this pressure and if they are serious about primary care centres, they should enter into this discussion and conversation that is going on through Brendan Drumm, Dr. Ronan Fawsitt and the many other GPs who now are holding public meetings.
Mental health services are in absolute chaos. Whether private or public, attempting to get the professional assistance individuals and families need in respect of mental health is chaotic. The number of suicides is significant and Members must ask themselves why. People have been under debt pressures from banks and other institutions, which has pushed them over the edge and they have ended up committing suicide. This is a serious problem at present and the mental health services are not equipped to do with it. One can get neither timely access to the professionals nor the required level of engagement through these professionals because they too are under pressure. I appeal to whatever Minister will be in place to ensure there is some change this regard. Similarly, in respect of community health care for the elderly, I refer to Newpark Close centre in my home parish where there is an elderly population. It is impossible to get either the service or engagement from the HSE and I ask the Minister to address this issue.
As Members sit in this Chamber, the issues in respect of the person known as Grace and sexual abuse in foster homes still remain to be dealt with. A commission of inquiry is to be set up and I ask for it to be included as just as much of a priority issue in a programme for Government as the legal issue arising from the courts will be taken as a priority. Those investigations into the foster care homes and into the rape and sexual abuse of young intellectually disabled men and women must be brought to a conclusion in the interests of their families, just as the case of Mary Boyle in County Donegal must be investigated. That campaign, which is being led by Margo O'Donnell, has raised significant concerns regarding child welfare and child protection. The Garda whistleblowers must be listened to in this regard in order that there can be an approach to these problems which can lead to reasonable hope for families and a reasonably healthy life thereafter.
The same can be said about Lucia O'Farrell and the death of her son, Shane. It is a shame on this House that that inquiry led to nothing while all of the evidence spoken about in this House and available to Members of this House showed there needed to be an inquiry and an addressing of those cases, but it was not done.
Medical cards were mentioned earlier, and I will finish on this point. Some 50,000 medical cards are to be withdrawn. It is an awful reflection on the policymakers and the HSE that people who are terminally ill and appealing to the HSE for a medical card do not get one. They are often put into a process where further information is constantly being sought although the information has already been made available. It is hugely difficult for public representatives and the clients making the application to engage with the bureaucracy of this State. It is an appalling situation that so many are waiting for those cards and are waiting on trolleys and that nothing will be done.
Finally, the 15 day timeframe for the return of an answer to a parliamentary question by the HSE is not being adhered to. It is being ignored. No respect is being shown to Members of Parliament as we try to deal with issues for the people in our constituencies and throughout the country.
Yes, we are sharing time.
It never ceases to amaze me that we have lengthy debates on health care issues in a policy vacuum. It is quite obvious the two parties involved in Government talks at the moment do not have a plan or strategy for health care yet we can come in here and have lengthy debates about how we will solve the problem. At least before the last election, the Minister's party did have a plan in respect of universal health insurance but, when he came in as Minister, that was ditched. It has not been replaced at all with any vision as to how we will sort out the problems in health care. We have heard about all of the problems, which have been articulated by members of Fianna Fáil and Fine Gael who have already spoken, in respect of people's medical cards being taken from them, including people who are terminally ill and very sick children. These are people who need medical cards but they have had them taken from them.
Almost every minute of every day, in acute hospitals across this State, including that in my constituency in Waterford, we have patients lying on hospital trolleys. This happens every minute of every day under the Minister's watch and it has happened under the watch of previous Governments as well. We have all the problems in mental health services, especially the lack of out-of-hour services for adolescents. This is a big problem in the south east and it is a big problem for many parents who struggle to support their children - young adults and teenagers - going through difficult times.
Of course, we have the real problems in our acute hospital settings. Capacity has been stripped from hospitals up and down this State. We have fewer doctors, nurses, theatre spaces and beds, all of which has resulted in increased waiting times. I will give all the figures on Waterford, which I got from the HSE, to the Minister. As he knows, I take an active interest in the hospital in my constituency all of the time and not just at election time.
It is also quite obvious that Fianna Fáil does not have a strategy either because I examined its policy very carefully and it can be summed up in five words-----
-----which are "leave things as they are". This is the policy being put forward by Fianna Fáil, which is not good enough. We have left things as they are for so long and ended up with a two-tier, unequal health service which is not delivering for people. The real victims are the sick children who are without medical cards, older people who are left without home help and adequate supports, the patients left on hospital trolleys and all those waiting on long waiting lists. We have 8,500 patients in Waterford who have been waiting longer than 15 months to see a consultant. Figures last week showed that 495,000 patients in the State are waiting for hospital appointments. Again, this has been under the Minister's watch. We lost 300 staff in University Hospital Waterford since the Minister's Government took office. Many of them are nurses and junior doctors as well as support staff. Surgical theatre space was taken from the hospital as well as wards and beds closed. The impact of all that is that people are waiting for longer for treatment.
Today I got an e-mail from a constituent who was in chronic pain and had a hip injury seen to in 2011. He went to a private clinic in 2012 because he could not wait any longer to get assessed. He was then referred back to University Hospital Waterford because he did not have private health insurance. In 2013, he eventually saw an orthopaedic consultant at University Hospital Waterford, but he was not treated. He was referred to St. James's Hospital in Dublin. It was only in June 2015 that he was put on its waiting list. He said at the end of his e-mail that the whole ordeal has left him depressed, stressed and unable to support his wife and two children because he is out of work. There are many practical examples which we can give as well as human stories we can bring to this Chamber today. Will the Minister outline his vision for health care because I do not see it?
My final point is a question to the Minister. There has been an awful lot of talk about the need for 24/7 emergency cardiology care at University Hospital Waterford. We do need it; it is very important. However, we had an extraordinary claim from an Independent Deputy in Waterford over the past number of weeks who claimed that, at a meeting with the Minister and one of his senior officials, the senior official said to him - this was relayed to the people of Waterford - that the reason we are not getting the 24/7 emergency care had nothing to do with medical need but concerned hospital budgets in Cork and Dublin. Will the Minister clarify that for the people of Waterford today?
Any decision is not one based on political deals. It is based on the recommendations of the national clinical programme for acute coronary syndrome and that is how it should be.
I had the privilege of representing workers in our health service for many years. I stood with them as the services they advocate so passionately for were dismantled. This project was started by Fianna Fáil with the recruitment moratorium, among other measures, and taken up fairly enthusiastically by those in Fine Gael and the Labour Party. I have had to support health workers as they tried to highlight the impact of Government policy on their services and on those who depend on those services. I have defended those same workers when their employers threatened sanctions against them for the very act of speaking up and speaking out.
The acting Minister for Health would do well to listen to those people who are carrying the can for the failure by his Government under his watch. There is no point in saying it was like that when he got there because the Minister, Deputy Varadkar, was put there to make a difference. He and his predecessor have presided over unprecedented increases in the number of people waiting on trolleys. That is, of course, after he stopped arguing with the nurses who are counting the trolley waits. I wonder if the acting Minister has ever waited with an elderly relative who had to suffer the indignity of a long trolley wait. Has he ever had to calm down a home help worker after he or she has been told the hours have been cut. These workers need the money and the work but, more important, their clients need the home help hours. I wonder if the acting Minister has seen the human impact of Government actions and, more important, inaction because I think if he did he would spend less time fighting those who deliver health services and contradicting them when they highlight the problems and try to advocate for their patients.
I represent the constituency of Dublin Fingal. On the Monday after the Minister and I were elected, there were 27 patients awaiting admission to Beaumont Hospital, 17 in Our Lady of Lourdes Hospital and 14 in Connolly Hospital Blanchardstown. The people I represent have to choose between these hospitals because, despite the fact that this is the biggest constituency in Dublin, they have no hospital. In the intervening time, while those in Fianna Fáil and Fine Gael have been jockeying for position in front of every passing microphone and the members of the acting Government have all been in receipt of wages, the number of patients on trolleys awaiting admission or inappropriately placed on wards has risen by 35% in the three hospitals.
We learn from leaks to newspapers that the Minister will be raiding the mental health budget yet again. Ten years on from the launch of A Vision for Change, we see psychiatric nurses forced to highlight the failure of the services to deliver for patients. They recently published a survey, carried out in conjunction with the Psychiatric Nurses Association of Ireland and the Royal College of Surgeons in Ireland, which shines a light on what is really happening in our mental health services. They say that, among other things, there are no multidisciplinary manpower plans in place, limited access to day services and a lack of assertive outreach.
I am shocked that anyone needs to be reminded of the need to ring-fence funding for mental health services, but apparently this is necessary so I will say it here today. We need to ring-fence funding for mental health services.
We can only make statements here today, but the Minister can take action. He can stop the ludicrous spend on agency staff, which totalled €250 million last year. He can intervene to ensure public money is not spent where workers' rights are disregarded, such as the case of the 999 workers who are currently engaged in a dispute in Navan. If the Minister so chooses, he can publish the capacity review for our ambulance services. Even now, much can be done to alleviate the impact the two-tier health service is having on people.
The Minister and Ministers of State are still being paid to run our health service. I call on the Minister and his good friends in the Labour Party, who may have lost their seats but, curiously, have not lost their jobs, to take immediate action to make our health service a place where the brightest and best of our young people want to work and where those who are desperately in need of care and treatment can feel safe and know that they will be treated in a decent environment.
In 2002, the then Minister for Health, Deputy Micheál Martin, published the Codd report, entitled Acute Hospital Bed Capacity A National Review. In his written foreword he said:
For some time, it has been evident that the capacity of our acute hospital system has not kept pace with the increasing demands being imposed on it. The consequences of that under-capacity are well known, i.e. cancellation of elective admissions, long delays in accident and emergency departments, waiting lists for elective procedures and unacceptably high bed occupancy levels in the major hospitals.
I use this quote merely to illustrate that very little has changed. Operations are still being deferred and there are long waiting lists and terrible stories of elderly and ill patients lying for days on trolleys. We must construct a way forward for our health system. I refer to the Parliament and not the Government on its own or parties or anybody with ideological or immutable beliefs in the supposed best way forward. There is no perfect way, but surely there is a much better way to provide better results for our citizens.
From the days of Dr. Browne, ideas for the reform of health service have been stymied by vested interests - medical, political and others. If we go on in this fashion, our health service will never be fixed. If this debate were to result in Members of the House merely leaving down their political cudgels and resisting the temptation to knock metaphorical lumps out of one another, it would be something to show the people that we are serious about fixing the system and that we are not playing politics with the issue. This is a new Dáil and it is time for a new start.
There have, of course, been improvements in the health service over recent years. If we were honest, we would acknowledge that the last three Ministers have made improvements, but how can a Minister direct health policy when he or she is constantly firefighting?
I will compare the approach in my constituency, Galway West, with that of Cork to illustrate the problems of health management thinking in this country. These are the people who advise the Minister and devise service plans year after year and decade after decade. Cork is currently in the early stages of planning a new 300-bed acute hospital to relieve pressure on other hospitals and provide state-of-the-art accommodation. One of the first things that stipulated was that the chosen site should be at least 50 acres, and preferably 100 acres. This was to provide room for expansion and the provision of all necessary ancillary services. There is nothing shocking about that. In fact, it proves that good planning is in place.
I refer to the plans for University Hospital Galway. It plans to build a 75-bed extension, but health management cannot tell us how many additional beds that will provide. The extension will not be on a 100-acre or even a 50-acre site but, rather, a 42-acre site. The site is hemmed in by major roads on all sides, and there are significant traffic issues and virtually no parking. The site is very cramped and a car park had to be removed to make space for a new mental health unit.
University Hospital Galway is not a small local hospital. It is a major acute hospital and one of the busiest in the country. It has the longest waiting lists for inpatient and outpatient treatment in the entire country. It is a regional centre of excellence, offering treatment in a variety of specialisations to patients from Donegal to Clare and as far east as Athlone. It has an occupancy rate of almost 98% and is bursting at the seams. The internationally recognised figure for full occupancy is 85%, yet it is building an extension costing €70 million on an already cramped site and cannot tell us how many beds, if any, it will add.
I and others have tried to get answers for months and the hospital simply cannot provide the information. The real fear, which is not unfounded, is that spending a significant sum of money will provide perhaps only seven additional beds. All of this would be bad enough if there was not a second hospital campus in Galway, in Merlin Park, which has been vastly underutilised over the years. It is located on 150 acres of State-owned land and has acres of empty parkland right beside a dual carriageway system. The people of Galway and the rest of Ireland need a state-of-the-art modern acute hospital with sufficient beds. We urgently need a plan to relocate University Hospital Galway to Merlin Park on a phased basis.
Local consultants need to take the lead on this. We have had the Codd report on the need for extra bed capacity and the Hanly report on the need for extra consultants, neither of which was implemented. We have lower numbers of consultants than most of the developed world, something which needs to be addressed. To address the issue, consultants need more beds and the development and funding of proper primary care centres in strategic locations to take the pressure off our hospitals and accident and emergency departments.
I welcome the opportunity to speak on the issue of the health service. The provision of health and hospital services are probably the most important issues regularly raised by my constituents in Louth. There is no doubt that the health system in Ireland is far from perfect. Waiting list numbers need to be reduced, the number of patients waiting on trolleys is still too high and there are too many unfilled vacancies. The easy and popular thing to do is to criticise the health service. Simply attacking the HSE yet offering no realistic or viable alternative is a tactic used by the Opposition benches, in particular Sinn Féin. This is of no benefit to anyone and it is simply a political point-scoring exercise.
Our Lady of Lourdes Hospital in my constituency is regularly in the headlines because of the number of patients waiting on trolleys. It is an issue, but it should not be the only reason the hospital is in the news. It is widely accepted that once a patient gets past the initial admissions process, the treatment he or she receives is excellent. I do not hear any patients complain about the treatment they have received, only the admissions procedures. The system needs to be examined and new ideas considered.
I know from my investigations into this matter from my time on the Joint Committee on Health and Children that in many cases patients do not need to visit accident and emergency departments. In many cases, a visit to a local GP would have ensured patients received the necessary treatment and avoided waiting times in accident and emergency departments such as that in Our Lady of Lourdes Hospital.
Another factor that needs to be examined is that at times patients are not aware of services available in the Louth County Hospital in Dundalk. In many cases, patients could have visited the hospital to get the treatment they required instead of going to Drogheda. The perception among many people is that the Louth County Hospital is closed, but it is not. Since 2010, it has worked tirelessly to develop and expand its services. It treated more than 20,000 patients in 2015 alone. The minor injuries unit was established in 2010 and in 2015 treated more than 9,000 patients. If the service were not available, those patients would have to attend Our Lady of Lourdes Hospital in Drogheda and put further pressure on it. The unit recently expanded its opening hours and the age of the patients it can treat.
The problem in Louth is that not enough people know the unit is open and instead travel to Our Lady of Lourdes Hospital when they could have instead visited the minor injuries unit in Dundalk. We need to raise awareness of the service. I have been in regular contact with the hospital and its manager, Louise O'Hare, about this issue. The Louth County Hospital, far from being closed, provides many valuable services to the community. It currently has 53 inpatient beds over three wards. It has an eight-bed multidisciplinary stroke rehabilitation unit under the clinical leadership of a consultant stroke physician.
There are five palliative care support beds for access from Our Lady of Lourdes Hospital and 34 inpatient step-down beds for those patients who are medically discharged from the hospital. There were five beds for medical rehabilitation, and these have recently been increased to ten. In addition to the above, there is a very active and busy medical day services unit which includes a direct access consultant geriatrician providing a one-stop assessment for GP referrals. This service has been increased from three to five days a week and the waiting list has been reduced from 15 months to 12 weeks. There is also a venesection service, with more than 1,600 procedures carried out in 2015. In November 2015, the diabetic department was relocated to a newly refurbished standalone unit incorporating a diabetic nurse specialist, an antenatal diabetic nurse dietitian and a podiatrist. This is the first unit of its kind in the region and there are plans to expand the service further. In addition to all of this, Louth County Hospital has a very busy day services unit, with more than 5,000 procedures carried out in 2015.
While all of the above is very welcome, I acknowledge that we all need to do more to make the health service more accessible and patient-friendly, particularly at the admission stage. This should not be a political issue; it is an issue on which we should all work together.
All sides of the House agree that changes need to be made and also that simply throwing money at the problem will not solve it. It has been proven time and again that money alone is not the answer. Since the last election, we have all stood here and spoken about Dáil reform and how the Government needs to embrace new ways of doing business. Why not test this now, given that the health service could be an example of how Dáil reform will actually work?
I want to tell the Minister that I am here as an Independent, not to lambast or pick up a cudgel, metaphorical or otherwise. I am here to articulate what the people elected me to, which is a different narrative from the one the Minister has articulated. In regard to the health service, people have told us repeatedly at the doors in Galway that they want a public health service based on need, not greed or profit, and they want that in return for taxes. Not one of them asked for a reduction in taxes.
We are here seven weeks now and the Minister has made his first statement on health to an empty Dáil. Presumably the gentlemen and women involved are outside the House, negotiating behind closed doors on health and public health, but not one of them is present to hear what Independents and other like-minded people are articulating today in order to inform a policy for the new Government from the Opposition benches in a positive and constructive manner.
There was one Minister here for most of the morning. I welcome the other colleagues who have now come into the Chamber.
In regard to the Minister's speech, I deplore the lack of vision and the utter failure to recognise the crisis that exists in health, as it does in housing - two issues among a number of other issues that have driven me into the Dáil to have a voice. There is an interconnection between the lack of provision of homes for our people and health. While I welcome the positive initiatives referred to in the speech, I note - I do not want to personalise this with regard to the Minister - that it sums up the complete failure of the outgoing Government and, presumably, the incoming Government to recognise the extent of the crisis and, more importantly, the utter failure to give a solution.
In his conclusion, the Minister told us that our growing and aging population means that more is required in order to maintain the current levels of health service provision. The current levels of health service provision have led us to a crisis and to all of the stories about people on trolleys, people failing to get surgery and the cancellation of cancer clinics. They have led us to the most recent and deplorable example in Galway, which has been in all the national newspapers, in which a doctor, under extraordinary pressure - I have an understanding of that pressure - pointed out if that if one gentleman who was seeking surgery was to have that surgery, then somebody else's life would be in danger because of the lack of intensive care beds. There was also a letter from a consultant in Donegal. We have seen orthopaedic surgeons marching in Galway and we have seen doctors put their names to a letter about the lack of intensive care beds.
None of this is new - we know it is the case. The question is why. I had the privilege of being a local councillor from 1999 until this year and I sat on a regional health forum, which I used very effectively, with other colleagues, to elicit information. There has been a systematic running down of the public health service and a channelling of money into private hospitals. There was the failed co-location policy, already mentioned by Deputy Shortall, and it took all of our energy to stop the placing of private hospitals on public lands. We had the National Treatment Purchase Fund, an absolute failure, except for providing a window-dressing service for patients. It may help them, indeed, but in terms of the overall system, it is an utter failure and a channelling of public money into private hospitals. We had the special delivery unit from the last Government, an utter failure. We had the creation of a trust system, about which Professor Drumm himself recently expressed great concern. Huge effort and public money has gone into the establishment of a trust system in Galway, which I believe is wrong and amounts to following a failed system in England. Still we go on with more initiatives that are doomed to failure, because the very thing we were asked to do when Dr. O'Rourke wrote to all of us was to look at what is wrong. Let us have an audit and an analysis of the system so we can come up with a solution. Let us stop focusing in on one aspect such as accident and emergency departments - although the accident and emergency service is at crisis point in Galway - because the more we zoom in on that, the more pressure we put on wards that are holding trolleys. Deputy Pringle mentioned Dr. O'Rourke's point that beds remain empty because of the accident and emergency protocol that demands that beds remain empty and cannot be used. We could go on and on about this.
Primary care has been mentioned. I have seen no roll-out of primary care of any substantial nature. The primary care centres that have been rolled out have followed the failed model of building more buildings and then renting them back. The new primary care centre in Galway is costing €250,000 per year in rent alone.
There has been no mention of domestic violence. Some of us attended a conference yesterday at which a startling figure of €1.2 billion per year - year after year - was mentioned as the cost to the economy of domestic violence. For one patient, the cost of admission through the accident and emergency department after she was subjected to domestic violence, plus follow-up care, was €60,000. Yet this does not feature in any debate or programme for Government, as far as I can see. Those at the conference made very moderate demands, all of which would reduce the cost to the Exchequer in the long term.
To go back to the public health system, I am tired of listening to lines such as "We cannot afford it yet," "The budget will not allow for it," and "We will do as much as we can." That is upside down. This Dáil has to realise that when we put money into public health and keep people healthy, we will actually help the economy to thrive.
I welcome Deputy Hildegarde Naughton's request today for a new hospital in Galway. I have been a lone voice on that matter for a long time. Her own colleague does not agree with her, nor do her Fianna Fáil colleagues. If there is a change, I will absolutely welcome it. There are 158 acres in Merlin Park, while the site in Galway has been built out of all proportion. It has had to move a helicopter pad and a car parking area, all to build what Deputy Naughton has already referred to as a new building whose capacity to increase the number of beds available is greatly in doubt.
To conclude, I will work with any Government in regard to public health when I see a commitment to a vision for public health, but that is what is lacking.
It has been lacking not only on the part of this and the last Government, but by previous Governments, beginning with the vision, or lack of it, of Mary Harney and the Progressive Democrats. Their whole vision was for the privatisation of services. That has not changed, unfortunately. Although the political parties have changed, that vision has not changed. This is the vision that I unapologetically stand against in this Chamber.
The outgoing Government introduced five consecutive budgets which needed massive supplementary budgets to keep the Department of Health afloat. The over-run in the Department this year could be between €330 million and €500 million. That is the background to this debate.
The outgoing Government also failed in a number of areas, including that it failed to implement universal health insurance. There are broken promises relating to the abolition of the HSE and there is an escalating general practitioner recruitment crisis. There has been a 42% increase in patient waiting lists in the past year alone. The fair deal nursing homes scheme for the elderly is in crisis. Some 405,000 people are waiting for outpatient appointments. Moreover, we have constant overcrowding in the country's emergency departments.
I wish to deal with this latter point in particular. The ongoing crisis in our emergency departments is a scandal and the situation raises serious concerns about patient safety. Hundreds of patients, many of them elderly and frail, are being left for days on end on trolleys in corridors and makeshift wards without privacy and dignity as front-line staff struggle to cope without the necessary resources or supports. Patients are left in queues in emergency departments. There is a loss of dignity for patients. There is an infection risk due to overcrowding. In general, patients and patient safety are put at risk. This annual crisis needs to be tackled once and for all. There must be substantial investment in more hospital beds and staff as well as increased funding for home care packages, dementia care and the nursing home support scheme.
I wish to be parochial for a moment and deal in particular with Beaumont Hospital. I make no apology for this. The situation in the emergency department of Beaumont was the major issue on the doorsteps in the recent general election campaign in Dublin Bay North. Over the winter months it was not uncommon for up to 50 patients to be left on trolleys each morning in the emergency department there. This is totally unacceptable. Beaumont has a number of particular problems and the catchment area for Beaumont Hospital has a number of special circumstances. It serves north Dublin and the north-east region. The population is ageing and growing. There are a large number of those over 65 years of age, including a large number of people over 85. Many of these older people are living alone. There are fewer nursing home beds compared to other regions in the country. Beaumont has is the national centres for neurosurgery, renal transplantation and cochlear implantation. It also has a cancer centre of excellence.
The fact is that the emergency department in Beaumont Hospital is not fit for purpose. It was opened in 1987 when the hospital itself was opened. There has been no development of emergency department capacity or infrastructure since then. As an initial step the emergency department needs to be doubled in size. The hospital has prepared a capital investment plan. Phase one involves the construction of a new building. This would consist of a new emergency department, a new intensive care unit, a new high dependency unit and new facilities for cystic fibrosis patients. The cost of this project is approximately €100 million. There are also plans for phase two, which include 100 new beds, including single room beds. These will go a long way to prevent the problem of infection in the hospital. Phase one of this project must be sanctioned as soon as possible. I understand, however, that the Health Service Executive capital budget is completely full up. The projects that have been given priority include the national children's hospital and the relocation of Holles Street hospital and the Central Mental Hospital. Therefore, it is a rather gloomy picture for all the other hospitals seeking capital funding, in particular for Beaumont Hospital.
I have no criticism of the management and staff in the hospital. Recently, I met the management team in Beaumont to discuss the situation and I am satisfied that they are doing everything possible to tackle the problems in the emergency department. However, they have to contend with a number of particular issues. For example, nursing homes will not take patients with dementia due to strict regulations. There are waiting lists in the National Rehabilitation Hospital in Dún Laoghaire and this causes problems in Beaumont and other hospitals. Private care companies are finding it difficult to recruit staff and Beaumont is finding it difficult to recruit in general because employees would prefer to go to more modern hospitals.
I make no apology for outlining the position relating to Beaumont Hospital. It has been a major issue my constituency and there has been no capital investment-----
Deputy Chambers is going to take three minutes.
There is a problem with hospital waiting lists as well. Between January and September 2015, a total of 854 operations were cancelled at Beaumont Hospital. Outpatient waiting lists at Beaumont Hospital have dramatically increased by over 570% since July 2014. Since the Minister, Deputy Varadkar, took over the health portfolio there has been an astonishing 579.5% increase in the number of people on outpatient waiting lists for more than 12 months at Beaumont Hospital. From January until September 2015, a total of 854 operations were cancelled in Beaumont. Given the proposed cut in hospital funding of €100 million, the signals are that 2016 is going to be a difficult year for Beaumont Hospital.
I appeal to the Minister and to his incoming successor. The capital project for Beaumont Hospital is vital. The emergency department is in crisis and needs physical investment. I hope to be able to press the matter with the incoming government with all the effort that I can manage.
The list of failings and shortcomings in our health care system is long and makes for grim reading. Some of the proposals that Deputies from across the House have made are important and they resonate with people. We need to de-politicise health. We need to look at a longer term vision and strategy, something like the National Association of General Practitioners has proposed, which is like a Tallaght strategy for health. In a fragmented Dáil, it is important that we converge all our ideas towards a longer term strategy. Deputy Shortall referred to how different Ministers have tried to bring in different proposals at different times only for every subsequent Minister to change those proposals. We go through the cycle again and again and we need to change that. We have seen the consequences of constant political change and the over-politicisation of health. In this reformed Dáil, it is important that we try to change how we approach health policy in Ireland.
In discussing our health services it is important to recognise the work of doctors, nurses and all health care workers, for whom it is not only a job, but a vocation. Our greatest asset in the health care system is the people who work in it and the passion and dedication they bring to their work. As I see it, the first issue we have to address is recruitment and the actual numbers in the system. The retention of graduate nurses and attracting home those who have left should be the primary focus. In many cases those who left did not do so because they wanted to. It is true they would have had better pay and working conditions on offer in London, Manchester, Sydney or wherever else and that would have made emigration enticing. Indeed, it is understandable that so many of our best and brightest of this generation have opted to leave. However, many have left reluctantly and out of necessity because of few or no career prospects here.
The nursing in Ireland scheme was drawn up to entice nurses home, but it has been an abject failure. The figures I obtained show that only 83 nurses have taken up the offer. The target was 500. All the while, hundreds of vacancies remain in our hospitals throughout the country. That is one of the core issues. We cannot improve the quality of our health service if these vacancies exist day in, day out. We cannot improve our service if that continues to be the case. Similarly, there has been a brain drain with doctors. In fact, we have breached our own commitments under the World Health Organization code of global practice. We have the greatest reliance on doctors from developing countries among countries in the OECD.
That is a great shame for many such countries which are trying to improve their health care systems.
In the context of primary care, we must promote and foster GP services to keep people out of hospitals and thus prevent overcrowding, backlogs and increased waiting times. At present, GP clinics are not being utilised as well as they should. I obtained figures from the HSE this week which indicate that although the free GP care for children under six was introduced in good faith, instead of improving point of access it has exacerbated the issues in accident and emergency departments throughout the country, with people waiting to enter primary care centres. Overcrowding in our hospitals means that every week thousands of elective surgeries are cancelled, the net result of which is that people's suffering and pain is prolonged.
There is one example at a primary care level. I received a response about occupational therapy waiting times in Dublin 15 that would bring home to many what is the issue with regard to primary care. The wait time is between 50 and 65 weeks. That might affect an elderly lady or man who wants to stay in the home and remain independent.
I will conclude. The funding is there to provide the adaptation scheme but people cannot get the occupational therapy appointments they need. When a person is waiting up to a year for an appointment and occupational therapy assessment, he or she might need and accident and emergency department or orthopaedic intervention if he or she ends up in hospital. It is important that we look at improving our allied health professions and intervention at a primary care level.
This is one of many debates of an emergency nature we have had about health during my time in the House. Like others, I spent considerable time as a member of both a local authority and a health board. The conventional wisdom at the time was that the health boards were a failure and we needed to change the structure. The latter was duly done and I am of the opinion that it was a mistake. I held that view for a long time. I agree with those who say the HSE needs to be abandoned and that a new structure somewhat along the lines of the old health board system should be put in place. That system should not be as convoluted as the old model and there should not be as many health boards. The structure put in place should have more clarity of direction and should be able to respond to the needs of the people in a region. The centralised system currently in place is seriously lacking in that regard.
Another issue that must be dealt with as a matter of urgency relates to determining how our health service compares, in terms of expenditure, with those in adjoining jurisdictions. A report was produced some time ago which indicated that we spend relatively more on health services than many adjacent jurisdictions. The question is whether we obtain value for money. I agree with the suggestion that an audit should be carried out in order to discover exactly where our weaknesses lie. What is happening with regard to expenditure in this country compared to others? For example, why is there repeatedly congestion in accident and emergency departments? Is it because of a lack of nursing staff and accommodation or people's failure to get into the system in any other way? The latter appears to be the case. Is it because of a lack of primary care in local communities? This also appears to be a factor. To what extent will the primary care centres address the issue? It has been suggested that the existence of primary care centres does not seem to divert attention from accident and emergency departments in local hospitals. We need to re-evaluate where we are going with our health service. We can spend as much money as we like on it but if it is not spent in the right areas at the right time and with the correct agenda, we will not succeed in making progress. We will have a very expensive health service that does not deliver. Having listened to debates like this on many occasions, that is what concerns me most.
Like many other Members, I am strongly committed to a public health system. It is absolutely essential to realise that we need a strong public health system which is capable of competing with the private sector. Both areas will improve and benefit from that kind of competition. The failure to move into the market and be prepared to compete with others, whether in the public or private sector, is of no advantage to anybody.
We must consider how the numbers in the health service have dwindled in recent years. This happened for obvious reasons. There was an embargo, which was understandable, and very difficult economic periods. Nobody is suggesting that we could expect an expansion in that environment. However, we need to examine the areas which may have suffered before the embargo and the economic recession. The position relating to them will have become immeasurably worse. If we expect services to improve and become responsive and for the public sector to be competitive with the private sector and have a bring future as a result, we must find out where the weaknesses lie. I tabled a parliamentary question some time ago and I discovered that the biggest single diminution of staff was in nursing, which is the very first area with which a patient would have contact when referred to hospital. I cannot understand how that could have been the case. Everybody who spoke in and outside this House repeatedly mentioned the need to ensure that administration could be reduced as much as possible and that front-line staff could be maintained in every possible way. That did not happen, which is sad. It should surely have been obvious to all of us that this was of primary importance. If those on the front line did not have adequate support, the service would creak at the seams and fail. Consequently, what could be delivered would be diminished. Public confidence in the system would also be diminished.
One of the faults of the HSE is its remoteness. It tends to become centralised and self-dependent and refers to itself as a means to assess its own behaviour. For example, how often have we come across cases where HIQA makes a statement to the effect that a hospital, ward or institution is closed down? It is in the business of health and safety. As a result of its involvement, other issues can be exacerbated in terms of overcrowding of accommodation and use of personnel. To what extent could we at this stage expect a total evaluation of the delivery of the services expected by the general public? They expect us to be able to deliver a service, although I am not so sure about a first-class service. It should be a good service, 24 hours a day and seven days a week. It should not be intermittent and it should not be bureaucratic in nature. It should not be immovable but should be transparent.
Transparency is another issue that should be borne in mind. Under the old system, public representatives and members of the medical profession, including consultants, nurses, chemists, etc., were represented on health boards and they all had the opportunity to make an input. That made for a far better delivery of a more comprehensive and cohesive service and the system worked reasonably well.
The next question is whether the structures in place are adequate to meet the challenges of an increasing population with an expectation of better delivery and a higher quality of response. I am sure many people have had the following frustrating experience. Issues relating to medical cards should be simple enough to deal with - we have all been obliged to deal with such issues from time to time - but the system is not as responsive as it should be. It is completely impervious to the individual circumstances of people. A classic example is the patient suffering from cancer who is suddenly beset with the challenge of all that disease entails. The patient and the family are worried and they need a medical card urgently. A card will be supplied as a matter of urgency provided that other conditions are satisfied. That process could take two or three months or even longer. That is simply unacceptable. If a person is suffering from a serious illness of that nature, his or her life is dedicated to doing what he or she can in order to try to survive. The entire day is taken up with the constant worry and threat of the illness.
It should not follow that some bureaucrat sitting in a corner somewhere suddenly decides whether they will get the service.
We will engage with that again. If the Deputy wants to have an engagement on that issue, I would be happy to accommodate him. I know where the policy came from, but I will not say. The impervious nature of some parts of the health service is entirely due to the fact that the only answer to it was to abolish health boards that had been doing a reasonably good job. I would not go there if I were the Deputy.
We are back where we are now as a result of all those decisions which were wrong. As regards the assessment of eligibility for medical cards, it would be a great idea if the patient's illness could be taken into account in the first instance while dealing with the rest of it afterwards. These situations are hugely challenging for individuals and their families.
Although we each have only a few short minutes to contribute, a debate such as this requires more time. I therefore look forward to a longer health debate in the not too distant future. While I do not claim to have all the answers, I do know a bit about it. I have served on various institutions that led me to getting a first-hand education in health matters. We have the combined wisdom to offer assistance to the Minister or his successors.
The ongoing crisis in our health service is nothing short of disgraceful, and I do not choose that word lightly. The delivery of health services has deteriorated severely in recent years. This has happened in conjunction with the Fine Gael-Labour Party Government's policy of austerity. Various cuts in the service have left citizens more vulnerable when entering the health system. Nurses, doctors and other hospital staff work extremely hard in the face of exceptional difficulties arising from cutbacks. They are overworked and under-resourced. Only for their hard work and determination the situation would be a lot worse.
We were promised that the scandal of patients being left on trolleys would be addressed by the previous Government, but this has not happened. In fact, the number of patients on trolleys reached a new high under the Fine Gael-Labour Party Administration. Yesterday, 323 patients were on trolleys throughout the country. At Beaumont Hospital in my constituency, 37 patients were recorded as being on trolleys. Furthermore, the cancellation of elective surgical procedures, while less mentioned, is a central part of the fallout relating to fewer hospital beds.
Last week, I was contacted by a patient whose surgery was cancelled at the last minute for the second time. This is completely unfair and unacceptable. In recent days, an equally unacceptable and deplorable act has taken place. HSE officials have said that €12 million of the €35 million ring-fenced for mental health in the previous budget is now being diverted to other health areas. The threat of €12 million being taken away from the mental health budget is deplorable. It is indicative of a Government that is out of touch with the realities faced by many who suffer mental health issues.
Successive governments have failed to provide an adequate level of mental health services. This is despite the fact that one in seven adults has experienced mental health difficulties in the past year. The situation is unacceptable and cannot be allowed to continue. People's lives are being put at risk because of the failed policies of previous governments. There must be a cross-party consensus to solve the health service crisis. I implore all Deputies to support a range of imaginative and intelligent solutions in order that together we can solve the crisis in our health system.
Yesterday, 39 patients were lying on trolleys in Our Lady of Lourdes Hospital in my home town of Drogheda. This was the highest figure throughout the State bar none. In recent years, Our Lady of Lourdes Hospital has consistently been one of the worst hospitals for overcrowding, with patients forced to lie on trolleys in packed corridors. The cause of this is the removal of the accident and emergency department in Louth County Hospital in Dundalk. That day marked the start of the trolley crisis in Our Lady of Lourdes Hospital in Drogheda. People in Dundalk must now drive past their local hospital and travel on to Our Lady of Lourdes Hospital in Drogheda where, if they are lucky, they will face a minimum of eight hours waiting in an overcrowded accident and emergency department.
Another contributory factor to the crisis was the removal of respite and long-stay beds from the Cottage Hospital in Drogheda in 2012. This was flagged up by the cottage hospital action group but the Government refused to listen. Instead it bulldozed ahead with a deliberate policy of downgrading our public health system, while ignoring the misery, distress and pressure this put on patients, their families and front-line staff alike.
This election has shown that despite the Government's arrogant approach to cuts in vital public services such as health, the people have made it clear they want to see more investment in our public health services. They also want to see better management in such services and above all they want better patient care. The public does not want to see a continuation of the monster two-tier health system the Government created. I hope this time the Government will listen.
In Drogheda tonight, SOSAD, a voluntary health service that provides vital intervention for those who find themselves in crisis, has to hold a public meeting because it is on the brink of closure due to lack of funding. SOSAD's presence in Drogheda and Dundalk is invaluable. These are the services that require funding. SOSAD is saving lives by engaging with approximately 500 people every week. Last weekend, we learned that money which we were told was ring-fenced to provide mental health services has not been ring-fenced at all. That is because €12 million has been taken out of the paltry sum of €35 million which the Government committed for mental health service provision this year.
In 2015, we had 554 deaths by suicide. At what stage will the Government stop looking the other way? This is bigger than party politics. It is clear, however, that thus far a broader ideological approach has been taken which views our public health service as a vital private commodity. That is why the Government has pursued policies that have deliberately run our public health system into the ground.
Perhaps some of their cronies are waiting in the wings rubbing their hands at the thought of another public service being outsourced and privatised - well, no more, and not on our watch. What the people want, as they expressed clearly in February 2016, is a properly funded public health service with better management and patient care for every citizen across the State from the cradle to the grave. Regardless of its composition, every Government has a moral and social responsibility to maintain, fund and invest in a public health service for every citizen.
I am sharing time with Deputy Seamus Healy.
I thank the Acting Chairman for giving me the opportunity to speak in this very important debate about the urgent need to do something practical to assist and support patients and staff in our health service. Over the past few weeks, the Independent Alliance has been pushing the major issues relating to the crisis in our health service. At times, we have been criticised by some for doing so. I make no apologies for going into talks to try to resolve the crisis, particularly with regard to the number of people on trolleys and on waiting lists, sick children, people with cystic fibrosis and people with physical or intellectual disabilities. I gave a commitment that I would go in and fight for them, and that is what I am doing every day.
There are many issues relating to the health service, but I have priority issues that I want any future Government to deal with. They include the number of people on trolleys, particularly at Beaumont Hospital, where a crisis exists. Deputy Mitchell said that there were 37 people on trolleys there yesterday. That is not acceptable in any society. It is not acceptable when people gave Deputies a mandate to come in to resolve these issues. There are also problems relating to services for very ill children. Adults and children with cystic fibrosis urgently need services. We also need urgent care for our senior citizens. Above all, we need radical reform and investment in our health service. That is where I stand and that is what I am trying to do. Staying off the pitch in respect of health should never be an option for any Member of the Oireachtas. I agree with some of the points made by my colleagues earlier. I would like to see cross-party consensus. We are in a new Dáil and we are supposed to have a new politics. Let us get on with it.
I accept that we all want a decent health service, but we must face the reality that we must pay for it. That will have to come from general taxation. It will not be popular with some people, including the tax cuts brigade. We also need structural change in our health service. We can start with small changes. We talked about the 37 people on trolleys at Beaumont Hospital. We should target areas like that. We can also start with cystic fibrosis, including the need for 20 cystic fibrosis beds in Beaumont Hospital. We can start small and develop and build on that. The important thing is that we must change the mindset in respect of the management and governance of our health service.
We should not be afraid to say that we have examples of good practice in our health service. We have fantastic doctors and nurses working in our health service. I have spoken about how there should be a cystic fibrosis unit at Beaumont Hospital. A unit opened recently at St. Vincent's University Hospital, for which many of us campaigned for many years. It contains 30 beds in separate rooms with no risk of cross-infection. That is an example of something that is working every day. Those people were taken out of accident and emergency departments and can go straight into an individualised service. We should look at the examples of good practice and implement them and look at examples of bad practice and deal with them.
In respect of this broader debate, politicians should stop beating up our consultants, which is a very popular thing for them to do. We have many top-class consultants. We should stop driving them out of the country. A professional footballer across the water can earn €120,000 per week, yet we have a problem paying some of our consultants their salaries. These consultants, who politicians think are on mega-salaries, also use those salaries to employ staff. I know it is not popular to defend them. I was in Beaumont Hospital last night with a friend who is getting over a major cancer operation. The consultant delivered for that patient. What a talented person to have delivering a service like that at Beaumont Hospital. It might be populist to beat up consultants in the media, including on television and radio, but politicians should stop doing it. The same goes for nurses. There are nurses on low pay.
There are many issues relating to the health service, and I strongly support the call by a number of colleagues for a cross-party consensus to hammer out solutions for the health service.
I thank Deputy Finian McGrath for sharing time with me. Over the past eight years, something like €4 billion, 2,000 beds and two million home help hours have been taken out of the public health system. That simply must stop. Reinvestment in the system is urgently required. We need a public health system that is based on medical need, that does away with the two-tier system and that ensures that anyone in medical need can have access to health services.
I will briefly refer to three matters that exercise all those who use or work in the health service. The first relates to carers and the directive issued by the HSE about the reduction in home care packages and home help hours. This has shocked and angered the public, and particularly family carers, who give hugely of their time to ensure that family members in most cases are looked after properly in their own homes and communities. They are saving the State millions on an annual basis. I ask the Minister to instruct the HSE to withdraw that directive and make available increased home help hours with the aim of restoring the 2 million home help hours that have been lost over the past number of years. It is a win-win situation in terms of Government expenditure because it is far less costly to look after someone at home, supported by a family carer, than to have that person in a public hospital bed, regardless of whether it is an acute or a long-stay bed, or in a nursing home.
I also wish to mention the suggestion last week that €12 million out of the €35 million earmarked for mental health services is being redirected. Mental health services have always been the Cinderella of the health service. Far from reducing funding for these services, it needs to be urgently increased, particularly to ensure that community-based teams are properly staffed in accordance with A Vision for Change.
I appeal to the Minister to immediately agree to the reopening of what is effectively a new 40-bed unit at Our Lady's Hospital, Cashel, to relieve the crisis at South Tipperary General Hospital. When I spoke here during the nominations for An Taoiseach on the first day of the new Dáil, there were 44 trolleys in the wards and foyer of that hospital, the highest number in the country on that day.
On the second day that the Dáil met, there were 38 beds on the corridors. There has been major pressure on the hospital which is working at 130% capacity. The 79 medical beds are operating at 150% capacity. The hospital urgently requires additional beds and step-down beds. It is a scandal that when there is such pressure on the hospital and so many people are on trolleys that there should be a vacant unit at Our Lady’s Hospital, Cashel, that is ready to go, fully revamped and refurbished. It is effectively a new building that is available and would address the current problems at South Tipperary General Hospital arising from the huge pressure and the large increase in attendance there.
As this is the first time I have spoken in the House since the general election, I thank the people of the Limerick County constituency for returning me for a second time to Dáil Éireann in what was a difficult election. I was very honoured to be re-elected to represent my constituency. I thank everybody who helped and supported me, including my family, canvassers and supporters. Without such help, neither I nor anybody else would have been elected.
Regardless of who has been in government, health has been an issue on the political agenda since the late 1970s. There has been a lot of talk of Dáil reform and new politics here over the past few weeks, which is very good. It is great to see a bit of interest in trying to reform the Dáil but the advocates of reform are the same people who tramp in and out of here and try to apportion blame to everybody without looking at the actual health situation. I have been following politics since I was a child and health has always been an issue, including in the 1980s and the 1990s when there were various scandals. It was inevitably going to be an issue when the economy crashed and the country was wrecked. Coming in to apportion blame to one individual or government is not necessarily what people want, particularly as those who do that also advocate a new way of doing politics. We have to consider this with a degree of honesty. The money simply was not available in the past few years to do what we wanted to do. Nobody wants to see problems in the health services. There are, however, some glimmers of hope. Leaving aside the acute accident and emergency situation which has bedevilled every region, there are many positive things happening, particularly in the area of community care.
There is a great opportunity for more to be done in community care. In my region, without any foresight, thought or plan, Nenagh, Ennis and St. John’s accident and emergency services were taken out by a previous government. No provision was made in the accident and emergency department in the regional hospital in Limerick which is now the University Hospital Limerick. It was left that way for several years until this Government decided to do something about it. Now that has been done, there is huge pressure on the accident and emergency unit in Limerick which has a knock-on effect on our community hospital network in Clare, North Tipperary and Limerick. If we could relieve the pressure in the accident and emergency department by having a greater level of discharge from the University Hospital to community-based units in Newcastle West, Thurles, Limerick, Nenagh, Ennis and across West Clare, it would be of major benefit. Significant capital investment has gone into St. Ita’s Hospital in Newcastle West and there are plans for St. Camillus Hospital in Limerick, but we need to see more of this and at a faster rate because there is an opportunity to relieve it.
I represent probably the most rural constituency in the Dáil, with no town of a population of over 7,000 people. I spoke recently to members of the National Ambulance Service which covers enormous areas in rural counties. During the heyday of the so-called Celtic tiger, no real investment was made in ambulance stations around the country. They are in dire need of capital investment. We also need more of them because of the areas they cover and because the delays in accident and emergency departments are too long. The turnaround is too sharp. Some people wait over an hour for an ambulance to come from Limerick, Tralee or Mitchelstown to places across County Limerick. That needs to be urgently addressed.
Over recent years in this House I have drawn attention to another Cinderella subject, orthodontic care, a matter in which very few people, apart from Deputy Carey and I and one or two others, have shown any interest. This has been languishing on the dust-ridden shelves of the Department of Health for a long time. There is a dire need for some sort of overall strategy to make sure that children across the country who are waiting for badly needed orthodontic care get it. The same is true of many childhood issues which are not topical for many. Maybe there are not as many votes in them as there are for the bigger issues people have already discussed here.
The health issue has been around for a long time and several Ministers for Health have experienced a horrendous time in the Department. A predecessor of the Leader of the Opposition did not refer to the Department as Angola for no reason. It is a very difficult place to be put into, and I wish anybody who goes in there well. If the ethos and concept of Dáil reform is that we are all going to put our arms around each other and do the right thing for the country, we could start with this debate on health. Rather than blaming one person, we could think collectively about what could have been done and what we can all do.
As this is my first opportunity to speak in the Thirty-second Dáil, I thank the people of County Clare for placing their trust in me again. It is a huge honour and privilege to have been elected to Dáil Éireann on three occasions.
As the previous speaker said, health has been an issue in this country for many years, through good and bad times. It must be remembered that when the public coffers were strongest during the Celtic tiger era we had a trolley crisis, as described by the then Minister for Health, Mary Harney. Unfortunately, the Ireland of today still has faults and failings in this respect. We have not addressed the issues well enough in the mid-west region, including Counties Clare, Limerick and North Tipperary. For example, today 41 people are waiting on trolleys at University Hospital Limerick. This is not acceptable and a solution is required. While there is a state-of-the-art accident and emergency unit under construction at University Hospital Limerick, with a completion date of quarter one in 2017, this will not solve the problem. More use must be made of the model 2 hospitals in Ennis, Nenagh and St. John’s in Limerick.
Ten years ago, for example, public confidence in Ennis general hospital was at an all time low. This happened because of very tragic misdiagnoses and because hospital acquired infections such as MRSA and C. difficile were rampant. Thankfully, following investment, a new 50-bed wing of the hospital has been opened. It complies with the Strategy for the control of Antimicrobial Resistance in Ireland, SARI. We no longer have to deal with hospital acquired infections; we have a modern, safe facility now. It is fit for purpose but we must make more use of it. We need to build on the progress that has been made.
The HSE has failed utterly to communicate with the public what services are available in Ennis, such as the opening hours of the medical assessment and minor injuries units. We need to tell people what services they can get at Ennis and how to access them. I welcome the fact that the opening hours at the medical assessment unit have been extended.
An announcement was made this week by Professor Cowan, the CEO of the UL hospitals group. I welcome that the hospital will be open on Saturdays and Sundays from next month. That is long overdue. It is an issue I have pushed as a Deputy. I welcomed the Minister, Deputy Varadkar, to Ennis last year and I raised it with him and his team on that occasion. It has taken that long to make it happen.
I also welcome the discussion to establish a cross-party consensus on health. This is a new Dáil and we have a new opportunity. We have set up committees on housing and Dáil reform. We should also consider establishing a new high-powered committee on health where every Deputy can have a say and put forward solutions instead of pointing out the problems. We need solutions on health.
We need to make progress on a primary health care centre in Ennis. The key elements of bringing together a team of GPs and securing an appropriate building are in place. I have been dealing with groups on the ground in Ennis. I appeal to the HSE to redouble its efforts to make a primary health care centre in Ennis a priority. We need to divert more people away from University Hospital Limerick and provide them with an alternative location to be dealt with. I believe primary health care centres represent the way to go. The progress in Ennis has been far too slow. I appeal to the HSE to redouble its efforts in that regard.
I am tempted to call a quorum in light of the absence of Sinn Féin Deputies from the Chamber, but I will desist for the moment as we are only starting here today. It is a bit surprising because I know if we were not here today, they would certainly make an issue of it.
This debate is very important. As other Deputies have done with regard to their constituencies, I wish to thank the voters in Meath East who elected me to the Dáil to represent them. They want me to champion a range of services in Meath that we depend on, including Our Lady's Hospital in Navan, Our Lady of Lourdes Hospital in Drogheda, Cavan General Hospital and, indeed, the Dublin hospital service.
We are concerned with protecting all the services that are there to ensure the better health of the people. However, it is not acceptable for me or any other Deputy to come into this Chamber and go back 12 years to a Minister for Health who has long since departed the scene, to go back six or seven years to a previous Government or to even refer back to the last Government to start laying blame for what has happened. That seems to be the tone of much of the commentary from Sinn Féin and the Independents on the issue. Unfortunately, that is all we are getting in this debate, apart from everybody championing their local situation, which, of course, is very important. Fine Gael Deputies seem content to blame the last Government but one and then claim that the last Government delivered and made matters better. Clearly, it did not do so.
If a minority Government comes into being - judging by what the media are reporting right now, that seems a less-than-likely scenario - it will be obliged to realise that it will represent only a minority of the membership of this Chamber. It certainly will not have the monopoly of wisdom on the health services - nor will the Department of Health - and it will not have a monopoly on power either. The converse is also true. In the scenario to which I refer, Opposition Deputies will have a huge amount of power and influence. The Minister and his officials will also need to recognise that. It will not be good enough for us to come into this Chamber and engage in broad attacks on those in government. It will be our role, in collaboration and partnership with the Government, to set the budget, to outline our priorities for what we want to do and to achieve some level of collaboration and agreement.
There are issues in respect of which, quite rightly, there can be criticism and castigation. I refer, for example, to the decision to move in respect of the ring-fenced funding relating to mental health. Deputy Munster mentioned SOSAD, a very important organisation across Ireland that originated in Drogheda in the north east. It is considering closing down because it does not receive Government funding. It could have been one of the organisations that could well have benefited from this money, which has been taken from mental health services.
These decisions need to be taken by all Members in this House. I look forward to engaging with officials from the Department. The latter will have to get used to engaging more frequently with Opposition Deputies in the new scenario because the Minister will effectively be executing the will of the Dáil - which might not necessarily be the will of the Government - and the Government will need to realise that. The Fine Gael Party in particular has been slow to realise that.
A number of things could be done very quickly. Deputy Connolly, on ideological grounds, was very quick to criticise the National Treatment Purchase Fund simply because it involves a private sector element. However, I am certain her constituents do not care how an operation is paid for. These operations all have to be paid for irrespective of whether they are performed by people in the public or private sectors. The waiting lists for operations for hip replacements, etc., have increased dramatically since the National Treatment Purchase Fund was abolished. It was not abolished due to a lack of funding but because the Government wanted to abolish it and bring in the special delivery unit, which has been a gross failure.
There is spare capacity in the private sector. It would be unconscionable if we were to sit here and criticise the private sector without proposing to utilise the private sector while, of course, getting the best price for it. Let us provide relief to some of these people, particularly older people, who are in severe pain by ensuring their operations are carried out. It is heart breaking to talk to an older person in severe pain because of the need for a hip or knee replacement while people in this Chamber are saying that a solution that exists cannot be pursued for ideological reasons. To some extent, the previous Government brought it back towards the end of its term because it saw it was practical and could work. I certainly know of people who were getting operations paid for in the private sector. It needs to be brought back and people valued the guarantee to get an operation done within a certain period of time that was there with previous Governments. I urge the Minister and the Dáil to look at this scheme again. Those Independents who see themselves as left wingers should leave the ideology behind, particularly if we can have operations performed and allow people to have their pain removed on a lasting basis.
It is opportune to let the Government know that the broad consensus in Dáil Éireann - this has come from Fine Gael Deputies as well - is that we have a public health service. We should not deliberately move to privatise elements that it is not necessary to privatise. We have seen this across a range of health services. I am concerned about moves within the HSE to transfer some of the administrators into the private sector into what, inevitably, will be lower-paid jobs. There seems to be a move afoot to get rid of some of the payroll services from the HSE. Some of these have already gone out to the private sector. Staff who provide such services are quite worried about their positions.
The provision of home help services has been completely privatised, though not because of a shortage of home helps. While in the case of the National Treatment Purchase Fund there was a shortage of capacity to do operations and, therefore, we went to the private sector, in this instance it seems to have been an ideological decision to get home helps on a cheaper basis, which is not acceptable. If that is the way the health service is going, we are well on the way to a shabby service and it cannot continue like that. The Dáil must - I believe does - support a public health service that is free at the point of delivery and by means of which people can be satisfied that what they need in terms of health care will be achieved and their right to that care - because health care is a right - will be upheld. Bunreacht na hÉireann confers the right to free primary education. As a medium-term project, we should look at the possibility of the right to health care. It has to happen. We do not have that right. We have a Health Act that depends effectively on the funding that is allocated each year. That is a matter I would like to examine.
The reality is that there are many problems. All previous speakers have mentioned their local hospitals. I think the hospital in Navan is clear at present in terms of people on trolleys. However, it is a small facility. Our Lady of Lourdes Hospital, of course, has 22 people on trolleys and, inevitably, there are some real horror stories among those patients who have to wait.
As I said, we must come together to collaborate. However, the latter does not mean that Ministers will not be held to account in this Chamber with regard to the individual decisions they make. The recent decision to take moneys from mental health services was a politically expedient move which went against major policy announcements made by the previous Government, the Minister of State, Kathleen Lynch, and others. This is not acceptable. Lives will be lost. It sends out a message that once the brouhaha in respect of important issues such as suicide and mental health in general dies down, the Government is willing to turn the other way. That is not acceptable. We must continue to prioritise this area. We are hardly prioritising it by allocating a relatively small amount. There are other priorities in the health service. However, even that amount of money needs to be kept and delivered upon to provide effective services for people who need them in the field of mental health and to show that it is not the poor relation in the health service. It must be shown that it is recognised as an illness that can, in many cases, be treated and that the stigma associated with it for so long is gone. Unfortunately, this type of decision will only worsen that stigma and make the health of the people involved suffer enormously.
Nelson Mandela once stated, “A nation should not be judged by how it treats its highest citizens, but its lowest ones.” The World Health Organization's constitution enshrines “the highest attainable standard of health as a fundamental right of every human being.” These are not aspirational achievements but the basic fundamentals for a fair society and the bedrock of a true republic. However, this State has failed its citizens and has failed to uphold their rights. The chaos in our health service is a direct consequence of the bad policies of the former Fine Gael-Labour Party Government and of Fianna Fáil before it.
Last year, 92,998 people were treated on trolleys in hospitals. This was the highest number since 2006, representing an increase of 21% in hospital overcrowding. Over 490,500 patients are awaiting treatment or assessment in the public hospital system. Since 2008, there are 8,982 fewer front-line staff working in the health service. It is no wonder there is a crisis.
My constituency, Wicklow, has been served appallingly by successive Governments in the context of the provision of vital health services. What limited health services we did have were eroded by successive Governments. The Fianna Fáil-Green Party Government closed down Wicklow district hospital in 2010, along with 20 beds. It also closed the Orchard welfare home in Bray, which had 39 beds, as well as St. Bridget’s ward in St. Columcille's Hospital, Loughlinstown, with the loss of a further 23 beds. The previous Fine Gael-Labour Party Government closed the 24-hour accident and emergency department at the hospital, which served my constituents well for many years and the staff of which did fantastic work. The move to impose the 21,000 patients who used that accident and emergency department on the already overwhelmed St. Vincent's University Hospital was bound to fail and, indeed, it did fail all our citizens. As we debate this issue, 21 patients are lying on trolleys in St. Vincent's hospital. Across the State, 420 people are lying on trolleys. The acting Minister’s failures do not stop there. When it comes to the hospital that serves my constituency, 15,306 people are on outpatient waiting lists at St. Vincent's, while nearly 900 patients have been waiting for treatment for over a year. The Minister stated it was his goal to ensure that by the end of the 2015 no patient would be waiting longer than 15 months for treatment. It is now clear he has failed to deliver on that aim.
The true extent of the health crisis does not stop there. Last week, it was reported St. Vincent's University Hospital will stop accepting new patients with malignant melanomas for four months because it does not have enough consultants. Melanoma is the third most common cancer found in the 15 to 44 age bracket. Each year in this State, more than 700 new cases are diagnosed and, unfortunately, there are 100 melanoma-related deaths. As is the case with all cancers, early diagnosis is key to treatment. For patients to be turned away from any hospital for four months is totally unacceptable. Ultimately, this is a matter for which the Minister bears responsibility. He needs to take responsibility and ensure that the recruitment of a permanent consultant can take place immediately in order that patients can receive the necessary diagnoses and treatment.
We in Sinn Féin have argued that the only genuine way of solving the health crisis is to stop undermining the public health system and start investing in and properly resourcing our hospitals. In our alternative budget for 2016, we outlined how an investment of €383 million would begin to make serious inroads into tackling the crisis. This investment would provide 500 additional nurses, 250 midwives and 250 consultants, thereby helping to alleviate the strain on the delivery of front-line services. In the recent election, Fine Gael’s priority was to cut taxes. We all know that when Fine Gael cuts taxes, it prioritises the mega rich above those on low and average incomes. Unfortunately, Fine Gael’s type of nation is one judged by how it treats its highest citizens but not its lowest.
I will switch the debate slightly. Many Members have spoken about hospital waiting lists, overcrowding and the lack of hospital consultants. I want to talk about an issue which is important to me but which, unfortunately, is not dealt with as a health issue but rather as a criminal justice issue. I refer to drug addiction. People are dying in doorways and in public toilets as a result of taking overdoses. Only last week in Cork, a 19 year old tragically lost his life because of an overdose. As Deputy Barry is aware, in Cork we have an ever-increasing number of people losing their lives through addiction. The way in which we tried to address this matter in the past has clearly not worked. We have addressed it as a criminal justice issue by criminalising addicts. We even had a situation where a needle exchange programme was shut down because it had given needles to somebody not on its list.
Unfortunately, this is an issue we need to re-examine. Drug addiction should be viewed as a public health issue. When people are contracting diseases and dying as a result of injecting or over-medicating, we need to examine that from a public health and not a criminal justice point of view. I implore that this be done.
We had a Minister of State with responsibility for drugs in the Minister's Department who progressed some of the work on medically supervised injecting centres. The heads of that Bill were to be drafted but, unfortunately, because of the current impasse in forming a Government, we do not know where that legislation will end up. I hope that whoever takes over the position of Minister or Minister of State with responsibility for drugs will progress that quickly, because there is no doubt that medically supervised injecting centres will save lives. In the centres that have been opened, there have been no deaths from overdose as a result of heroin use. They have reduced crime levels in those areas and also reduced the number of infections due to intravenous drug use.
I will conclude, as I wish to allow Deputy Tóibín to contribute, but this is an issue that must be dealt with from a public health point of view. We need to stop criminalising addicts.
Go raibh míle maith agat, a Chathaoirligh Ghníomhaigh, agus gabhaim mo bhuíochas le Deputy O'Brien freisin.
I want to give two or three examples of the travesty which is the health service currently. A woman in Navan, who lives five minutes from the hospital, had a stroke, but it took 40 minutes for the ambulance to get to the hospital. She was admitted to the hospital for treatment, but then had to wait to be admitted to the National Rehabilitation Hospital, which took approximately 16 weeks. She finally got treatment there and returned home after a period, but had another stroke and was readmitted to the hospital. She was brought to the shower room on one occasion by two nurses, but after one of the nurses was called away, the woman fell and suffered a major brain injury. She was then brought to Beaumont Hospital, where she was given a blood transfusion, but it was the wrong blood, which left her unconscious and with organ failure for a number of months. Now in her mid-60s, she is facing the possibility of being in a nursing home, at her cost, for the rest of her life. The HSE has not stepped up to the plate with regard to this charge.
Another patient at Navan hospital has been waiting to get into the National Rehabilitation Hospital in Dún Laoghaire for the past six months. When one telephones the hospital one is told he is not there due to a clinical decision when, in reality, it is a resource issue, because they do not have the space.
Believe it or not - this is startling - I know of a woman who stayed in Navan hospital for two years, having been clinically discharged, because the pathway of further treatment was blocked by a lack of resources somewhere else in the system. Her lying in a hospital bed for two years incurred a cost of millions of euro to the State, taking account of the hospital charge per night. She was forced to be there because she could not move on to the next stage of her treatment. There is a massive capacity issue in the health service and it can only be addressed by the provision of funds. There is a need for reform of the HSE as well, but the Government has failed to invest the necessary resources for these issues to be tackled. Until it does so, we will have a two-tier health system, with half a million people remaining on waiting lists for treatment while those who have private health care are fast-tracked.
Twelve minutes remain in this time slot before I must call the Minister to make his concluding remarks. Deputy Danny Healy-Rae has ten minutes; if he shared three minutes of his time with Deputy Mary Butler, he would have eight minutes and Deputy Mary Butler would have three.
I thank the Acting Chairman. I have raised many of the issues that I wish to raise with the HSE at its HSE South forum meetings in Cork over the years. We have now reached a crisis point in Kerry. One of the issues is the provision of home help services. A lady, a double amputee, was getting an enhanced home care package with 20 hours of home help in County Cork, where she was moved to stay with one of her daughters on being discharged from hospital, but when she moves back to County Kerry she will get only ten hours of home help. With regard to the reduction in home help hours, there is a serious anomaly between the two counties that needs to be addressed. We have been told it is a staffing issue and that the service does not have the necessary funding to acquire more staff. That needs to be urgently addressed. It is not satisfactory that very sick people who are being cared for at home do not get home help at the weekend, on bank holidays, or on Christmas Day, St. Stephen's Day or New Year's Day. That is not good enough.
Kenmare Community Hospital and Dingle Community Hospital are operating at half their capacity, as only half of their bed complement is open. There is only one respite bed in Kenmare Community Hospital for the catchment area served by that hospital. Those who care for their elderly relatives at home - often it is a son or daughter who minds an elderly parent at home - should be able to get respite care for those they care for, but only one respite bed is open in Kenmare Community Hospital. It is a new state-of-the-art building but, sadly, it is only operating at half capacity.
A new mental health facility built on St. Margaret's Road in Killarney at a cost of €40 million was completed almost a year ago but has not been opened. The provision of mental health services throughout the county is a serious issue. What is the delay in the opening of that grand facility? Independent Deputies were criticised over the weekend for having lists of requests or projects to be completed in their constituencies. I make no apology to the Minister for asking him to staff that facility. Funding was provided to build it, and now that it is has been built, all that is required is that it be staffed. Regardless of whether the Minister is in office only for a few more days or is the incoming Minister, I ask him to address this issue urgently while it is still within his power to so do.
There is a serious deficit in catering for the needs of physically and mentally handicapped teenagers in County Kerry. Funding for St. Francis Special School in Beaufort has been seriously cut. Despite the fact that we have highlighted the issue to the Minister and other politicians and made it a national issue over the past two years, the facility has been hit with a lack of funding.
There is a serious delay in the provision of orthodontic treatment for young people. I am dealing with the case of a young fellow who will lose some of his teeth if he does not get treatment shortly. The waiting list is such that it could take anything from one year to three years before he is seen. That is not acceptable.
Elderly people who are on the waiting list for cataract operations are in danger of going blind. Some of them have severely impaired vision. Our requests to the HSE to intervene are falling on deaf ears. That is the problem in this country. No one appears to be responsible for what is not being done or for any wrongs that are done. In his role as Minister for Health, the Deputy should be in total charge of what is happening in the health service, but that does not seem to be the way it is. When we ask representatives of the HSE about these issues at HSE South forum meetings, they say they will ask the Department, and when we ask for more funding, they say they have to refer it to the Department. Yet when the Minister is asked about these issues in the Chamber, he seems to say he will refer the question to the HSE. The buck must stop with someone. That is what is wrong in this country. No one seems to be responsible for anything. I am asking the Minister and his successor to ensure that the disadvantaged and sick and elderly people are seen adequately and equally, because that is not happening at present.
I thank the Acting Chair for his indulgence. I am a member of the housing committee, so I am learning to run from a committee meeting to the Dáil. Fianna Fáil has consistently argued for the restoration of the National Treatment Purchase Fund. This would reduce waiting lists and waiting times by referring public patients for treatment in private or public hospitals here, in the North or abroad. This could be done with the patient's agreement, taking quality, availability and cost into consideration. It worked in the past and can do so again. These dangerously long waiting times have to be tackled.
We are now in a situation where patients can wait up to 18 months in University Hospital Waterford to see a consultant about a hip or knee replacement. Patients who are in pain cannot endure this long a wait. This will have to change. I will refer to some figures for waiting lists I received this morning. Currently there are 4,426 people waiting on the inpatient day case list, which is slightly up on February, but up 53% since the Minister took over. I cannot understand why the waiting list in Waterford is almost double the combined total of all three hospitals in Cork. There are 223 people on the waiting list at Cork University Hospital, 162 at the Mercy University Hospital and 107 in the South Infirmary-Victoria Hospital, whereas in University Hospital Waterford there are 888 on the waiting list. That is a significant number of people impacted by waiting lists.
The setting up of the south/south west hospitals group in 2013 has been a retrograde step for University Hospital Waterford. Many people feel the hospital has been downgraded. Let us take the lack of 24/7 cardiac cover in Waterford and the south east region as an example. I have spoken about this already. Why are people living in the oldest city in Ireland being penalised? By providing cardiac cover only from 9 a.m. to 5 p.m. Monday to Friday, we are playing with people's lives. Why should these services be time sensitive in our region? We cannot put time restrictions on the emergency heart issues that people in Waterford and the surrounding areas might have. If a person in Waterford or the south east has a heart attack after 5 p.m. or at the weekend, they are dependent on a service in Cork. Mr. Bob Landers, clinical director at the HSE, has stated that best practice is cardiac intervention within 60 to 90 minutes. This is known as "the golden hour". However, this gives patients little hope when they have to travel between 100 km and 120 km to receive treatment. During the winter, with storms battering the country, the main road to Cork was closed for ten days due to flooding between Castlemartyr and Killeagh, with a diversion in place. The prolonged journey on country roads is not best practice for the patient or for the paramedics trying to work on a patient in the back of an ambulance. As first responders, the ambulance network and workers play a critical role in saving lives.
UK medical guidelines state that a cath lab should deal with a minimum of 100 emergency cases per year. Last year in Waterford there were 80 cases between 9 a.m. and 5 p.m, when the cardiac unit was open to the public. A similar number of patients - 77 - had to be transferred to Cork out of hours. This is a total of 157 cases. We clearly have the figures to support 24/7 cardiac cover. Are we being actively discriminated against? Why should it matter where a person lives? Are we being denied this treatment to maintain the skills of Cork and Dublin-based cardiologists?
I call on the Minister to review this situation. I understand this cannot happen overnight - we need a second cath lab and we need more consultants - but this could be rolled out incrementally. For example, it could be 8 a.m. to 8 p.m. to start, then 8 a.m. to midnight and finally the full 24-hour cover. This was not achieved or improved by the previous Government. I appeal to the Minister, if it is in his hands, to look at this again. We are playing with lives here and this has to change.
Another issue is mental health. Mental health issues continue silently to inflict immense damage on our country. The undercurrent of depression and anxiety is a major problem for society. No family is untouched by some form of mental health issue. The affliction of depression is exacting a hefty toll on the day-to-day lives of many people. People with mental health difficulties continue to experience significant social exclusion in Ireland and face difficulties like finding employment. People with a mental health disability are nine times more likely to be out of the labour force than those of a similar age without these problems. In child and adolescent mental health services the situation is more severe, with just over half the required staff in position. All too often we hear about children being placed in adult psychiatric units because there are not enough children's beds. Surely it only compounds the issue to place children in acute psychiatric wards where there are adults with serious issues.
I appreciate that we are trying new procedures in the Dáil, but this has been a four-hour debate, in which any number of speakers have made contributions totalling 225 minutes. To be brutally honest, it is not possible for me to do justice to those 225 minutes of speeches, all of which I was present for and all of which I listened to. In the spirit of the procedures we may develop in this House, allowing a Minister only ten minutes to lay out the state of play and only five minutes to reply to four hours of speeches is not going to work. I can only address one issue, therefore, which was raised by several Members. That related to funding for mental health, which I know has been a matter of public commentary in recent days due to the suggestions of a recent transfer of funding from the mental health budget.
First, I would like to point out that the mental health budget is €791.6 million for this year. It is ring-fenced and it is an increase of 4.4% this year. I have heard people using the figure €35 million. That is the increase in the development funding for mental health. The total budget is €791.6 million. That is €160 million higher than it was when this Government came into office, so it is one of the areas where there has been a substantial increase in funding, whereas in other areas funding has been frozen or has decreased. The €35 million will be fully provided for in the base budget for next year, and the key task is to ensure we get the best value from this assessment and that it benefits the greatest possible number of people.
Some time related savings are being made. Recruitment takes time and while new posts are being filled, it was not possible to fill them all from 1 January. Developments take time - one needs to hire people and to tender - so it was not possible to fill all posts and start all new developments from 1 January. As was outlined on page 8 of the HSE service plan, it was decided that savings from the timing of the implementation of this and other initiatives would be utilised elsewhere in the community. These are known as time related savings. They occur in other areas of service development and not just in mental health. This is clearly spelt out in the service plan which states that the HSE will use €20 million in time related savings from these planned initiatives on a one-off basis to continue to provide the 2015 outturn levels of home care and transition care beds, which is above the 2015 planned service level, and to put in place up to an additional €1.5 million as a purchase agreement for vaccines.
The national service plan was approved by the Government last December. It was launched and endorsed by the Minister of State, Deputy Lynch, by me and by Tony O'Brien thereafter. It was approved by a motion of the Dáil following a debate. Therefore, claims of some sort of raid are entirely inaccurate. I do not believe the acting Government should make any material changes to the service plan for 2016. Of course the new Government can do so if it wishes to when it takes up office. I do not believe there is anything to be gained from setting one part of the health service against the other part, and in this case it is people attempting to set mental health against social care for the elderly, and I do not agree with that approach at all.
In the time left to me, I will make one or two other points. One relates to the issue of Waterford, which a number of Members mentioned several times. If something is a matter of money or allocating resources, money can always be found. It cannot be found out of thin air, however. It is found at an opportunity cost of doing something else or it comes from another service, but money can be found. That is the prerogative of politicians: to find money and to allocate it. From time to time, political deals are done in that space, but I do not think it should ever be a political decision or that there should be a political deal when it comes to where we locate specialist national and regional services. That ended a long time ago. The former Minister, Mary Harney, in fairness to her, put a stop to that. She set up the national clinical programmes, which are a partnership of the HSE, the royal colleges and the specialists on a national level.
That meant that decisions were not made by politicians looking for votes or making promises or by local clinicians who, of course, will always advocate for their local region or hospital no matter where it is, whether it is in Dublin, Waterford, or Cork. Out of that came the national cancer plan. Specialist centres were designated in which services were centralised. It was difficult and there were marches on the streets. It was very unpopular but I think we almost all accept that it was the right decision. I am not prepared to go back to a situation in which the decision on where we locate specialist regional and national centres is made based on political deals. That would be wrong and I would not like to see us go back to that under any circumstances. When it comes to cardiology services, I am not an expert. No politician is an expert. We have a national clinical programme that looks at the numbers and decides where specialist services should be located. That is how it should be done. It should not be based on lobbying, political speeches and certainly not on political deals.