Mary Henry (Independent)

I agree with the part of the Government amendment that states there has been substantial investment in the health service. The only issue which bothers many of us involved in the sector is the question of where this money has gone because there are terrible deficiencies in the sector.

Senator Browne mentioned that Dr. Declan Keane, the master of Holles Street Hospital, has warned there would have to be a limit on the number of deliveries that can take place there next summer. I compliment Dr. Keane on informing young people of this nine months ahead of time because it casts an entirely new light on family planning. A woman hoping to conceive must ensure there will be a bed available for her in nine months time. It is interesting that the former master, Mr. Peter Boylan, advised patients not to contact the hospital or any doctors about this situation but to discuss it with their local Deputy. This is a serious political issue. There is a terrible shortage of beds in the maternity service, not only in Holles Street Hospital. There is an increased population, including an increased population of young people, and we are pleased to observed that, following a drop to 50,000 from 70,000 some years ago, the birth rate is again rising.

The major crisis relates not only to the lack of accommodation within the hospitals for the safe delivery of babies but to the serious lack of midwives. Ireland is well below the United Kingdom recommendations on staffing in this regard. It is difficult to ascertain the number of midwives necessary to ensure good care for women, antepartum, during labour and postpartum, but we cannot seriously say that we have already achieved such levels. The expert group on midwifery education at graduate level is due to report shortly. The worry is that, if the group recommends we should train a given number of graduates here, there will be insufficient graduates to train until 2009 or 2010.

There is a serious discrepancy in the number of graduates available to be recruited and the number that will be required. This problem is exacerbated by the change to a four-year degree programme from a three-year course for nursing, which means there will be no qualifying people next year. There will be a dearth of recruits to midwifery for several years after that. A pilot scheme was conducted in Trinity College which proved popular, with almost the entire class graduating. That scheme ended in 2003, however, and there has been no attempt to operate it again.

It is astonishing to see the emphasis put on overseas recruitment because we know that we cannot recruit midwives abroad. This is interesting in the context of the debate which took place in the House this afternoon about trying to ensure that our registration arrangements are acceptable on an international basis. Many midwives who qualify outside the EU are regarded as obstetrical nurses and are not in a position to be employed here. We must be careful about these issues and cherish those people who qualify in this country. We are not doing this.

I am sure Senator Brady is aware that the other day, 76 mature students graduated from the Mater Hospital but only 30 of them were offered permanent posts at a time when the master of the hospital has a dire shortage of nurses. When one hears of beds being closed in a hospital it is usually because there is a shortage of nurses. When one hears of operations being postponed, it is frequently because there are no intensive care nurses or operating theatre staff available. We have a serious situation regarding nurses. We are not cherishing them enough and are offering them only temporary posts. Is that being done to save on PRSI payments or such like? It is a serious issue and one we need to immediately address.

We also have a crisis in our accident and emergency departments. I was interested to hear the Tánaiste's solution when she addressed accident and emergency nurses at a recent meeting. It is to set up treatment units run by nurses. There is nothing the matter with that, but where will we find the nurses? If we cannot find them to staff the hospitals in the established posts, how will we get them to staff the new units proposed to be, set up? At the same time we are concentrating on primary care and, as the Minister of State described earlier, many of the co-ops that have been set up are doing extraordinarily well.

However, the Mater Hospital is in a crisis regarding its accident and emergency department. It is dreadful. I have seen people in the outpatient department being treated on trolleys and doctors treating people who were still in ambulances in the car park. The CEO of the Mater Hospital said that general practitioners in the area should try to do more to prevent so many people attending the accident and emergency unit, with which I agree.

Why is the Ballymun health centre still unopened two years after it was built, long after it should have been commissioned and opened? There is a problem with the provision of heating and electricity in the old Ballymun health centre such that it is dangerous to use. The centre is allowed to employ more staff but it has nowhere to put them. Whatever sort of turf war is going on there should be resolved immediately. This is not the only case where this type of thing is happening. Good facilities have been built in many institutions throughout the country but they have not been opened due to the fact that they are not being commissioned or the hospital in question is not allowed to employ the necessary staff.

Some Members may remember when I used to debate with former Senator Cassidy the position regarding the wing in Mullingar General Hospital, which had not been opened. As far as I am aware, that remains the position today.