Mary Henry (Independent)

It was a wise move for the Cathaoirleach to call me. While I realise that the Department of Health and Children is very busy and complex, we have seen an example of the most extraordinary maladministration within the Department. If one could feel that this was the only area in which there was the problem, I would not be quite so concerned. One could consider that this was one specific topic which was not addressed well or examined carefully enough over a very long time. However, there seems to be a serious lack of diligence in the running of the affairs of the Department which costs Irish taxpayers a considerable amount. While I know of the concern of the Minister of State, Deputy Tim O'Malley, for people with mental illness, it frequently seems to affect such people or, as in this situation, elderly people.

Members may have read in yesterday's The Irish Times a report concerning Dr. Aisling Denihan, a consultant psychiatrist who carried out a survey of 89 recently appointed consultants in psychiatry to ascertain the status of the job. I heard her present the same information some months ago and I am glad it is now coming into the public arena, although I found it profoundly depressing. She consulted 89 of her colleagues and, according to the report:

. . . she was nine months waiting for an office and clerical support after she was appointed as a consultant psychiatrist for older people with the former North Eastern Health Board in January 2003. "It was a full nine months before I could start accepting referrals from GPs. I did what I could but it was an absolute waste of money. We are expensive personnel," she said.

Dr. Denihan brought some interesting facts to light. She stated she "was finally given a 'beautiful suite of offices' by her health board in Navan [but] it emerged that the building did not have planning permission to allow her to see any patients in it, so she has to see patients in their own homes".

This is utterly ridiculous when one considers that in general health boards have approximately five months knowledge of when a new consultant will be coming forward. The Department of Health and Children has all the knowledge because it must make sure the funding is available before Comhairle na nOspidéal can advise appointments. It is a terrible waste of money. Dr. Denihan found that three months after taking up their posts, 44% of her colleagues were in much the same situation as her, namely, they did not have an office, clerical support, a junior doctor or a community nurse. I would like to be able to say that when they got going, all was well. However, worse followed because the funding for the support services was not in place. When Dr. Denihan eventually got up and running, she found that the funding had gone. A manager told her it had gone "to the corporate good". What sort of waste of money does this represent? It is totally ridiculous.

In today's newspapers, we read that Dr. Oscar Breathnach, an oncologist at Cork University Hospital, has resigned stating he would be moving to Beaumont Hospital because after four years in Cork he still had not received the required back-up staff. There is no point appointing a person without appointing the team needed to work with that person. I have seen this repeatedly and I regret to say the problem is getting worse. I have frequently pleaded with colleagues who returned to Ireland from the United States or the United Kingdom not to leave jobs because they were so disillusioned after two years here. However, the Minister of State knows that some of them leave after deciding the promises made to them would not be realised. This is an appalling waste of their time and our money.

Something must be done to improve the administration of our health service. When the Health Service Executive legislation came through the House, I was the one Member on this side who voted in favour of it, although some other Members voted against it because it was guillotined. However, while I supported the Bill, I am afraid it was just re-branding. We will be certain of this in a year or two.

If the events concerning nursing homes had taken place in a major multinational company, I do not know what would have resulted from such an appalling level of communication. While I will not judge who is at fault, there is some political onus on those who passed through the Department because I am sure it must have been mentioned to them at some stage. However, the other part of the Bill provides for doctor-only medical cards for, we hope, some 200,000 people. I do not oppose the doctor-only medical cards; to have one is better than not having a medical card at all. Despite the involvement of the Minister of State in the pharmaceutical industry, I am sure, like me, he does not believe there is a pill for every ill. As the number of medical cards has fallen by approximately one third under this Government, I am sure much good can be achieved with the doctor-only card. However, I have concerns with the logistics of the process.

When the over 70s medical card was introduced, I welcomed it despite thinking others were more deserving at the time. However, I would not have welcomed it if I had known of the lack of logistics in regard to how it would be applied. For example, there were twice as many people over 70 than had been expected. I discovered later that this oversight was not the fault of any of those working in the Department of Health and Children because the decision was made shortly before the budget speech by the former Minister for Finance, Mr. McCreevy, in which it was announced.

What planning has gone into the production of these cards? Will all the cards come on stream on one day? Will there be a doctor-only card day? Will the primary health care service, which is sadly underfunded and has terrible problems in many areas, simply be told to cope? One of the most serious problems is that there are areas without general practitioners. Therefore, some people will receive cards to visit non-existent doctors. Moreover, we know that people use doctors more often when they have a medical card, probably because they need to and should visit their doctor. From the perspective of preventative medicine, I welcome this. Will there be any increase in the funding of primary health care so that doctors can employ more practice nurses or receptionists, for example? We have not been told if this will be the case.

The process seems not to have been thought out. I do not know how it will operate except as one great shambles in which people will turn up at the surgeries of general practitioners, who will be told to cope with the situation. Theirs is not to reason why, but to do and die or live on, if they can, and keep going. There should be more consultation with those working in primary care so people receive the treatment they deserve.

There appears to be considerable discretion in regard to the granting of the cards. I remember the bad old days when discretion was very important in acquiring medical cards. I hope this does not recur.

I have concerns with section 5(3), which states "Insofar as it is considered practicable by the Health Service Executive, a choice of medical practitioner shall be offered under the general practitioner medical and surgical service made available under this section." This suggests we could, if we are not careful, return to the days when there was no choice of general practitioner. This would be dreadful when we consider the great improvements made by allowing medical card holders to have the same choice private patients had.