Margaret Cox (Fianna Fail)

I welcome this opportunity to debate the issue of accident and emergency services as it gives us an opportunity to mention a number of other issues regarding the health service. The first issue I wish to address is the complaint that the health service is either overfunded or that health service funding is being improperly spent. If we were to examine health system funding today and what we get out of it and compare that with what was spent and received in the past, we would see the additional services throughout the country that we are paying for and recognise that we have a high quality health service. For example, ten years ago, very few people survived cancer. Today, people can survive cancer or extend their life expectancy when diagnosed with cancer due to the full range of oncology services. There is also a full range of support services for cancer patients and their families.

Cardiology is another area where great progress has been made over the last ten to 12 years. Ten or 12 years ago — I know this from personal experience — the prognosis for people who suffered heart attacks was bleak. The situation is much brighter today with advances in cardiac surgery. Cardiac surgery is now available in the west, which was not the case three years ago. A range of services is now available throughout the country which means that those who are seriously ill receive the best care available, better than they would receive anywhere else in the world. I challenge anyone who says that cardiology, oncology and radiotherapy services are better in the United States or anywhere else to produce the proof. We have an excellent health service. It is incorrect to say it is a black hole that drains and misuses funds. While it is heavily funded it produces top quality services.

However, the health service needs more funding. It is time for the Department of Finance and the Department of Health and Children to realise that the system has been cut down to its very bones. There is no fat left to trim. When things go wrong in the health system, it is only possible to provide band aid solutions to problems because there is no excess funding to fix problems. Two or three years ago, there was a problem with an operating theatre that was used for orthopaedic procedures in a hospital in the western health board area. Orthopaedic surgery demands complete clean room environments because of developments in surgery. There was insufficient funding to provide the proper systems in the hospital in question so a quick-fix solution was found. Something then went wrong and the health board wound up spending €300,000 fixing it. If that money had been spent on the original problem it would have been properly solved. However, nothing was heard from the Department of Health and Children because the money had to be obtained from the Department of Finance.

Time and time again, quick fix solutions are used that cause more and more problems and waste money. This happens because there is no opportunity for local management, which understands the real issues, to find solutions that it knows will save money in the long term. Due to lack of access to funding and lack of power to direct where the money is spent, local management is forced to resort to half-hearted measures that never solve problems.

Health service funding must be ring-fenced. Among other things, we are now providing excellent oncology and cardiology services. These services have benefited from strategies that were put in place by various Governments over the last ten years. Not only should funding be ring-fenced, the decision as to how to spend it should be decided at local level. This is my main problem with the Health Service Executive.

While I recognise that we needed reform in the way that the health service is being run, centralised control is not the answer. Decisions need to be made at local level. I understand that the executive's budget has not been agreed, or if it has been agreed, this has only happened in the past few weeks. This situation is unacceptable. When I was a member of the Western Health Board, we worked around the clock from mid-December to 23 January to establish our service plan, agree our budget figures and decide our plans for the year. Why can this local control not continue? Why do these decisions now have to be made by one organisation? I wish to draw the Minister of State's attention to employment levels within this service. While we should not employ people who are not nursing and doctoral staff, we have a significant problem with front line medical staff being unavailable. What will happen at hospital level when we do not have enough people to provide a service to patients?

Hospitals are forced by the cap on public sector recruitment to hire agency nurses or examine other solutions. I will explain how the charging for agency nurses functions. First, they are paid at a premium as they work on a part-time, on-call basis. Second, the agencies must also make money because they maintain a service and cover their people with insurance. This service is invoiced to the hospitals. The cost to the hospital includes the following: the payment to the nurses at a premium; the margin to the agency provided to the nurses at a premium; the PRSI that must be paid as the employer also pays; and 21% VAT. Of hospital budgets, 21% of expenditure in these circumstances on top of PRSI is paid back to the Department of Finance. Has the Minister of State ever heard anything so ridiculous in his life? This makes no sense. For every product bought by the hospitals, such as a €3,000 defibrillator, VAT is paid at 21%. Where does this go? It goes to the Department of Finance. From where does the Department of Health and Children receive its funding? It receives it from the Department of Finance. We are going around and around making jobs for accountants and administrators when we moan and groan that there are too many administrators in the public sector.

It is important to be parochial on these occasions. We do not have BreastCheck in the west. People whose lives could be saved if BreastCheck were available are dying from breast cancer. There is no reason it is not. The Merlin Park Regional Hospital is falling apart due to a lack of capital funding. We have a paediatric unit from the dark ages and there are no plans for continued development and investment in UCHG. This is unacceptable in this day and age. We must have continual planning. I fear the regions are losing out because they do not yet have representation or a public voice in the HSE.