Mary Henry (Independent)

I am delighted to welcome the Minister to the House because she has a difficult role and I support many of her initiatives. I am particularly impressed by the initiative to get home support for older people which is incredibly important. Most people want to stay in their homes as long as possible. While it is expensive to have customised services for them, it is worth doing and is much less expensive than admitting them to nursing homes. I am concerned, however, that the programme may mean that the person must become an employer to deal with such help. The Minister can examine that position.

The management of chronic illness should also be transferred, as often as possible, to the primary services but frequently general practitioners want the advice of a consultant before they continue with the care of a person with a chronic illness. It can be a long time before a person can get access to a consultant appointment in order to be reassured that he or she is handling the person in the right way, or to get extra advice. For example, many diabetics wait long months, or sometimes years, to see endocrinologists. This does not encourage general practitioners to take a person back on to their books and mind the person alone because they are afraid that if they are not sure of what they are doing they will get repeat appointments every six months in the diabetics clinic and the person will be out on a limb again. It is important we try to establish services for general practitioners in order that they may rest assured their patients will be seen by hospital consultants rapidly and not after a year or more. This will ensure they receive the advice they need.

Many diabetics require additional supports. After arterial disease and neurological disease, one of the most common complications caused by diabetes is the development of foot ulcers. Access to podiatrists is almost impossible. There has been an ongoing fracas between the Department of Health and Children and the podiatrists since pussy was a kitten. As a result, patients with lesions that could be dealt with by podiatrists must be admitted to hospital, when their foot ulcers become sufficiently bad, and must endure a minimum stay of six weeks in an acute bed. Some of these individuals have had feet amputated because their ulcers were left untreated for so long. I am informed that it is proposed to appoint one podiatrist for every county. I do not know if that is true but surely we should appoint one podiatrist for every few thousand people. Money invested in this regard would be well spent.

The Minister referred to respiratory disease. As she is aware, I have a special interest in the respiratory unit at Peamount Hospital. It is important that one should not examine just bed occupancy when looking at conditions such as respiratory disease. Patient turnover must be also considered. A friend of mine who worked as a respiratory physician stated he used to try not to let his patients get into bed because if they could be kept sitting in chairs — I do not mean overnight or on a trolley — they frequently regained confidence in themselves. It is extraordinarily depressing and frightening to feel that one cannot breathe. However, the patients to whom I refer regained their confidence and were discharged by evening. Bed occupancy should not be seen as the only parameter and consideration should be given to patient turnover within units.

The Minister also referred to the different lengths of stay experienced by patients suffering from the same conditions in different hospitals. It can become traditional to retain patients for certain periods. This is an aspect which must be examined. However, we must also take into account the socio-economic conditions to which patients are exposed. If patients come from areas where such conditions are not so good, they may be retained in hospital for an additional two or three days in order to ensure they are back on their feet. Other patients who enjoy better living conditions at home may well be discharged earlier.

The position regarding nurses threatening industrial action is most unfortunate. We must take into account that there is a shortage of nurses and that the market is in a position to dictate. I am not convinced that nurses frequently carry out jobs that could be done by others.