Phil Prendergast (Labour)

I extend a warm welcome to the Minister for Health and Children, Deputy Mary Harney. Health remains and will continue to be the single most important issue for many families. As we get older we become all too aware of our increased need for involvement with the health service in acute hospital settings and in long-term nursing care. Above all, we need to know that when we engage with the health service we do so in a safe manner. With the current staff embargo the Heath Service Executive is working with a reduced pool of employees. As a result, those already employed are suffering from the effects of having reduced staff through unreplaced sick leave. This undoubtedly will result in increased sick leave and burnout among remaining staff. It is a vicious circle and cutting frontline staff is not the answer. Patients will suffer and so will the standard of care. Managers in the HSE must go back to the drawing board on this.

The present state of the health service does nothing to reduce the anxiety of families. We hear constantly about the lack of hospital beds and hours spent on trolleys in draughty accident and emergency departments, with accompanying lack of privacy and dignity. Such a situation is full of opportunities for mishap. Patients who are nursed on trolleys are at increased risk of contracting infection because such areas are over-populated. There is a further problem with the dangers of MRSA and other hospital-acquired infections. Frontline staff are vigilant but their proximity to infected people means that it is difficult to reduce the risk of contracting infections, with the constant flow and activity and the increased numbers occupying such hospital areas. Trolley use also reduces access for staff, with the possible worst case scenario of a resuscitation trolley being unable to pass through in an emergency situation. When emergency equipment is needed at a particular location, time is of the essence. This has a direct impact on the outcome for the patient. If beds and trolleys must be moved to facilitate movement of patients it is certain that there will be delay in delivery of vital care.

Waiting times and delayed access to mainstream health care continue to be a problem. While the Department of Health and Children prides itself that waiting times are reduced, my experience is that this is not the case. Instead of a long delay inside a hospital setting, the delay now happens between initial referral from a general practitioner and the first appointment within the hospital. I know of a particular lady who urgently needed a hip replacement. Her mobility was severely affected and she was in constant pain. Her GP referred her to Waterford Regional Hospital in July 2006 and by the time she contacted me in April 2007, she had heard nothing regarding an appointment. When I contacted the patient services manager, I was informed that as this lady was categorised as a "routine" patient, she could be waiting up to four years for an initial appointment with the consultant. This is not good enough. It is an insult to people to refer to this inadequate response as a "service". Service implies that a level of care and standards is being upheld. Again, this is not the case.

I am particularly concerned at the level of summer bed closures that are planned. In South Tipperary General Hospital, we will see the loss of gynaecological beds over the summer months, with an associated reduction in surgery. Having worked with women in the hospital setting, I know all too well that many women will plan their surgery around their families' needs. Many wait until the summer when it is easier to make provisions for the care of their children without the usual school routines. It is dreadful to see that year after year, women's services are reduced. It is unsafe and unfair to target a particular group and it should be possible to rotate these bed closures between medical, surgical and gynaecological services in a fairer way to ensure that one particular group is not overly disadvantaged.

Psychiatric care services also fall far below acceptable standards. On 26 February 2008, a parliamentary question was put to the Minister in respect of the number of psychiatric beds available to adolescents in the HSE system, whether there is a waiting list for such beds, the waiting times if this is the case, the numbers on such waiting lists and the geographical spread of those awaiting beds. It was further asked what plans the HSE has to provide beds and the areas in which these beds will be located. The Minister replied that this was a matter for the HSE, citing the Health Act 2004. The HSE has not yet responded with an answer to this question. Telling people that there is no bed or service available is not good enough. I would like the Minister to tell me who is responsible for giving the information and the reason for the lack of response on such an important issue. I know somebody who cannot let their child out of their sight. They are on 24-hour suicide watch.

When a parliamentary question is put to the Minister, there is a specific timeframe after which one is assured of a response. However, there does not seem to be any duty on the HSE to provide a timely response. While I appreciate that the HSE is an independent entity, I assume that since this organisation was created and moulded by the Minister, it is ultimately answerable to her office. If a response is slow in forthcoming in respect of such an important issue, I would expect the Minister to seek a timely and comprehensive response.

I would also like to see the provision of stroke units throughout the country given priority by the Department of Health and Children. Each year, of the 10,000 people in Ireland who suffer a stroke, 2,500 people die through the lack of essential stroke services. A recent national audit of stroke care by the Irish Heart Foundation in conjunction with the Department of Health and Children found that an estimated 350 to 500 lives could be saved through the rollout of such units. Dr. Brian Maurer of the Irish Heart Foundation said that:

[T]he report confirmed what is widely known by professionals working in front line services — stroke services in Ireland are appalling. People are dying unnecessarily simply because they cannot access the optimal treatment.

He also stated that "at the moment, people's survival is determined by chance and location with the virtual non existent service provided". While the involvement of the Department of Health and Children in this audit is welcome, we need to see it implement the report's recommendations without delay.

Once again, I wish to highlight the plight of cystic fibrosis sufferers in Ireland. We have the highest incidence of this chronic disease in the world, yet it is widely known that the treatment received by such patients in Ireland falls well below the accepted European standards of care. In February 2005, this was highlighted by the publication of the Pollock report. Since then, the Cystic Fibrosis Association of Ireland has been tireless in its efforts to lobby for an improvement in the level and quality of care to patients. It is clear that dedicated beds are needed for these patients, who are highly susceptible to lung infections, with associated facilities to allow for isolation and segregation to, as the Minister stated, reduce the risk of cross infection.

Owing to the unique nature of the condition, it is essential that a process be put in place to minimise hospital contacts by arranging for direct admission to the hospital room. This would ensure patients have a reduced risk of acquiring infections which, ultimately, would result in reduced demand on the health care system. I call on the Minister to release the findings of the Pollock report and to implement its recommendations without delay.

I would like to know the status of the review of ambulance services that was due for completion last year. In south Tipperary, Carrick-on-Suir is especially disadvantaged through the lack of an ambulance service based in the town. Instead, the people of Carrick-on-Suir have to rely on an ambulance being dispatched from Clonmel, which is a 50-minute round trip, or Waterford, which could be a 58-minute round trip, depending on the time of day, the level of traffic and whether the bridge is up. This timing does not include time spent on the stabilisation and preparation of the patient for transfer on site. It is clear that the halving of this transfer time would support a positive outcome for patients, particularly those suffering from heart attacks or stroke where time is critical

Ultimately, addressing each of these issues is inherently associated with improving patient care and safety. The HSE and Department of Health and Children seem to be eternally involved with assessing standards, highlighting problem areas and developing strategies and standards. However, when it comes to translating all of this into providing a safer service to patients, both the Department and the management of the HSE are notably inadequate.

I have the highest personal regard for the Minister. I was present on the day when the report on services in Portlaoise was given to us. I could see that the Minister was deeply upset by that. I have no doubt that she is very upset by recent events, including errors that have happened, especially the case we heard about this week and the case of the lady who lost her life. None of my remarks is personal. The embargo is having a serious effect and I continue to be very concerned about psychiatric beds and services, particularly ambulance services, that are not provided fairly throughout the country. I conclude by thanking the Minister for her time and for giving us the opportunity have this debate.