Alan Kelly (Labour)

I welcome the Minister of State to the House.

I am disappointed that some of the Senators who have been criticising the HSE for the past nine months have not shown themselves in the House today. I would like to hear them repeat some of the comments they made during the year about the HSE.

There is a philosophy in the HSE of budget management rather than demand for services. That is the reality I see every day. It is there in the answers I receive to my questions and in what people tell me. I agree with Senator Alex White, who summed it up better than me when he said that the body should not have the power of answerability over its own budget. It is true. When we ask a question about the health service and hear the phrase, "This is a matter for the HSE" in the reply, the reality is that the HSE is not accountable, despite the efforts of the previous speaker to outline his version of the lines of accountability. It is not accountable in a similar way to any other agency in the State, which, given that we are talking about people's lives and health, is shocking. That is why the second point in our motion states that we want the HSE to be accountable to the Oireachtas. This is an imperative.

While speaking I will dip in and out of various areas, mentioning in particular the area from which I come, the mid west, and specifically north Tipperary. I wish to mention the future of acute hospitals, particularly smaller hospitals. Last week in my area of Nenagh — not to be too parochial about it — two of my colleagues, Deputies Lowry and Hoctor, were falling over themselves, as usual, to announce a new surgical and endoscopy service and a sterile unit in Nenagh hospital. When the HSE gets its act together this will cost €15 million, as there are various components to be put in place. This is fantastic news and it is very welcome. However, it does not in any way suggest that the existence of this hospital and its services will be prolonged. Using it as an example of a small acute hospital — it is one of the smallest although it has a large geographical area — it can be seen that despite the large geographical area and the 15,500 people who use the accident and emergency department, it is constantly under threat.

We have an elderly care unit that is much in demand but is sporadically closed down, despite the fact that it is in the backyard of the Minister of State with responsibility for older people. As everybody in the House is aware because it has received national attention, we have a CT scanner that has been sitting in bubble-wrap for a year and a half while people are ferried to and from Limerick for scans. In addition, the bed capacity is continually being cut. This is the reality of what the HSE has done to small acute hospitals. This hospital is underfunded, like many other small hospitals, despite the small — or minute — increase in funding it received this year. Medical inflation and national inflation are raging. The manager is left in the impossible situation of being forced to sign off on budgets with which he or she is unhappy in order to meet the demands of the HSE which, as I said at the beginning, manages its services based on budget rather than need.

Where are the Teamwork reports and why have they not been published? They were promised in February, March and April, but we are nearing the end of May. I am unsure as to whether they will be published because they are too politically sensitive. The Hanly report recommendations were implemented by stealth and it looks like the Teamwork recommendations will be also implemented by stealth. Many believe we will get what Professor Drumm outlined in a number of public utterances concerning small acute hospitals, namely, he will turn them into day hospitals. He stated that there were too many unsustainable accident and emergency units. If a unit with the geographical basis of my area is unsustainable, the health service has a serious problem.

The ambulance services, a pet subject of mine, sometimes get a raw deal and have been negatively affected by the changes administered by the HSE. In many cases, the work of ambulance crews is so vital that, without them, we would be in serious trouble. Many of those involved work long and unsociable hours and shifts, on which they must double up due to a lack of qualified staff. There are not enough emergency medical technicians or advanced paramedics, a situation affected by last year's embargo. Neither is there enough capacity, but this is due to a lack of ambulances rather than the change to single-bed stretchers in ambulances. The confusing protocols should be addressed.

The concept of primary care is worthy, but it has different meanings to many inside and outside these Chambers. Before we get rid of the old system, we need to bring in the new. We have not even reached the 50:50 point. Several years ago, the budget between acute and community health care was divided 70:30, but that ratio has become 40:60. This is not necessarily good. There are problems in a number of areas. For example, the number of home help hours offered is a joke in some cases and there are long waiting lists for occupational therapy. In my area, some 693 children are awaiting speech and language therapy. I do not believe the staff recruitment issue and the number of years they must work prior to getting their jobs comprise the sole problem. Half of the therapist posts in the north Tipperary-east Limerick area are vacant.

Many point to the success of the NHS in Britain and claim that community driven care can work. We each must consider our own circumstances and there is no such thing as best practice. The glue that holds together acute and community care is the GP service. The difference is that GPs are not under the HSE whereas they are under the NHS in Britain. Hence, the same model will not fit Ireland.

In many ways, some good people in the HSE's management are not treated well and some of the criticism is unworthy. As many of the HSE's managerial positions are temporary, people who make decisions watch their backs. I have an issue with the PR policy of the HSE.