John Kelly (Labour)

I welcome the Minister to the House. When the former Deputy Mary Harney took over at health, I sent her a letter to the effect that she had taken the poisoned chalice. I was proved right. I would nearly say the same to this Minister, although I hope that, like the priest who drinks the wine at Sunday mass, he puts a good gloss on the chalice. I wish the Minister well in doing that.

I welcome the extra €35 million provided for the psychiatric services in the national service plan. I know that front line services right across the country are being run at skeletal levels. Even at this stage, nurses feel threatened and afraid to go to work. I welcome the extension of medical cards to long-term illness patients, but the Minister should consider including people with cancer. They should have a medical card without having to undergo a means test. I say this from my years of experience as a community welfare officer, when anyone with cancer who ever applied for a medical card was granted it.

I have a couple of questions. Is the National Treatment Purchase Fund gone by the wayside, or is it still in place? What are the plans for Roscommon County Hospital? The Minister said that the future of smaller hospitals is guaranteed. Once the accident and emergency department in Roscommon was closed, a group came together to try to salvage something for the health service in the county. The group has promoted the opening of an ambulance base for west Roscommon. I hope the Minister will work with us on this issue and when the ambulance base is proposed for west Roscommon that it will go to west Roscommon. What is the update on the provision of advance paramedics following the closure of the accident and emergency unit at Roscommon hospital? Perhaps he would help dispel rumours circulating in the media on the urgent care centre in Roscommon that it will be further downgraded to five days per week.

On the issue of the 600 community nursing home beds that it is proposed will be lost, I urge the Minister, by virtue of the debacle with Roscommon hospital, to ensure no nursing home in Roscommon is lost as a result of the reduction in bed numbers. I am concerned that we may be going down the privatisation road. I have worked in the health service for many years and have visited all the community nursing homes. The residents in those community nursing homes need 100% care, as distinct from many of those in private nursing homes who may not need to be there, as stated by the Minister. The main issue is that we do our best to keep people out of nursing homes. In seeking to do that a reduction of 4% in home help hours will not help the position. However, I have a proposal for the Minster which I have mentioned previously, namely, that consideration be given to the opening up of home help hours through the community employment scheme. There are many unemployed persons who are well able to provide care as home helps and perform such tasks as bringing in turf, sweeping floors, taking out ashes, doing the shopping and so on, the net cost of which to the Exchequer is €1.70 per hour given that they will still receive the social welfare payment. For an extra €1.70 per hour a home help service can be provided. That is an issue that should be dealt with.

The fail deal scheme, as I said previously, is in many cases an unfair deal. When a person applies for the fair deal he or she is put on a waiting list. That person may be in the nursing home for four to five weeks but subsequent to that the HSE will write to him or her and authorise that the fair deal is in place but it will not be retrospective to the date of entering the nursing home.