John Crown (Independent) | Oireachtas source

I will not get involved in any recrimination, name calling or umbrage. I know the Minister is a caring person. I also know she is not an unthoughtful person. In the big spectrum of contemporary politicians she would be from a tradition that puts some thought and - to use what is considered a bad word but it should not be - "ideological" inspiration into how she acts. I am not being critical of anyone, it is just the way history has evolved here over the past 90 odd years; there was a certain amount of flip-flopping, especially in times of recession, and parties that are in government get the task of cutting and parties that are in opposition get the task of being suffused with umbrage. That is the way it is. No matter which side of the House one is on, depending on which part of the job one has at a particular time in history, it is always a little galling to hear the other group express their umbrage and hold one personally to blame.

In the trajectory of the history of our republic, we have plenty of blame to be shared. Every penny the Minister has to cut is associated with hardship for the person in receipt of it and, in the case of the every penny the Minister spends, it is hardship for the person whose opportunity cost is not met by spending it elsewhere. There is a finite amount of money to go around and the Minister has been dealt a terrible deck of cards. She found herself coming into a caring ministry at a time when demand for services underwent a sudden, dramatic and nearly unprecedented increase, which coincided with an unprecedented decline, even in international terms, in the revenue base from which she operates. This is an extraordinary situation and cannot be met easily. It is like trying to keep afloat in a perfect storm while clutching at the straw that, at some point in the future, we will get a renegotiation of bank debt.

It is a special case and I have had multiple representations made to me by people across the social spectrum, from well-off people, those who are not, and those who are looking after an elderly relative or a young child facing no future. Most of us who are parents know what it is like to have a helpless young child whose nappy needs to be changed and who needs to be hand fed. I am not preaching to the Minister because she knows this. In the case of many of the people we are talking about, the phase of nappies and hand feeding never ends. It goes on not for two or three years but for 30 or 40 years. The frustration of trying to deal with people who cannot communicate because they cannot speak, which will end in the case of normal children when they reach three or four years of age and start making their own opinions well known, will not end in the case of many of these folks.

As a doctor, I do not deal with those kinds of patients but I deal with cancer patients who may be in the final stages of their lives. I see them for an intense exposure of ten to 15 minutes and then I move on. They do not move on and the person who is with them, who I am talking to about tablets, pills and the necessity to turn up for tests or scans, does not move on either. That is their life sentence until the life ends. This is a special case but there are many special cases.

I hinted at this point yesterday in our short exchange and I hope to amplify the point today. The Minister did not do this because she is unkind, because I know she is not unkind. She did not do it because she is unthoughtful, because I know she is not unthoughtful. When she thinks more about the economic implications of the measure, a case can be made that this may not save the money she thinks. People talk about not receiving the carer's allowance driving them into illness, which is theoretical but could potentially happen. What does happen on a daily basis is that when we in the hospital try to discharge someone with cancer or another chronic illness, we find that we do not have good stepdown facilities. We do not have convalescent homes and other facilities. Very often, someone stays in hospital for one, two or three days more because the carer is not ready for the person to come home. Provisions are not in place. A family told me they were at the end of their rope because they had another sick relative at home taking up all of their attention. Every time it happens, it costs the Exchequer between ¤500 and ¤1,000 for the patient's inpatient day.

I will make some suggestions about where the money could be found. I hinted at it yesterday. The Minister should discontinue every public relations contract in the public service. No public servant needs a PR contract.