Marc MacSharry (Fianna Fail) | Oireachtas source

The reality is that the entire health service is underfunded. I am not saying it is perfectly well managed. Clearly, there are management challenges and changes that have to be made, but inadequate funding is the underlying problem. It has moved beyond the point of crisis and I do not envy the Minister his position.

I accept that it is difficult to come up with adequate solutions. The Minister is noted for his straight talking, but we also need action and, above all, funds to address the difficulties. The overcrowding we saw in the run-in to Christmas and again more recently had been predicted. At the beginning of the preparations for the service plan, the director general of the Health Service Executive, Mr. Tony O'Brien, outlined the risks to patient safety and the difficulty of delivering necessary services safely without an additional injection of funding in the region of €1.3 billion. We all accept that there is only so much pie to go around, but in response to the request for €1.3 billion, the Government allocated €100 million or thereabouts.

We all are aware of the situation in hospitals around the country, with patients being left on trolleys and elderly people left unattended. That is unacceptable. I have told people not to bring an elderly family member to hospital, unless they are able to wait with him or her. In fairness to nurses, orderlies and the various other hospital staff, they are pressed to the pin of their collar in trying to carry out their duties and cannot give the time required to patients. The reality is, as the figures outlined by my colleague clearly show, we have a health service that is at breaking point.

Dr. Tony O'Connell left the HSE less than one month ago after just eight months in one of that body's most senior roles. At one stage he wrote a three-page analysis in which he indicated that there were 703 delayed discharge patients taking up 30 wards of capacity. Why can these patients not go home? Are there no nursing home or convalescent beds available for them? Are we thinking outside the box at all to deal with this problem? Has the Minister sat down with the Tánaiste and Minister for Social Protection, Deputy Joan Burton, for instance, and considered whether we should look at abolishing means testing for carer's allowance? Should we explore the possibilities in that regard? Do elderly people have aunts, brothers, sisters or children who would be in a position to look after them in their own homes if they had sufficient support, including medical cards and other back-up supports? That might well be a more cost effective way of doing things, given that it costs €900,000 per week or something like it to keep people in nursing home beds.Has it been examined? Has a costing been done because, if not, that is the kind of outside the box thinking we need. I do not know whether it will work but it is certainly worth considering the abolition of the means test which, with other supports, could provide a solution to the hold up on the fair deal waiting list of some 2,000 and free up some of the 30 wards of capacity. At one time 703 people were waiting to be placed. In other material I have read that is credited to Mr. O’Connell he states there are several patients in hospital waiting up to three years for a place. They are effectively living in hospitals. That is not the kind of management we need.

I do sympathise with the problem of resources faced by the Minister. He is sent out with a statement laundered through some public relations industry, which is not I am sure how he likes it, in terms of calling it as it is, to say everything is rosy, the special delivery unit is doing its job, we are making progress, it is a difficult task. It is way beyond a difficult task. Dr. Fergal Hickey of the Irish Association for Emergency Medicine has warned about the risks but we do not seem to be any nearer a solution. The Minister needs to think outside the box and say this is what we will do rather than say this is challenging, this is unacceptable. We are all sick of that rhetoric. I am sick of saying it. That is one suggestion for the Minister. He can come back to me the next day and tell me why it is not workable to abolish the means test for the carer’s allowance on a trial period to free up some space in nursing homes and acute beds in hospitals and see if it is practical. Let it not be said that I am not trying to make some suggestions.

While it is slightly off the subject of today’s motion, I predicted when this Minister took office that it would not take long before he issued the parrot like responses his predecessor, and indeed Mary Harney when she was Minister, wheeled out regularly, to the effect that under the Health Act 2004 the chief executive officer of the HSE is now responsible for that area and the Minister has written to him and asked him to respond directly to the Deputy or Senator. That kind of behaviour is not acceptable and I am sure the Minister does not like doing it.

Following the debacle of recent years I want to bring up three medical card cases I have asked the Minister about: one concerns X and Y, twins, aged three, born prematurely, whose lives have revolved around medical appointments, X has had cerebral palsy since birth and has numerous other health issues as a result; and Y has recently been diagnosed with asthma which will require increased doctor and specialist visits in the future. Both boys qualify for domiciliary care allowance from the Department of Social Protection and medical reports are provided to qualify for that. It is clear the Departments do not talk to each other because that case is under appeal through the Minister’s office. The second case involves an 18 month old who has Down’s syndrome with medical complications and is seeing a consultant in Crumlin hospital who cannot believe she does not have the medical card. Once again the response was that it is under appeal through the Minister’s office. These cases are all in south County Sligo. Another child, two years old with serious medical problems, awaiting a call to Crumlin hospital qualifies only for a general practitioner card.

The final case concerns a man who has cancer in two places and heart conditions. I have written to the Minister’s office about him. I will not name him here but he is from Cartron in Sligo. I am sure somebody in the Minister’s office can look him up. We cannot continue on the autopilot that I will quite openly say ran this country into the ground in so many ways. The Minister should not let autopilot rule his tenure in the Department of Health. We know how challenging it is. He does not need to tell us. We hear it every day. He should tell us the tangible things he is going to do to make it different this time.