Michelle Mulherin (Fine Gael) | Oireachtas source

I welcome the debate and I also welcome the Minister of State, Deputy Corcoran-Kennedy, and the Minister, Deputy Harris, who has just left. I ask that the Minister of State raise with the Minister, Deputy Harris, the point that there needs to be an analysis of the health care groups which have been established and how they are actually operating, how effective they are and at what cost. We know the theory that streamlining health care services in hospitals along with academic input will improve the system, but I just question if that is really happening.

Since the advent of the health care groups, and to facilitate them, in the past year or more some 122 new general manager positions have created in Dr. Steevens' Hospital. These are new grade VIII positions at a cost of perhaps €100 million. Some 90% of managers are based in Dr. Steevens' Hospital and, as I understand it, 10% are in the rest of the country. At the same time as we see 122 new grade VIII general managers in Dr. Steevens' Hospital, there are 120 vacant consultant posts around the country that we cannot fill. We all know we cannot get front-line staff, including nurses, occupational therapists, physiotherapists and speech therapists. Why are we hiring more managers in what is supposed to be a streamlined and better service? What are these managers doing? Do they have budgets and what are their responsibilities? Why are they necessary? I am very impressed by many of the managers in our area. They are under a lot of pressure and they are making ends meet very well, but I was quite shocked to hear that these positions were created at this time. I acknowledge the additional funding in the last budget, but how can the Minister of State justify those positions? I would like some answers on that. I appreciate this may not be something the Minister of State can answer now, but I would like to know what is going on in Dr. Steevens' Hospital.

How are the health care groups operating on a regional basis? In my own area, there is the Saolta University Health Care Group, which incorporates Galway, Roscommon and Mayo. At present the budgets for home-care packages and primary care services right up to hospital services are going towards Galway because the main university hospital is there.The reality is that the budgets for home-care packages are not coming, as they ought to, to Mayo. There is proportionately more going to Galway to clear out trolley, etc., but we have a trolley problem in Mayo too. What is happening is that the big fish is getting more food and smaller hospitals such as those in Roscommon and Mayo, which are under pressure and, as far as I am concerned, give very good value for money, are losing out. We need more transparency. I have representations from people who need home-care packages. They need to be at home or to get out of a step-down facility or a nursing home, where the State has to pay for them because no bed was available in a step-down facility.

The next issue is that of primary care. In the Saolta west-north west region, we have seen a 16% increase in demand in primary care, but there has been a 25% cut in the budget in the past year. As a direct result, primary care services have been severely diminished, which is a reversal of what we ought to be doing given what we know about early intervention and about it being cheaper if we get to people earlier. However, resulting from this, in the past year alone 167 whole-time positions have been lost in our area. These include occupational therapists, physiotherapists and those working in the primary care sector. I am wondering what is going on. I know it is difficult and that there are so many aspects and layers to the health care and its budget, but these facts that I am bringing to the Minister of State do not impress me much.

I do not see any benefit arising in my county from the new health care groups for those who need health care and for the ageing population. They need these services. I would like to see some accountability on the part of the HSE for its 122 new grade VIII general managers. What is going on in St. Stephen's Hospital? I will conclude now. However, they should not be fattened up. Other areas need the resources. We cannot attract nurses. Who would want to work in an emergency department given the stress and pressure involved? A cousin of mine is a newly-qualified nurse. She has all the opportunities in the UK available to her. She would not dare come back to what she calls battle zones. This is complex. It is not just on the Minister. The HSE has service level agreements. What is going on? I would like some answers.