Rose Conway Walsh (Sinn Fein) | Oireachtas source

I thank the Minister of State for being here and the Minister, Deputy Simon Harris, for attending earlier. I wish to address a couple of points. The first relates to the rural Ireland document. I presume the Minister and the Minister of State had an input into it. It is disappointing in its vagueness on what is being done to address health care from a rural perspective. I will refer to a couple of matters in it relating to mental health. There is no realisation in it of the situation. It states: "In line with the Connecting for Life Programme, provide support for local strategies across rural Ireland to address suicide and ... mental [health and] wellbeing." I know many people, and their families, who present at accident and emergency departments with mental health difficulties but are sent home. Young people, in particular, are presenting. These young people may have been protected under the child and adolescent mental health services, CAMHS, system and sometimes were residential patients under the CAMHS system. However, because the CAMHS criteria are so inflexible, once they reach the age of 18 they are kicked out and sent back into their communities. Time and time again, they present at accident and emergency departments and are sent home without any supports or services. I am extremely concerned for these young people and for those who are not being seen through the accident and emergency departments. I ask the Minister of State to address the matter in a real and proper way.

The document is too vague on health matters. While it needs more clarity and to be teased out, I welcome that there will be extra investment - €435 million for 90 projects - in public nursing home facilities and district and community hospitals. My fear, however, is that this provision is just to address the HIQA requirements and that we might end up with fewer beds than are there at present. Perhaps the Minister of State will clarify how many extra beds the investment will mean for rural Ireland. Does it address problems such as the closing down of bed spaces? Many of them, including some in my community, were closed down by the Fianna Fáil Government. For instance, in 2009 and 2010 half of the beds in Belmullet District Hospital were closed down. Is it the Minister's intention to reopen those beds with some of this capital investment? I think that is the way forward.

I do not like to use the word but there is almost a kind of a schizophrenic attitude towards primary care: we will invest in primary care; no, we will not; we will centralise and privatise it; and then back to primary care. It reminds me a bit of when the Department with responsibility for agriculture used to have us put as many sheep as possible on the hills and then have us bring them back down. The primary care model was first mooted in 2000-01 when the pilot projects were carried out. The Minister of State knows that they were never resourced - even in the boom time - in the way that was intended. There was never the investment in personnel or technology that is needed to run proper primary care centres. When the Government refers to 18 new primary care centres in the plan, it means nothing to the likes of me. That pilot primary care centres are not working because the investment has not been made is a huge failure.

There are many cancer patients who are not getting their treatment. They are ringing the hospital and being told to stay at home because the hospital does not have a bed for them. That these patients are not getting appropriate treatment is extremely serious.

I could raise many other issues, but I wish to raise one in particular. Has the Department examined the possibility of an all-island approach to health care? I see that as the way forward. Have any reports or scoping exercises been done? If not, will the Department oversee a consultation and scoping exercise on an all-island approach to health? We, including our Ministers in the North, will co-operate and work with the Minister and the Minister of State in whatever way we can to bring that about. Huge benefit could be gained through an amalgamation, if one likes, of resources under the NHS and the HSE. There are only 6.5 million people on this island. We should be able to provide a proper, robust and sustainable health service that is based on need and not on ability to pay.