I am glad of the opportunity to speak on what I consider to be one of the most important Estimates to come before the House during the course of any year in any Government's lifetime. Before I confine my remarks to four particular areas I am concerned with I would like to correct something Deputy Gay Mitchell said this morning — I am sure it was inadvertently — when he made a comparison regarding medical cards between Donegal and Dublin on the basis that the percentage of people who held medical cards in Dublin was around 20 to 23 per cent and the percentage of those who hold medical cards in County Donegal would be far greater than that. He seemed to feel that people in Dublin were being treated more unfairly than people outside Dublin. It is important for the record to show that the guidlines which operate for medical cards are common to every health board area. If Deputy Gay Mitchell was referring to any unfair treatment it must be an indictment of the community welfare officers in his constituency. I presume it was his constituency he was speaking about this morning.
I am very concerned, particularly in the Western Health Board area, which deals with three very large rural counties, Mayo, Roscommon and Galway, with the whole orthopaedic situation as it has operated for quite a number of years. The average time spent by a patient in that health board area waiting for a hip replacement operation is 1.9 years. I have asked numerous Parliamentary Questions about this particular area. Tenders were received in the Department of Health for the provision of a new orthopaedic suite at Merlin Park Hospital some considerable time ago. I keep getting the same reply, as Deputy Tunney stated he got in relation to orthodontic treatment, over a period of years that the Minister is not in a position to say at the moment when the project can go ahead.
The Minister for Health recently informed me that he was reviewing the capital allocation of his Department with a view to looking at the contractual commitments which had been entered into, the level of resources available to him and the priorities of the various health agencies. There is only one main orthopaedic theatre available for the whole of the Western Health Board area in Merlin Park Hospital in Galway at the moment as well as the use of a converted classroom used as a temporary theatre. The Department of Health officials have agreed that at least three theatres are necessary to meet the workload of the orthopaedic surgeons in that area. The tenders from a recommended contractor were submitted to the Department of Health in August 1981. The updated cost, according to the figures in the Department of Health and the health board on 1 January last, was £1,250,000.
There is a three-year waiting list for hip replacement operations. I am sure everybody in the House, as well as outside, would agree that for very many people this operation is a lifeline. We have seen those people all around the country coming into a hospital to have a hip replacement operation barely able to walk, maybe in a wheelchair or walking with the aid of crutches or walking sticks, and they leave after this operation has been performed on one or both hips like new people. In the Western Health Board area there are 2,900 people on the orthopaedic out-patients waiting list. The long waiting list is basically caused by the inadequate theatre facilities and because of this, great hardship, which I consider is totally unnecessary, is caused to all the people who are waiting for this operation.
There is another problem in the orthopaedic situation in the Western Health Board area. The facilities in one of the theatres cannot be used safely during the summer months. The Department is aware of the reason for that. It is because it is very difficult to maintain a proper degree of sterility. The result is that acute patients are being referred to Dublin hospitals where there are already long waiting lists. This situation has continued for quite a number of years. The solution to the problem lies in providing the orthopaedic surgeons in the area with proper facilities so that they can get on with the workload.
Like Deputy Tunney I, too, am concerned about dental services and in particular the orthodontic service. I was somewhat consoled to hear the Minister say this morning that arrangements are being made to appoint a number of orthodontists to the health boards. However, the statement rings a little hollow in the light of my own experience. I have been told on a number of occasions that it is expected the post of orthodontist will be advertised shortly and then one discovers that the period of waiting for treatment is no less than three-and-a-half years. In complicated cases requiring fixed appliances the waiting period can be as long as five-and-a-half years. There is no use in telling parents of children who need treatment that applications will be invited soon because "soon" can mean three years' time or even ten years' time. The post of orthodontist was approved by the Western Health Board on 3 July 1981. Since then successive Ministers have stated the post is about to be filled or will be filled soon. In my opinion, as Deputy Tunney said, "soon" should be next week.
The Department have been pressurised by members of the board acting collectively to clear the vacancy. In the meantime the board have tried to provide a limited service with the help of a private orthodontist in the area. It is of the utmost importance — I cannot emphasise this enough — that this post should be advertised immediately. Here I am talking about next week, not next month, or in three years' time, so that we can clear the existing huge waiting list.
I have had personal experience of the maternity unit of the Regional Hospital in Galway. An extension of that unit is vitally necessary. As a result of my experience I am aware of the serious overcrowding that exists there. It should not be tolerated. Progress has been made, and I am delighted to say it was under a Fianna Fáil Government, in that we got the go-ahead for the extension. The bed occupancy is over 120 per cent and the average stay for the year ending 31 December last was 4.6 days. Most women who have occasion to use this unit can feel very low emotionally. Doctors and nursing personnel are under tremendous pressures. Patients quite rightly object to the lack of proper accommodation. There is no privacy. It is very difficult for the patients and it must be even more difficult for the nursing personnel and medical staff to operate under such circumstances.
In July 1982 application was made to the Department for extra funding to provide staff and equipment. That application has not yet been approved. Unless the staff and equipment are provided it will not be possible to open the new extension and the serious overcrowding will continue. I asked a Parliamentary Question recently about this and the reply I got was that the new extension will not be ready for use until early November 1983. The question of funds therefore will not arise until that stage. Will it arise on the day the contractor hands over the new facilities and does that mean the matter will be put on the long finger once again and we shall have to await a further deterioration in the services? Is it not in the best interests of everybody that a commitment to funding should be given now so that the hospital authorities and the health board will know when the facilities will be available to come on stream immediately?
I was interested in what the Minister had to say about the drug problem. We hear a great deal about the problem in Dublin but we should not lose sight of the fact that there are other urban areas which have a drug problem, not as great perhaps as the problem in Dublin but certainly a growing problem. I would hope the special committee would not just review the problem in Dublin. I would hope they would look at the whole country. As public representatives we should encourage a much greater degree of co-operation between the medical services and the Garda authorities in relation to the problem. Glue sniffing seems to be a problem of the teenage group. Sadly it is now becoming a major problem. Very young children are falling into the trap. They think they will not be one of the gang if they do not sniff glue. We probably could do a great deal through health education in the schools, and that health education programme should start in the primary schools.
As I said, the problem is not confined to Dublin and so we should have regional centres to deal with the rehabilitation of drug addicts. I am glad the Minister recognises alcohol as a major problem. It is one that causes great distress and not just to the individual involved but also to the individual's family. It is one of the causes of marital breakdown. I am glad the Minister intends to give support to the specialised treatment programmes in operation. Huge costs are involved in some of these. It sometimes calls for a major effort and involves a great deal of sacrifice on the part of a family to bring an alcoholic to a treatment centre.
One area about which we have heard a lot of talk, which has been given a lot of lip service over the years, and which needs to be tackled urgently is that of alcohol advertising. It is something that must be looked at very seriously by all of us and I would encourage the Minister and his Minister of State to do so as quickly as possible. All of us would agree that the advertisements we see, in particular on television — because what we see tends to have a greater influence on us than what we read — put drink across as glamorous, it is always associated with glamorous people, places and so on. This tends to encourage young people to take to alcohol earlier. There must be some curbing or control of this kind of advertising.
On the nursing situation there is just one comment I should like to make, that is, I should like to know if the Department could ensure that a certain percentage of the student nursing intake in each of the health board areas could be allocated to Irish-speaking students. It is very necessary in health board areas with large Gaeltacht areas within their jurisdiction.
I am somewhat confused about this £5 casualty fee we have heard so much about, both during Fianna Fáil's term in Government and indeed since the present Government came to power. I understand that it is operational in three health board areas only, the Western, the North Western and the Midland Health Board areas. That creates a sort of ill-feeling amongst people that, once again, people in different health board areas are being treated differently, or that they are different in some way from other areas. Either we should have it in every health board area or we should not have it at all. I know the Minister of State probably will say that in each of these cases it was a decision of the health board themselves. I am aware of that but the Department, as the overall controlling body, must decide once and for all that either we are going to have a £5 casualty fee in every health board area or else we are not going to have it at all. For instance, excluded in my health board area are cases of persons referred to the casualty department by a registered medical practitioner and accident and emergency cases. Recently there was a case in which a little boy fell, a constituent of mine. His father was away; his mother rushed him to the casualty department of the local hospital where he had to get three or four stitches in his chin. His mother was presented with a bill a week later for £5. If we are talking about accidents I would have considered that to be an accident case and the quickest way of dealing with the situation was to take the child to the casualty department of the local hospital which was closer to the patient. The mother probably would have lost a lot of time trying to locate her general medical practitioner or, if he were not on duty, somebody else. Therefore, we need to clear up the question of whether we are going to charge the fee in every health board area or specifically in the three, as at present. We must also confine ourselves to what is meant by an accident case.
One area about which I am very concerned — and this will be my last point — is that of children in hospital. As a parent myself, and perhaps more so as a mother, I am very concerned about the whole attitude taken to children in hospital in this country today. It is perhaps one of the most traumatic experiences for any family to have a small child hospitalised, even overnight. In particular, it is a traumatic experience for the child itself, to be left alone in a large, impersonal building with so many strange people all around. Certain attitudes are adopted in hospitals — particularly after a child has an operation — that they cannot have visitors for perhaps 12 or 24 hours afterwards. We should have — and I think in my health board area we do — an open all-hours policy for parents of children in hospital. The quicker the Department of Health, as the controlling body, realise this has to be done in every health board area, in every hospital throughout the country, the better. Nobody can aid a child sick in hospital and get them better quicker than one or other of the parents. It is very important that we provide facilities for parents to stay overnight even if, in certain cases, it means they have to sit beside the bed or perhaps sleep in another room. It may not always be possible — and I do not think anybody would expect that it would always be possible — to have 50 or 60 parents in the same ward as 50 or 60 sick children, but we can compromise; we can be helpful and the open, all-hours' policy is essential and something which the Department of Health should push with all hospitals.
Basically that is all I wanted to say. The Estimate on the Department of Health is one on which all of us could talk for a very long period of time but it is easier to pick out the areas of concern to ourselves immediately. I would ask the Minister, in particular, in relation to the orthopaedic services in the Western Health Board, the extension to the maternity department — and I would like to join with Deputy Tunney in his remarks on the whole situation regarding dental health and, in particular, the appointment of a consultant orthodontist — that he look at those as a matter of urgency. I think the Minister of State probably will have many cases in his constituency, in all of those areas, requiring immediate attention. I would ask him to have those points I have made taken into account.
