(Carlow-Kilkenny): Ba chóir go mbeadh córas sláinte éifeachtúl againn i gcónaí, mar bíonn daoine tinne ag brath air go mór; ag brath ar leapacha bheith ar fáil sna hospidéil, gur féidir leo coinne a dhéanamh le dochtúirí. Mar sin, cosnaíonn sé seo a lán airgid chun an tseirbhís seo a dhéanamh éifeachtúil. Tá súil agam go bhfuil an córas atá againne amhlaidh agus go gcuirfidh na hathruithe seo feabhas air.
The three main objectives of this Bill are to improve financial accountability and expenditure control procedures in health boards; to clarify the respective roles of the members of health boards and their chief executive officer and to begin the process of removing the Department of Health from detailed involvement in operational matters. We are spending £2.4 billion each year on health services.
Section 2 provides that health boards must have regard to certain matters in carrying out their functions. They relate to securing the most beneficial, effective and efficient use of resources, cooperating and co-ordinating their activities with other health boards, local authorities and public bodies and giving due consideration to the policies and objectives of Ministers and the Government. Given that this section must be included in the Bill, is it the case that those matters were not considered in the past?
A total of £2.4 billion will be spent on health, of which £1.3 billion will be allocated to health boards. I was concerned that in the past consideration was not devoted to the efficient use of resources and to ensuring adequate co-operation and co-ordination among health boards, but I hope this section enshrines in the Bill what was the practice in the past. The allocation of £1.3 billion, for health boards works out at almost £4 million a day. That is a considerable amount of money and there must be co-operation across all sections of health provision, whether among hospitals or health boards, to ensure it is spent efficiently.
Irrespective of how many improvements are made, an unusual approach to dealing with hospital waiting lists, particularly for patients awaiting heart operations, appears to have been adopted. Cardiac surgery is traumatic for the patients and their families. Patients on a waiting list for a hip operation can survive even though they may have pain, but the life of patients awaiting heart surgery may be in danger.
I know of a person who was involved in an accident which necessitated surgery while he was on a waiting list for a heart operation. That person had to have the heart operation first. People on a waiting list for surgery find it difficult to understand why there is such a delay. Most heart operations are performed on an emergency basis. People collapse, are rushed to hospital and have a heart operation, thereby displacing the next person on the waiting list. I feel sorry for a person next on a waiting list whose operation is cancelled because of an emergency. We are all aware of people who have had emergency surgery and some of us have had personal experience of it. We are grateful that an excellent surgeon is available to perform emergency heart surgery when required. The skills of the surgeons who save so many lives and give people lucky enough to have a heart operation a better form of life are appreciated.
Health boards, which spend almost £4 million a day, play an important role in administering health services and it is vital that they put the best arrangements possible in place. I question whether in the past hospitals were located with the interests of the patients in mind. I am mindful of the south east region. I do not understand how Waterford hospital, situated on the coast, is regarded as central to serve the south eastern coastal region. Only seagulls with broken wings can fly in from its west side and they will not visit the hospital. Hospitals should be located centrally.
One of my county council colleagues pointed out yesterday that a patient from Hacketstown on the Wicklow border must travel to Waterford to attend a hospital and the people of Waterford would be nearer to Fishguard than Hacketstown. There is also the added problem of the need to travel a road that is not in the best state of repair. In this regard the condition of the bridge in Waterford could also be improved. The future location of hospitals should be given serious consideration. I appreciate that a decision made in the past will not be changed but dragging people from one end of a region to the other does not represent good planning and some planning in the past was bad.
There should be a certain amount of decentralisation of health services. Patients from north Carlow should be able to avail of health services in Carlow rather than being transported, even while recovering from an operation, to the other end of the health board region. It would be better if medical specialists saw 20 patients at a venue, such as the district hospital in Carlow, than to ask those 20 patients to travel to Waterford to attend the hospital. I accept the South Eastern Health Board is reviewing the position and I hope they will make such a recommendation.
Health boards administer many areas of health service. I have particular interest in facilities for the mentally handicapped. I am thankful that I do not have any personal experience of mental handicap, but I am involved in a group, Delta, which operates a training centre for adults with a mental handicap. The health boards do great work in this area and I do not wish to criticise the South Eastern Health Board in this regard as it has given financial assistance to our group but I find it difficult to accept that it is considered sufficient for health boards to provide 80 per cent of the cost involved. People with a mental handicap need special care. School, youth and adult facilities for the mentally handicapped should receive 100 per cent funding. I appreciate that talking in terms of facilities receiving 100 per cent funding seems extreme, but in the case of ordinary schools the parish and parishioners provide all the necessary funds. Parents of children who have a mental handicap, and their friends, are worn out fund raising to provide necessary facilities. Instead of attending talks designed to assist parents help their children with a mental handicap, they must attend fund raising meetings organising the selling of tickets and so on. The parents and friends of people with a mental handicap should be relieved of the awful burden of non-stop fund raising.
When an extension was added to the training centre in Carlow a few years ago, the parents and friends of the children collected £36,000 which involved a great deal of hard work. Those parents and friends also look after St. Laserian's Special School and Teach Sonais, a house which provides overnight accommodation. There are many demands on the funds raised by parents. It is becoming increasingly difficult for them and their friends to encourage people to take up official positions and they cannot be blamed for that. It is difficult in any walk of life to raise funds, but parents with a child with a mental handicap have much more to worry about. They should not have to attend fund raising meetings, run cabarets, sponsored walks or sell tickets they should be able to attend meetings designed to assist them to help their children.
The Department should consider transferring funds to meet the needs of such children. People with a mental handicap deserve the best facilities available and the provision of them should not mean any trouble for the parents. I include elderly people who represent an increasing proportion of the population. We must provide first class facilities for those people who kept the State going, worked for miserable wages in many cases, did not have the benefit of electricity when they were growing up and suffered many hardships. The least we can do is provide proper facilities for them in their old age. Many hospitals provide excellent services for the elderly. This represents a major change from the time people talked about the "county home" which in many cases represented the final straw. This is still the case in many instances: one can change the name of a hospital and modernise it, yet some people still think of it as the county home. In the past some old buildings were not up to standard but in fairness the nursing profession provided excellent care for the elderly. Health boards must continue to ensure that beds are available for elderly people and those suffering from, for example, Alzheimer's disease.
Section 15 requires a health board to publish an annual report on the performance of its functions during the preceding year. Deputy O'Malley said that in some cases reports had not been published for three or four years and this amendment will ensure that action is taken as soon as possible to deal with a problem which arose in the previous year. Section 20 deals with nursing homes. Most nursing homes provide excellent facilities but we always hear about those which are not up to standard. Such homes should not be tolerated and section 20 will ensure that people cannot cash in, so to speak, on the fact that elderly people have to be admitted to nursing homes. No mercy should be shown to nursing homes which do not meet the required standard. In saying that, I admit that most nursing homes provide excellent facilities. While people must have adequate financial means to be admitted to private nursing homes at least they ensure that people can end their days in peace.
I welcome section 21 which provides that the Minister may extend the term of office of An Bord Altranais pending the enactment of a Bill to revise the Nurses Act, 1985. I hope An Bord Altranais will prosper and that the present dispute with the nurses will be resolved. It is of little use referring to the vocation of nurses when they believe they deserve more money. The Minister has gone a long way towards meeting the demands by providing £40 million and I hope a solution can be found to this difficult problem. We do not want nurses to go on strike as it would not be good for patients or the nursing profession.
I welcome the Bill which I hope will improve the workings of health boards and their members who are being given responsibility for the allocation of funding. I was a member of a health board for a few years before I became a Deputy and I know how easy it is to criticise the chief executive officer for not doing certain things. However, it is not easy to cut back on the funding for one section and give it to another. I hope that the members of health boards will spend these vast sums of money wisely so that we have a better health service.