I welcome the opportunity to speak on this important issue. The problem in our health system is the most serious one with which the Government and country must deal. We all know of cases where the system has let people down badly. I warn the people of Ennis and Nenagh that it is only two years since the people of Cavan-Monaghan were given strong promises regarding Monaghan General Hospital.
This Bill aims to abolish the health boards as we know them and to give power to the CEOs to deliver the service. As one who has experienced the activities of the administrators of the health board in the Cavan-Monaghan region in recent years, this proposed change frightens me. Admittedly, the administrators did not take account of the views of the elected representatives in the area because the board, as structured, comprised many other members plus Government hacks. Many measures were bulldozed through regardless. The needs of the people of the area concerned were not a priority.
This Bill seeks to abolish the structures put in place under 1970 Act, the 1996 Act and the 1999 Act. It will amend the provisions of the Local Government Act 2001, which govern the nomination of members from the city and county councils. The main points of the Bill are that it provides for the abolition of the membership of the health boards, etc. and leaves the way open for the CEOs to take control. To use the Minister's words, what is proposed is the termination of office of all members of the health board on the date on which the order is made.
We are taking a serious step in this. A previous speaker said that prior to the health boards being set up, the health service was administered by the county councils. The record of Monaghan General Hospital reveals that when it was run by the local county council and by its chief — a matron — the services available were much better than those available today.
Section 10 states that the CEO must provide the Minister with any information on the performance of his or her functions as the Minister may from time to time require. Section 13 assigns to the Minister the board functions in the appointment and removal of the CEO. The Minister should take this provision seriously because he has avoided making any decision such as that, even having regard to the powers he has had under the existing legislation in the recent past. As a result, the people of Monaghan have seriously suffered. Somebody said that the Hanly might not be perfect and might need tweaking here and there. Those who believe the Hanly report can serve the good of the country need to note what has happened in Monaghan General Hospital.
We are advised that these proposed changes must be made because of the provisions of the working time directive and that the boards will be replaced by a group which will discuss issues with the Minister, the CEOs, etc. That will be a talking shop with no power. I record that in the case of the North Eastern Health Board, even members who were elected to it did not adhere to the agreement made by the people who put them there. I am mindful of the nurses' representative who voted at all times against the interests of Monaghan General Hospital, but when she resigned she was encouraged to go back there not by the nurses but by the administration. That is the type of concern people have about who will run our health service in future.
I want to return to the point I made about Monaghan General Hospital and the comment I made about the people of Ennis and Nenagh.
Some of the comments I intend to make about Monaghan General Hospital may not be pleasant but they reflect reality. Two years and three months ago the Minister visited the hospital. As reported inThe Northern Standard at the time, he stated: “I have been left in no doubt about the depth of feeling in Monaghan about the hospital. My visit has been very positive and productive from that point of view.” He further stated there was no question of Monaghan hospital closing and that this was simply not on anybody’s agenda. He then said: “I understand and realise there are significant credibility issues here. People do not believe what they are being told from official sources. I accept that.” He proceeded to list everything that would be done and stated that in the previous three years alone, €4.5 million had been invested and that 15% more people were using the medical and surgical services than was the case in 1997. All Ministers like to refer to the latter year. The Minister further stated at the time that, in terms of the future, the health board had adopted a plan in 2001 and outlined all the promises it had made.
These were the commitments made by the Minister to the people of Monaghan in the run-up to a general election. He was adamant that the hospital was needed because the country required additional capacity in its acute hospital services. Referring to the bed shortage nationally, he stated there would be no percentage for any Minister in closing hospitals because all spare capacity was needed. On concerns about the planned surgical services review, the Minister said the health board had indicated that surgical services in Monaghan could not be closed down and that the additional workload could not be met by other hospitals. He added that extra junior doctors would be appointed in order to ensure the accrediting body would not recommend the surgical service be closed. He also said that the latter issue would be "looked at in the coming weeks".
That is what happened in Monaghan. When one realises what happened in Ennis and Nenagh a few weeks ago, one is left to wonder about the future. What we want, from the Department's point of view, is for surgical services in Monaghan to continue. In the run-up to the most recent general election, the Minister's party gave absolute guarantees that future developments would include a midwife-led maternity unit. It further promised that all medical emergencies would be treated in Monaghan, that surgical emergencies would be treated in Monaghan as determined by the consultant on call and that 80% of accident and emergency would be treated at Monaghan General Hospital. It also promised that substantial funding would be made available for building and refurbishment, that ten extra beds out of the 38 for the North Eastern Health Boards would go to the hospital, that there would be one new consultant geriatrician, one new consultant dermatologist and one new consultant with five junior hospital doctors, and that Monaghan hospital would be staying open. What happened? On 2 July, Monaghan hospital was taken off call.
The staff at Monaghan General Hospital are doing a great job for those who know how to get in through the backdoor, namely, those who arrive by car. People cannot avail of the ambulance service unless doctors, in individual cases, insist that an ambulance is required. In one recent instance, a doctor simply ordered the ambulance staff to take a patient the short distance to the hospital. The man in question literally died on his way through the doors of the hospital but the staff were able to resuscitate him. That man would not have lived had he been obliged to travel to hospital in Drogheda or some other location. We are talking about matters of life and death.
In his contribution, the Minister outlined the reasons he wants to do away with the health boards. I am not completely against replacing the health boards, as currently structured. There are difficulties in the current service and there are reasons for making it more organised. However, it is naive to suggest this will result in an end to all our problems. The Minister stated the health strategy will bring about, "better health for everyone, fair access, responsive and appropriate care delivery and high performance". He also stated there are too many agencies and the service is too fragmented. He did not mention a health ombudsman or anything else that might improve the situation. The Minister also referred to:
a major rationalisation of existing health service agencies, including the abolition of the existing health board-authority structures; the establishment of a health services executive, which will be the first ever body charged with managing the health service as a single national entity . . . the establishment of a health information and quality authority to ensure that quality of care is promoted throughout the system.
I will read no more of the speech because what the Minister said was meaningless. I do not mean that in any derogatory sense because that is not the way I operate.
We must consider what is happening at present. Only last week the Minister provided an outline of how well he is doing in terms of reducing waiting lists. I was visited in my office this morning by an aged lady who was making representations on behalf of her 79 year old husband who has been seeking help with his hip problem for the past three years but who, as yet, has not been placed on a waiting list. It is easy to state that waiting lists are being reduced if people are not allowed to be included on them. It is as if they do not exist.
I was contacted by a young man in connection with his three year old daughter. The man in question also has a four year old son and a year ago he had to bring him to a Dublin hospital to have his tonsillitis treated. The child's throat was literally closed and the man asked when the child would be dealt with. He was informed it would take three years. When he asked what would happen if he went private, he was told it would only take two weeks. He was obliged to part with €1,300 in order to have the operation carried out. A year later, he is again desperate because his three year old daughter has a similar problem. He is hoping the operation can be done at Omagh. These are the types of matters with which Members must deal in their clinics on an ordinary day.
I cannot help but think about the family of a man who had a heart attack the other day. He was rushed to one of the major hospitals in Dublin at 5.30 p.m. He was 22nd on the list for treatment and was cared for by a junior doctor between 5.30 p.m. and 7.30 p.m. However, the doctor's shift ended at that time and it was approximately 9 p.m. or 9.30 p.m. before the man was dealt with and he passed away. How must his family feel today? We have all seen footage on television of ambulances with their sirens sounding arriving at hospitals and being awaited by emergency teams. Hospital staff used to be able to do that and they should still be in a position to do it. However, Monaghan hospital and other hospitals are now off call and services are being grouped at centres of excellence that are not yet prepared to deal with people.
As a member of the British-Irish Interparliamentary Body, I was recently privileged to be part of an inquiry into health services in particular areas. One of the places we visited was the Isle of Man. People may say that money from this country has been invested there illegally and that it has adequate funding as a result. However, I saw how the service there operates. A new 314 bed hospital was built within four years for a population of 75,000 to 85,000 people, depending on the number of holidaymakers in the area. The new hospital will have 24 new consultants and does not seem to have any trouble getting personnel. The charge on the taxpayer for the health service there is just a little higher than what we charge, about half as much again. They apologised because they have a waiting list of six months for a person needing a hip operation, but they hope to reduce that time to three months shortly with the six new theatres in the hospital.
On another occasion we visited a hospital outside Cardiff to see a new modern midwife-led childbirth service. A similar service was promised for Monaghan, but nothing has happened. We then went up to Wick, 108 miles north of Inverness and 15 miles short of John O'Groats. There the maternity service was under pressure with only about 200 patients using it in a year, I think it may have closed since.
That visit opened my eyes to what is wrong with our system. The Minister's personal adviser was with us on the trip and he pointed out that there was nobody in the emergency unit of the hospital we visited. It is true it was not under pressure, but it was at least able to provide a service to any patients who turned up and to ensure they were safe to travel the 108 miles to Inverness.
We also visited the health care service there where five or six doctors worked. They ran an ultra modern health service providing care at primary care level for people so that they do not have to end up at the accident and emergency unit. This service is provided free, which makes all the difference. The Minister should remember that a promise was made before the general election that 200,000 extra medical cards would be provided. However, a reply to a parliamentary question indicates that instead some 47,000 cards have been withdrawn.
I listened to a colleague from the Fianna Fáil party and Deputy Olivia Mitchell argue on radio about the issue. The Fianna Fáil Deputy said the reason the cards were removed was because all of the people involved were on such good incomes that they no longer needed the cards. This is one of the biggest issues in my office on a daily basis. People with genuine long-term illness have their medical cards removed and their families are in dire distress. If the Minister does nothing else, he should fulfil the commitment to deliver the extra 200,000 medical cards. He should also restore the 47,000 which have been withdrawn.
I cannot help reminding the House of an 87 year old woman who has to take care of her adult disabled children. She worries about what will happen when her life ends or when she is no longer able to look after them. The "Prime Time" programme on RTE last night dealt with the area of autism. When will this Government pass the disability Bill which will give some rights to people who desperately need help? I did not have the opportunity to see the programme last night. However, I heard snippets on the radio. It would make anybody cry that so many people are enduring so much distress at a time when this country was never as well off financially. Some €500 million more than expected has been added to the kitty from taxes and €150 million extra has come in from dormant accounts. Money is also available from other areas.
I beg the Minister to do what is necessary to get Monaghan General Hospital re-opened on call to provide a proper service to people. He appointed Kevin Bonnar to examine the issue and said that €14 million was necessary for the service. The Minister has decided he will provide €2.75 million. In order to provide some comfort to hospitals such as Ennis, Nenagh and other hospitals around the country, the least the Minister should do is to treat Monaghan General Hospital with some dignity and respect and bring it back on call.