Other speakers have dealt with the structural changes in the health boards, which will come into effect in the new year. I would like to focus on whether the changes proposed in the Bill will have any real consequences for those using the health services on a daily basis. The Bill will merely result in more quangos, more bureaucracy and anything and everything to reduce the accountability of the Minister in the House and prevent us as public representatives from getting answers about anything to do with health. I sometimes wonder whether the Government wants the Opposition to ask questions anymore. These proposals were mooted 18 months ago and now in the run-up to Christmas we have a few hours to debate this important Bill. I was elected to bring the views of the people of south Kerry to this House. I have ten minutes — and lucky to get those — to speak on the issues I want to bring from south Kerry. I do not believe we live in a democracy anymore — the sooner people realise that the better — I believe we live in a dictatorship.
Widespread concern has been expressed on all sides of the House about the decrease in the level of public accountability in the new health service structures. The Tánaiste and Minister for Health and Children has not made adequate provision for accountability and transparency in this legislation. Many Deputies on all sides of the House fear that the Minister for Health and Children will have a much reduced level of accountability in this House. While a number of Deputies have asked the following questions, they cannot be asked often enough. I hope that whoever replies at the end of this debate will answer them.
Will we, the elected representatives, be able to obtain information from the Tánaiste and her Department in response to parliamentary questions? When pressed about a matter by a Deputy, will the Tánaiste or a Minister of State adopt a new mantra of claiming the matter is one for the HSE or the hospitals agency? When I submit a health matter for debate on the Adjournment, will I receive a note from the Ceann Comhairle stating it is not a matter for the Dáil but for some other body, as happens today with issues under the remit of the National Roads Authority? Despite what Deputies on the other side of the House say, it will not be possible to give local input into the services for local people and those of us representing the local people will have no say. One wonders whether the Health Service Executive and the other bodies will bring about any improvement for the health consumer. Will the people on trolleys in accident and emergency departments get a bed sooner or will the thousands on orthodontic waiting lists get to see a consultant?
I refer to a number of deficiencies in the health services in my constituency which I hope will be addressed by the new Health Service Executive, although I doubt it. For example, Kerry General Hospital provides an outstanding level of service for the people of the county. However, it is facing underfunding and a shortage of capacity at present, particularly in the accident and emergency and maternity departments. The hospital is crying out for a new expanded accident and emergency department. The hospital submitted plans to the Department of Health and Children in 2002 but the Minister has not sanctioned the development which would provide an extension to the accident and emergency unit and a renovation of the existing unit. Regrettably, the Tánaiste chose not to include this much-needed development in her recent Estimates for 2005 under the capital programme. How much longer will we wait? Under the new proposal I believe we will wait a long time.
The maternity department at Kerry General Hospital is in acute crisis at present. Births in County Kerry have gone up from 1,010 in 1994 to 1,446 last year, a 40% increase in a decade. However, the maternity unit has not been upgraded to deal with this increase. The hospital has a major shortage of midwives and services are under extreme pressure. The consultant obstetrician in the maternity unit has described this as potentially dangerous and the management of the hospital has indicated it may have to reduce the number of planned gynaecological procedures to ensure a safe service is available to all patients. As we all know consultants very rarely make such public statements.
The Kerryman newspaper reports this morning that nurses at Kerry General Hospital with qualifications in midwifery are being asked to work extra hours to cope with staffing shortage in the maternity wards. How does the Minister respond to this totally unacceptable situation? Can she give any guarantees that the new National Hospitals Office, being established under the Health Bill, will ensure that facilities such as the maternity department at Kerry General Hospital will be adequately equipped and staffed to a level sufficient to provide fully for the needs of patients?
According to a recent reply to me in a parliamentary question, the Tánaiste and Minister for Health and Children advised me that the establishment of a project team to progress proposals for a new maternity unit at Kerry General Hospital is to be considered in the context of available funding under the capital fund for 2004-08. She is, therefore, admitting that it may be as late at 2008, four years away, before this vital project progresses. If the delays in progressing this work are as long as the delays in advancing the construction of a new hospital in Dingle or an extension to the hospital in Kenmare, the people of Kerry will be waiting a very long time.
A few weeks ago in this House, I raised the major delay in sanctioning the new community hospital for Dingle, which has been delayed by Fianna Fáil representatives in my constituency for almost a decade. I have little confidence that the Health Service Executive or the hospitals office, which will come into being in the new year, will deliver on these projects given the track record of the health boards and the Government to date.
I take this opportunity to refer to the mounting orthodontic waiting lists in County Kerry, which are not being addressed by the Government after seven long years in office. The average waiting time for orthodontic treatment in Kerry at the moment is four years. Some 875 patients are waiting to see an orthodontist in Kerry at present and 75% of those patients are waiting for more than a year. This is an absolute scandal. While orthodontics, by its very nature, requires early intervention to deal with dental deformities, especially in children, in Kerry it now takes an average of four years to get an appointment. Delays in getting orthodontic treatment represent one of the greatest problems in the modern health service, which has not received the appropriate level of funding or personnel from Government to meet demand. When the history of the modern health service is written, the scandal of the orthodontic waiting lists will go down as a major blot in the copybook.
While I could speak at length about other issues, I have insufficient time. Why, for example, are we still waiting for the BreastCheck programme to be rolled out to the south west? While the capital funding has been allocated, it will be another three years at least before the programme is operational and the Government has made no current expenditure provision for its operation.
How much time do I have left? Am I nearly finished?