As the first two items are being taken together each Deputy has five minutes and the Minister of State has ten minutes to reply.
Health Services.
I wish to share time with Deputy Sherlock. One of the issues Deputy Sherlock and I have in common is Mallow General Hospital. I congratulate Deputy Sherlock on his efforts for the hospital over many years.
Mallow General Hospital is just outside my constituency but serves many people from Cork North-West stretching back to Limerick West. Once, Mallow General Hospital was threatened with closure but I am pleased that threat has been lifted. What is needed is to ensure the proper facilities are put in place. There have been a number of commitments in regard to Mallow General Hospital and in recent years many improvements have been made.
I ask the Minister of State at the Department of Health and Children to outline his Department's vision and that of the Health Service Executive for the future of Mallow General Hospital. I have been a patient of that hospital as have members of my family and I cannot praise sufficiently the level of care provided. Many of my constituents who have had reason to be patients of Mallow General Hospital have spoken of the excellent care provided to them.
I thank Deputy Moynihan for his kind remarks but I hope he will impress the Taoiseach and the Tánaiste with the same remarks. In 2001 there was a permanent radiologist in Mallow General Hospital. However, when an application was made to Comhairle na nOspidéal, Mr. Donie Ormond, the Fianna Fáil member who was vice-chairman of Comhairle na nOspidéal at the time, suggested that two should be appointed, that Mallow General Hospital should have seven sessions and Cork University Hospital should have four sessions rather than Mallow having ten sessions and Cork University Hospital having one session. The volume of work in Mallow General Hospital is sufficient to warrant the appointment of a radiologist directly to Mallow. This is five years after the issue was raised in the first instance. That is outrageous at this stage.
Progress is not being made and the delay is for the purpose of downgrading Mallow General Hospital and have patients transferred to Cork University Hospital. I have no doubt about that.
Mallow is a developing urban area that is designated hub town. Mallow General Hospital serves a population of 90,000 to 100,000 people and allows them access acute accident and emergency services as well as medical and surgical services within the accepted golden hour. The general practitioners in that region back up the case. We demand action as we believe there is no reason the hospital which has been served by a temporary radiologist for the past five years should not have a permanent radiologist appointed now.
The Tánaiste and Minister for Health and Children, Deputy Harney, wrote to me on 25 March stating, "it is a matter for the Health Service Executive. Under the Act the executive has responsibility to manage and deliver the service." On 19 April 2005 the medical manpower manager, Cork University Hospital, in the Cork region said, "The outstanding issue is funding for which we are still awaiting authorisation". The reason it is not happening is that we are waiting for funding.
A sum of €1.5 million has been collected for a CT scanner approved in 2004. We were informed the scanner would be installed in an area occupied by a staff canteen adjacent to a radiology department. To date nothing has happened.
In Mallow General Hospital 90% of the people can be treated in the general hospital system. In Cork University Hospital the daily cost per patient is €747 while in Mallow General Hospital the cost is €477. Given that the facts are now on the record of this Dáil I hope the Minister of State will act on this.
The Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for the provision of acute hospital services and the appointment of new or replacement consultant posts. As such, the Department of Health and Children no longer has a role in regard to funding arrangements for individual consultant posts.
Provision of radiology services at Mallow General Hospital had been the subject of detailed discussion between Comhairle na nOspidéal and the former Southern Health Board up to 2004. Comhairle na nOspidéal had advised that a stand alone single-handed consultant appointment could not be sustained. Considerable efforts have been made to find a solution to resolve the problem of consultant radiology staffing cover at Mallow General Hospital, including the possibility of partnership arrangements with Cork city hospitals. It is now a matter for the Health Service Executive national hospitals' office to ensure the radiology service at Mallow General Hospital is supported to meet the needs of the local population.
Capital funding has been allocated for the provision of a CT scanner at Mallow General Hospital. This will improve the quality of services to patients and avoid difficulty in transferring such cases to and from Cork city hospitals, as occurs at present.
The Department of Health and Children has been informed by the HSE southern area that the CT scanner will need to be housed in purpose-built accommodation adjoining the radiology department. This will involve careful architectural and planning work. Tender specifications for the purchase of the CT scanner in accordance with EU procurement directives are also being prepared and will be placed in the EU Journal shortly. The Department of Health and Children has been assured that the HSE southern area is moving as quickly as possible on the project.
The Government must provide the finance.
Care of the Elderly.
I thank the Ceann Comhairle for allowing me to raise this important matter. A society can be judged by how it treats its older and infirm members. On that basis this Government stands condemned for its cruel, callous and uncaring actions and attitudes towards our elderly and infirm citizens and particularly by its withdrawal of home help workers.
The home help scheme was intended for and used to good effect to assist elderly and infirm people to continue to live in their homes for as long as possible and in comfort and dignity. Home helps were usually neighbours who were known and trusted by the recipients of the service. They performed everyday but essential tasks. They cleaned the house, made the beds, helped to dress the recipient and did the shopping. These are simple tasks which the old and infirm were no longer able to do for themselves. The home help workers sometimes did much more. This simple and economic service allowed the recipients to live in relative comfort and dignity in their homes.
This service ensured the recipients were not forced to leave their homes and go into long-term care in very expensive institutions. This service ensured that the recipients were enabled to return home following hospital treatment, thereby leaving an acute treatment bed free for others. There has been much comment about accident and emergency departments and hospital trolleys in recent times and very expensive solutions to remedy same, but restoration and expansion of the home help service was not considered. Beds in hospitals and places in long-stay care could be freed up immediately if the home help service were restored.
For some reason best known only to themselves, the Government, now known as the caring Government of Fianna Fáil and the Progressive Democrats, God help us, has reduced incrementally the hours available in the home help service each year since 2002. In County Kildare, the figures are as follows. In 2002, 590,000 hours were available, 440,000 hours in 2003, 367,000 hours in 2004 and 336,000 hours in 2005. This is a cut of 254,000 hours of service to the old and sick, which is a cut of 40%. In the northern Kildare area, the cut amounted to 50%.
This has left many vulnerable people, the weakest in the community, at great risk. Many have had to opt for long-term care, others struggle on as best they can with a drastically reduced quality of life while others remain in acute hospital beds because the service is not available at home. This cut in service makes no sense. It is cruel and callous in its disregard for the suffering of our weakest citizens and shows no gratitude, respect or regard for their lives of work and contribution to society. It makes no economic sense. There is no saving as the alternatives are more expensive.
I call on the Minister of State to restore the hours available for the home help service to at least the 2002 level. Even if he has no regard for the elderly or the infirm, I suggest he does it for good economic reasons given that his party is driven by economic policies. The home help service provided on a shoestring was the best social and economic scheme and must be restored.
I pay tribute to the home help workers who did an excellent job in a neighbourly way with a large number of people. Many of them have been physically withdrawn from helping 80 year olds living alone who must now live in expensive, State-run institutions. This is the situation at local level and it is crazy. I am aware the home help workers were awarded increases in pay but the allocations were not made to meet the increases in pay and the hours were reduced by 40% in County Kildare.
As the House will be aware, the policy of the Department of Health and Children for the development and delivery of services for older people is to maintain them in dignity and independence at home for as long as possible in accordance with their wishes as expressed in many research studies; to restore to independence at home those older people who become ill or dependent; and to encourage and support the care of older people in their community by family, neighbours and voluntary bodies. The role of the home help service is vital to the implementation of this policy.
Following the publication in 1998 of the report, The Future Organisation of the Home Help Service in Ireland, by the National Council on Ageing and Older People, there has been a major step forward in the implementation of the home help scheme from 1999 onwards with the service being provided to an increasing number of older people.
On a point of order, the Minister of State may be inadvertently misleading the House because what he is saying is not true.
There is no provision for a point of order.
I will deal with the figures, if the Deputy can be as patient as I was. There are a number of reasons there are increasing demands on the home help service, one of which is the demographic fact that approximately 6,000 people are coming into the over-65 bracket every year with a proportionately higher percentage increase in the more dependent over-80 category.
The aim of the home help service is to enable people to remain at home, where appropriate, who would otherwise need to be cared for in residential care. It is recognised that the home help service is an essential support to family and informal carers. The service, by its nature, is a flexible one designed to respond to clients' needs. It is targeted at high and medium-dependency clients in accordance with their assessed need. As a result, the level of service required in individual cases will fluctuate from time to time. I assure the House that this Government is committed to developing the home help service as a community support for older people living in the community.
There seems to be a discrepancy in the figures but I will give the figures I have been given by the HSE south western area.
I was given the figures by the Minister of State's Department.
The HSE south western area confirmed the following figures for the last three years: In 2002 the number of home help hours was 527,622 and the corresponding funding was €3,558,849; in 2003 the home help hours were 441,096 and the funding was €4,745,000; in 2004 the home help hours were 428,642 with funding of €4,565,000. I acknowledge a discrepancy in the figures. I will confirm the figures for the Deputy.
The figures indicate a 16% decrease of home help hours in 2003 from the 2002 figures. A further 3% decrease in hours in 2004 gave a total of 19% less home help hours since 2002. The HSE south west area has advised the reduced service levels were due to the demands on service beyond the available budget allocation.
The Tánaiste is concerned at the reduction in home help service levels that has arisen in this area since 2002. She has asked the Health Service Executive to reconsider this as a matter of urgency in the context of the needs of the area.
I thank the Ceann Comhairle for selecting this issue for discussion. Planning permission in respect of refurbishment and extension works has been granted for the MacBride community nursing unit in Westport, County Mayo. The unit has been open since 1974, has 49 full-time residents, one respite bed, and 20 to 25 patients availing of day care services.
Extra equipment has been provided to the unit but the problem is that there is insufficient storage space for it and not enough beds. Planning permission has been granted to refurbish and extend the premises and there is a health and safety issue with the storage of equipment. This unit is one of several public day care centres in Westport and it has provided a good service over the years. I congratulate the matron and her staff on the excellent job they have done in looking after their elderly patients. It is proof of their good work that so many seek beds in the day care centre.
The previous Minister for Health and Children, Deputy Martin, announced a package of €170 million for the provision of 800 community beds, of which Westport expected to receive a proportion. I was disappointed to learn on the Order of Business this morning that the new Minister, Deputy Harney, has stopped the sanction for these beds. We cannot have a situation where badly needed beds in every hospital are occupied by patients who should be in long-stay care but for whom no such facilities are available.
The Government must get its act together and I call on the Tánaiste and Minister for Health and Children to provide the necessary funding for the MacBride unit in Westport so that extra beds can be provided and equipment properly stored. Patients in need of long-stay residential care must be accommodated in nursing homes such as this so that hospital beds can be freed up. The MacBride unit has the necessary planning permission and a willing staff. Extra staff will be required when the extension is completed because there is only one nurse and one care attendant looking after 50 patients every night. This is unacceptable.
Is the Government serious about providing adequate care services for the elderly? The home help scheme and the new home care package announced by the Government are inadequate. We were told in the House this morning that the funding for the latter scheme has already been spent. This Government is engaged in too much spin. The Tánaiste has 14 spin doctors but there are fewer than 14 medical doctors in Mayo General Hospital to look after the needs of the entire county. We must get our priorities right and provide adequate resources for care services for the elderly. I call on the Minister of State to provide the necessary funding for the MacBride facility in Westport.
I must correct the Deputy. The Tánaiste does not have 14 spin doctors but it is a good line.
That information was provided in last week's Sunday Independent.
Does the Deputy believe everything he reads in the Sunday Independent?
The Government gets a great deal of coverage in that newspaper. I do not have the privilege of writing an article for it.
The Minister of State should be allowed to reply without interruption.
The Government has made services for older people a priority and is fully committed to the development of a comprehensive health service capable of responding quickly, fully and effectively to the health service needs of older people. In recent years, health and social services for older people have improved both in hospitals and in the community. Since coming into office, the Government has substantially increased the level of funding, both capital and revenue, in respect of services for older people. In excess of €302 million in additional funding has been provided for services for older people from 1997 to date. This serves to demonstrate the Government's ongoing commitment to improving services for our older population.
Significant capital funding for the health sector has been provided since the commencement of the national development plan in 2000. A day care centre is recognised as an important service in the continuum of care necessary to support older people to remain living at home. It provides older people in the area with a facility where they can meet new friends and enjoy recreational activities, thus promoting social contact among older people and preventing loneliness. Such facilities provide a break for carers and social and physical stimulation in a safe environment for older members of the local community.
Older people deserve first-class facilities and recent years have seen dramatic changes in both the concept and practice of services for older people. Good progress has been made, and continues to be made, in developing a comprehensive, community-based service that is integrated with other health services. The shift in the delivery of services from predominantly hospital-based care is achieving success. There is no doubt the quality of care for older people has been enhanced by this development. The issues surrounding older people and their welfare are given priority by this Government.
The MacBride community nursing unit is a 40-bed Health Service Executive western area facility located in Westport, County Mayo. The existing services include residential, respite, day care, physiotherapy and occupational therapy outreach services. The Health Act 2004 provided for the Health Service Executive which was established on 1 January 2005. Under the Act, the executive has responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services, including its capital programme.
The progression of the proposed day care centre at the MacBride nursing unit is therefore a matter for the HSE. The proposal to refurbish the building is primarily aimed at increasing day care capacity to cater for the waiting list for this service. Approximately 18 to 20 persons attend the service on a daily basis. To increase capacity, it is necessary to reorganise the services internally as the site available is limited for development purposes.
The Department has been provided with the details in respect of this project by the HSE. The proposed works consist of both new build and refurbishment proposals at the existing unit. Planning permission has been granted and a fire safety certificate has issued for the project. However, an outstanding issue of site ownership must be addressed before the project can proceed further. Professional fees paid to date for the project amount to nearly €47,000, an element of which was in respect of upgrading works to the existing nursing unit. It is a matter for the HSE to consider the proposed development at the unit in the context of its overall priorities and funding resources for 2005 or beyond.
The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Thursday, 28 April 2005.