Provision of Health Services by the HSE: Statements (Resumed)

I wish to share one minute of my time with Senator Mullen.

I thank the Minister for being here and I, too, will cut to the chase. I am sorry for being parochial, but I must be. Like Senator Feeney, I consider that the glass is always half-full, but the situation in the Athlone and Mullingar area services of the HSE is desperate. Only yesterday I received a reply from a consultant whom I had asked to expedite a hip replacement operation for a 75 year old lady, as she had been waiting for two years. He wrote to say he would if he had a bed, which he did not.

I also have very serious concerns. When our delegation met the Minister last week to discuss the moratorium on the filling of nursing posts, she stated five administration staff had to leave the service before she could employ another nurse. Most nurses are female and will at some point go on maternity or parental leave or retire. As such I am concerned about how we will keep beds open in Mullingar hospital if we do not have the required number of nursing staff. I ask the Minister to address the issue because HIQA is highlighting the serious issues with regard to agency staff.

While the overcrowding in Mullingar hospital last year had nothing to do with junior doctors, it is a major concern for them, a point that adds weight to Senator Dearey's comments regarding services in Louth. Some 4% of doctor posts in Mullingar hospital have not been filled this year. When the junior doctors rotate on 1 July, the figure will double and we will reap the rewards of the serious understaffing. Last Christmas, our accident and emergency department was closed because of overcrowding owing to 40 beds being removed from the system.

I am concerned about the constant niggling away at services in Mullingar hospital, which has won many awards. The Minister referred to hygiene awards, but we have won them all. She stated that hospitals would be rewarded for doing a good job. Mullingar hospital has done an excellent job, but we are constantly being downgraded. Our post mortem facilities were removed in recent months because we could not upgrade them to the tune of €250,000. Last week, someone told me how a relative's remains needed to go to Cavan for a post mortem because the services in Tullamore were full. This is not acceptable. We needed to fight to get a sexual assault unit for Mullingar hospital, but the possibility of moving it to Tullamore has been mooted. Tullamore does not even have gynaecological services. The unit is badly positioned in Mullingar hospital, there are no bathroom facilities and there is a staffing problem. Will the Minister address this issue?

We have spent much time thrashing out the serious issue of Loughloe House. I thank the Minister for listening to us and taking the time to meet our delegation last week. I accept her statement that fair care of the elderly was the way forward. It is a good system, but the closure of the nursing home in Athlone has led us to realise we have no respite service. This matter has not been addressed since our meeting one and a half weeks ago. All of the area's public representatives who attended a meeting with the mid-Leinster health forum yesterday supported keeping those care homes open. There is one in Mountmellick, Athlone, Longford and Mullingar.

I examined the configuration — a word the HSE uses often — of the membership of management at Naas General Hospital yesterday. I have never seen such a top-heavy room of managers. They each had a role, yet nothing was being done.

Some 15 people will be turfed out to sterile, cold places to which they do not want to go and will be separated from their friends. The money spent on re-accommodating them would keep them in Loughloe House until they died. There is no compassion for them. One old man has two dogs. Two ladies who are best friends, talk to each other and go to mass and prayer meetings together will be separated. It is morally wrong. I cannot stay quiet about it, although I am sorry for labouring the point. Of most importance is dignity and respect for the individual. We can never lose track of this point, regardless of economies of scale.

I must ask the Senator to conclude if she is to share her time.

My final point is on HIQA. The HSE has become a monster behind which we can hide. There must be accountability and the buck must stop somewhere. I worry that HIQA is being used as cover. Issues can be addressed without closing facilities.

Senator Mullen has less than one minute.

I will try to make this a miraculous minute. I welcome the Minister. It was a pleasure to listen to her, as she has a fantastic mastery of her brief. It would be nice were more Ministers to speak in the House in such an informed and competent way without the aid of notes. I compliment her in this regard.

I will make four brief points. First, the Minister mentioned the cardiovascular implementation plan, which is to be welcomed, but funding is the issue. She rightly pointed out that there were 12 stroke units, but some, including the Irish Heart Foundation, would say not all of these measure up to international standards. Some 20% of people could benefit from thrombolysis, yet only 2% get it. The good news is that money up front in stroke prevention can prevent the outlay on nursing home care or hospital stays down the line. The emergence of a business plan that would allow the investment needed to improve the service should be possible.

Second, everyone appreciates the good work done by the hospice movement. The Irish Hospice Foundation insists on there being greater strategising in respect of end-of-life hospital care. When I recently attended a conference on this matter, everything from a hospital's layout to the question of whether there was room for the soon-to-be-bereaved to meet the soon-to-be-deceased to discuss sensitive issues was raised. There is great potential for investment. A die with dignity programme has been proposed by the Irish Hospice Foundation and I hope it will be given a listening ear, as it could do so much to help people in difficult and trying situations.

The Senator is running out of time. I will need to indulge him.

The Acting Chairman is kind and I am forever in her debt, or at least until the end of the day.

Third, we have all heard from the Save St. Luke's Hospital campaign today. Is this a done deal? The campaigners asked whether the projected increase in new cancer cases should lead to a questioning of the decision to close St. Luke's Hospital and move to St. James's Hospital. I would welcome the Minister's opinion.

Fourth, legislation is expected on the delicate area of assisted human reproduction. I ask that we will have a unifying approach in this respect. I hope that telephone interference is not coming from me.

It is gone. I hope our approach will unite the community, given the potential of induced pluripotent stem cell research in particular. This is an area in which we could fight the way up the mountain together without dividing the community. I hope this consideration will be taken on board in the shaping of legislation. I thank the Minister. I also thank the Acting Chairman for her indulgence.

May I share half my time with Senator Carroll?

Words fail me in trying to describe the Minister's eloquence. It was a magnificent presentation and listening to her was a joy, pleasure and education. As she knows, I have been supportive of the fair deal scheme, which has led to a dramatic change in the lives of older people who need to enter long-term care and their families. They no longer need to worry about where they will get the money, so I compliment the Minister.

To make the most of this opportunity, I wish to raise a couple of points. I am supportive of the fantastic centres of excellence idea and free breast cancer screening, although I previously asked the Minister about when the latter would be introduced for older people. Women over 65 years of age are seven times more likely to get breast cancer than a woman under 65 years of age. As I mentioned yesterday, Dr. Somers recently stated that the Department of Finance says "No" to everything. The majority of people in that Department are men and do not comprehend that women over 65 years of age need health care as much as women of 25 or 40 years of age. I plead with the Minister on this important issue of the human rights of older women.

Loughloe House has roused the emotions of people in the midlands. If people in the area are strongly of the belief that it can be saved in its present form, they have a democratic right to be heeded. The Health Information and Quality Authority, HIQA, gave them a good report and a different decision was made. It would be well worth the Minister's while examining that issue again.

The other one dear to my heart is the thalidomide issue. I am putting my reputation on the line by saying I intend to stick with this issue until we get a fair and just solution. The suggestion in the Minister's proposal about assessment of the needs of the people is very welcome but in terms of the monetary compensation, each one of the 32 survivors of thalidomide has different physical needs and we just cannot give a sum. Each person must be assessed in terms of what he or she needs to help him or her live a normal life.

The Minister is aware of Maggie Smith, who is 3 foot 8 inches tall. She has a job and works every day. She has two children. In terms of thalidomide, I remember it all happening and the thalidomide survivors are an inspiration to me. It is extraordinary what they have been able to do with their lives. I intend to stick with this issue and I will put my reputation on the line. I would appreciate it if the Minister could examine this again. It is critical that we do something because the State failed on that issue. Dr. John O'Connell stated in his autobiography that four years later he could still buy a thalidomide tablet in a hospital in Donegal. It is frightening. There is an obligation to do something.

I have been hearing on radio programmes about child carers but it was not until yesterday that I understood that term. As I stated at the health and children committee, 95% of people in Ireland have never heard of child carers. There are thousands of children in this country who are looking after dysfunctional parents, grandparents and siblings. Apparently, five year olds are looking after parents who are dysfunctional either from mental illness, alcohol abuse or whatever. They are worrying about issues such as food and the safety of their parents or grandparents. Apparently, there are thousands of child carers in the country between the ages of 15 and 18 years and their emotional, physical and educational needs must be met. I asked Enda Egan, the chief executive of the Carer's Association, what is being done currently for child carers and to prioritise what we must do for them. He said nothing is being done. We must address that. I plead with the Minister on that issue. It is horrific to hear about child carers minding their parents. God help them.

I thank the Minister. I love listening to her speak. She is an example to all of us. I am aware that in terms of the Health Service Executive there is a lot to be done——

The Croke Park agreement is the key to the smooth deployment of the staff.

I thank the Minister for attending. This is my first time to be in the House when the Minister is present. At 26 I am the youngest Member of the Seanad and I am aware the Minister was a Member in her 20s also. I understand she was the youngest ever Member and if I have half the success in my political life that the Minister has had I will be delighted.

I have six key points that I would like the Minister to address. The first concerns the impact of the 1 July deadline on health services nationally. The second is on the status of the transformation programmes in light of the cuts in last December's budget and being conscious of next December's budget. Third is the reasons for her rejection of the universal health service model. I am aware that when the Progressive Democrats Party was formed that was an area its members examined but then turned away from. The fourth point concerns the Minister's update on the co-location plans. The fifth point is on healthy eating lifestyles, which I believe must be advocated in a far more direct way, and whether the Minister has any plans in that regard. The sixth is about delivering political accountability. It is my belief that there is a need for the Minister for Health and Children to have more power to get and give answers to public representatives to deliver full accountability.

On the first point about the status of health services post-1 July, the Minster's brief is possibly the most unpopular and unwanted but it is also one of the most influential and powerful. While there is constant good and bad news on occasion, I would like to raise the issue, which has also been raised by my colleague, Senator Dearey, of Louth County Hospital in Dundalk, which according to the HSE is due to close as an acute hospital from 1 July as a result of the shortage of junior doctors. I ask the Minister to expand on that when replying.

There has been talk of three particular areas being hit — anaesthetics, emergency medicine and general medicine. I ask the Minister to elaborate on that because as we all know, people's greatest fears are about their health and the health service, whether it is to do with their children, parents or grandparents, and having a safe structure in place in the various regions throughout the country is of vital importance. I hope the Minister can allay some of those fears today.

My second point concerns the new emergency department opening in Our Lady of Lourdes Hospital in Drogheda. That was an ongoing issue when I was elected to the county council last June. It was a matter of great importance. People who have been inside the new accident and emergency department have said it is magnificent, and it is an important step for us locally. My mother, who was a nurse in Our Lady of Lourdes Hospital — she trained there in 1966 — is horrified when she hears the bad stories that come out about the hospital but it is a fine hospital. It has a fantastic reputation both nationally and internationally and while it has taken somewhat of a battering locally, the new €11.5 million emergency department will provide a great service. The new medical assessment unit, MAU, that will also open in Our Lady of Lourdes Hospital will also help alleviate pressure. I hope that will deliver major change for the whole area.

The emergency department in Our Lady of Lourdes Hospital was part of the transformation, which is my second point in terms of the way the transformation programmes will be affected by the cuts in recent budgets, and especially in light of the upcoming budget. Professor Drumm has said that a plan for a reduction in staff will not be met this year because of a slowdown in the number of retirements.

On my third point, I heard the Minister say in the past in the Dáil that when the Progressive Democrats were formed they were in favour of a universal health service but that she turned away from that view. Fine Gael's model for a new health and health insurance system is based on the Dutch model. Has the Minister examined this model and those of other countries? Were there reasons she decided not to follow them?

In the last general election, different stances were taken on hospital co-location. Some argued it was correct as a private patient should not be taking up a public bed. Others claimed it was giving more effect to a two-tier system. Currently, there is the perception the co-location plans are on ice. Will the Minister elaborate on the policy's future?

As the youngest Member of the House, I tend to be more aware of the calls for healthy lifestyles. When I was in University College Dublin not too many years ago, healthy eating was not one of my priorities, to which many of my friends can testify. I recall reading Alan Carr's book on how to stop smoking and how he got into making his own juice smoothies every morning. Having to do something for my health, I decided to try this for a while. Five years later, I am still making a smoothie every morning and it has transformed my health. I no longer get the colds and flu that I used to when at school and college.

The HSE says obesity costs the taxpayer €1.8 billion each year. If a certain cancer or other ailment was costing as much, there would be a clamour to take direct action and introduce a screening programme. Instead of just putting up warning posters, we should be involved in direct preventive action against obesity such as getting schools to get their transition year students make smoothies for school consumption. This would be much better than having school children full of Coke and Pepsi running hyper around the place.

The creation of the HSE made sense, particularly with delivering best practice in one health board to all areas. However, not everything was done right in the transition. Up to 90% was done right but the other 10%, such as delivering more accountability to Members of the Oireachtas, was not.

Sitting suspended at 1.40 p.m. and resumed at 2.30 p.m.