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Dáil Éireann díospóireacht -
Wednesday, 23 Apr 2008

Vol. 652 No. 3

Health Services: Motion (Resumed).

The following motion was moved by Deputy Kathleen Lynch on Tuesday, 22 April 2008:
That Dáil Éireann,
concerned at the impact on patients and those dependent on the health service of continuing cutbacks, staff shortages and under-resourcing; and noting in particular:
that there are an estimated 10,000 people who acquire a brain injury in Ireland every year;
that up to 2% of all people have disabling problems following an acquired brain injury, whether from traumatic brain injury, stroke or other causes;
that there is only one rehabilitation hospital in the country, with just 110 beds, for those who suffer from acquired brain injury;
that the number of neurologists, neurosurgeons and rehabilitation consultants available to treat these patients is well below the levels available in other countries; and
deplores the long waiting times that can see patients waiting up to two years for rehabilitative care;
calls for:
the establishment of a regional network of rehabilitation facilities and services to be established in the context of a national rehabilitation strategy;
the immediate publication of the national review of neurology and clinical neurophysiology services;
an increase in the number of approved posts for consultant neurologists from 24 to 42 and neurosurgeons from nine to 16;
a significant increase in the number of rehabilitation consultants to reflect demand for these services; and
the provision of effective community rehabilitative and support services for post-medical ABI patients.
Debate resumed on amendment No. 1:
To delete all the words after "Dáil Éireann"and substitute the following:
acknowledges the substantial resources, €14.931 billion, provided by the Exchequer for the HSE to provide health and personal social services;
recognises that this is an increase of over €1.1 billion over the funding provided in 2007;
supports the Government's position in prioritising and providing additional funding of €344 million in the 2008 budget for additional services for older people, people with disabilities and cancer control;
recognises that the number of people employed in the public health service since 1997 has increased by over 64%, from just under 68,000 to 111,505 whole-time equivalent staff in December 2007; and
in particular, by the end of 2007, there were:
3,029 more medical and dental staff, a 61% increase;
9,767 more health and social care professionals, a 164% increase; and
11,660 additional nurses, a 43% increase;
notes that the HSE has been given approval for an additional 1,050 new posts arising from development funding provided by the Government in the budget day package for 2008;
notes that the temporary recruitment pause put in place by the HSE towards the end of 2007 ended on 31 December 2007;
reaffirms the statutory requirement that the Health Service Executive should manage its budget within the Vote approved by Dáil Éireann;
supports the Government's National Disability Strategy;
recognises the substantial additional funding provided for new and enhanced disability services over the past number of years;
acknowledges the Government's multi-annual investment programme for services for people with a disability;
acknowledges the plans to develop the National Rehabilitation Hospital and increase its capacity to treat more patients;
notes that the Department of Health and Children together with the HSE is committed to developing a strategy for the future of rehabilitation services and both parties have agreed to jointly address this area as quickly as possible;
welcomes the additional revenue investment of €7 million since 2006 to support the development of neurosciences (including neurology, neurophysiology and neurosurgery services), acknowledges the increase in the level of consultant manpower on foot of this investment and notes the intention by the HSE in the national service plan to continue the development of these services in 2008;
welcomes the progress being made by the HSE in developing a framework for the future development of services in the neuroscience area;
welcomes the emphasis in the new consultant contract on providing for consultant delivered services through a significant expansion of consultant numbers across all specialties; and
welcomes the increase since 2003 of ten additional consultant neurologist posts and four additional consultant neurophysiologist posts, bringing the total approved complement of posts in these specialties to 24 and seven respectively; the increase since 2006 of two additional approved consultant neurosurgeon posts at Beaumont Hospital and the provision of the necessary funding by the HSE for the creation of a fourth post at Cork University Hospital; the recent advertisement by the HSE for two permanent consultant neurologists at Beaumont and Waterford and for a consultant neurophysiologist at St. James's-Beaumont Hospitals.
—(Minister for Health and Children).

At the outset, I congratulate the Labour Party on the motion before the House this evening. I fully support it, as does the Fine Gael Party, although it is regrettable at this stage in the life of a Government in which some Ministers have been in office for 11 years. The Minister, Deputy Harney, who has served as Tánaiste and now is simply Minister for Health and Children, has been a member of a Government for 11 years that has utterly and completely failed to provide the type of neurological services to which people are entitled. A myriad of reports have described the inadequacies of the services and have prescribed what is required. In the health strategy of 2001, the Government promised to prepare an action plan for rehabilitation services for people with brain injuries and recognised the shortage of inpatient and community-based services. The action plan was supposed to set out a programme to meet existing shortfalls in speech and language services, occupational therapy and physiotherapists.

Today, the usual nauseating and self-congratulatory amendment tabled by the Government in response to the motion provides an insight into the negligent manner in which the health service has been treated. One line of the Government's amendment notes that the Department of Health and Children together with the HSE is committed to developing a strategy for the future of rehabilitation services and both parties have agreed to jointly address this area as soon as possible. In 2008, the HSE and the Government now promise to do what was originally promised in the health strategy of 2001. In seven years, the world in that sector has not moved forward.

Experts recommend that patients with a brain injury must be seen within two weeks to maximise recovery. However, Irish patients must wait up to two years for an initial assessment because our sole rehabilitative hospital, which has 110 beds, only has the capacity to treat approximately one quarter of the 10,000 people who suffer from brain injury each year. The Disability Act 2005 promised an independent assessment of needs for all those with a neurological condition. At present, that is being rolled out to all children under the age of five. However, anyone over that age is not being assessed.

The HSE strategic review of neurology and clinical neurophysiology services was due to be published in February 2007. I understand the review was given to the HSE in December last but it still has not been published. It is not merely unacceptable, it is scandalous that those who suffer from brain injuries as a result of a car crash, stroke or other accidents and illnesses must wait for as long as two years for rehabilitation services.

Access to early rehabilitative treatment is critical to helping people to talk or walk again and to normalise their lives. Although the health budget has never been larger, accessing services such as speech and language therapy, occupational therapy and physiotherapy has not improved. Long waiting lists have resulted in patients being left in debilitating conditions, dependent on others at home or in nursing homes, for the rest of their lives. Many patients are being cared for at home by relations or spouses, who are available 24-7 to take care of them. However, the State is utterly failing in its duty, not only to those who are stroke victims but to the carers who are undertaking duties that otherwise would fall on the hospital and nursing home services, by failing to ensure they have the relief and services they require to maintain their own physical and mental well-being.

I refer in particular to the problems now developing in the respite sector. I will read out a letter that I received a few days ago which states:

I am writing to you with some disturbing news, that my mother received this morning.

Firstly let me tell you quickly what her story is:

Both my parents are in their late 70's and my father is suffering from Parkinson's and also due to an operation he had a stroke, so he needs care, my mother provides this with the help of carers — so far so good, but my mother is suffering from blood pressure and on the advice of her GP and the district nurse has been told to take a break otherwise she will end up in hospital and will be of no use to either herself or my dad.

So after getting the forms from the district nurse and getting them signed, getting the GP to sign them and booking him into the respite care ... in Leopardstown [Park Hospital], where I might add he attends the day centre every Thursday and then booking a holiday for 7 days with JWT, she has now found out some really disturbing news and that is — the respite care in Leopardstown hospital is being closed, so they have cancelled the respite, surely they could see their way clear in letting the people who have booked a break, have a break.

How can the HSE live with itself with the deplorable way it is dealing with the sick, disabled and old of this country. Mary Harney wants you to keep "them" at home, but she does not have to look after them 24-7 — we do. ... I cannot look after [my father], I work and have 3 children of my own to look after. . . . My father over the years paid taxes and never, never could he claim anything back, but he was able to get respite care — but now that has been snatched away from them, private care is not ... an option, due to the fact of a severe lack of "carers" they do not have the back up if a carer is not available to attend — and where does that leave the "client" as they like to call them!!

Leopardstown Park Hospital withdrew respite care for all those booked in for the months of May, June and July as a consequence of not having the requisite funding available from the HSE to maintain such care. This is a cutback that affects the most vulnerable people within our community. I understand that Baggot Street and Cherry Orchard hospitals also will terminate respite care.

I understand, to use a good old Yiddish and American phrase, there is a schmozzle going on in the background whereby the HSE is disputing that it was necessary for Leopardstown Park Hospital to take such action. However, the hospital is asserting that in March, the HSE knew of the position in which it found itself. This constitutes a classic example of the deplorable state of the health service. I ask the Minister to take action this week to ensure the respite care service provided by Leopardstown Park Hospital is restored and to ensure that respite care is not withdrawn in other hospitals for those caring for stroke and other victims.

The HSE has commissioned three reports on neurology services, first in 2003, then three years later and finally the aforementioned report that was presented in December 2007 but which has not yet been published. Like its predecessors, the third report criticises the fact that there are only 20 neurologists, nine neurosurgeons, six rehabilitation specialists and 110 rehabilitation beds in Ireland. Services are seriously under-resourced and this is having a devastating effect on patients. Ireland, with only 20 consultant neurologists, proportionally has the lowest number in Europe. Although the 2003 report found that 42 consultants were required, after three reports within five years there still are fewer consultants than the recommended number.

The HSE and the Department are failing brain injury and stroke victims. Their function should pertain to the provision of medical care and not to the drawing up of reports that are ignored and the maintenance of a costly, bulging unacceptable and ever-growing bureaucracy that is denying resources to frontline services. In recent days, Members have learned of a variety of cutbacks being introduced by the HSE, all of which are in respect of frontline services. The Government has presided over the creation of a bureaucratic and administrative monster, in circumstances in which it should have streamlined the available administration to provide the health service that is needed and should have ensured that scarce resources went into the frontline essential patient care services that are required so badly.

The Neurological Alliance of Ireland has a number of specific aims, which include increasing the number of neurologists in Ireland to 42 from the present total of 17. It also seeks to have neurologists in those parts of the country in which none is in place at present, as well as an overall increase in the number of consultant neurologists to cut down the unacceptable waiting lists. Doctors and neurosurgeons in Beaumont have pleaded for additional consultant staff and, even though the need for those staff has been recognised, there has been extraordinary lethargy in recruiting them.

The Government's report on neurosurgery, which was published in 2006, needs to be implemented, as do the key recommendations of the Irish Heart Foundation. The latter's report highlighted the fact that only one Irish hospital has a fully resourced stroke unit, despite the myth spread by the Government that other hospitals have such units. One in 37 hospitals, or 3% of the total, compares with the 91% of similar UK hospitals which have stroke units. It is likely that between 350 and 500 deaths per year could be avoided if stroke unit care was properly introduced in the Republic. In this and in other areas of the health service the Government has totally failed in its public duty to provide the patient care, hospital services and back-up respite care to which the people of this country are entitled.

I wish to share time with Deputy Charlie O'Connor.

Is that agreed? Agreed.

I welcome the opportunity to contribute to this debate. Like many of the debates we have had on the health services, it gives us a chance to put forward our views on various topics. It is the duty of the Opposition to raise what it sees as the Government's inability to address the issues concerned. It is unfortunate, however, that specific areas of the health services are often bandied from one side to the other. Individual cases are used to bash the Minister of the day or the Government, notwithstanding the difficulties that exist on the ground and the pain suffered by individual families.

Like every other Deputy, I meet constituents on a weekly basis to discuss their real concerns and the pain and suffering they experience. To some extent, it is important this is recognised but the action required must be on a strategic level. Last night's contribution by the Minister for Health and Children clearly took account of that. Notwithstanding strategic thinking and service plans, it is clear that funding is required to address individual cases. However, if we continue to dwell on individual cases on a daily or a weekly basis, our attention will be distracted from the need to restructure our health services generally.

Is the Deputy suggesting that the plight of individuals should be ignored?

I did not interrupt Deputy Shatter and he might afford me the same level of courtesy.

We should ignore stroke victims.

If the Deputy wishes, I would be happy to heckle him.

I would prefer if Deputy Dooley did not do so.

I, too, would prefer not to heckle. It is critically important that we focus on developing a strategy. We can all be the wise man in the pub or the hurler on the ditch and play down each element of the game, but the public expects more from us. It has put its faith in us to come at this from a different point of view by suggesting solutions that meet their needs rather than acting as commentators or loudhailers on individual issues. That does not take from the individual cases raised by other contributors.

The Government's strategy is bringing the real reforms required in the health services. Debates such as tonight's often distract us from the discussions we should be having on the strategies we need to develop. The public's attention is turned to individual cases rather than to the broad framework for delivering a coherent policy that meets the needs of citizens. In that context, it is critical that we understand from whence we came. My mother is a retired nurse who worked as a midwife in a small district hospital with 34 or 35 beds. Nobody would suggest today that delivering children in such an environment is a safe practice. We have made significant progress over the decades in terms of delivering services. Last night, the Minister set out the improvements made on life expectancy, which has risen from considerably below the EU average to above it. The continuous efforts by vested interests to focus on individual heart-rending cases do a disservice to our attempts to introduce a better model that can address these cases.

I acknowledge the tremendous work being done in the National Rehabilitation Hospital. I have personal experience of people who have been involved with the hospital over the years. Any Deputy who has ongoing contact with constituents will be aware that its limited number of places are much sought after. I look forward to the implementation of the strategy set out by the Minister for defining the services required through further research into best practice and understanding the needs of the population. We need to put in place financial supports to enhance that service in Dún Laoghaire and elsewhere. I would like similar facilities to be established in the south, perhaps in the Munster region, and in the north west. The Government provided €30 million this year and, while we all agree we would like to see more, that is an issue which the HSE will have to address within its overall budget.

I would like to see professionals in the HSE, particularly consultants, coming together to agree strategies for progress. For too long, the HSE and the Government have been negotiating the consultants' contract. The sooner we get beyond that to focus on the delivery of coherent services to all citizens, the better.

I welcome the opportunity to make a brief contribution to this important debate. I would love to have spoken this morning but I sat silent, observant and dewy eyed as tribute was paid to my fellow Dubliner, the Taoiseach. I wish to be associated with what was said in that regard.

I commend Deputy Kathleen Lynch on bringing forward this motion. I do not want to pick on Deputy Shatter but sometimes it is forgotten that Fianna Fáil Members have the same concerns and cares. We may have a different way of going about our business but we are concerned about health matters on a daily basis. With the exception of this morning's business in the Dáil, I have spent most of my day dealing with health matters. The presence in the House of my colleague and Chairman of the Joint Committee on Health and Children, Deputy Moloney, reminds me that we held a session of that committee today. Deputy Moloney will acknowledge that we are concerned about various issues relating to this motion and other aspects of health.

Later today, I will take part in the Adjournment debate — I appreciate the facilitation of the Office of the Ceann Comhairle — when I wish to raise the issue of HSE funding and the HSE threat to the hospital in the home programme, which does tremendous work. The programme is based in Tallaght and looks after not only my constituency area, its greater catchment area is in the Beaumont area. I have no doubt that many of the people Deputy Lynch and all of us are thinking about in the context of the motion have been helped by that service. I will make that point during the Adjournment debate.

The presence of the Minister of State, Deputy Devins, is important as he has particular responsibility for mental health issues and disability. It is important that he hears, across the floor of the House, the various concerns that are being expressed. The Government amendment lists what is being achieved. All of us who listened to the Minister for Health and Children, Deputy Harney, earlier in the debate will understand that an effort is being made. While I will not be flippant, the phrase "a lot done, more to do" is perhaps accurate. It is important that all of us support the Minister of State, Deputy Devins, as he goes about that business, which he has taken on with much enthusiasm and energy. It is important that he understands this is what we want him to do.

I will not stand here and say everything is perfect. In my daily political work, I come across many families affected by disability and other issues listed in the Labour Party motion. I recall the particular case of an active young family man living in Tallaght who had a horrendous crash and was badly hurt. I remember the family conveying to me their absolute frustration with the system because there did not seem to be a response. There was certainly a good response in the local hospital and when he went to the National Rehabilitation Hospital in Dún Laoghaire, but their issue was with regard to accessing services. This man was living a normal life when suddenly, out of the blue, there was a crash and everything stopped.

In a different way, I had a similar experience nine years ago when I had a heart attack — I am never afraid to talk about it. A person is busy, active, living a normal life and able to do anything when suddenly he or she is in a hospital bed, unable to respond in the normal way and needing the help of others. In my case, thank God, I recovered and was not disabled. People sometimes need to have life experiences, although mine was very much at the lower end of the scale in terms of the stories we have heard during these two days of debate. My heart attack was a good experience in the sense that I understood even better what people had been telling me about being struck by difficulties of this nature.

It is very important that the Government and the Minister of State understands the need for the system to work. When families are struck by this kind of sudden event, they need to know how to access services and that there is a service available to respond to them and help them through. I keep in touch with that family and know that in many such cases the effects last for a long time. Other issues also affect such families, for example, with regard to local authority schemes for converting houses and providing facilities in dwellings. Again, the response can sometimes be quite slow.

The Minister might argue, as Deputy Dooley has, that one cannot highlight just one case and believe that to be the norm. However, it is fair that those of us who have experiences in this regard, whether through family, community or our political clinics, should be able to ask for a response. The Department of Health and Children must deal with many issues — we could talk all day about HSE accountability and how it is dealing with these matters — but in the midst of all these issues that must be dealt with, the most vulnerable in our communities should always be looked after, certainly in regard to disability and mental health. We should not be ashamed to make the point that even if there are difficulties with regard to Government or if the economy is contracting somewhat, priorities should be made. I had a conversation with a member of a disability organisation some weeks ago to the effect that sometimes in the midst of trying to make a case for everything, one has to fight one's corner in a very specific way.

We should also acknowledge the Minister's point that the Government, in January 2008, established the Office for Disability and Mental Health to support her work in that area. It is very important that we understand it is now finding its way through this maze of bureaucracy. I repeat that it is important the Minister of State, Deputy Devins, understands there is a strong well of support, not only here in the House but in the community, for this work to continue and for funding to be maintained. Everything we can do for people affected by disability and mental health should be done.

I welcome the motion and recognise the sincerity of Deputy Kathleen Lynch in moving it. I recognise that it is not the usual political motion. It is obvious a national strategy should be put in place, rather than relying on one centre, although we know of the excellence of the National Rehabilitation Hospital in Dún Laoghaire over many years. Times have moved on, however, and while we have always paid fulsome tribute to the excellent care in the national hospital, there are just 120 beds there while the population and its demands are growing. The possibility of acquiring greater technological supports must be embraced.

I see the merit of the Minister's response in the debate where she referred to the never before achieved level of funding of €15 billion allocated to the national health services, €30 million of which was allocated to the National Rehabilitation Hospital, which I support. I welcome the Minister of State, Deputy Devins, to the House. Since his appointment, he has met the Joint Committee on Health and Children on several occasions and while he was a member of the committee he gave full support to the need for more than one centre in Dún Laoghaire. In that context, I am glad the Minister referred to the possibility of a satellite unit linking the National Rehabilitation Hospital and Beaumont Hospital, which must be the way forward.

More important has been the commitment and time put into the development of a new hospital, which will possibly be in Dublin, although some colleagues suggest it should be located elsewhere. Whether it is located in Dublin or outside it, I welcome the fact that we will have a centre similar to the excellent centre in Dún Laoghaire and I hope nothing stands in its way. I fully appreciate that deals have been struck and planning permission is apparently about to be lodged. The fact that this is part of the Government programme Towards 2016 convinces me this is for real. It is the response to the motion and is a genuine attempt to provide the most up-to-date skills and services.

The Minister of State's new brief includes responsibility in this area. Having heard the Minister of State, Deputy Devins, and read his recent speeches, I know the political commitment is there. I will not waffle about what funding is available in the health services. I believe the Government recognises that while we have to date tried to have the best level of services, far more can be done and will be done. In that context, I congratulate the Minister, Deputy Harney, on explaining this to the House yesterday and giving clear commitments on funding and the level of medical supports.

I recognise we have a great need for another hospital to deal with the issue of spinal and brain injuries. An issue which causes huge difficulty for politicians is that of trying to secure a bed for a person who has had a serious accident. This calls into focus the involvement of politicians, which should not be necessary. I hope we can move on in light of the commitment by the Government to provide the best level of services.

I welcome the opportunity to contribute to the debate. I attended a presentation by Brí on 12 March here in Leinster House and that presentation gave me a great insight into the needs of people who suffer brain injury. While most people assume that strokes and traumatic brain injuries are the main cause of acquired brain injury, I learned there are many other causes. We must always strive to promote full recovery and allow people, if at all possible, to return to full community life. The March 2008 Brí newsletter points out some stark facts, one of which is that three quarters of the victims of traumatic brain injury are children and young adults. That is a major trauma facing those patients but also those nearest and dearest to them.

In recognition of the need to develop neurology and neurophysiology services, additional revenue funding of €3 million was allocated to the Health Service Executive in 2006. In 2007, further additional revenue funding of €4 million was allocated to support the continuing development of services in the area of neurosciences. The HSE has advised the Department of Health and Children that there has been an increase in the number of consultant neurology posts arising from this investment. In the area of neurology there are currently 24 approved posts of consultant neurologist in Ireland, of which 19 are filled. These are strong and positive measures which must be furthered and enhanced. I reiterate the sentiments of some of my colleagues who said we have a lot done but we have more to do.

A new national rehabilitation hospital, under the national development plan, is in the planning stages. When built, the new hospital will provide additional treatment and diagnostic capacity. The aim is for a completion date of 2012. All patients will agree that when they are admitted to these centres, the treatment and the service they get is excellent. The difficulty is getting into them. The HSE has also stated that plans have been prepared to develop a satellite unit of the National Rehabilitation Hospital attached to Beaumont Hospital, linking the rehabilitation expertise of the NRH with the neurological services in Beaumont. That is to be welcomed.

This neurology debate is crucial but likewise we must raise and examine other issues. For example, the HSE interim report earlier this week reflects the plan for a further removal of acute services from my own hospital in Monaghan and the north east generally. We in Monaghan were promised that no services would be removed until safer and better alternatives were put in place. We have a situation where seriously ill patients who need to be ventilated can no longer stay in the hospital but must be transferred to Cavan or any other available hospital. The HSE says patients can be stabilised in Monaghan but must be sent on afterwards when a bed is available. That is just another step in the removal of services. Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda are already stretched to near breaking point before any patients from Monaghan are sent there and sending more could lead to fatalities.

In a speech to this House on 6 February I called for an audit of the HSE. To reiterate the central thesis of my speech that night, we need a wholescale audit of the organisation from top to bottom — financially, managerially and at human resource level. We must identify the black holes that appear to be swallowing up millions of euro, which must be prioritised for frontline services. In this debate we are talking about people with acquired brain injury. I suggest we start here. Savings must be made but they must not affect frontline services. This audit would ensure that money was directed to the patients to allow them receive the top quality care they deserve.

We must always strive to help those people suffering from traumatic injuries of types such as this. As a matter of urgency, I call on the Minister to expedite the process for the new rehabilitation hospital, continue the increase in funding for neurology services and always strive to ensure that the patient is the central focus for all her work.

I express my appreciation of the opportunity to participate in this debate. There is a need for action in the development of services to support further the great work being done by the National Rehabilitation Institute in Dún Laoghaire. There is no doubt that excellent services are being provided there but it is always frustrating for us as Deputies to have to constantly get on to the hospital to try to get people admitted from hospitals in the west for proper rehabilitation. Once people are admitted to the facility, however, it is an excellent service and the progress being made there by patients who in many cases have been seriously injured in tragic accidents is very welcome.

There is some light at the end of the tunnel. In Galway, for instance, a new rehabilitation unit is planned for Merlin Park Hospital but unfortunately it is taking too long to have that facility delivered. The planning started when I was a Minister of State in the Department of Health and Children and it has still not commenced construction. One of the significant issues is that these facilities are costing massive amounts of money. The Galway facility was costed at approximately €30 million for 30 beds. It is clear that the intensive care provided in those facilities means that a significant current cost goes into staffing. There is no doubt that the facilities are urgently needed, however, especially in the west where there is no such facility. It is vital that the HSE should proceed with the construction of this project. I welcome the recent announcement that it would put the project to tender.

The number of acute beds being occupied by people waiting to access the facility in Dún Laoghaire or proper rehabilitation facilities represents a terrible waste of acute beds in hospitals throughout the country. From time to time in Galway there could be anything up to ten patients occupying acute beds awaiting a transfer to Dún Laoghaire or a facility in which they can get the proper services. That is a waste of money and it is one of the areas where reform must take place.

I share the views of everybody in the House that these extra services must be provided as quickly as possible but that must be done in the context of the fundamental reforms the current Minister, Deputy Harney, is trying to bring about. The Taoiseach was asked this morning if he was happy with the establishment of the HSE. I am convinced that the HSE structure, although it is experiencing problems, is the only way forward. We must have a properly planned health service. It must become much more efficient. We must change the old habits and prejudices of a lifetime which are to be found across the health system. We must cut out the existing wastage in terms of expenditure.

In Galway last week there were a large number of people in casualty. I called the hospital on three occasions about a patient who was holding down a bed for six days waiting for an MRI scan. Eventually the patient was sent home and told to come back a week later. Holding an acute bed while waiting for an MRI scan is ridiculous. Unless and until we get these reforms, and unless the health care workers are prepared to operate this very expensive equipment for more hours each day to cut down those waiting lists, we will not see reform. Regardless of what anyone says, we can throw as much money as we like at the health services but until reforms such as that are carried out -I see my good friend, Deputy Michael D. Higgins, agrees with me — we will not see the necessary progress in this area.

I wish to share time with Deputies Seán Sherlock, Mary Upton, Joanna Tuffy and Ciarán Lynch.

I fully support this motion and congratulate Deputies Kathleen Lynch and Jan O'Sullivan on bringing it forward for debate. At a time when crises and scandals pour out of the health service on a weekly basis, it is important we include in our debates the concerns of those who, because of the nature of their condition, do not hit the headlines yet suffer chronic disability and need constant support.

I will start with a bit of good news. With the health service, every report published seems to highlight deficiencies, loss of opportunities, mismanagement, delays and patients' pain and frustration. Yet at times, when appropriate provision is in place, patients can benefit enormously. Since tabling this motion, the Labour Party has received much correspondence. One e-mail described how the life of a young Kilkenny man with acquired brain injury has been transformed for the better. His sister writes:

At the age of 23 he needed 24-hour care and specialist medical people to look after him. My family could not give him this care. Our family had to fight for everything that he got. There always seemed to be resistance from the health board in looking for care for him. This was our problem and not theirs. They were ignorant people who hid behind their desks and would not meet our family face to face.

The good news is that a voluntary body, the Peter Bradley Foundation, understood this young man's needs and stepped in to give him a chance of independent living and a real future.

In her e-mail, the man's sister points out that despite his terrible injury, which he acquired when he was only eight, he cannot claim disability allowance because of a compensation award he received. She has asked that this issue be raised in this debate because the refusal is based on a formula that is unfair and does not recognise that this young man would be only too delighted to work. He cannot do so because of his head injury.

It is remarkable that we do not know how many people living in Ireland have a brain injury. If we compare our population with that of other countries, we can very roughly estimate that somewhere between 9,000 and 11,000 people are so affected. Many of those suffer brain injury as a result of stroke, a condition for which treatment has improved significantly. However, the recently published national audit of stroke care shows our health service is failing patients who urgently need these treatments.

We should have 365 dedicated stroke beds but we have 12. Some 90% of British hospitals have a stroke unit but only 3% of Irish hospitals — one hospital — has a stroke unit. The rehabilitation centre on Rochestown Avenue, Dún Laoghaire, provides an excellent service for patients but they are often forced to wait an inordinate period of time for vital rehabilitation, for which they pay a price. As a result, the health service has acute beds that cannot be used by anybody else. It is incredible that after 11 years of unprecedented economic success, we are still waiting for that new hospital, which is only now going to planning stage.

This morning we paid tribute to the outgoing Taoiseach and we are soon to elect a new one. I sincerely hope that with the election of a new Taoiseach we will not simply get more of the same. It is time to recognise that the Minister, Deputy Harney, gave this her best shot. Nobody would question her commitment to tackling a very difficult brief. Stubbornness is no substitute for leadership, and an ideological attachment to private health care is simply not providing a solution to the problems we have.

To put it at its crudest, there is no profit to be made from the chronic patient with brain injury. Private health care is interested in the quick operation and turnaround of patients.

We need a turnaround for all patients with a new Minister for Health and Children alongside a new Taoiseach and a new vision for the health service that includes care for all patients on the basis of their need.

I welcome the opportunity to speak on this motion.

Head injury and related trauma is a lottery in Ireland, which I can state from my own personal experience of its effects. Three years ago, my wife was taken to the accident and emergency department of Cork University Hospital because she suffered a very serious fall. While she lay unconscious and under examination, the doctor explained that due to the complexity of brain injuries, it was far too early to indicate how serious the accident was and much too early to indicate the long-term consequences of the injury.

I recall the very words used by the doctor that evening. She stated that head injuries are "like a lottery," as sometimes people make a full recovery and sometimes they do not. There is no timeframe or definite outcome with regard to the recovery. It comes down simply to how quickly the patient is admitted and how he or she can be best supported on the road to recovery. In the words used by the doctor, it is a lottery. The accident is a lottery in terms of seriousness when the person comes in the door of an accident and emergency department, and the manner in which the patient will recover is also a lottery.

In my wife's case, we were very lucky and she made a full recovery over a matter of months. I specifically use "we" because living with the consequences of a head injury does not just affect the victim, but his or her family, relations and extended network as well. Head injury is a "we" injury, not an "I" injury or a one-person injury.

We were lucky in that lottery but others are not. It should not be a game of chance when somebody has a serious head injury or stroke in this country. It should not be a matter of being lucky to live close to a hospital, as in our case that night. It should not be a matter of being lucky that there just happened to be a neurological surgeon on duty that night, by the grace of God.

It should not be a matter of bad luck to learn that if a person survives the initial trauma of the injury, he or she will have to wait another two years to begin the road to recovery. We were lucky we did not have to travel that road but thousands of head injury and stroke victims must face it every year. That is two years of being denied the right to services which would radically improve their quality of life and chances of recovery. It is simply unacceptable.

I will restate a number of points made by my party colleague, Deputy Kathleen Lynch, when she brought the matter before the House last night. I acknowledge the work of Headway Ireland, Brí — the acquired brain injuries association — Brainwave, the Irish Epilepsy Association, the Peter Bradley Foundation and others. These are all non-State services. It is outrageous that the drivers of head injury and related services are completely in the non-State sector. Meanwhile, the Government, the senior Minister and everybody sitting at the Cabinet table has abdicated from a strategy which was supposed to be put in place ten years ago. It is outrageous.

I pose again the question asked by Deputy Kathleen Lynch of the Minister relating to patients with neuro-disabilities in the HSE south area. Will the Minister quantify financially, with regard to lost beds, the cost arising from the delays in discharge or transfer to rehabilitation services? An answer was given in an Evening Echo article earlier this year. It stated that a survey of admissions for acute stroke victims to Cork city hospitals was carried out in 2001 as part of a proposal for a stroke unit developed by medics at the hospital. The findings demonstrated how, over a two-month period, the three Cork city acute hospitals admitted a total of 72 stroke cases. The mean age was 70 and the mean length of hospital stay was over 20 days. The total number of hospital bed days consumed was almost 1,500. According to one of the doctors involved in the report, if the region’s acute hospitals had stroke units in place, they would cut the average length of stay for stroke victims by six days. This would mean 440 beds would be saved in two months, with an average of over 2,500 bed days saved per year.

Stroke and serious head trauma injuries are life-changing circumstances but they should not be a life sentence of delayed recovery, which is currently the case. There is an absence of a national strategy, localised regional service and political leadership from those currently in Government. Treatment in respect of serious head injuries and stroke will continue to be a lottery under this Government and people will remain dependent on luck.

I welcome this debate and I wholeheartedly support the motion, which calls for some simple, pragmatic solutions to a problem that afflicts the 10,000 and more people who are affected by acquired brain injury. The motion also requests the establishment of a regional network of rehabilitation facilities and services to be established in the context of a national rehabilitation strategy. The response from the Government side offers nothing that would provide comfort or encouragement to those suffering from acquired brain injuries in the context of addressing their needs.

There is a regional disparity in the delivery of health care. If one lives in Cork, Kerry, Galway or Donegal, one is already at a disadvantage if one suffers with an acquired brain injury. The disparity to which I refer must be addressed as a matter of urgency. Not only does this disparity exist in the area of health, it is also prevalent in the economy and in the Government's regional policy.

I recently made representations to a neurologist on behalf of a person with an acquired brain injury. He confided in me that if he was to close the doors of his practice tomorrow, he would have sufficient clients to deep him in business for the next two years. That illustrates the seriousness of this issue.

Those on the Government side stated that the development of a new rehabilitation centre is at the planning stage and that this will hopefully be up and running by 2012. That assertion does not provide any grounds for confidence. The motion before the House calls for an increase in the number of approved posts for consultant neurologists from 24 to 42. Such a development would almost, if not quite, bring us up to a standard which obtains in other European countries and would represent an immeasurable improvement on the existing position.

What we are ultimately concerned with is people's dignity. There are those who have no access to the services of which they should be able to avail as a matter of right. These individuals will gain no comfort from what is being said by those on the Government side because there does not appear to be a sense of urgency about this matter. The Labour Party is requesting that there be such a sense of urgency in order to preserve people's dignity and give them the right to a standard of health care their tax euros should afford them. Be they resident in Dublin or the regions, they should be treated as equals. That is what we are calling for in this debate.

I welcome this opportunity to contribute to the debate on the serious issue of acquired brain injury. It is often stated that a society is judged on how it treats its most vulnerable. If that is the case, I fear we are failing badly in respect of those with acquired brain injuries. We are also failing their families, friends and carers and those professionals who are working with them and doing their best to deliver a quality service in absolutely impossible circumstances and unbearable conditions.

If one applies international studies to Ireland, one discovers that between 9,000 and 11,000 suffer from acquired brain injuries each year. In addition, some 30,000 people are living with long-term problems following brain trauma and over 7,000 people suffer strokes each year. I accept that these figures were already alluded to but they bear repeating, particularly in light of the huge numbers of people in respect of whom poor-quality services are being provided.

Every brain injury is unique and a fully complemented staff of neurologists and neurosurgeons is required accurately to assess its extent and the level of treatment required. The very least to which those afflicted with such injuries, and their friends, families and those who work in this area, are entitled is that the Government, without delay, should increase the number of neurologists and neurosurgeons to the level required by our population base. As Deputy Sherlock stated, this would bring us up to the European average, namely, 16 neurosurgeons and 42 consultant neurologists. Furthermore, there is a need to ramp up our rehabilitation services. As previous speakers stated, there is only one rehabilitation hospital in the country, at which there are only 110 spaces available. Priority must be given to addressing this appalling situation.

Non-critical care represents the greatest hope for people across the health services. It can give a patient an opportunity to recuperate in a non-acute centre, offer him or her the chance to redevelop his or her independence skills in more familiar surroundings and help ease the pressure on our critical and hospital services by freeing up beds. When the HSE is required to trim its sails, it immediately targets non-critical care. There is evidence of this in my constituency in the aftermath of the decision to cut roll-over respite care in Cherry Orchard. The level of such care was also reduced at other respite centres throughout the country.

I received a telephone call from an extremely distressed constituent this afternoon. The woman's husband suffered a stroke and she wants him to remain at home. The city council will provide some funding towards the provision of the facilities she requires in her house. In order to provide her husband with care, she also requires a top-up grant. However, top-up grants are no longer available from the HSE. The woman to whom I refer consulted me to discover where she might obtain the additional funding necessary to allow her husband to remain at home in the environment with which he is familiar and also to relieve the burden on the State. However, the money is simply not available.

The Labour Party's motion calls for the establishment of a regional network of rehabilitation facilities. This is not an unrealistic request. The report, Acute Hospital Bed Capacity Review: A Preferred Health System in Ireland to 2020, published in January states that community-based services have a vital role to play in meeting our hospital bed space requirements in the future. The Government and the HSE must realise that regional rehabilitation centres form part of a cogent, long-term strategy to develop community-based non-acute services that are decentralised and present the opportunity for people to leave hospitals or long-stay care facilities.

Central to all of this is the provision of the various forms of therapy. I refer here to physiotherapy, occupational and speech therapy, which are crucial to ensuring patients can make a full recovery. The groundbreaking Bacon report, published in 2001, stated that a major expansion is necessary in the number of therapy professionals in order to pre-empt a persistent and growing deficit in our service provision. I wish to draw attention to another major anomaly in the system. In response to the Bacon recommendation to which I refer, the number of college places in occupational therapy and physiotherapy has significantly increased in recent years, particularly since 2003. While the number of graduates has also increased, the employment opportunities on offer from the HSE have declined. The latter is in part due to the HSE's recruitment freeze last year and the cutting of many so-called non-essential services, such as roll-over respite care in many centres. Figures from the Irish Society of Chartered Physiotherapists indicate that 89 physiotherapy posts that were in place prior to the HSE recruitment pause no longer exist and many of the current temporary posts will not be renewed. While the Government is providing college places for physiotherapy students, there are no jobs for them when they graduate. That is a problem for both the graduates and those who require, but are not being provided with, physiotherapy services. Physiotherapy, occupational therapy and speech therapy are essential services to those striving to regain a better quality of life. If these services are denied, then those with acquired brain injury face a bleak future. I urge the Minister of State to address as a matter of urgency the shortfalls in the many facets of treatment and services for those patients dependent upon them.

Despite all the issues that have been raised here, many people are urgently in need of support. One of the most demanding services in terms of the provision of family care is for those with acquired brain injury. Stroke is one of the most commonly acquired brain injuries and many of us are familiar with it. Historically it was often associated with older people, but unfortunately I hear quite regularly of young people who are suffering from stroke. They also need the chance of rehabilitation. They require services such as physiotherapy, speech therapy and occupational therapy that are so important to their rehabilitation. In that way they can regain a place in society and will have an opportunity to lead a full life of quality. What does it say about this Government and this country when such people do not have access to hospital beds, neurosurgeons, neurologists or therapists? We have heard so much about the financial resources that were available to us in recent years. However, while we provide further physiotherapy courses, encourage people to pursue them, produce graduates and make professionals available, we fail to provide such services to those most in need of them.

Deputy Stanton has noted that in yesterday's debate the Minister, Deputy Harney, and the Minister of State, Deputy Devins, just made general statements. He said that while the Minister spoke about billions in expenditure, there were no specific deadlines or actions. Deputy Stanton was right. The Minister did not engage in debate on the Labour Party motion, choosing instead to make a general statement. She basically read out a script that was provided to her beforehand. The motion referred to a specific aspect of the health service and a group of people with acquired brain injury. The Minister should have responded to the problems and gaps in the health service that we have identified in the motion. Given her experience both as a Deputy and a Minister, she could have spoken about cases of which she is aware or should be aware, in addition to how such problems are being faced by those with acquired brain injury and their families. The Minister should have outlined what actions she will personally see are taken to improve the quality of life for all those affected, but she did not do that.

In paying tribute to the Taoiseach earlier today, the Minister for Health and Children said the Government was not perfect. In her contribution last night, she would have given much more hope if she had acknowledged that fact concerning services for people with acquired brain injury. She should have outlined the failings and gaps, as well as what commitment she could give to deal with them. Instead she made generalised comments — the way the Government does nowadays — about projects way in the future. She gave a vague commitment to a satellite centre for Beaumont Hospital but it was just a proposal with no specific date. She also spoke vaguely about plans for rehabilitation beds but there was no specific commitment on numbers or locations.

Deputy Stanton said the Minister is not currently engaged with the health debate. She could start with the experiences of people in her own constituency. Like Deputy Upton, I have received a few calls about Cherry Orchard Hospital where respite care beds were recently closed. The 70-year-old husband of a constituent who rang me suffered a severe stroke a few years ago. She is now ill herself and finds it difficult to care for her husband at home. She took advantage of the respite care facilities in Cherry Orchard Hospital, which was a godsend for her. However, she was recently told by the hospital that the service is at an end. I have come across similar cases, including the family members of a frail 91-year-old man who were caring for him at home. They used to carry him upstairs to bed every night. Every couple of weeks he went to Cherry Orchard Hospital for a few days' respite care. That was the family's lifesaver but it has now been taken away. When I and Deputy Mary Upton raised the issue in the Dáil I got a generalised two-page reply about millions being spent here and there for older people. There was nothing in the reply that responded to the specific issue I had raised concerning the closure of respite care beds at Cherry Orchard Hospital. There was one sentence which stated that the matter would be kept under review.

Despite the gloss of the Government amendment, the Minister's speech and speeches by various Government backbenchers, there are cutbacks in the health service. As a result people are losing services they relied upon up to now. Those being hit are the most vulnerable. They are easy targets. If the Minister took responsibility and engaged with the health service, she could start with Cherry Orchard Hospital. She could intervene and halt the closure of those respite care beds, which affects the most vulnerable people. She is not doing that, however, and takes no responsibly, claiming that it is nothing to do with her. That kind of generalised response to the problem is not only happening in the Department of Health and Children; it is also happening in many other Government Departments. Ministers are always talking generally about the expenditure of millions and billions, national development plans, strategies and reviews, but these solutions are far in the future — it is basically deferred Government.

Last night the Minister spoke about a rehabilitation centre for which the target opening date is 2012, but her tenure as Minister will then be at an end. We will probably be told that they do not have the money anyway, so it will be left as a problem for the next Government. Ministers often look hurt when they are told they are remote, not engaged in the process and out of touch, but that is the reality. The Minister is disengaged and is not taking responsibility for her Department. Apart from incompetence and remoteness, what is really wrong with the health service is the ideology involved. The reason we have a poor public health service is that the Minister is not committed to providing a good one.

All Members on this side of the House share the concerns of Opposition Deputies and of the concerned individuals, their parents, relatives and friends, some of whom are in the Visitors Gallery. Let me first put in context the Labour Party motion, referring as it does to cutbacks and staff shortages. This year alone the Government has increased funding to the HSE for the provision of health and social services by some €1.1 billion.

What has it done with it?

An approved staffing level of over 111,000 whole-time equivalents has been agreed for the health service.

When will we get neurosurgery in the west?

It was promised in 2006.

In addition, the recruitment of an extra 1,050 staff has been approved as part of the 2008 budget investments in the areas of services for older people, those with a disability, and cancer control.

Where are they being put?

The motion refers to the National Rehabilitation Hospital, whose allocation is nearly €30 million. The hospital provides a range of diagnostic, treatment and training services to people from all over the country. We are planning a brand new hospital on the site of the present hospital which will dramatically increase the treatment and diagnostic services to the public.

Not a red cent yet.

The design will be submitted for planning approval this year. Deputies will appreciate that this is part of the process. Plans have also been prepared to develop a satellite unit at Beaumont Hospital, to which Deputy Tuffy referred, linking the National Rehabilitation Hospital with the national neurological centre in Beaumont to provide acute medical rehabilitation services and early rehabilitation for those suffering from brain injury.

For an injury in Donegal.

A clear policy direction is needed on rehabilitation. I give credit to those in Letterkenny hospital who are providing rehabilitation across the road from the general hospital. I am glad Deputy Higgins gave me the opportunity to pay tribute to them.

It is a disgrace that there are no plans for neurological services in the west of Ireland. The current situation is costing the taxpayer millions of euro.

The Department of Health and Children and the HSE are committed to developing a strategy for the future of rehabilitation services. A working group with broad representation from relevant stakeholders, including users of the services, is being established. The motion and the debate have raised the issue of neurology services. A review of these services has recently been completed and the final draft report of the review has been submitted to the director of the National Hospitals Office for consideration. The findings of the report will help to inform the approach taken by the HSE to the future development of these services.

In recognition of the need to develop these services, additional revenue funding was provided to the HSE. Some €3 million was provided in 2006 and a further €4 million in 2007 to support the continuing development of neurology and neurosurgery services. This funding has resulted in an increase in the number of consultant posts for these services throughout the country.

The HSE and agencies such as Headway, the Peter Bradley Foundation, the Irish Wheelchair Association and BRI are involved in providing services and support to people with acquired brain injury and their families. Ministers have met with these organisations and many families feel, and maybe rightly so, that they have had to fight hard to access appropriate services for their loved ones. A range of services are provided to people with acquired brain injury and their families by the HSE and the other agencies mentioned.

Two of the main service providers for people with an acquired brain injury are the Peter Bradley Foundation and Headway. With the help of the HSE they have developed a range of community-based services throughout the country including assisted living community residential services, community rehabilitation services, clinical support teams, rehabilitative training and occupational day services. BRI is a voluntary advocacy group for people with acquired brain injury whose focus has been on establishing support groups throughout Ireland.

The need for acquired brain injury specific services is acknowledged due to the highly individualised nature of the disability. The HSE has a greater awareness and is developing a more integrated multidisciplinary approach to acquired brain injury. It acknowledges the need for facilities that are appropriate for people with acquired brain injury.

It has done nothing about it.

The Irish Heart Foundation national audit of stroke care was raised in this debate in the context of, among other things, the need for rehabilitation following a stroke. This audit was conducted with the support of the Department of Health and Children. The report covers the spectrum of care for people who suffer a stroke, from prevention to treatment and rehabilitation. In 2007 the Minister established the cardiovascular strategy policy review group to advise on how to prevent the occurrence of cardiovascular disease and stroke and how to improve services. The audit highlighted a number of areas where clinical care and the organisation of stroke services can be enhanced.

I am glad of the opportunity to respond to a number of the issues raised and I conclude by referring to a feature article in The Irish Times this morning about four young men living with acquired brain injury living in a Peter Bradley Foundation house in Waterford. A presenter on “Morning Ireland” referred to the four young men being in “A house full of life, music and hope” and another presenter said “It was great to read a health story that has wonderful consequences for the people involved”.

Despite the substantial increase in service provision, this Government acknowledges the significant demand for new services and a growing requirement to enhance existing services. This Government will continue its commitment to develop public health services in line with our budgetary strategy to provide a sustainable and significant level of funding for public——

There goes the rights-based approach.

I do not want to enter dialogue with Deputy Higgins but I could go back a number of years when there was very little money provided.

I did a lot more with it than the Minister of State.

The Irish people did not give that result last year. This Government will continue to invest in high quality health and personal social services.

I wish to share time with Deputy Kathleen Lynch.We are winding up a debate on a Labour Party motion on the issue of care for people with acquired brain injuries. These are the thousands every year who suffer a stroke, an accident or who survive a car crash. These are the thousands who form part of the 700,000 people in Ireland living with a neurological condition, an average of one in every two households in the country.

It is time that the care of so many of our citizens, particularly rehabilitative care, became a political issue. I thank Deputies Kathleen Lynch and Jan O'Sullivan for their work in bringing this motion to the House, researching the case they made so eloquently last night and putting this issue on the political agenda, where it will remain until satisfactorily addressed. This debate is about the fundamental right of our citizens to be cared for when they are sick and cared for to the best of our ability. It is about the enormous contribution of unpaid carers, whose invaluable work needs more than gratitude. If the litmus test of a society is how its most vulnerable members are treated, then it is a debate about ourselves and our society.

An estimated 10,000 people a year suffer from some form of acquired brain injury. In total, one out of six of our fellow citizens, neighbours, spouses, parents and children, are living with a neurological condition, including acquired brain injury. However, they are not the only ones affected. Acquired brain injury can have a devastating effect on the patient's family, who often provide care and support on a 24-hour basis, and with very little assistance. A brain injury or a stroke can change a person's life, and that of his or her family, overnight. It can make a sufferer dependent on others for assistance in everyday tasks, it can change personality, and it can leave the sufferer physically impaired. It can turn a breadwinner into a dependant, and a child into a carer. The trauma of acquired brain injury can be lifelong, for both the patient and those who care for him or her.

How does our society, and the health service we pay for, respond to the silent epidemic of acquired brain injury? The good news is that appropriate rehabilitation care can make an enormous difference to the quality of life of acquired brain injury sufferers. The bad news is that Ireland only has one, 110-bed rehabilitation hospital. The exceptional work of the National Rehabilitation Hospital deserves to be recognised. It is located in my constituency and, everywhere I go, when I say I am from Dún Laoghaire, I hear nothing but praise for the NRH staff and their commitment to their patients. I welcome plans to build a new hospital on the site.

However, one hospital is simply not enough to cope with the flow of acquired brain injury patients every year. A person with a brain injury can wait up to two years for a place in the National Rehabilitation Hospital, instead of the 24 hours which is the recommended time lag between acquiring a brain injury and specialist rehabilitative care. It should come as no surprise that the Peter Bradley Foundation estimates that 69% of patients with acquired brain injury end up in inappropriate facilities, such as geriatric services. Ireland has less than half the recommended number of neurologists, and half the recommended neurosurgeons, for our population. Only six consultants in the country specialise in rehabilitation.

This shortfall in rehabilitation and specialist care is replicated in outpatient and community services. ABI patients wait up to two years to see a specialist consultant. They can wait up to three years for an appointment with a speech and language therapist, an occupational therapist or a physiotherapist. Respite care to relieve carers is scarce. None of this is news to the hundreds of thousands of sufferers of ABI and carers, for whom this is the daily reality. Nor is it news to the Minister for Health and Children or the HSE, which has commissioned no less than three reports to examine the needs of ABI sufferers since 2003.

What we need are solutions and I offer some to the Minister, Deputy Harney, and her Government. Build more regional rehabilitation beds as part of a joined-up national rehabilitation strategy. Increase the number of posts for neurologists, neurosurgeons and rehabilitation consultants in line with our population needs. Instead of cutting back frontline services in the HSE, put patients first, and employ sufficient speech therapists, physiotherapists and occupational therapists to meet the real needs of ABI sufferers. Recognise that carers are invaluable, but not inexhaustible, and provide sufficient community respite care and counselling.

Around one in six of our population lives with a condition which affects the brain. Over the next ten years, that number is expected to grow by 100,000. Delays in accessing life-altering medical and rehabilitation care are already unacceptable. Without urgent action now to deliver care that matches people's real needs, an already chronic situation is set to get worse. Let us be clear about what is being debated here. For many ABI sufferers, rehabilitation is the difference between being alive and living. For some, successful rehabilitation will mean a return to work. For others, it will mean regaining some independence and some dignity. For their families and carers, it is about being able to manage the new circumstances in which they find themselves, instead of being overwhelmed by them.

ABI sufferers, and their families, are not asking for special treatment. All they are asking for is a fair chance of recovery and dignity as well as a fair chance at living. The neglect they suffer through grossly inadequate resources and disjointed services denies them this fair chance. I ask the House to accept the Labour Party motion and take a step towards giving these patients — our fellow citizens — their due.

I thank all who contributed to the debate on both sides of the House.

My first encounter with people who have acquired brain injury was on several levels. The one that made me take a serious look at this issue and try to persuade others to use our very valuable Private Members' time was a presentation given here by Brí. The one thing that stuck in my head — and this is all about heads — was the caption, "Mind your head because your head minds your mind." That was something I had never thought about before. Whether ABI comes as a result of an injury from outside or inside, the fact that so much can be done, but is not, is shameful for all of us. Neither the Labour Party nor, I dare say, Fine Gael or any of the other party wants to just have a go at the Government on this. That would ultimately be pointless since this Government is beyond that. It is shameless and simply does not react to anything. This is not about that, but rather holding out hope for the tens of thousands of people who know their lives could be better — and for those who look after them, their carers. It is a question of saying to them, in effect: "Your struggle will not be in vain. We will do something better for those who come after you."

In my opening address last night I spoke about one rehabilitation unit with 110 beds. The Minister spoke about a rehabilitation unit with 120 beds. What she did not tell us, and should have — and I just hope that she knew — was that 11 of those beds are closed because of cost cutting. At present we do not have 110 beds, but less than 100 because 11 are closed owing to shortage of funding. The HSE has cut the funding and the Minister has allowed it to do so.

The Minister can talk all she likes in general terms about the millions put into health care, an extra billion here or there. Let us talk about the 10,000 people who will this year acquire a brain injury, and the few chosen ones who will be able to get into a rehabilitation unit and have an expectation of a proper life as a result. I can quote all night from e-mails I have been receiving this week, but they are too many. Deputy Liz McManus quoted from one e-mail, but we could cite hundreds. I am sure the Minister of State has received them as well. There was a young family here last night, a brother, sister and a mother, whose son received the type of rehabilitation that is required for seven months, and came home to nothing. All that he had gone through had been for nothing. No speech therapy was available to him, as the Minister of State implies in his speech, and no physiotherapy. They are trying desperately to provide it from their own means on a private level, but that cannot happen. How can the average worker afford to provide the type of service that only a communal pot can pay for?

All types of issues are attached to this. It is not about having a go at the Government but rather shining a light on an area of health that has been left in the dark for far too long — that is all. Last night and again today in her eloquent tribute to the Taoiseach, the Minister made a big play of the fact we are all going to live three years longer than average. Darwin will confirm it is about the survival of the fittest. Is that what this Government is about as well, the survival of the fittest? Ultimately, it is a question of quality of life, not just longevity. What is the point if one's quality of life is not what one knows it can be? Imagine what it is like to be trapped within a body that, with the right expertise, development and processes, can be returned to normality and a fully functioning life. We are not even talking about something that would cost us more, but rather the fact that if the resources were shifted, millions would be saved, and those of us who are expected to live three years longer could have the quality of life we deserve.

In ten years time some 800,000 people will have acquired brain injury because we are going to live three years longer. It makes no sense for the Government to do what it is doing. It is about the inherent waste within the system. Someone once told me the system did not encourage savings. Neither does it encourage good sense or the type of shift we are suggesting. We are not asking the Government to study this issue any longer. We have the studies and figures and know what needs to happen. We are not asking for miracles overnight. A regional roll-out is not possible in one go. We are looking for teams to be put in place to assess needs and work on the ground and for an inpatient service to be developed from this. It is not right that the chances of survival should be better if one acquires a brain injury in Dublin, nearer to Beaumont or Dún Laoghaire, for instance, than they would be in Limerick, Galway, Wexford, Cork, Mallow, Kerry or any of those areas.

We should not and cannot conclude a debate such as this without acknowledging and paying tribute to all the consultants, therapists, nurses and workers who struggle daily to try to raise awareness and enhance the quality of life of ABI sufferers. I have in mind in particular the often unpaid and overlooked carers and family members who dedicate their lives to improving the lot of their loved ones. I trust and I hope that this motion will be a landmark step in providing proper services. This is an opportunity for politicians to stand up and be counted. I am not fussed as to who provides the service as long as it happens. As Deputy Gilmore has just said, acquired brain injury is a silent epidemic in Ireland. Those of us who have the ability to speak out should not be silent about it. I move the motion, in anticipation. Someone once said the job of all backbenchers is to hold the Government to account. Maybe they will have the courage of their convictions and vote for this motion.

Amendment put.
The Dáil divided: Tá, 71; Níl, 67.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Behan, Joe.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Johnny.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cuffe, Ciarán.
  • Cullen, Martin.
  • Curran, John.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gallagher, Pat The Cope.
  • Gogarty, Paul.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • Lowry, Michael.
  • Mansergh, Martin.
  • McDaid, James.
  • McEllistrim, Thomas.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • Moloney, John.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Brien, Darragh.
  • O’Connor, Charlie.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Rourke, Mary.
  • O’Sullivan, Christy.
  • Power, Peter.
  • Roche, Dick.
  • Ryan, Eamon.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.

Níl

  • Allen, Bernard.
  • Bannon, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burke, Ulick.
  • Burton, Joan.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Coveney, Simon.
  • Crawford, Seymour.
  • Creed, Michael.
  • Creighton, Lucinda.
  • D’Arcy, Michael.
  • Deenihan, Jimmy.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Gregory, Tony.
  • Hayes, Brian.
  • Hayes, Tom.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Naughten, Denis.
  • Neville, Dan.
  • Noonan, Michael.
  • Ó Caoláin, Caoimhghín.
  • O’Donnell, Kieran.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Mahony, John.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P.J.
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Varadkar, Leo.
Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Emmet Stagg and Paul Kehoe.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 71; Níl, 64.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Behan, Joe.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Johnny.
  • Browne, John.
  • Calleary, Dara.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cuffe, Ciarán
  • Cullen, Martin.
  • Curran, John.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gallagher, Pat The Cope.
  • Gogarty, Paul.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • Lowry, Michael.
  • Mansergh, Martin.
  • McDaid, James.
  • McEllistrim, Thomas.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • Moloney, John.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M.J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Brien, Darragh.
  • O’Connor, Charlie.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Rourke, Mary.
  • O’Sullivan, Christy.
  • Power, Peter.
  • Roche, Dick.
  • Ryan, Eamon.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.

Níl

  • Allen, Bernard.
  • Bannon, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burke, Ulick.
  • Burton, Joan.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Crawford, Seymour.
  • Creed, Michael.
  • Creighton, Lucinda.
  • Deenihan, Jimmy.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Gilmore, Eamon.
  • Gregory, Tony.
  • Hayes, Brian.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McGinley, Dinny.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Naughten, Denis.
  • Neville, Dan.
  • Noonan, Michael.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Mahony, John.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P.J.
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Varadkar, Leo.
Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Emmet Stagg and Paul Kehoe.
Question declared carried.
Barr
Roinn