10 December 2004
Dr. Henry: I welcome the Minister to the House and very much welcome her Bill. I support Senator Browne's comments about the reports which have been issued by the Department of Health and Children over the past seven years. Approximately 130 reports have been produced at a cost of approximately €30 million but there has been very little action on any of them. While I welcome warmly the Minister's decision to take action, I remain concerned that the legislation will constitute a process of rebranding rather than of real reform.
Health boards have been in place for a long time and have had varying success over the years. Those involved in them have lost a certain amount of their enthusiasm. It is not wholly the fault of those who work within the health boards. I have seen brave initiatives by some boards receive very little support from the Department. The pilot scheme for cervical screening in the Mid-Western Health Board has been a recognised success for almost a decade but despite the efforts of the board has not been extended to the rest of the country. There have been disasters in some places where health board management appears to have completely lost control. In that context, I will be pleased to see the establishment of the executive.
I was a member of a the Eastern Health Board a long time ago when services were less complex and we could keep some sort of eye on them. I was a Member of the House when we agreed to split up the health board area, a process everyone must now recognise was not a success. While it was not intended thus, I found myself in scenarios in which I was dealing with a consultant psychiatrist in one area who was treating people from another on an inpatient basis in a third. It was completely out of hand and unsuccessful.
There are some interesting revivals provided for in the Bill. I was a member of the National Health Consultative Forum 30 years ago, which is approximately when Senator Browne was born. It is interesting to see it return. It was a pretty useful body and while I do not know if anyone took any notice of us, I was pleased to be on it. While the city and county council area local fora provided for in the legislation are a positive idea, discussion of the need also to recognise town councils in the context of the Garda Síochána Bill should be borne in mind. Perhaps we could consider the matter on Committee Stage. Comhairle na nOspidéal, another body on which I served, is being dissolved. It is correct to place it in a more mainstream position.
All Members must be aware that representatives of the voluntary and community sector are not best pleased that it has not been positioned more prominently in the Bill. They would like the sector to be recognised on a statutory basis. While an advisory role has been provided for in section 47, the failure to include the community and voluntary sector further has disappointed people in the context of the endorsement of the Minister for Finance in his budget speech of the role it plays in Irish life.
In establishing the executive, the Minister should be careful to ensure medical interests are not over-represented. While the Irish Nurses Organisation will want to ensure a nurse is appointed and I am quite sure the Minister will appoint one if not two doctors, running a health service requires the advice not just of those working in it, but also of people with a great deal of managerial experience. Given that this Bill is about the management of the service, it is not only its medical aspects which should be considered. We also need people with experience in personnel and information technology. This is the context of my concerns that the legislation may simply represent a process of rebranding. There do not appear to be enough provisions regarding management.
There have been examples of disastrous health service management over the years, some of which were interrelated. There have been continual complaints about the accident and emergency department at the Mater Hospital, which is in a dire state. It is always grossly overcrowded and people end up on trolleys for days. The same is true at all the other major hospitals in Dublin. What annoys me most is the fact that up the road in Ballymun the new health centre, which was completed two and a half years ago, has still not been equipped and opened. The old Ballymun health centre is completely incapable of dealing with the population in the area. It is unsafe at times due to the interference of water with its electricity supply and there is no heating. It must be shut down frequently.
If we tell people constantly not to attend accident and emergency units when they should more appropriately attend a general practitioner, we must ask who is responsible for the fact that one such unit which is significantly overcrowded is situated at most one mile from a new health centre which has not been opened. It is ridiculous carry-on and typical of the circumstances which obtain nationally. Staff have yet to be recruited to operate the surgical wards in South Tipperary General Hospital in Clonmel which have existed for approximately a year and have yet to be commissioned. Patients at the hospital who require surgical procedures are transported across country to Cashel. Who is responsible for this ridiculous carry-on? I do not know how long the wards at Mullingar General Hospital have remained unopened. When I last raised the matter in the House, Senator Glynn said progress was being made, but one would like to see a great deal of it.
We must do something about information technology. The extension of medical cards to people over 70 was an unbelievable debacle with 30% more people than expected being found to be eligible for them. How can one plan a health service if one does not have the statistics one needs? The Scandinavian countries and some others also have a personal identification number which people are given at birth. That number remains with that person for whatever service they are availing of. They have population registers as well which gives an idea of where people are at any time. Information like that is needed when trying to plan services.
I have been talking about an identification number since we brought forward the legislation regarding BreastCheck. The other day Senator Cox brought up the delay in extending the BreastCheck programmes to the west. One of the major problems is the difficulty in making up the lists of those who are eligible. When the lists were being made up initially we had to get them from the GMS and the VHI; we now have to get them from BUPA also. We then have to correlate those and tell anyone who had been left off them to get on to the service. We are moving towards some process with PRSI numbers but it is not the same as having a personal identification number. That is something the new board should examine immediately because we cannot plan if we do not know the number of people for whom we should plan.
There is a major problem with people attending accident and emergency departments who should be going to see their general practitioner. Apparently, 40% of people should be going to see their general practitioner. Rather than bringing general practitioners into the hospitals we should start training members of the general public to see general practitioners. Frequently in this House I am asked a question by people who are feeling sick and I tell them they should go to see their general practitioner. They reply that they have not got one. I tell them that if they go in one direction there is the Albany Clinic, in the other there is the Grafton Street Clinic in Anne Street or if they want to go a little further they should go to the Radcliffe Clinic on Fitzwilliam Square. Several GPs have their plates up, one on Merrion Square and others in Baggot Street. I walked from Dublin Castle the other day and passed a general practice. There is another general practice in Temple Bar. People will have to get the message that they should go to general practitioners when they are sick. They should only go to hospital if they have had an accident or some other emergency. We should try to get that message across to people and I hope the new boards will do it. I hope the college of general practitioners becomes involved in that too. Senator Feeney will be well aware of the problem about advertising but perhaps we should do more advertising. People should be able to get lists of general practitioners not just in local health centres but in shops and so on. It is easy to understand the reason people end up in casualty when they become ill.
Terrible problems are caused in accident and emergency departments as a result of over-consumption of alcohol. This is one area where reports have been ignored. All we do is wring our hands about it. A report was published in 1996, another in 2001, one last year and another this year, yet nothing has happened. Specific recommendations were made about identifying the mainly young people in accident and emergency departments and getting them involved in some sort of programme. Specialist nurses in particular were mentioned in the report.
I read a report to the effect that the Minister, Deputy Harney, is considering setting up special treatment units for minor injuries run by nurses. I would be more inclined to advise people to see their general practitioner in that case and get the nurses, if they can be found, involved in the programmes suggested by the four reports on alcohol, the last of which was sent to the joint committee on which many Members of the House sit. We must take notice of what is contained in those reports in terms of what we can do to improve the service.
We have a notion that once we produce a report we have done something but we have done nothing. We have just produced a report, although I suppose it is nice to have a sack of reports. I threw out a lot of them the other day because their recommendations will not be implemented in my time. We should have no more reports. We should implement the recommendations in some of the good reports already available.
I frequently raise the problem about the enormous amount of money spent on the health service for which there appears to be very little accountability. I welcome the fact that this board will try to deal with that problem. I realise a great deal of that money goes on wages but large amounts go on areas where I am sure more savings could be achieved.
The time spent on waiting lists is a major factor in the minds of the public but they are not the only important figures we need to consider. The United Kingdom recently reduced its waiting lists but the waiting time for diagnostic procedures has increased greatly and the waiting time to get on to a waiting list has gone up in some areas. We should not get too tied down with waiting time figures. It is important to remember that while the hospital treatment purchase fund is getting people off waiting lists, it is not doing anything for our health service.
I applaud the initiative which suggests that hospitals not offering accident and emergency services on a 24-hour basis should start doing elective work. I worked in the Adelaide Hospital when that hospital and the Meath Hospital had an entente cordiale and agreed to work together. We closed the accident and emergency department in the Adelaide Hospital — one had to travel only a short distance up the road to the Meath Hospital — and everyone in the Adelaide Hospital did elective work. The dreadful disappointment of operations and procedures being postponed is caused by major car accidents where six or eight people have to be admitted. That takes up the resources in the intensive care unit and other acute beds and the result is that other people's procedures have to be cancelled. In our case we were doing the elective work for both hospitals which meant that operations and procedures were not cancelled. That gave great satisfaction not just to patients but to staff as well because when everyone is geared up for a day's work and then the procedure is cancelled because of a serious incident, it is very disappointing.
Having read in the newspaper this morning that there would be a longer lead-in time to the Bill I had hoped we could put off taking Committee Stage next week and not rush it through the House. I have not had an opportunity to read everything that went through the House last night. I read the Bill as initiated and as amended in select committee but I have not had a chance to read it all as yet. I am sure that is the case with other Members. I had hoped we could put off Committee Stage to allow us do that. The Minister, Deputy Harney, provided a good deal of time for Committee Stage of the Environmental Protection Agency Bill and I had hoped this Health Bill would get just as much consideration by this House. Perhaps the Minister might think again about that.
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