23rd October, 2002
Dr. Henry: While I also wish the Minister of State well, he will be hearing from me regularly. I am glad he ended his speech by congratulating those who work in the acute hospitals. Never has there been a greater throughput of activity within these hospitals. What is being done on a day-care basis is amazing, but that is not to say I agree totally with all that is being done in this respect. Many patients could do with the care and comfort of at least one night in a hospital bed, for example, when having a gall bladder removed. Unfortunately, more straightforward operations of this kind are now being done on a day-care basis.
I do not agree with Senator Ryan's statement that the electorate was fooled prior to the last general election with regard to health service expenditure. I watched the Minister for Health and Children, accompanied by the new Secretary General of his Department, as they left the Government meeting in Ballymascanlon. They had presented the new health strategy, yet one could see quite clearly from their faces that the €12 billion sought would not be forthcoming. Anyone who really believed the strategy would be implemented was only fooling himself or herself, although it is a good strategy that should be implemented.
In recent years, there has been an unparalleled level of expenditure on the health service. However, when one looks at health spending levels in other EU member states, we have come from a very low level. If we are not prepared to pay the taxes necessary to support the health service we say we want and the Government is not prepared to levy them, we can only expect what is happening now.
What worries me most is the terrible loss of morale in the health service. I was glad to see that the Minister of State used the word "retain" because one of the biggest problems in the health sector is retaining staff. Despite the fact that there have been wage increases all around, we still have great difficulty in retaining nurses and now have to hire nursing staff from abroad. Worse still, we have a terrible problem in retaining staff during their final five years of service prior to retirement. The number of consultants and senior nurses opting for early retirement is alarming. Early retirement not only represents a loss of personnel but also a loss of expertise because it takes newly appointed staff some time to build up experience.
I cannot say exactly how many who qualified from medical school with me have chosen to retire at 60 years of age rather than 65. Doctors are under appalling stress in this country, which has higher levels of litigation than anywhere else in the world. Medical personnel do not deserve this.
I am a member of the board of the Rotunda Hospital and can say Irish midwifery services are second to none. Our maternal mortality rate is among the lowest in the world, even accounting for the fact that in recent years pregnant asylum seekers and refugees, who have had no ante-natal care, have given birth shortly after their arrival here.
It costs €50,000 to insure a midwife working in a labour ward, yet what proportion of the health service's budget goes towards these major costs? I do not know what health boards have to pay to insure their personnel, but it amounts to a considerable sum. We must examine our compensation culture to see how much money is being taken out of the health service. Claims arising from medical treatment are causing great concern internationally.
We should do more to ensure health service workers are not unnecessarily tired. We know that errors occur more frequently when staff become tired. Recently, I read a worrying report by a Ms Hilary Coates at the department of health and science at the Royal College of Surgeons. She extrapolated figures from American statistics in a survey that considered clinical errors which led to patients' deaths. Ms Coates's figures indicated there could be as many as 90 Irish patient deaths due to clinical errors, the vast majority of which were made when staff were working overlong hours. We know, for example, that mistakes can be made in prescribing drugs. I cannot say whether Ms Coates's figures are correct, but they are worrying. Perhaps the Department of Health and Children could look into the report. The surveys quoted from America were carried out in Colorado and Utah. The report stated there was a 2.9% occurrence of error due to treatment, 53% of which were said to be preventable.
At the same time the 17 October issue of the New England Journal of Medicine has been addressing the issue of fatigue among clinicians and the safety of patients. I suggest to the Minister of State that this publication is well worth reading. Morale among hospital workers is low and needs to be addressed. It is not entirely the fault of the Department of Health and Children, but only the Department can ensure the position is improved upon.
I do not know if the Department is aware of the fact that it is becoming impossible to replace general practitioners in the more deprived areas of our cities. It is proving impossible to get people to take jobs from general medical service lists. It has proved impossible, for example, to find a replacement for an excellent practice run by a husband and wife team in Ballyfermot. Something will have to be done to improve eligibility levels for patients in the general medical services scheme because many who are not really in a position to pay for health care are having to do so with difficulty.
The expansion of the number of acute beds is an excellent development, but, unfortunately, people seem to gloss over the fact that while beds may be available, there are no staff to service them. This still presents a major problem. The fact there are new facilities does not mean they can be provided because it may not be possible to recruit the necessary staff.
It is a pity there is not better co-ordination within the health service to move patients who should not be in acute beds to step-down facilities. I am aware that the Department is doing something about this, but every week one reads about patients who have spent months in hospital, when they really should not be there, because there are no step-down facilities available for them.
The Minister of State devoted part of his speech to hospital accident and emergency services which have been abused by people who should have gone to their general practitioners instead. The planned one-stop-shops represent a very good idea. It will take quite an effort to promote them, however, because it has proved difficult to get them going in the United Kingdom. It may, therefore, take quite some time before we are in a position to see changes taking place due to their introduction.
A dispute has been ongoing for years with the Department of Health and Children over the recognition of those eligible to be considered as chiropodists or podiatrists. That is to be resolved. I want to point out another area where the lack of these sorts of paramedical people makes such a dent in the finances. There is no foot clinic in St. James's Hospital but there is a huge diabetic clinic. The hospital has no chiropodist at present; someone comes in occasionally. Last year they had to admit 30 patients with foot ulcers. The average stay in hospital was 30 days. Eight lost their legs. They reckon it cost €1 million. Surely one could run a foot clinic for less than €1 million.
A Leas-Chathaoirligh, you are indicating my time is up when I have many more issues to raise, but I will finish with two important points. The Minister wants to produce 29 new accident and emergency consultants. That is a very good idea, but before this comes to fruition some sort of agreement must be made with these consultants about staffing the place on longer than a nine-to-five basis.
I strongly support all those who said something must be done about radiotherapy services. Recently I wrote to a constituent in Wexford about his wife, who has breast cancer and whom I had seen in the summer when she had chemotherapy. The reply I received thanked me for my remarks about the patient. He stated that she is doing well but we must surely get a radiotherapy unit in Waterford, and that trying to get into St. Luke's is a nightmare. He stated that she was hoping to commence radiotherapy two weeks previously, but he rang, the day before he wrote this letter to which I refer, to be told there were 22 people on the waiting list before her for this treatment, and that she will be at least another two weeks waiting. What difference is that making to her survival chances?
It is all very well talking about setting up centres of excellence around the country, but it is only theoretical unless we actually put in place the physical units which are needed. There are two only and that really will not do.
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