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Health Services: Motion (Resumed) [Private Members] (Continued)

Wednesday, 29 January 2014

Dáil Éireann Debate
Vol. 828 No. 2

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(Speaker Continuing)

[Deputy Mick Wallace: Information on Mick Wallace Zoom on Mick Wallace] Wexford General Hospital is also experiencing direct cuts to resources and a recruitment embargo that has led to junior doctors working excessively long shifts without proper periods of rest. Some doctors are working 36 hours without a break.

All this has been taking place against the backdrop of austerity cuts to the health services that are destroying people's lives. As noted by Michael Taft yesterday, since the beginning of the crisis, health expenditure has been cut by 12.6%, with a further 2.6% cut planned this year. Health spending was once seen as a positive investment that carried tangible economic and social benefits, but now we have a neoliberal government with a different vision. While our public services are getting bad press, the ground is being made fertile for the bogus claim that the private sector must step in to pick up the slack, while failing to mention that this would mean reinforcing the two-tier system where the poor are punished for their inability to pay and the rich are rewarded for their ability to pay. This further entrenches inequality in Ireland, which is currently four times the OECD average. Ministers may claim that they have a different vision on how things should be done, but it is probably a bit far-fetched to call it a vision.

Deputy Maureen O'Sullivan: Information on Maureen O'Sullivan Zoom on Maureen O'Sullivan Ar dtús, ba mhaith liom aitheantas a thabhairt do na buntáistí agus na rudaí dearfacha a bhaineann leis na seirbhísí sláinte. It is important to acknowledge the progress that has been made. I would like to acknowledge the palliative care available to people here. I had experience of it before Christmas, and it was an excellent service. Waiting lists are improving, but the difficulty now is that while people are getting the initial appointment quicker, the delay then starts. I would love to see the statistics on the time between the initial appointment and the actual date of the operation, the treatment, the occupational therapy or the physiotherapy, or the detox bed, or presenting with an eating disorder or a mental health issue.

Before Christmas, the director general of the health service gave a briefing on the service, and I was one of three Deputies who attended. It was excellent for the three of us because we had real one to one engagement. It was very obvious, looking at the plan, that there are challenges and reductions, and it is difficult to see the match between the requirements and the increasing demands and resources and funding available. It is happening today with a further increase in private health insurance, which will see more demands on the public service.

I would like to list a couple of examples which show that we are very far behind, one of which is related to CAHMS. I am hearing from the management of schools and from doctors who are referring young children to the Child and Adolescent Mental Health Services, and who are being refused. They do not make those referrals lightly, so I do not know if it is a resource issue or if the criteria have changed, but certainly there are many more refusals and there is still a big gap for those presenting with issues in the 16 to 18 age group.

Diabetes is an area in our medical system that does not get very much attention, but I think there is a need to look at those presenting with chronic diabetes in a much more holistic way. If patients come into an accident and emergency department with a kidney or heart problem, it should not be seen in isolation from the diabetes. I hear from people who have serious difficulties because they have chronic diabetes. The same is the case with stroke victims. While the therapies are good, there can be shortfalls in medical care.

I want to make one plea on substance misuse in the service plan. I hope that all of the local knowledge and the initiatives that have been built up in the communities most affected by the drugs issue will not be lost, and there will be supported drug recovery and accommodation. We must separate those in recovery from those who are actively using.

In the Government amendment there is a commitment to patient safety, but I recently came across an incident of a young woman delivering a baby in one of our maternity hospitals who was sent home and came back on three occasions because she continued to bleed for ten days after birth. It was discovered on the third occasion that the cutting had happened during birth. With the extent of the loss of blood, that is not patient safety.

Deputy Seamus Healy: Information on Seamus Healy Zoom on Seamus Healy Serious and significant damage has been done to the health service over the last five to six years, with huge cuts of €3 billion and 11,000 staff. Again this year we have €619 million of cuts and 2,600 staff lost. I pay tribute to health staff all over the country who work above and beyond the call of duty, every hour of every day. I especially wish to pay tribute to the dedicated and committed staff at South Tipperary General Hospital. This is a progressive, modern hospital which, in spite of a loss of one quarter of its budget and almost 200 staff, has increased its activity levels over the last few years. It is now akin to a regional hospital, with patients attending from north Tipperary, Waterford, Cork and Limerick.

Cuts to budgets and reductions in staff have serious implications for patients, and one of the serious problems at the hospital is the ongoing difficulty for patients on trolleys, not just in the emergency department, but also in the corridors and the atrium of South Tipperary General Hospital. This is simply unacceptable and must stop. I have made continual representations on this. I finally got a commitment from the HSE for the opening of ten beds which were closed in the hospital. Even though there is a significant number of patients on trolleys, beds were actually closed in the hospital. There is a commitment to open those beds and to provide additional staff for the emergency department. However, the national recruitment service is simply unworkable and there are huge delays in filling posts. I call on the Minister to allow for local recruitment in cases such as this. There is an ongoing difficult situation in respect of patients on trolleys. Beds have been closed and we have approval to open those beds, but that has been delayed by the delay in appointing staff through the national recruitment service. That could and should be done locally and I ask the Minister to ensure that approval is given for filling those posts through local competition.

Deputy Clare Daly: Information on Clare Daly Zoom on Clare Daly We used to aspire to having a society and a health service where we look after people from the cradle to the grave, but I want to deal with the period before we get to the cradle and the crisis that exists in the maternity services in this State. Since 2001, the directors of the midwifery services and the CEOs of the three major maternity hospitals have spoken about having a scenario of too few obstetric staff, too few midwives and overstretched to the point of raising fundamental concerns about safety. Despite that, in response to the closure of the Mount Carmel Hospital last weekend, the Minister for Health states, without a shred of evidence, that the existing hospitals will absorb the 1,000 plus births that Mount Carmel Hospital used to deliver. How could this miracle possibly happen? It is true, as the Minister stated, that the birth rate has declined slightly, but we are nowhere near the levels that we were at in 2007 and 2008, when at that time the HSE commissioned a report into our maternity and gynaecological services in the greater Dublin area which declared a crisis. The report stated that the hospitals were understaffed and they needed an additional 20 obstetricians, 221 midwives, 20 neonatal nurses and 35 theatre staff across the three main maternity hospitals. Since then, the birth rate has increased by about 40% and the CEO of the Rotunda said at the end of 2012 that the figures given to staff those hospitals, at a full-time equivalent of 707.73 staff, were not sufficient. Yet last year, the hospital was given 679.42 full-time equivalent staff.

This crisis is replicated around the country. There are high sick levels, there is an embargo on recruitment and staff and midwives are leaving. The result of this is the type of analysis that we got in the report commissioned by HIQA in the services at University College Hospital Galway last year, where there was deemed to be a general lack of provision and fundamental care. The answer to this has been to cut funding further. Unless we have a radical overhaul of our maternity services, then further lives will be put at risk. The safest way, with the best results for women and their children, has been established as an investment in midwifery and midwife services, yet this Government has failed to replicate the pilot programmes that were carried out. If we were to invest in that, we would save money and have a better outcome for women and their children. Cutting budgets and failing to attend to that will not deliver.


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