Statements on the current state for our health system, to Minister Varadkar

Health Care Reform

[Speaking in the Seanad during ‘Statements on Health Services’ debate]

I welcome the Minister. I wish him the best in his efforts to try to reform the health service. The Minister does not need my advice in this regard but I urge him to remain firm and steadfast in respect of the national children’s hospital. The decision has been made and the hospital should be built. As I have written and stated on multiple occasions – and I mean no disrespect to anyone involved when I say this – one cannot obtain an opinion from any professional commentator on this issue which is not tainted by institutional prejudice. I am not referring here to self-interest and I am not saying that people want to line their pockets. Rather, I am referring to the fact that people love and have loyalty to the institutions in which they work and they naturally have a desire to see these institutions being built up. At the time the relevant decision was taken, I believed that the right thing to do was just to rebuild Our Lady’s Children’s Hospital, Crumlin, on the existing site. When it was then decided to locate the new hospital on the site of the Mater, I also voiced my support. Through gritted teeth I indicated my opposition to the delay caused by what seemed to be an utterly irrelevant intervention on the part of An Bord Pleanála, which seemed to be offended by the fact that the view northward up O’Connell Street would be destroyed by the sight of a wonderful monument to our desire to care for our children being built near the site of what were some of the worst slums in the history of the State. Of course, the mortality rate among the children who lived in those slums was among the highest in the world at the time. Now that the decision has been made to build the new facility on the site of St. James’s Hospital, I support it 100%. The Minister should go ahead and deflect it and should not allow anyone to deflect him in that regard.

At some quiet moment, the Minister should ask the people who made various statements at the time of the controversy surrounding Roscommon hospital to give him the relevant telephone numbers in order that he might issue quick and gentle apologies to Dr. Paddy McHugh and the staff of that institution. During the most recent general election campaign, Fine Gael pledged that Roscommon’s accident and emergency department would remain fully open. When the decision in this regard was changed shortly after the general election, it was suggested that this was done on the basis of a report which showed an unconscionably high mortality rate among heart attack patients at Roscommon hospital. The then Minister, Deputy Reilly, to whom I gave great support, stated at the time that he felt he had no alternative other than to close the 24-hour accident and emergency service at Roscommon hospital and that patients who suffered heart attacks would be transferred to Galway, where they would be safer. It subsequently emerged that the figures with which the then Minister had been presented were entirely incorrect. I am not stating that the current Minister should revisit the issue of restoring the full accident and emergency service at Roscommon hospital. However, Dr. Patrick McHugh and the staff at the hospital, who built up the cardiac unit which it was suggested had an unbelievably high mortality rate among heart attack patients, are owed an apology. Roscommon hospital was completely neglected by successive Governments over many decades. The staff there went to great lengths to ensure decent care was available to those who suffered heart attacks. The record in respect of Roscommon must be put straight.

It was not the Minister’s doing, but I have grave concerns about the graduate nursing programme. I note the Minister will try to plug some of the gaps which, ludicrously, are being plugged at present by more expensive agency nurses. Parenthetically, I have often attended going away parties of nursing staff in my hospital, only to return to work the following day to find them back working at their old job at a higher rate for an agency. It is one of the many dysfunctions I believe the Minister will attempt to address. The Minister is, perhaps, the straightest-talking politician I have ever encountered in Ireland. We need very firm assurance the graduate nursing programme has not, is not and will not be used as a means of replacing fully-paid experienced nursing staff with cheap labour.

Will the Minister philosophically address the issue of corporatism in the health service? The health service is the people’s health service and not a separate corporation for which the people are some type of external threat. It sometimes seems this is the case. I understand there can be legal complexities in specific cases in the Department, but recently there have been multiple examples where it is very apparent people were badly treated by the health service. Even a good health service will occasionally get it wrong and there will be legal challenges and people will need redress. Something needs to be done about a corporatism which allows individuals to be kept dangling five, ten or 15 years, with multiple legal denials of wrongs which the health service and its lawyers know occurred. There must be a better, more efficient and more humane way to deal with this.

I would like the Minister’s assurance that the recent disclosure of data about the spending policies of some aspects of Positive Action, which represented a group of women who were very shabbily treated by the State, was truly coincidental. The women it represented are hepatitis C sufferers, infected with the potentially lethal virus by the incompetence of actors of the State which, in some cases I believe, was covered up in a malfeasant manner by the actions of the State. I find the level of coincidence troubling, as it happened when agitation was being launched on spending money on drugs which could cure these women of an illness which, in many cases, the State gave them.

I have received multiple representations on medical cards for people with specific disorders. I was troubled when we heard some weeks ago that members of the expert group threw their hands up in the air, stated it was too difficult and they could not do it. Will the Minister tell them to go back and try harder? Recently I spoke to a mother of three children with muscular dystrophy, and the Minister knows as well as I do the inevitable decline of those who suffer diseases such as muscular dystrophy and Friedreich’s ataxia. They will never be able to work normally or return to work. They will need maximum support. In the presence of some of these conditions people should automatically qualify for the full assistance of our health service.

Recently I spoke to a neurosurgeon who works exclusively in private practice in Dublin. He told me the combination of the elevation to €11,000 per month of the malpractice premium he must pay, with the fact the VHI has reduced its reimbursement structure for one of the bread and butter procedures he does, means the arithmetic no longer adds up. He has tendered his resignation and is moving to another country. One can argue this is the private sector, but all of the patients I send to him in the private sector will now go to the public sector. Stereotactic radiosurgery, an increasingly used treatment modality for patients with primary and secondary brain tumours, is available on a national level in Beaumont Hospital. I believe the system will go under when this particular private outlet is removed. I desperately ask the Minister to examine the circumstances. He is the sole shareholder of the VHI, which has partly contributed to this situation.

The Minister must examine the question of waiting lists. He is an impressive young man and I am an older dog. I believe very firmly that waiting lists are the business plan of the HSE. It is built into the structure. When people are on the waiting list they are free. When they come off the waiting list they cost money. This is the fundamental arithmetic of how a system such as ours is budgeted and financed.

I ask the Minister to please remember he came into power with a Government which, more forthrightly than any before, put on page 1 of its election material the intention to reform the health service. It was specific about the type of reform it would follow. We were going to get a Bismarck-style, insurance-based mixture of social democratic and private health insurance to replace the current State-funded scheme. That was one of the reasons that I and others so enthusiastically supported the Government.

I cannot begin to tell the Minister how crushingly disappointed and cynical it makes me about the process of politics when one views the trajectory of this issue’s handling throughout the course of this Government, from an early statement following the election that, while the Government would do it, it would happen after the next election, to the recent disclosure of documents from the actual civil servants and bureaucrats whose job it would be to implement this popularly mandated and democratically authored policy with which the Government went to the people and for which the people supported the Government to implement showing that they did not believe it could be done. There were also recent disclosures to the effect that the Minister did not believe it could be done.

The Minister bears a greater responsibility than just fixing the health service. I am sorry if I sound like I am inflating the issue but, as a democrat, the Minister bears a responsibility for preserving the integrity of our democratic process, which has recently been shown to be under great threat. There is a tendency of people leaking their loyalty to democratic parties to organisations that have a thin veneer of adherence to democracy. The only argument that we can advance against people who do so is that truly democratic parties are better, more honest and more reliable and will do what they say. This is a part of the mantle that has been passed on to the Minister. I hope that he understands the seriousness of that responsibility.

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