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Health services facing worse fate than 1980's cutbacks - Ferris

10 March, 2009


Speaking in the Dáil this evening on during the statements on the challenges facing the health services Sinn Féin TD Martin Ferris called for strategic decision making to be taken out of the hands of the HSE and placed with the elected representatives of the people in the Dáil. He said if the Government and HSE proceed with plans to cut services to patients the damage to public health services will exceed the damage caused by cuts in the 1980's.

Deputy Ferris also drew the attention of the house to the revelation that a whole range of health and community projects for disadvantaged areas are in jeopardy as the Department of Finance is blocking their finance.

He said, "The Health Service Executive faces a shortfall of over €1 billion in 2009. Our already inequitable health system is now faced with even more savage cuts that will drastically affect the care of patients if the Government is allowed to continue to hide behind the HSE which will wield the knife on behalf of Fianna Fáil and the Green Party.

"Real savings need to be made and can be made by ending all State subsidies for the private for-profit health sector, reining in those consultants who profit from both the private and public systems, cutting the drugs bill through the use of generic drugs and the establishment of state pharmaceutical procurement and distribution company.

"The Government could also cut the massive salaries and allowances at the top of the HSE, including €16,000 per month for an advisor to HSE Chief Brendan Drumm.

"Instead the Government and the HSE are preparing to cut services for patients and the pay of front-line healthcare workers. If they proceed in that way the damage to our public health services will be catastrophic and will exceed the damage caused by cuts in the 1980's.

"It is now time for strategic decision-making to be taken out of the hands of the HSE and placed where it belongs - with the elected representatives of the people in the Dáil. Any revised Service Plan and Budget for the HSE must be placed before the Dáil so that the Taoiseach, the Health Minister and their colleagues can be fully accountable. Equally importantly, the Government must listen to and take on board the constructive proposals of all parties.

"I would also like to draw the attention of the House to the discovery by my colleague Caoimhghín Ó Caoláin TD that a whole range of health and community projects in disadvantaged areas, including 120 announced by Government last December, are now in jeopardy as the Department of Finance is set to block their funding.

"These are all projects in disadvantaged urban and rural areas across the State which were to be funded by the RAPID and Clár programmes and administered by the Health Service Executive." ENDS

Full text of Deputy Ferris' speech follows:

The Health Service Executive faces a shortfall of over €1 billion in 2009. Our already inequitable health system is now faced with even more savage cuts that will drastically affect the care of patients if the Government is allowed to continue to hide behind the HSE which will wield the knife on behalf of Fianna Fáil and the Green Party.

Real savings need to be made and can be made by ending all State subsidies for the private for-profit health sector, reining in those consultants who profit from both the private and public systems, cutting the drugs bill through the use of generic drugs and the establishment of state pharmaceutical procurement and distribution company.

The Government could also cut the massive salaries and allowances at the top of the HSE, including €16,000 per month for an advisor to HSE Chief Brendan Drumm.

Instead the Government and the HSE are preparing to cut services for patients and the pay of front-line healthcare workers. If they proceed in that way the damage to our public health services will be catastrophic and will exceed the damage caused by cuts in the 1980s.

It is now time for strategic decision-making to be taken out of the hands of the HSE and placed where it belongs - with the elected representatives of the people in the Dáil. Any revised Service Plan and Budget for the HSE must be placed before the Dáil so that the Taoiseach, the Health Minister and their colleagues can be fully accountable. Equally importantly, the Government must listen to and take on board the constructive proposals of all parties.

In the absence of real accountability and a Government that listens to the people, especially those who use the health services, what do we have? We have decisions such as the disgraceful decision to scrap the National Carers Strategy.

Across this State dedicated people are looking after family members in the home with inadequate support from the State. In my own County of Kerry there are nearly 6,000 carers. Continued lack of adequate support will lead to worsening health for both carers and cared-for, resulting in much greater healthcare costs to the State.

To begin with I would also like to draw the attention of the House to the discovery by my colleague Caoimhghín Ó Caoláin TD that a whole range of health and community projects in disadvantaged areas, including 120 announced by Government last December, are now in jeopardy as the Department of Finance is set to block their funding.

These are all projects in disadvantaged urban and rural areas across the State which were to be funded by the RAPID and Clár programmes and administered by the Health Service Executive. The announcement of the projects was made just before Christmas by Minister Ó Cuív and Minister Máire Hoctor who said that €4.6 million would be made available for the 2008/2009 scheme. This was to allow elderly people to be able to live independent lives.

The 120 projects range from a drop-in centre in Cavan Town to a Meals on Wheels service in Dublin 12, from a bus project in Cork city to refurbishment of an Alzheimers' Society facility in Drogheda. All of these are worthy projects and would have contributed greatly both to the needs of the individual older people concerned and in many cases to their family members who would be given some respite from constant care particularly in the situation where people were suffering from conditions such as Alzheimers which places such a demand on carers.

My own county is among does badly hit by the proposed withdrawal of funding. Projects with a projected investment cost, funded by a combination of CLAR and HSE inputs, of €1.2 million are under threat. They include programmes to improve services and community support for older people based in the Lixnaw Community Centre, Knocknagoshel Community Centre, Listry Community Centre, the Coomnassig Centre in Sneem, the Caherciveen Social Services Centre, Portmagee Social Services, Duagh Resource Centre, Glencar Care of the Aged, and The Glen Social Centre, Ballinskelligs.

Also at risk are plans to improve childcare and family support at the Scartaglin childcare association and the telemedicine centre in Faranfore.The overall cost of the proposed joint Clár and HSE programmes was to have been €8.9 million and was also to included the provision of day-care services development in Castleblayney, County Monaghan, and the upgrading and equipping of 10 day-care centres for older people in County Donegal.

The HSE has apparently now been required to re-submit all these capital projects to the Department of Finance and there is a general expectation within the sector that the funding will now be withheld. I would like to reiterate Deputy O Caolain's appeal to the Minister for Finance Brian Lenihan TD not to axe any of these projects which are based in disadvantaged areas and which are especially important in enhancing the health and quality of life of older people. I would also ask him to reflect on the fact that while withdrawing the funding may represent a small short term saving, that in the long run it will actually increase the demand of those concerned on the health services, on their GPs, on hospitals and ultimately represent an even greater draw on the exchequer. It is surely far better and makes more sense, including economic sense, to provide those services which will improve the quality of life for the people affected and therefore improve their health and lessen their dependency on direct provision from the health services.

This is only the latest in a series of blows to the health sector throughout the country, and one which will inflict more hardship on those least able to cope with it, especially elderly people. The overall impact of the health cuts in Kerry have already been dramatic. The HSE has announced planned cutbacks of €4.5 million which will devastate an already overburdened and under funded service. This will have a serious impact on patient care, particularly at mental health facilities in the county. And of course the Government imposed cuts in staffing and beds stand in stark contrast to the fact that the Private Health Industry continues to enjoy massive tax breaks.

Among the proposed cuts is €1.2 million to be removed from Mental Health Services in Kerry. This will include bed closures and staffing reductions at the Acute Psychiatric Unit at Kerry General Hospital. The HSE has implemented these cutbacks without properly consulting with the staff's union representatives as they are required to by the Labour Court. I tabled a series of questions about this last week but have to date received no reply and they have been referred to the HSE.

Psychiatric Nurses at Kerry General Hospital have one of the most demanding jobs within the health service and to attack them in such an underhanded way and against the spirit of the earlier Labour Court rulings requiring consultation is repulsive. I have also asked that a full health and safety audit be carried out in the Acute Unit in order to assess the likely impact of the cuts on both the staff and the patients and likely implications which that may have on the safety of those concerned. People are appalled that such miserable cuts are being made to frontline services while the Minister for Health continues to defend the tax breaks available in the Private-for-Profit Health sector.

The threat to services for old people I referred to in the threatened withdrawal of the promised CLAR and HSE funding for services for the elderly comes shortly after the Government decision not to publish its long-promised National Carers' Strategy. That will affect somewhere in the region of 160,000 family carers whose work in the home saves the State many hundreds of millions of euros every year.

The decision is also in direct breach of the Towards 2016 Agreement and reneges on the commitment in the Programme for Government to 'ensure a National Carers' Strategy focusing on supporting informal family carers in the community will be developed by the end of 2007.' It can also be deemed to be extremely short sighted even within the context of the current desire to save money as any scaling down of the Carers schemes will exacerbate existing problems and lead in the long term to greater dependency on direct provision by the state. Not to mention of course the economic consequences of the withdrawal of Carers payments. So instead of making real savings the miserly cutbacks are actually only creating a vicious circle that in the long run adds to the costs of the health service if peoples health disimproves and they require more direct care from the state. Assuming of course that even such basic provisions survive the current onslaught on the existing services.

That illustrates the extent to which health spending and the health services in general are inextricably linked to the overall state of society. It is no mystery that those on lower incomes tend to have poorer health and therefore to be more dependent on the health services. It is also true that peoples lifestyles in terms of what they eat, drink, whether they smoke, whether they use illegal or legal drugs and the extent to which they engage in physical exercise also effects their health.

People obviously have a responsibility for that themselves but society must create an environment which encourages people to live in a more healthy manner. Unemployment, low incomes and poor accommodation contribute greatly to poor health and the lack of sporting and other recreational amenities prevent people from engaging in healthy pursuits. All of these are of course greatly impacted by the economic situation and in the current circumstances all of those negatives factors are on the increase.

That is why it is all the more important that in the current situation that the state does not actually make things worse by implementing cuts that will on the one hand contribute to a worsening of peoples health and on the other impost actual cuts within the health service itself. The first contributes to an increased demand on the health service while the second further increases the difficulties of adequately addressing those problems when they do arise.

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