This motion acknowledges all the hard work by doctors, nurses and other health care professionals in the North Eastern Health Board region. However, there has been a number of tragic events in the north east that the House should discuss because there is a need to restore patients' confidence in what is happening in the North Eastern Health Board region and in many other health board areas. The Opposition is afraid that when the new health authorities come into place on 1 January 2005, they may have even less accountability to the House.
I am calling on the Government to explain fully its intended role in the operation of the new health service executive. I also wish to see all stakeholders in the north east having a say in such future services. It is also intended to discuss the resourcing of the Cavan-Monaghan and Louth-Meath hospital groups.
In two months' time, the North Eastern Health Board, like all other health boards, will cease to exist. My fear is that the transparency, accountability, value for money and the role that public representatives have as watchdogs of the health care system will disappear under an increasingly careless, arrogant and uncaring Government.
Doctors, nurses, other health care workers, hospital administrations and local community groups have worked together to try to maintain health services without adequate Government funding. At one point or another, all these groups have endured attempts by the Government to blame them for these problems. Health board officials have been a particularly soft target for scapegoating since they cannot defend themselves in public. They are obliged to remain silent as they are pilloried by members of the Government for the current Administration's failings.
The manipulation of facts by spin-doctors was accepted by many in the community who felt they would never need health services. Now, however, everybody knows someone who is unhappy with the health services. The Government has failed totally during the past seven years and we are concerned and fearful that our families will be affected in the foreseeable future by the health crisis.
By focusing this debate on the North Eastern Health Board we will try to deconstruct the myth that the Government cares about the health services. During a visit to three hospitals in the north east, I found everybody saying that it is a question of resources. That major issue in our health services was referred to repeatedly by nurses, administrators and others we met on that visit. The Government will have to face the fact that the health services are not properly resourced.
If there are other difficulties — or inefficiencies as they are being described — and if millions can be saved from the health budget, then I would like to hear Government Deputies talking about that. They should indicate all the areas where millions can be saved. I do not want to hear a reiteration of what has been done since 1997. They should simply point out where this money can be saved. Every time there is a health crisis we get a knee-jerk response from the Government with Ministers indicating where money was spent. However, one of the last jobs undertaken by the former Minister for Health and Children, Deputy Martin, before he left that portfolio, was to announce an expenditure of €85 million to commission €400 million worth of hospitals and health centres that have been left idle for years.
In a recent speech to her own supporters, the Tánaiste and Minister for Health and Children, continued this deception of the Irish people, stating:
It is fair to say also that we have not had the more widespread improvements that all might have expected from tripling health spending in our health services since 1997. This is because our health services are not nearly as efficient or effective as they could be in using this additional investment.
This is a real kick in the teeth for nurses and hospital administrators who are trying to keep the health service going. I wish to focus on the two major issues to which the Tánaiste has referred, namely spending and inefficiency. As regards spending, Ireland reached the EU average on what we call health spending in 2001. If we are to believe a recent ESRI report, 20% of the health budget is actually social welfare spending. If that is true, then we have never reached the EU average on health spending during the lifetime of the current Government. If that is so, it puts to rest the argument that the health service is well resourced. It has not been well resourced at any stage of the Government's term of office.
Today, there are patients lying on trolleys in Cavan Hospital, Our Lady of Lourdes Hospital in Drogheda, and Beaumont Hospital in Dublin. They are too sick to contemplate why our accident and emergency crisis has become an all-year-round affair, when even four years ago it was simply a winter crisis. The number of patients on trolleys continues to grow every day. That is one statistic that has been increasing annually. At one time, 20 or 30 patients were in A & E departments overnight, while the figures now exceed 150, with patients spending two or three nights on trolleys
When Government Deputies reply to this motion, they should discuss the inefficiencies of the health system. They should indicate where the problems lie. I think many of the difficulties are due to a lack of focus and coherent Government policies. Government Deputies should also explain to taxpayers where their money is being wasted in the health services. I do not believe that is the major problem.
Blatant mistakes have been made by the Government. Since 1997, for instance, up to 30 new statutory and non-statutory health service organisations have been established by the Government. Within seven years of their establishment, however, the Department of Health and Children's own "Prospectus" report recommended the disbandment of most of these statutory bodies. One of Deputy Martin's first jobs as Minister for Health and Children was to establish the Eastern Regional Health Authority and three new health boards. One of his last jobs in that portfolio was to disband the Eastern Regional Health Authority and the three health boards he had previously established. This is a Monty Python approach to health policy.
The only consistency we have seen so far came from a Progressive Democrats Minister's wife. When she wrote a report on behalf of the Department of Finance, she was consistent in so far as she continued the Government's tradition of blaming those who work in the health service for all the problems that exist within it.
I visited Cavan General Hospital on a bank holiday Monday and saw an elderly man waiting there who had broken his hip the previous Saturday. He was still waiting to be transferred to the acute trauma unit in Drogheda. The words "acute" and "trauma" indicate that patients should be moved for treatment faster than three days but that is what seems to be happening in Cavan. A Fine Gael councillor told me about a lady who had survived cancer treatment and now has to thumb a lift from Cavan to Drogheda in order to attend for an outpatient's appointment there.
Patients in the north east, and those who treat them, should be made aware that money is being wasted due to inefficiencies in the service, rather than the fact that we cannot afford the required investment.
At this stage, people at Monaghan hospital can think of only one useful purpose for the piece of paper listing the last of the promises of the former Minister for Health and Children, Deputy Martin, to the people of that county. Those promises all seem to have gone by the wayside within the past four weeks.
We have been told about the huge amount of money that is going into health services but what expenditure is being made? Let us focus on the Northern Eastern Health Board. In researching the provision of services in that health board region it became obvious that the north east has suffered from an unimaginative Government response to the crisis in that area. In the last three or four years the Department of Health and Children has been advising the North Eastern Health Board and other health boards that the initial allocation of their annual budgets will only cover what they did the year before. In other words, for a number of years Government funding for health and children has operated on the principle of an existing level of services. Government Deputies will say that the way to get extra health board services is through revised Estimates. That is where the extra money comes from, they say, but it is difficult to obtain facts and figures from the North Eastern Health Board in order to compare them.
What we got for 2003 were details on how the north east fared on big issues which we are told are very close to the Government's heart. With a population of 350,000 the region got an additional €2 million for cancer services. It got €1.8 million for services for older people. For the primary care strategy it got €400,000. We can understand why people get annoyed about €50 million spent on e-voting and €15 million on the equestrian centre at Punchestown. The amounts allocated for additional services in the region are minute in comparison.
I will again quote from the Tánaiste, who has set out her stall to be a reforming Minister for Health and Children. She said: "It's entirely appropriate that we should measure health service progress not by spending levels or reports and analysis, but by visible improvements seen by the public." This is certainly not a quote that would be attributed to her predecessor, who was a great man for reports, analysis and putting off everything until tomorrow. The Tánaiste is correct in one respect. Health spending is not the same as service delivery. The Government has allowed spending to go out of control without any idea as to how it will increase the services it is supposed to deliver. I ask the Tánaiste to show us how these millions are being spent and show us the great progress that has been made in recent years.
I am particularly interested in primary care, which I would like to make a cornerstone of Fine Gael health policy. What is happening to primary care in the area under discussion is a good example of how patchy the services are. Parts of the catchment area of Beaumont Hospital have one GP for every 2,500 patients. The national average is one GP for every 1,500 patients. One success story in the north east is the GP out-of-hours co-operative, NorthEastDOC. Unfortunately, it does not cover the area with the highest proportion of patients to doctors. No out-of-hours co-operative operates in any part of north Dublin. Even though some people have tried to link problems in accident and emergency departments with primary care, which is true, it is the lack of availability that is causing these problems. The Government has been aware of this issue and sat on it for some time.
The Government is still struggling to get its first primary care centre fully operational in the North Eastern Health Board region. The primary care strategy promised 600 primary care centres, and three years into a ten-year programme we are still struggling to get the first ten off the ground. In recent years, to try to save money, health boards have been forced to cut home help allowances and funding for primary care projects that do not make the national media every day. Unfortunately, this is the price some elderly people with the opportunity of staying in their own homes must pay. Proper provision of sheltered accommodation and recognition that primary care services must become more focused on our increasingly elderly population is an issue on which the Government can talk the talk but has failed to walk the walk.
Now that the Tánaiste is in the House, I ask her when she became aware of the problems of primary care and what she plans to do about them. Some of my colleagues will talk more about the Cavan-Monaghan hospital group and the Louth-Meath hospital group. The North Eastern Health Board has been vilified for the reorganisation of some of the health services carried out in the north east. The health board fully accepts it is not perfect but it was left with no choice because of lack of funding. Continually starving the health board of the resources to allow it deliver quality medical care, has led to it making some very hard choices to the detriment of the hospitals in question.
While my colleagues will go into more detail on these hospitals, I ask the Tánaiste to answer three specific questions. How does she intend to provide a five-day surgery at Monaghan General Hospital when a different surgeon is expected to be on duty every day? This is an unworkable procedure, which shows a clear lack of understanding of how the health services work. It is not possible to bring a different surgeon from Cavan General Hospital to Monaghan General Hospital and expect to have a five-day surgery unit that runs without hiccoughs.
Why has one third of Cavan General Hospital not been commissioned since 1997? It only recently received approval for an extension to its accident and emergency department even though the accident and emergency department of Monaghan General Hospital has been downgraded and practically closed for a number of years. Despite the extra workload, Cavan General Hospital did not get increased funding for acute beds when services were withdrawn from Monaghan General Hospital. This is why the health board has been forced to take decisions, which have, in some respects, been to the detriment of patient care.
Why has Our Lady of Lourdes Hospital in Drogheda not received its designation as a regional hospital? Why have the regional services not been properly organised for the north-eastern region? What will happen to Our Lady of Lourdes Hospital, which needs expansion immediately? It is amazing how doctors can work in that hospital given that it is so crowded and under-resourced.
The credibility of the Tánaiste is riding on her having taken the health portfolio. She should be commended for making such a brave decision. To show that she has the health services at her heart, I ask her to release the minutes of the Cabinet meeting held at Ballymascanlon. While most people here have forgotten about the meeting at Ballymascanlon, I have not. The media have a duty to revisit that fateful day in May 2001. The then Minister, Deputy Martin, brought some of his officials from the Department of Health and Children to give their views on the health services.
After the meeting the Taoiseach said the health services were well resourced. The then Minister for Finance, Deputy McCreevy, believed that putting more money into health services was like pouring it down a black hole. What did the officials from the Department of Health and Children say that day, given that their advice was completely ignored by the Government? An element of hypocrisy is creeping into this matter. Five months after the Ballymascanlon meeting, the health strategy became Government policy. Three years on, when we expected an additional €1 billion per year to be spent on the strategy, we find that this was also rich on aspirations but poor on delivery.
Despite the primary care strategy and the health strategy, no progress is being made. While this is true throughout the country, it has been particularly poor in the north east. The primary care service has not been developed in the way one would expect. The acute hospital services have undergone serious reorganisation, which has created huge conflicts in communities.
While Monaghan General Hospital has almost given up on maternity and accident and emergency services, I am sure the Deputies from Cavan-Monaghan will fight hard for that. The former Minister for Health and Children, Deputy Martin, wrote a letter outlining details of CAT scanners, extra beds, minor injury units and five-day surgery, which was called selective elective surgery. Even the commitment to that seems wishy-washy. The people in the region understand that a different surgeon is supposed to drive from Cavan every day to man this unit. However, a post like that is simply not workable.
The same applies to the way the hospital in Drogheda operates. It needs to get its designation, to be upgraded dramatically and to function as a regional centre. The population in the corridor between Dundalk and Dublin is growing at a huge rate. The accident there last week sadly shows why it needs upgraded acute services such as ambulances. We have neglected some core areas of the health services in the past seven years. We have seen developments in just one section of the health services to the detriment of others, which has led to poor value for money. I look forward to hearing what the Tánaiste has to say about these figures. The Progressive Democrats has always taken great pride in being the watchdog for the taxpayers' billions. Fianna Fáil gave up on justice a long time ago and has now given up on the health services. We will have to warn the voters with VHI that there is no point in voting for Fianna Fáil, and I wonder if they are any safer voting for the Progressive Democrats.