I move:
That Seanad Éireann condemns the present Fianna Fáil/Progressive Democrats Coalition Government for its gross mismanagement of the health services, thereby causing untold suf fering to the weakest and most vulnerable of our people.
Much as I like the Minister of State, Deputy Moffatt, I am intrigued that the Minister, Deputy Martin, who has found many opportunities to criticise the Labour Party's policies on health care and, in many cases, to make outrageous claims such as that we are going to close hospitals and so forth, declined the invitation to discuss this matter. Instead, he sent a likeable but junior Minister to deal with it. It probably reflects the Minister's view of Seanad Éireann; it clearly reflects his view of the Labour Party and might reflect his continuing despair at his inability to have any significant influence on Government on this issue. No doubt he is otherwise engaged in yet another stunt to secure publicity, perhaps for sponsoring a sporting occasion or the like or making nice rhetorical flourishes about under-age drinking. However, he is not in the Seanad to discuss the health services.
Perhaps the Government does not think there is a problem. It is only five months since the Taoiseach was quoted in The Irish Times as saying that there was no crisis in the health services. That is bad, although it is the type of rhetorical phrase one expects from politicians. However, he went on to say that it was an “excellent, well resourced health service” on which more than £5 billion was spent each year for a population of almost four million. I will wait to hear the Members on the other side of the House make their contributions. I do not expect them to say that little bits have been done on the margins, that bits have been added here and there and that they have a good PR conscious Minister who is forever flagging things that cost buttons by comparison with what the health service needs, but that the health service in each of their constituencies is excellent and well funded. I then expect them to go back to their constituencies and tell the people who work in the health service that the health service is excellent and well funded; “the Taoiseach says so and we believe it”.
Everybody in the country knows that the health services are a mess. Quoting numbers in absolute money terms does not get away from that fact. I have no wish to recite all the things that are wrong but one item that appeared in the newspapers at the end of last August sums it up. Consultants in the James Connolly Memorial Hospital, Blanchardstown, were told to reduce their workloads because they were overloading the hospital's administrative system. The doctors were working too hard for the bureaucrats. Was the solution to make the bureaucrats work harder or to simplify the system? No, it was to deal with fewer patients.
That sums up the crisis in the health services, quite apart from the 28,000 people who are waiting for services, the number of people who turn up in hospital accident and emergency departments and wait endless hours for treatment and the large number of people on middle incomes who find the prospect of needing a GP for their children horrendously expensive. There is a degree of detachment among many people in Irish life when they can think that spending £25 on a GP is something nobody need worry about. People should look at the Revenue Commissioners' returns to see the number of couples with children who live on less than £20,000 per year, perhaps less than £15,000. For those people, £25 is an enormous amount of money. If they have two or three children they have to think about whether they should ask the doctor to look at the child because he or she might have meningitis or take the chance that the child is okay and keep the money to pay for something else.
It is one of the myths of the last five years that this type of thing no longer exists. The reality is that GPs in the private sector can charge what they wish. Demand for their services to a large extent exceeds supply. However, and I must say this before Senator Fitzpatrick jumps down my neck, the GPs' part of the GMS, as far as it goes, is the best part of the service. Nevertheless, it is over-stretched with an ageing population of doctors and increasingly reluctant to get involved in single practices for all sorts of reasons with which nobody could argue.
Do we need further examples of the crisis? There are 800 hospital beds for planned medical admissions in the Eastern Regional Health Authority area, which serves 1.6 million people. That is probably about 50% less than is needed. In fact, the Eastern Regional Health Authority estimates that it needs a further 325 beds in this category but it only has the resources to produce 53. One can go through every health service in the country. Last September the Inspector of Mental Hospitals said there were not enough psychiatric beds to deal with psychiatric admissions, long stay and acute.
How many more facts need I put forward to convey the message to the governing parties? They will get their answer in the general election; of that I have no doubt. A previous eminent Leader of Fianna Fáil admitted during a general election that he did not realise how bad the health services were. That election exploded in his face. It will become the main issue in the next general election. If Fianna Fáil is to do anything about it – the Progressive Democrats have effectively ceased to exist as an independent entity – the fundamental conflict at the core of that party will have to be resolved. That conflict arises from the fact that the problem with our health services is that they are hopelessly under-funded, by any international comparison, to the tune of billions of pounds annually.
When the Minister, Deputy McCreevy, who controls the purse strings, wonders aloud why things have not got better after his spending so much money, he is illustrating the nature of the problem, which is that he and some of his colleagues will not listen. The Secretary General of the Department of Health and Children explained to him in Ballymascanlon precisely where the money went. It was used to replace clapped out equipment, to fill some of the major gaps that were created by the disastrous cutbacks of the 1980s, to provide additional services for children and to provide the necessary additional services for those with disabilities. Little of the money needed to deal with acute hospital services and the general medical service was provided. This country was the only member of the OECD to reduce the proportion of GDP devoted to health care between 1980 and 1990. All member states encountered an economic crisis during that time, but Ireland was the only country to make such a reduction.
The Minister for Finance does not understand where the money is going because the Government does not want to understand, which brings me back to the fundamental conflict. The conflict does not centre on the way in which my party or Fine Gael believes health services should be run, but it is about whether one believes it is worth spending money to have a good health service. The fundamental problem we face is that the health services are hopelessly under-funded. The Government decided when it took office in 1997 that its priority was not to use our new affluence to provide better public services but to cut taxes time after time, loaded mercilessly in the direction of the well off. In the last budget, 60% of the cash dispersed by welfare increases and tax cuts went to the top 30% of income earners. While the top 30% of income earners may be the natural constituency of the Progressive Democrats, or what is left of that party, they have not always been the natural followers of Fianna Fáil. The fundamental conflict faced by Fianna Fáil is that it does not want to do what its constituency demands.
This country needs to resolve the conflict between the need to provide funding and the ideologically driven view that tax must be reduced. The issue of quality can be addressed following the resolution of the conflict. It is nonsense to suggest that one can talk about quality systems to those who work in a health service that is close to collapse and who suffer from exhaustion and overwork. If the Government says it will provide the extra billions of pounds needed each year to fund a decent health service, it can say to people "in return for this money, we want to negotiate quality care systems". The way the Labour Party proposes is the correct way.
It would be wonderful to argue about how the resources needed for a health service will be spent, but we are instead faced with a dreadfully frustrating debate. Instead of a good and useful debate, the biggest political party in the State is pretending to be in favour of good health services and pretending that such services can be provided cheaply. The Progressive Democrats are involved in this conspiracy to deceive by claiming that our problems can be solved for £100 million per year. No member of the OECD has provided good health care with the levels of expenditure that have been committed to the health service by the Government and it will not be done in the future. Fianna Fáil, in whatever manifestation it takes after the next election and I hope it will be in opposition for a long period, has to reconcile itself to the fact that in a modern, social democratic Europe, good health care can only be achieved by paying for it. If Fianna Fáil does not accept that fact we are condemned to a succession of further disasters.