I move:
That Dáil Éireann deplores the failure of the Government to provide adequate funds in 1976 to enable regional health boards to maintain the health services at their existing level.
We in the Opposition have put down this motion in order to direct the attention of Dáil Éireann to the fundamental nature of the crisis which has arisen in the nation's health services this year. We are seeking to arouse the Dáil to its responsibility in this situation. In our view the Government have failed to discharge one of their primary duties in a modern society, that is, to provide for the basic health needs of the people.
In that situation we believe that this Parliament has an ultimate responsibility to ensure that these basic needs will be met. We believe that Dáil Éireann must refuse to accept this dereliction of duty by the Minister for Health and the Government, and must instruct them to make the necessary funds available to supply this essential public service and to avoid the widespread hardship and suffering that are definitely inherent in the present provisions.
Let me emphasise, in case there be any misunderstanding either in the House or among the general public, that we are not dealing in this motion with normal annual budgetary exercises, with superficial economies or even sensible cutbacks and savings. We are faced with a major deficiency in the level of funds needed to maintain the health services at an acceptable level throughout the country. This is not a matter of the cutting out of unnecessary luxuries or even eliminating waste. What is involved is a major dislocation of services which meet a basic community need; a dislocation which will cause widespread hardship among the weaker section of our community and which will directly accentuate the suffering of the sick, the disabled and the aged.
Nor is this something which is just temporary in its effects. I believe these cutbacks and this dislocation will have long-term lasting effects on the health of our community. That is the sort of situation that confronts Dáil Éireann today. It is a tragic price to have to pay for bad Government and fiscal mismanagement, but it is the reality we have to face. Dáil Éireann must confront the simple fact that we have arrived at a situation where an Irish Government have to say they are unable to provide the funds needed for a reasonable health service which meets basic humanitarian needs.
The Coalition apologists are seeking to explain away this crisis on two separate grounds. First of all they say it is all due to the economic recession, something that could not be helped, something that is due to world economic conditions. On the other hand they say it has arisen because health costs have escalated to a level that cannot be tolerated. I say categorically that neither of these excuses can be sustained. The economic recession basically has nothing to do with the health financing situation. What we are dealing with in regard to health administration are financial management and budgetary policy, and there is no reason why economic recession should at any time affect this budgetary situation.
What we are dealing with in this motion is the question of allocating the public funds that are available between different services, the question of settling priorities. I believe this situation has arisen because of a combination of two ministerial defaults. First of all we have the failure of the Minister for Finance to safeguard our public finances and we have the parallel failure of the Minister for Health to ensure that in the disposition of the funds that are available our health services are awarded their essential basic priority. To the over-all failure of the Minister for Finance has been added the specific failure of the Minister for Health—it is his particular responsibility.
The real situation is that the unwise, imprudent, misguided general financial policies of the Government have brought us to a critical budgetary situation and in that situation the Government have awarded other services a higher priority than health. They have deprived the health services of the essential level of resources that they require. Nor can it be validly argued that the health services are escalating to intolerable levels. That is not sustainable. An examination of the Estimates in recent years shows that health continues to absorb roughly the same relative proportion of the total budget and that there has been no major change in that overall situation, nor in the last three years have there been any major developments in the health services to which blame could be attributed.
I have maintained, and I still do, that it is not the duty of this House or the Opposition to order the budgetary provisions in detail. We do not have disclosed to us the full facts. We do not have the detailed knowledge of the exigencies and the pressures which would enable us to decide the manner in which the specific budgetary allocations should be made. Only the Government can do that. But we can as a Parliament give a direction to the Government, as we are seeking to do in this motion, that we want our health services to receive their proper priority and to be given an allocation sufficient to maintain them at their present level. We can also demonstrate that the 1976 Book of Estimates contains some very disturbing contrasts in their approach.
We can show that in the Estimates as published there has not been any consistent approach, any balanced coordinated attempt to regulate conflicting demands and to settle priorities on a fair basis of relative needs. Why, for instance, are the health boards being pinned to an artificial inflation-compensating increase of 15 per cent or 16 per cent when AnCO get a phenomenal increase in their current budget of 70 per cent? I want to know the sort of thinking that produced that sort of contrast. Of course at this stage we have only an abridged Book of Estimates to go on. So slovenly do this Government do their work that we are now well into this financial year and we still have not got the details of the Estimates, and if and when we get those details they may reveal some valid reason for this disproportionate increase in the AnCO estimate. Without some such explanation we can only regard it with suspicion.
I direct attention also to the fact that the Estimate for the Department of Industry and Commerce includes a provision of £3 million for investment in mining concerns. How can that be justified in the circumstances of this year? I think it is a piece of nonsense. There is no necessity to lock up £3 million of taxpayers' money in that way. The State can procure any reasonable share that it decides on of the produce of those mines without resorting to a foolish and unnecessary investment of this large amount of taxpayers' money. I believe this is being done for no other reason than to give the Minister for Industry and Commerce some empty status as a shareholder at our expense. This is a rich, extensive ore body, a project well capable of supporting its own development on commercial terms.
I should like to point out that the shortfall on the estimate of the Eastern Health Board is £3.7 million and I am seriously proposing that that £3 million set aside for that unnecessary investment in mining companies well able to look after their own investment be switched to the Department of Health and used to meet the Eastern Health Board deficit. That would not affect mining operations in the Navan area in any way. It is the kind of sorting out of basic priorities that should be taken in present circumstances. Admittedly, the £3 million which is provided is classified in the investment as capital expenditure, but I do not think in the context of this year's budget that need necessarily prevent the switching of it as I have suggested.
We cannot attempt to propound a budget from these benches. We have not got the necessary information to do that, but we want to indicate to the Government the sort of priorities they should adhere to. We want to underline the confused thinking and the false judgments that are manifest in many of the provisions in the Book of Estimates as published. I believe that if we were given the responsibility of doing so I do not think we would have any great difficulty in making other fully justifiable switches inside the existing budgetary dispositions which would take care of the health service deficiency this year without resorting to additional taxes or any similar measures.
I should now like to look at the extent and the depth of the damage the inadequate provisions made by the Minister for 1976 will give rise to in the administration of the health services. The total amount provided in the Estimate for the Department of Health is £249 million and that compares with an actual expenditure of £214 million in 1975, showing a paper increase of 16 per cent. It is instantly obvious that this overall provision is entirely cosmetic; it is mere window dressing. It simply represents the out-turn for last year with a 15 or 16 per cent added, allegedly, to cover for anticipated inflation. It is totally unrealistic. There is no provision for any normal development, any unforeseeable contingencies, any emergencies and, certainly, no possibility for any improvements of any sort.
Next to the allocations to the regional health boards, the largest item in the Department of Health Estimate is the global amount which is provided for the voluntary hospitals, the homes for mentally handicapped and the general medical service. The amount provided under that global heading for 1976 is £93.4 million against an actual expenditure of £80.6 million. Again, that is clearly unrealistic. It is widely known that a number of hospitals throughout the country, and particularly in Dublin city, have no possibility of carrying on their operations at existing level. They will have no alternative but to effect major reductions in staffing and services. In certain cases, as things are, they will have to close down entire wards. Can we allow this to happen? Are we prepared to contemplate a major reduction in something as basic to our community as the hospitalisation of the sick? Voluntary hospitals are in an unprecedented state of dismay and apprehension. Cuts varying between 5 per cent and 20 per cent on their projected budgets are being dictated to them. Some of them estimate that if they maintain their staffs at their existing level—heaven knows those staffs are in many cases already overstretched—they will have to stop feeding their patients sometime at the end of this summer.
The ban on overtime for lay staff in the case of the accident-duty hospitals in the city will result in there being no essential back-up service in these accident-duty hospitals after 5 p.m. It is rumoured that three of the North Dublin trauma hospitals, the Mater, Jervis Street and the Richmond, are being forced indirectly to close down 50 beds each. I should like to know if that is true and if that is the intention of the Minister. This city is seething with rumours of reductions, close-downs and lay-offs and the Minister must deal with this critically dangerous situation when he replies to the motion. We do not want irrelevancies; we do not want attempts to show that hospital X got £Y in 1970 and this year is getting £X and, therefore, there is an increase of a certain percentage. We want factual statements from the Minister as to what are his intentions and what are the possibilities, particularly with regard to the staffing and the servicing of these major Dublin accident hospitals.
It is certain also that the general medical service cannot be maintained at its present level with the moneys provided in that £93.4 million and it is obvious that curtailment, reductions and withdrawals to the poorer sections of our community are going to be savage in their intensity throughout the regional health boards. For instance, the Southern Health Board have already moved in this direction. I should like to read from a circular which the CEO issued on 17th February, 1976. He stated:
It has been the practice for a number of years to grant medical cards automatically to persons who are recipients of non-contributory old age, widows' and orphans' pensions. It has come to notice that a significant number of persons in receipt of such pensions at reduced rates have incomes which are much in excess of those which would normally qualify them for medical cards. The automatic granting of medical cards to pensioners with such incomes has given rise to anomalies. Accordingly, it has now been arranged to discontinue the automatic granting of medical cards to them and to consider their applications on their individual merits within the revised guidelines. Medical cards will, as heretofore, be granted automatically to those in receipt of pensions at the maximum rates.
There is the thin end of the wedge. Those in receipt of non-contributory old age, widows' and orphans' pensions are to be deprived of a privilege they have had for many years of automatically getting medical cards.
The allocations on current account which have been projected for the regional health boards have placed them in an intolerable situation. The economies and cut-backs they are being forced to consider are ludicrous. In the name of common sense and human decency they cannot be tolerated by the Dáil. The situation confronting the eight health boards is basically the same. The Secretary of the Department of Health, in the course of a letter of 12th January, 1976, and at a meeting with the chief executive officers of the eight health boards on 28th January, laid down the law. He stated that the allocations which had been notified will not be increased under any circumstances. He said that no further funds would be forthcoming, apart from budgetary welfare increases, and that section 31 of the 1970 Act would be fully invoked to ensure that these allocations were adhered to. The iron curtain came down with a very definite ominous finality.
It is important for us to realise that all this took place in January and February of this year. Neither the boards nor their management teams were given any advance warning or any opportunity to prepare for this cataclysm. The Secretary of the Department of Health had the good grace to say to the CEOs that he would have liked to have been able to tell them last September. Why did he not tell them? Why was this hapless Minister for Health still perpetrating the fraud at the annual conference of his party in November that he was improving our health services and saying that all was well? He was still going through the pretence when he must have known what the grim reality was. The Minister and his Department, in my view, are guilty of very serious neglect, guilty of accentuating a difficult situation by this coy reticence on his part and not giving the boards and their management teams timely notice of the situation they must face.
Even at this late stage I believe the Minister for Health must be absolutely frank with this House. There is no point in him coming in here with figures and percentages that we are not in a position to check and purporting to prove that he has been doing great things for the Irish health services. It will not wash. This great propaganda bubble has burst and we are now facing the hard and bitter results of the mismanagement by this Government of our financial affairs. On the 5th February, 1976, the chief executive officer of the Eastern Health Board made this report to his board:
The Secretary of the Department of Health has indicated in his letter of 12th January that the Board's allocation for the year will be £33.59 million. Taking into account other income estimated at £2.06 million, the amount available to meet expenditure on health services is £35.65 million. The estimated cost of maintaining the services at the levels obtaining at 31st December, 1975, at current price levels and excluding any expansion of services (other than such limited development as may be possible with the aid of ESF grants is £39.37 million. The Board is, accordingly, faced with the task of securing a major reduction of £3.72 million in expenditure in 1976, and it is clear that the level of services must be affected.
There is no shilly-shallying about that. That is a clear-cut statement of the situation. He goes on:
Paragraph 11 of the Department's letter stresses that adequate provision must be made to support certain items throughout the whole of 1976.
He goes on to say that the cost of those will be £29.08 million; and the cost of the other items is £10.29 million.
But this is the key paragraph:
It is clear that it would not be possible to achieve a reduction of £3.72 million in our estimate of £10.2 million. It is difficult therefore to see how the board can avoid reducing the level of services, including staff numbers and the payments to external agencies.
There is to be no misunderstanding about the situation. I am talking there about the Eastern Health Board, but the situation is exactly the same proportionately in the case of the other seven. The management team of the Eastern Health Board, faced with the alternative of running completely out of money sometime before the end of this year, or trying to carry on through the year on some basis, put forward proposals for the board as follows for consideration: Maintenance works to be postponed; transport services for the conveyance of patients to be reduced; maternity facilities to be reviewed; £30,000 saved by paring the rate of assistance of persons maintained in private homes; economies in various hospitals and homes in heating, lighting, power and household expenses to be actively pursued. We know what that means.
There are other suggestions: In certain hospitals to reduce the intake of junior medical staff; close certain wards; under the community care programme, reduce the age limit for the free milk scheme from five to three years; introduce a means test for the handicapped children constant care scheme; discontinue routine medical examination under the school examination scheme; withhold increase due to foster parents of boarded-out children; hold expenditure at the 1975 level—in other words, cut back on the disabled and infectious diseases allowances, home help, meals on wheels, employment of the blind and so on.
Does that not read like something out of "Oliver Twist", or the sort of regime that a Victorian board of guardians would lay down for a workhouse in 1870? The Southern Health Board CEO calculated that he would have a shortfall of £960,000. He had this to say in a report to his board:
A cutback of expenditure of close on £1 million to meet the cost of existing services cannot be achieved by minor economies here and there. It will necessitate quite severe measures, and no area of the Board's services can quite escape their consequences. Not alone is there no money for new services of any kind but a severe cutback on spending on present services must be made.
He goes on to elaborate a whole series of restrictions on the use of transport for patients being conveyed to hospital. The North Western Health Board will have a shortfall of £850,000. The South Eastern Health Board will have a shortfall of £750,000. The Midland Health Board will have a cutback of £900,000. There will be the same level of cut-back and restrictions proportionately all over the country.
Such proposals and, in particular, the proposals which the Eastern Health Board have had to put forward, are a negation of planning. It is an insult to our intelligence and makes us all look mean and shabby as administrators. Not alone does it cause unnecessary hardship, disappointment and suffering but ultimately it is, as always, counter productive even from the strict financial point of view. It is the blunt-instrument, panic-stricken approach, and it is all based on an erroneous impression that health expenditure cannot be controlled and regulated in an orderly way, because I believe it can.
This absurd situation will keep on recurring if this Minister for Health is guided, as he appears to be guided, by dogma rather than by realism and common sense. He keeps on foolishly suggesting that all that is needed to have a perfect health service is some vague good intention and that Fianna Fáil's insistence on ordered, planned development as resources became available was obscurantist and reactionary.
The situation we now face arises because of lack of sound long-term thinking about the kind of health services we need and the kind we can afford. In the absence of such basic thinking and planning we can certainly expect piecemeal, ad hoc attack on the estimates from time to time, depending on the extent to which the general financial budgetary situation is mismanaged. Of course we can hope that it will not, for a long time, be as seriously mismanaged as it has been during the last two or three years.
This sort of panic reaction to a financial crisis brings suffering and hardship to those unable to bear it, perhaps those who are least able to mount any effective volume of protest. On this occasion I believe there has been indiscriminate overkill and that the situation can still be met by a reallocation of existing provisions in the context of the budget, even as it is presented. We can hope perhaps that the urgency and the panic which this precipitate action of the Government in regard to the health services has generated will persuade the Government, and more importantly, those socialist theorists that we have imported into the public service and imposed on the trained and experienced civil servants, that a rational health policy for Ireland cannot be imported, that it must be built up on the basis of our own experience, our own needs, and that it must be realistically related to our own resources.
Perhaps this crisis will force upon the Minister some positive thinking about the future financing of the health services, the extension, for instance, of the insurance principle, the full utilisation of public and private resources and a variety of other possibilities. Perhaps it will, but I doubt it. Responsibility for the allocation for the health services for 1976 has moved from the Government to the Dáil. The Government have failed to see where their duty lies. They have become totally confused, being overwhelmed by the financial chaos of their own unwise and imprudent policies. It is now the solemn duty of Dáil Éireann, in this far reaching and fundamental situation, to restore common sense and sanity and to insist that the existing services be maintained during the coming year at their present level.
I would like to direct in a very special way the attention of the Labour backbenchers in particular to the implications for them of this motion of ours. Their respective electorates will be watching very carefully what action they take on this motion. They, like all of us, have heard grand humanitarian sentiments from them over the years. They have heard of their devotion to the interests of the poorer and weaker sections of the community. I believe the time has now come for those Labour backbenchers to demonstrate if those were genuine principles sincerely held or if they were merely political clichés.
We on this side of the House, with our voting strength, cannot stop the Government closing hospital wards, throwing old people out of homes, forcing nurses to work intolerably long hours, cutting out meals on wheels, cutting out children's clinics or cutting out free milk. But if only three of those Labour backbenchers stood by their principles Dáil Éireann could safeguard the people's health on this occasion. We can make the Government do their duty to the poor, the weak, the sick and the disabled. We can demonstrate that Dáil Éireann is the ultimate guardian of the people's welfare and not just a rubber stamp for the economists of the Department of Finance. Will those Labour backbenchers stand up and be counted now when the ordinary men and women of Ireland need them on this vital, important, fundamental, basic issue?
I propose this motion to the House. As I have said I believe that the cut-backs which the Government have proposed, the allocations which they have made, will cause fundamental, long-term, serious dislocation of our health services. This dislocation will cause immediate hardship, suffering and inconvenience but it will also have serious long-term implications from the point of view of the health services' structure and also from the point of view of the welfare and the health of the community. I believe we must express our complete rejection of the Government's proposal.
We must indicate to the Government by passing this motion that the fundamental community services cannot be dislocated and disrupted in this way and that we demand that the Government make an allocation which will be adequate to maintain services at their existing level. That is all we are asking. We are not asking the Government for improvements or for development, although we might well do that. When Fianna Fáil were in Government we were constantly harassed from the Labour benches in particular for increases of all sorts. We are not even asking for that on this occasion. We are only asking that the Government provide enough money to maintain basic services at their existing level and that they do not force health boards throughout the country to use the shabby, mean tricks of cutting out all sorts of basic humanitarian services. I had a case reported to me today of an old people's home in Ennis, which is only typical of what is happening all over the country, where old people of 75 and 80 years of age are being thrown out of the place, which has been their home for many years, because of this financial deprivement of the Government in the allocation to the different health boards.
I hope I have said enough to persuade the House that whatever has to be done be done. I believe it can be done by a reallocation of the existing provisions and that certain moneys which are being foolishly devoted to other purposes could be switched to meet the deficiencies in the health services. I believe, whatever way it is done, that there is a solemn obligation on Dáil Éireann to pass this motion and to insist that the Government make those provisions to enable us to maintain our health services at a reasonable level.
