Private Members' Business. - Funding of Health Boards and Hospitals: Motion.

I move:

That Dáil Éireann warns the Government that the lives and the health of members of the public are now at risk in many areas because of the dismantling of the health services and calls for the immediate restoration of adequate funding to health boards and hospitals as a matter of extreme urgency.

That motion is in the name of Deputy V. Brady. A Cheann Comhairle, with your permission, I intend to conclude at 7.20 p.m. and divide the remaining time between my colleagues, Deputy Reynolds and Deputy Conaghan.

The Chair will not make any difficulty on this occasion but I have made it perfectly clear that, if this division of time is to be followed up, it will have to be done by an order of the House. Otherwise everything will be all right when everything runs smoothly but some fine evening it will not run smoothly and there will be a row.

I appreciate your decision on this occasion. The reason for this motion is the serious concern on the part of members of our party at the continued dismantling of the health services. The level of service has been reduced over the past three and a half years and we are particularly concerned about the situation as it exists in 1986. The health boards will have a combined deficit of approximately £35 million in the current year. The Eastern Health Board have an estimated deficit of £8.95 million; the North Eastern Health Board, £1.5 million; the North Western Health Board, £3.2 million; the Western Health Board, £4 million; the Mid-Western Health Board, £3 million; the Southern Health Board, £5.5 million; the South Eastern Health Board £6.2 million and the Midland Health Board, £2.5 million.

When I asked him on 19 February last year the real decrease to the health boards the Minister admitted that the decrease was as high as 6.6 per cent in the Western Health Board and 6.7 per cent in the North Western Health Board between 1982 and 1985. All the other health boards suffered a decrease. The Southern and Eastern Health Boards were something less but that is accounted for by the fact that they had rapidly expanding populations. Their allocations were marginally higher in those years. It is a matter of serious concern that we are now almost half way through 1986 and some of the health boards have not yet made their final decision as to how they will manage their 1986 budget. This must be unacceptable. It is a direct result of the Government's policy in enforcing these cutbacks on the health boards.

The acute hospitals in particular will suffer. For example, in Letterkenny they are closing down medical, surgical, gynaecological and ear, nose and throat wards for two months in the summer. The Limerick regional are closing wards. The cutbacks are not confined to health board hospitals. St. Vincent's Hospital, a voluntary hospital, are a good example of what is happening. They closed 100 beds during 1985. This year the Minister decided that Sir. Patrick Dun's Hospital should close. This was announced here on 13 January. The staff, the governing body, the Eastern Health Board, and everybody else interested believed that the hospital was not due to close until 1988 but the Minister and the Government decided that it should close. In fairness to the Minister, the Government decided that it should close in 1986.

Nobody has said what is going to happen to the patients who formerly attended or who were in the catchment area of Sir Patrick Dun's. There were 4,500 patients admitted and over 12,000 attending as outpatients. Because St. Vincent's is the closest hospital to them, many of these will find they are obliged to attend St. Vincent's for their hospital services. The point I want to come to about St. Vincent's Hospital is that their outturn for 1985 was £21.683 million. The allocation they are receiving for 1986 is £21.340 million. Therefore, they are receiving a decreased allocation taking no account of inflation or the increased number of patients they will have to treat.

Tralee Hospital, a new hospital, where not all the beds had come into operation are also closing some of the beds during the summer. There is a particular problem in Ennis where male and female patients share the same ward. This, as I am sure the Minister will agree, is undesirable. We had a motion on Beaumont earlier this year. Therefore, I will not say very much about it. Again, it is an indication of the thinking of the Government that a major and very necessary hospital on the north side of this city has been left idle for the past two years. Rather than open it as a major general teaching hospital, as it should be, the Government intend to open one unit as a psychiatric hospital for the north side of the city. It is very difficult to understand why the hospital could not be opened as a major general teaching hospital, as was originally intended and as we have asked the Minister to do on many occasions.

The Minister has deducted from the majority of hospitals their overruns for 1984 and 1985, leading to further serious difficulty for the hospitals, all of whom have had their allocations reduced. In the past four or five years all the health care agencies, health boards, voluntary hospitals and other agencies, have made major efforts to curtail expenditure in so far as possible. They have reduced their staffs and have reallocated them so that the highest level of care would be provided. In 1985 and 1986 the position has become critical because hospitals are obliged not to have replacements for holidays or sick and special leave. This means that doctors, nurses and other staff will have to carry extra loads.

Inevitably, that reduces the level of care, and in 1986 we have had a similar pattern as in the past three years, indeed since the Government came to office. The level of services is being reduced to a totally unacceptable state, when patients' lives must be at risk. We have longer waiting lists for outpatients, for tests, for X-rays and admissions. There is earlier discharge from hospital. Because of ward closures over periods there is a backlog of patients awaiting treatment, and a consultant surgeon told me he is unable to overtake the backlog because his specialist unit was closed for two months last summer. Now the hospital is unable to deal with the backlog because of the extreme pressure on staff.

In the long stay hospitals there have been staff reductions because of the no replacement regulations, and in the hospital at Clonakilty one nurse is looking after 98 patients. The Minister will agree with me that this is intolerable. It would be unacceptable to all of us. The psychiatric hospitals find it impossible to cope because of the closure of wards. It happened in the midland region in regard to St. Vincent's psychiatric hospital and St. Loman's in Mullingar. They will be closing for two months in the summer and patients never before discharged will be let go during the summer months. Earlier in the year the Government decided overnight to close eight hospitals including Castlerea and Carlow. So much for their talk about planning. It is typical of the way the Government have acted since they came to office. They make decisions off the top of their heads at Cabinet meetings, but when Fianna Fáil tell them they were wrong they deny it, and during the following three months everybody in the health services do their best to help the Government.

The Minister should read the document Planning for the Future for the psychiatric services because it spells out how the services should be proceeded with in the next ten to 15 years.

The nurses are feeling the effects and it is significant that the INO have found it necessary to march to this House tomorrow at 3.15 p.m., not for anything for themselves—it has nothing to do with wage or salary increases—but to highlight the effects of the cutbacks on patients. In the North West Health Board region 55 posts will be left vacant during ward closures this summer. Public health nurses have been asked to reduce their mileage by 10 per cent. So much for the nursing services which have given so much to community care. The number of public health nurses in training this year is 15 in the eastern region, ten in each of three other regions and four health boards have no training this year.

I appeal to the Minister to meet the nurses tomorrow to discuss their grievances with them. We all owe a debt of gratitude to Irish nurses at home and abroad because of their dedication to the care of the most vulnerable people in society.

During the past three years the number of posts left unfilled in the health services was 624 up to the end of 1985. That does not take into account the serious cutbacks in 1986. The dental services have suffered severely, and the ad hoc dental service is non-existent. What, for instance, does the Minister intend to do for a widow on a non-contributory pension who cannot provide badly needed dental service for herself and who has no access to a public service? There are 11,000 children in the Western Health Board area on a waiting list of from 12 months to 18 months. I appreciate that the Minister is trying to fill the orthodontic posts but what is he doing about providing a service, especially an optician service for the elderly who are unable to read or to see television and who cannot provide a service for themselves?

Hospital transport has been curtailed and many people are unable to travel to clinics because they have not got the facilities. Voluntary organisations are in competition now for reduced funds through Government policy. They are on the same allocation as in 1984 and in 1985 because there has been no increase in the last number of years. That is not a sign of the Government recognising the tremendous work they do.

In regard to the mentally handicapped organisations, it is wrong for the Government to say they have increased the allocation. The allocation in 1985 was £11.67 million and this year it is £11.25 million, a reduction of £500,000 approximately, therefore, the community services cannot be developed to the extent hoped for and more and more children will have to go back into residential care. What advice will the Minister give to parents who have a severely handicapped child in need of care but where that care is not available?

I should like to compliment the health boards and the voluntary health agencies with their management and staff for their excellent work in very difficult times. I wish to point out to the Minister that the morale of the staff is very low as a result of the cutbacks and of the fact that the has never admitted to them that there are serious difficulties. I ask him to take account of the low morale among the staff and to do something about it before further damage is done. The reduced allocations take no account of the needs of particular areas. As one consultant said to me, when he inquired about the matter in the Department he was told it would be even-handed. The cutbacks have not taken any account of the needs of the areas in question.

Fianna Fáil are conscious of the cost of health care. We believe there is and always will be a need for efficiency. We know that money will not be available for everything we would like to do. However, there is a duty and responsibility on the Government to provide an adequate level of service, but that is not being done. It is a disgrace that half way through 1986 chaos exists in the health services.

I join with Deputy O'Hanlon in supporting this motion. Our objective is to try to bring home to the Minister the real concern of doctors, nurses and the patients about what is happening to our health services. We accept that hospital services cost a lot of money and that the Minister is entitled to look for efficiency and value for money. However, we also believe it is the duty and responsibility of the Minister to ensure that, where he is imposing cutbacks, the repercussions of the decisions taken do not fall on people who cannot take care of themselves. Incidentally, the Midland Health Board have been faced with a cutback of £2.5 million.

The Minister may say that we complain all the time, but we are responding to the real concern that exists in the community. At the start of this year the Government introduced expenditure Estimates based on an inflation rate of 4½ per cent. We know that the inflation rate will probably work out at 3 per cent; in fact, some Government Ministers say it will be 2½ per cent. Many Government Departments may not need the money as badly as do the Department of Health and they should not be allowed to spend that extra money. As I pointed out, the Estimates were based on an inflation rate of 4¼ per cent and if 1½ per cent were taken off the Estimates of those Government Departments it would supply the cash that is so badly needed in the hospital services and in other areas.

Is the Deputy suggesting that we cut the health services?

I spoke about Departments that do not need the money as badly as the Department of Health. I was talking about the responsibility of the Minister to provide health services.

My estimated expenditure is in line with inflation.

I am not talking about the Department of Health, I am talking about other Departments. If the Minister does not want to accept that there are inbuilt savings in the Estimates he is not living in the real world.

The Deputy is talking about funny money.

I should like to direct the attention of the Minister to an Adjournment debate in this House on 22 January last. At that time the present Minister for Education, then Minister for Defence, gave commitments on behalf of the Minister and on his own behalf to the people of Longford that when the County Longford hospital would close on 31 January we would have an emergency casualty service to fill the gap until a new emergency 24-bed casualty unit would be in place.

We lived up to that commitment.

The Chair does not want to interrupt but wishes to ensure that everyone gets a hearing. Unless the Chair gets a hearing for everyone he can get a hearing for nobody.

I cannot understand how the Minister can placidly sit there and say that. The casualty service that was put in place the day the hospital closed lasted for just ten days.

Who was to blame?

It is now closed and it is left to the nurses to carry the can. There is no medical back-up but yet we have the Minister sitting placidly in this House and telling us that they lived up to their commitment. The people of Longford are very well aware of what happened.

We lived up to our responsibilities and obligations.

What I am saying may annoy the Minister and he may not want to listen to me. I believed what I was told and I carried the story back to the people of Longford. I told them he was a man of his word.

The Minister does not want to face the reality. We have no casualty service operating in Longford and no medical cover. Now the Minister is trying to convince the people of Longford that the commitment of the Government and of the Minister in the constituency has been honoured. If the Minister wants efficiency let him sit down and do the sums. Let him consider the cost involved in sending a person with the most minor of injuries from an outpost in County Longford some 40 or 50 miles to Mullingar in order to get attention. If that is efficiency, may the Lord help the health services. The Minister gave a commitment that was accepted in good faith by me and was delivered to the people of Longford but now he has reneged on it. Worse still, we hear now what will happen during the summer. We hear of wards that will be closed in Mullingar Regional Hospital which the Minister said will cater for the hospital needs of Longford. We hear that nothing but emergency cases will be accepted. We have no casualty or emergency service in Longford, and Mullingar hospital will not accept any cases other than emergency cases during the three months of summer.

Fianna Fáil members of the county council and Fianna Fáil members of the health board voted for it to be closed.

That is not true.

The Chair must have order. Deputy L'Estrange will have an opportunity of contributing later.

Members of the Midland Health Board accepted in good faith the commitment given by the present Minister for Education, Deputy Cooney, and by the Minister for Health, Deputy Desmond, when he said we would have an emergency casualty service until such time as a new unit was provided. The people believed him and, foolishly enough, I believed him. However, ten days later the whole service was shut down and the nurses were expected to look after the people.

The Deputy did not attend one protest meeting in the past ten years.

That is not true.

I attended about ten meetings.

A lot of good it did.

Deputy Reynolds did not attend one meeting.

The Minister cannot tell us in this House that the service still exists.

I know what is going on. I was at every meeting.

What good did that do? The Deputy's attendance did not get him anywhere.

Wards will be closed in Mullingar hospital during the summer and the emergency services will not operate. Deputy L'Estrange has no concern for the people of Longford and where they can go when they are in need of the services. Wards will be closed in St. Loman's Hospital and in other hospitals. Houses in the area have been purchased in the past three months and the people involved are very concerned that there will be no supervision of the patients who will be moved out into a world in which they have no part. These people will not be subjected to supervision after 4.30 p.m. I want the Minister to take that into consideration as well.

Fianna Fáil started——

Deputy L'Estrange must cease interrupting.

It is obvious this has got under his skin because he has slipped up badly so far as his constituents are concerned.

I attended every protest meeting——

If Deputy L'Estrange does not cease interrupting I will have to invoke Standing Orders.

It would not be the first time.

Another aspect of crazy Government policy of which the Minister might take note is this: in the sister Departments he was given one Department in the game of musical chairs and the Minister, Deputy Hussey, was handed the second prize — a policy is now being pursued which is cutting out the prescribed relatives allowance by the new time. The Minister will, I am sure, agree that the repercussions of that decision will save money for the Department but will mean that more old people will find themselves in institutional care, the opposite policy to the one the Minister is pursuing. That is the kind of crazy policy we are seeing. One hand does not know what the other hand is doing, and it is nonsense to talk about saving money and efficiency when we look at these decisions.

We have all seen the hardships these cutbacks are imposing. In Mullingar Hospital there are patients in corridors and nurses have to step around them. One may have to cross four beds to get to a patient. If that is what our hospital services have come to, then the Minister has failed to look after our people, especially the less well-off. These people are suffering most because the transport services have been withdrawn and they are losing their medical cards. It is all right for people with money; they can look after themselves. The tale of woe in the Midlands Health Board area is very bad and I hope the Minister will tell us what he is going to do about the service, because he broke his promise to the people of Longford——

The Deputy must not speak while he is sitting. That is not in order.

With all due respect, there is the villain of the piece.

Deputy L'Estrange was brought into the House——

He was brought in here by somebody.

——by the noise in the House.

(Interruptions.)

I welcome the opportunity to put on the record the genuine hardship which is being experienced by many people due to the severe cutbacks in the health service. We can argue for and against this decision and we can bandy figures about, but the proof of the pudding is in the eating, and as far as the North-Western Health Board are concerned, there is no pudding to be eaten. I do not relish the coming of Christmas for the people who must be served by that board.

The Minister and the Department are very concerned about removing the services to the community, and I fully support that. The North-Western Health Board provide the most comprehensive health services in the country. What has been the response from the Department and the Minister each year? We have had to cut back on the development of those services. This year we will have a £3.2 million shortfall and it will be virtually impossible to implement all the services which we provide.

I would like to put the position in perspective. Since 1980 health boards have been experiencing cutbacks which resulted from a shortfall of Department funding of 20 per cent. During the 1980-86 period the North-Western Health Board received special additional allocations for a small number of approved developments, namely, the extension of Letterkenny Hospital, the orthopaedic unit at Sligo General Hospital, the community nursing units in County Donegal and the unit for the mentally handicapped at Stranorlar. The cost of these services in 1986 amounted to £6.4 million. The total value in 1986 terms of the 1980 level of resources, together with the adjustments made since then by the Department for the approved services, is £7.97 million, 20 per cent greater than our 1986 allocation. It could be said that we had 20 per cent more resources for the services in 1980 than is provided this year. This is a clear indication of the cuts that have been made during that period.

Despite these cuts, a number of significant changes have been made by internal transfers between services budgets. This allowed for the setting up of a number of new services. The massive cut of £3.2 million in the allocation to the board this year has made it virtually impossible to maintain and contain the services which have been built up over the past six years. The cutbacks have to be spread over the following: hospitals £2.2 million, a cut of 6 per cent; community care £7 million, a cut of 3 per cent; and central management £2 million, a cut of 10 per cent. To deal with the cutbacks in the north-western region it was necessary to spread these cuts across the three areas I mentioned.

I believe that when the Department were envisaging the cutbacks to the eight health boards they seemed to be orientated towards Dublin. Dublin is as far as they can see. There is no way the region I represent could absorb the cuts the Minister imposed. The emphasis was put on cutbacks in acute hospitals. It is only in this city that the health board stay within the limits imposed because they have a number of acute hospitals. In a region like mine where there are only two acute hospitals — one in Sligo and one in Letterkenny — it was virtually impossible to deal with these cutbacks and the brunt of that decision must be borne by the community welfare section of the health board. This will impose hardship on the underprivileged who depend on these services.

I put this point to the Minister during an Adjournment Debate and we had a successful meeting with him. I appeal to him tonight to look seriously at the difficulties we are experiencing in the north-western region which is mostly a rural area. People live long distances from the services. About 5 per cent of the population live outside towns. The average income per family is the lowest in the country and we have the highest population over 65 years of age. These are the people who avail most of the hospital services and the services of the health board.

The withdrawal of the transport services to clinics is imposing untold hardship on these people. There has been a cutback of £400,000 on that service. How can the Minister expect the sick, the invalids, to make their way to this city for hospital treatment? He must remember that these people come from an area where there is no transport system. They must travel to Letterkenny or Lifford, distances of 60 or 70 miles, to get a transport service. Then they are expected to pay £10 to get to Dublin and perhaps pay £20 for taxis to the hospital. They are then expected to find their own way back.

We are talking about imposing on the poorest of our population fees of upwards of £100 in order to maintain their life and to have their illnesses attended to. I ask the Minister to review the situation and to give back to the health boards the money needed to provide the necessary services within the region which I represent and which is under-financed. Unfortunately the worst aspect of it is that the people who are most dependent on it are being disallowed their just entitlement. In other words, the attitude of the Department would seem to be "If you can pay, you will survive; but, if you cannot pay, God help you."

I move amendment No. 1:

To delete all words after "That" and substitute the following:

"Dáil Éireann notes that the Government has provided in 1986 a total current estimated financial provision of £1,274 million for the health services which is £29 million more than 1985, £118 million more than 1984 and £183 million more than 1983 despite the constraints on public expenditure during these years, further notes that the level of resources provided is sufficient to ensure the delivery of essential health services to the community and commends the Minister for Health for his radical reform of these services as stated in the comprehensive ‘Progress Report on the Health Services 1983-1986' which has recently been circulated to all Deputies."

As Deputies know, there is available this year for the health services on current account a total of £1,274 million. That is £29 million more than last year, £118 million more than in 1984 and £183 million more than in 1983, and much more than was provided when the Fianna Fáil Party were in office. That money has been provided despite the constraints on public expenditure. We are keeping our GNP allocation constant, generally.

Deputies may want to consider what has been happening. We have published as a departmental document the Progress Report of the Health Services 1983-86 which I think is a reasonable rebuttal of the spurious allegations being made by the Fianna Fáil Party. The only reason this motion is down is that they wish to try to capitalise on the protest demonstration, one of those ritualistic demonstrations, being organised by the Irish Nurses Organisation tomorrow. I find it a little puzzling that they should have the demonstration at all, because the INO now have more members than ever in the history of the organisation, yet they are talking about reductions in the number of nurses. There has been no reduction in the number of nurses employed in the health services. The reverse is true. I see Deputy O'Connell at the back smirking and I will give him the figures. In 1981 when he was a member of the Labour Party——

I will shortly give them to the Minister.

——before he turned his coat, there were 26,100 nurses employed in the health services.

What about 1984?

In 1984 there were 28,000 employed in the health services.

What about 1986?

In 1985 there were 28,200 employed in the health services as nurses. These are the up-to-date, comprehensive survey figures of my Department up to recent weeks and that trend has continued——

What about recent weeks?

——into 1986. I will give further figures. It is of relevance that in the period 1977-81, when Deputy O'Connell was very voluble about the health services, the number of nurses employed increased by 14 per cent. Between 1981 and 1984 the number of nurses employed increased by over 7 per cent. There has been constant growth. Admittedly, we are on a plateau now and I ask the Deputies, where do we end in terms of the employment of nursing staff. In recent years the number of nursing posts has been maintained and even increased in some areas against the background of a small reduction in other staff areas, notably administration, some paramedical areas and temporary staff.

Deputy Rory O'Hanlon and Deputy Albert Reynolds waxed eloquent about nurses in hospitals being put under enormous pressure. Let me point out that nurses since that period have received very substantial pay increases. In the period since 1980 — mark the year — nurses' salaries have increased by over 160 per cent. I will not impose embarrassment on this House by asking Deputies what the increase in the cost of living was since that period. They can spend the night working it out for themselves and they will be even more surprised.

Why were the wards closed?

The total remuneration of nurses in 1985, last year, at £360 million accounts for approximately 46 per cent of total pay cost to the health services. Inclusive of overtime and premium payments, the average payment per nurse was over £13,000 a year. The nurses should come into Dáil Éireann tomorrow to congratulate me on these figures which I have issued in a public statement today——

(Interruptions.)

Unfortunately, I will be unable to meet them because, as Deputies know, I have been persistently seeking meetings of EC Health Ministers to discuss major issues such as AIDS, cancer, smoking regulations and so on and tomorrow I must travel out of the country to meet my fellow-Ministers for Health and prepare for that meeting. Unfortunately, therefore, I will not be able to meet the nurses, but a principal officer of my Department will meet them and will distribute to them copies of the press release which I have issued giving the real facts about the nursing situation.

Let me make a final point in that regard. It is remarkable that travelling expenses of members of health boards — and they whine and whine all round the clock — and the staff of health boards increased from £8.5 million in 1982 to £11.5 million in 1985.

Government policy costs a great deal.

That includes public health nurses who have been referred to, and that is an increase in expenses of 35 per cent in three years. Whom are we trying to cod in terms of availability of money?

The nurses obviously.

I want to refer to the general provision of the health services. There has always been difficulty on the part of most Deputies in assessing the precise resources available to the health services. There are times when I have had to work it out very carefully for myself. The Government have provided a total of £1,095.3 million for the non-capital health services in the current year. That compares with £1,013.8 million grant provision made available at budget time last year and it will support an expenditure level amounting to £1,274 million, taking into account the income derived by the health agencies from sources such as basic charges and so on.

Of the funds available, £799 million will be spent on payroll costs, £410 million this year on non-pay costs including cash allowances, and £65 million on cash allowances. The payroll budget will support the employment of around 62,500 nurses. I have an admission to make to this House. I had thought that the figure was lower until we did the recent census and discovered that the real figure of employment in the health agencies throughout the country is now at 62,500. There has been virtually no reduction at all in terms of employment. We have managed to keep it up and generally to provide an excellent health service. The range of services is exceptional.

I come to the point raised by Deputy Reynolds. Unquestionably I gave him an assurance in this House, which was accepted by his party's director of elections in his constituency and chairman of the health board, that we would initiate a casualty service in Longford town.

What happened?

The chief executive officer of the health board borke his neck trying to get it established. The programme manager of the health board also worked very hard to try to establish it. I did my utmost in that regard and the senior officers of the Department of Health, month after month, gave every possible assistance and encouragement in regard to this matter. Why was it not brought in? Because we got no co-operation from the general practitioners in Longford town——

Why did the Minister give the commitment?

The Deputy knows perfectly well that the matter is being dealt with by an outstanding chief executive officer who will recruit medical staff for the unit. It will be done; but I must get the co-operation of GPs, who did not want to co-operate because they were probably happy making money elsewhere.

That is not my business but it should be the concern of the Minister.

It is the truth. When Deputy Reynolds comes into this House and tries to make cheap political capital out of this situation——

I am not making cheap political capital out of this.

The Deputy did so tonight.

I am asked every week by my constituents about this service. It is not a matter of making cheap political capital.

Please allow the Minister to continue.

Deputy Reynolds supported me privately and publicly when I told him I intended to close Longford Hospital——

On the basis of the commitments given by the Minister, on which he has reneged.

When the going got rough, the Deputy ran away.

I do not run away from anything. Deputy L'Estrange was right.

I want to deal with the second point raised by Deputy Reynolds, St. Loman's Hospital. He made the allegation that patients would be pushed out of St. Loman's into the community and that there would not be adequate services available for them. That is not correct.

That is contrary to what the chief medical officer of the health board told——

The Deputy should bear with me for a minute. As a result of the closure of Longford Hospital we saved £320,000 and that money was transferred to psychiatric community care for the Midland Health Board to provide services in relation to St. Loman's, Portlaoise, and other services in the area. The health board have the money and I have been assured by them that the community care services which they are providing and developing in the midlands area will be adequate to meet the purpose. As Deputy O'Hanlon knows, we are making alternative arrangements in respect of the Meath area which will lessen the pressure on St. Loman's and that is well in train in relation to the North Eastern Health Board.

It is easy to come into this House and to table a motion with selective data in relation to the health services, because there is not a hospital consultant or GP who could not make a valid case for more resources in terms of the development of his or her speciality, area of responsibility or the services provided. We are providing a community health service which is outstanding by any standards at national or international level. We have an excellent general practitioner service which is now providing free medical care for 37 per cent of the people. There has been no reduction in relation to medical cards although I make no apology for applying fundamental equity in allocating medical cards to students on the basis of their family income. I stand over the decision we took in that regard over three years ago. The service is very good and costs about £100 million per year. There is a refund of drugs scheme, a home nursing service, domiciliary welfare and family planning services and dental, opthalmic and aural services——

If some people were not so preoccupied with private practice in those areas we would have a far better service——

That is not an excuse.

There have been major developments in services for the mentally handicapped, although there has been exploitation in the media by certain people in regard to individual cases. However, I know from the census data available to me, and from the moneys that we made available to the Order of St. John of God, the Brothers of Charity, St. Michael's House, Cheeverstown, a new day centre in Belcamp and Drumcar, what is happening——

(Interruptions).

Tell that to someone else.

I recommend that the Deputies should read chapter 8Services for the Handicapped from pages 73 to 77 which will give them the precise services provided, area by area, for individual sections.

Provided on paper.

I would even go so far as to say that when the Irish Medical Times published chunks of it they should at least have adverted to the fact that they were quoting from this report.

Send in a Bill for copyright.

I wish to assure the House that we have an exceptionally good general health service which is being expanded and developed regularly. For example, we recently provided substantial additional resources to enable cardiac surgery to be carried out in Cork. That unit alone is costing £680,000 per year to pay for consultants, specialised and other staff. The capital resources for that unit alone was well over £600,000.

Last week, I sanctioned the appointment of a paediatric consultant in Wexford Hospital, six additional nurses and two senior house officers which, this year, will cost about £180,000.

In the midlands I was able to do something which no other Minister for Health had succeeded in doing by rationalising and bringing to finality the delivery of health services there. I thank Deputy Reynolds for his co-operation in that regard. If there is overcrowding in Mullingar Hospital at present, the reason is that we are putting in £17 million worth of capital works there. The hospital is being reconstructed in very substantial measure.

That is not much good to the people who have been waiting for two years for a hip operation.

Deputy O'Hanlon referred to Ennis Hospital. I am surprised that he chose to refer to this hospital because he knows the reason why male and female patients are currently in a particular ward area. It is that, for the first time in decades, we are bringing in effective fire regulations at that hospital, as well as rewiring, refurbishing and redoing the theatre, which was substandard. There has to be a substantial degree of overcrowding in the hospital for a few months to enable that work to be done. That is the kind of thing which people fasten on to, saying that Ennis Hospital is going down the tubes. It is not. Local Fianna Fáil hacks, with due respect to that party, are prepared to exploit the position.

The Minister will be telling us that they will exploit it in the Abbey Theatre.

There are many areas where we can develop and in some areas we could have gone much further. I refer, for example, to the bringing into operation of the CAT scanner in Galway. It is a shame that it is not in use. It is ridiculous that we have not been able to open Swinford centre for the mentally handicapped. If we had the co-operation of the Western Health Board instead of spurious, appalling political point scoring, more concerned about keeping the name of the Minister for Health of the day off a foundation stone instead of going ahead and commissioning a new unit in Swinford and bringing in a new CAT scanner in Galway, we would be delivering the health services.

There is a precedent involved. The Minister is not the first to have his name left off a headstone.

There are many people in the country who would like to see his name on a headstone.

I am profoundly concerned and I am sure I will yet open the centre in Swinford. I would be entirely dishonest if I did not say that our budget for 1986 is very tight. There is no spare fat in it, unlike many a budget in the health services over the years. A number of cost reduction studies have been carried out by my Department in recent years. We are very concerned about conserving energy. I have had an increase this year in my Estimate of about 3 per cent, which is in line with inflation. The money is there and I do not accept for one moment statements made by health boards to the effect, for example, that they are short of estimated needs by £7 million in 1986. If one looks at the accounts coming in at the end of the year, one will see that they may be short £1 million or £750,000 out of a budget of £120 million. This kind of hype is frequently indulged in by members of health boards.

The CEOs say it too.

I will give a classic example. The Southern Health Board were claiming last year that they needed an extra £9 million in 1985 to cover essential needs, yet at the outturn of the year they had an overrun of just about £1 million.

They dismantled the services.

They did not dismantle anything. They spent £10 million running Tralee Hospital, which is a very expensive hospital. This year I think they will run it comfortably with £9.5 million and they will not be short of anything. The orthopaedic surgeons can treat public patients there as well as treating their private patients, with whom they are more preoccupied.

It is easy to reduce the money by just closing down the service.

During 1986 no lives will be lost, contrary to the allegations which it is so easy to make here. I know that no essential services were withheld in 1983, 1984 or 1985. I refer to all the services including dialysis and maternity services. I challenge Deputies to produce any sustainable, confirmatory, provable information rather than anecdotal nonsense and shroud-waving which we get on a regular basis.

I do not go around promising that I can provide extra resources. I would be grateful to the Fianna Fáil Party and to the cost-conscious Progressive Democrates, who are not here tonight, if they could suggest to us where we might get extra resources for the health services in the current year. Do they wish the Government to increase health contributions? Since I came into office the rates of PRSI and the rates of health contributions have not been increased by a single percentage.

They are going to do away with PRSI.

The Fianna Fáil Party say they will bring in a 35 per cent standard rate of tax. I know what their funny money is like. The Progressive Democrats can come into this House and say they will top Fianna Fáil by bringing in a 25 per cent standard rate of tax. The PDs are going to top that up by abolishing £962 million worth of PRSI, virtually the total health budget.

If the Minister's party said they would bring in a 5 per cent rate of tax the country would not believe them anyway.

Our net budget is around £1,014 million, grossed up to £1,200 million.

Fianna Fáil brought in the hospital charges.

When we faced hard realities and closed down entirely redundant hospitals the PDs went into the Níl lobby and voted against the Government.

(Interruptions.)

Please, Deputies. Allow the Minister to conclude.

I can assure Deputy O'Connell that there have been no closures in his area, depending on what constituency he intends to fight in the next election.

I have demonstrated that there are substantial resources available for the health services in the current year. There is no question of any measure being taken which would put lives at risk or result in the withholding from the community of vital services. I would not act as Minister for Health if I thought that could be the situation. I am determined to ensure that our health services remain in good shape, as they are at present. We have taken many very difficult policy decisions in many areas to bring about much needed improvements. That has been possible within the resources available to me.

I have not rushed into any decisions or carried out any cosmetic operations like Deputy Haughey, issuing toothbrushes and promises all over the place. I have issued unambiguous policy decisions after seeking, and for the most part accepting, the objective professional, medical, administrative advice of the senior staff of the Department of Health. Their competence and dedication I am quite prepared to defend in any forum and I do not even have to go before the so-called Committee on Public Expenditure to do that. My record and that of the Department of Health are for all to read and to reflect upon in the published documents available. I think I am the first Minister for Health since 1954 to publish what he is doing and make it available.

I am accordingly recommending to the House that this motion be rejected for what it is, a purely opportunistic motion designed to impress the nurses of Ireland tomorrow when they come to Dublin and are entertained to tea by the Opposition. Quite frankly, apart from offering them some tea, they are not in a position to offer them any other words of wisdom. Our record in this regard as a Government stands. While the Deputies on the other side have gone down to 25p in the £ in income tax, by outbidding the PDs, I at least will be able to say that the resources for the health services were provided by this Government without any spurious electioneering or synthetic motions before the House.

I never cease to smile when I hear Ministers get up to speak. This Minister is perpetually in cloud cuckooland. He has the audacity to come in here tonight and tell us that the health services are normal and that he has provided adequate finance for them. He fails to see why this motion appears on the Order Paper and why we should engage in this exercise of calling for more funds to finance the health boards and hospitals operations.

The Minister says he has provided more than he did last year. But an indication of how bad things are can be gleaned from the health board allocations. There are cutbacks of £3.2 million in the North Western Health Board and there is over £4 million deficit in the Western Health Board. Is the Minister listening or is he engaged in something else? Does he not want to listen to the truth? In the Eastern Health Board things are so bad that proposals were put forward for consultant and prescription charges for GMS patients and an end to free hospitalisation. These are proposals which were put to the Eastern Health Board. There is a cutback of £3 million in the Mid-Western Health Board, and yet the Minister says things are normal. In the Southern Health Board the Minister is trying to effect savings of £2.9 million and wants a £1 prescription charge and an increase in the limit for drug refunds from £28 to £33 because things are so bad.

The Minister has the audacity to come in here and say that everything is all right in the voluntary hospitals. St. James' Hospital in Dublin is down by £1 million for the year. The Mater Hospital is down £1 million. The National Maternity Hospital is down by £750,000. The Rotunda Hospital is down £600,000. St. Vincent's is down £2 million for this year, with 40 beds to be closed. The Adelaide Hospital is down £500,000. The James Connolly Memorial Hospital in Blanchardstown is down £1.5 million and have had to close 60 beds. In Baggot Street Hospital a quarter of its beds are closed and two wards have been closed in the Meath Hospital in Dublin. That is apart from hospitals in Cork, Waterford and Galway. I defy the Minister to contradict me and say those figures are wrong — and I will give him a minute to do that. His silence is enough.

This is a load of rubbish.

Are those figures right or wrong? The Minister would wriggle his way out of anything, a Leas-Cheann Comhairle. You have seen him at party meetings and, by God, it was some sight. I have never seen the likes of that Minister.

Which party?

How does the Minister look upon cutbacks? How does he know what it is like trying to get a patient into a hospital? What does he know about the mentally handicapped people and trying to get occupational therapy for them? The Minister has the audacity to read out from his book and say things are perfect. I have been trying for four years to get a mentally handicapped adult anywhere but the house he has been in for four years with nothing being done for him. I have been trying since this Minister came into power and I am told by the workshop in Ballyfermot that there is an 18 months waiting list and there are no staff. I was on to the National Rehabilitation Board. They have no staff to even go to see this person. They said that they were sorry they could not take him and I would have to see what could be done. I am going from one place to another and nothing can be done. The Minister does not appreciate that. He sits in that office looking at figures and he deludes himself into believing that things are normal, and he will go on like that until he goes out of office. Dr. Johnson said that when a man knows he is to be hanged in a fortnight's time it concentrates his mind wonderfully. This is exactly what will happen to the Minister, Deputy Barry Desmond.

The Minister says that he gave £29 million more for health services last year. He is right. But that represents a 2.2 per cent increase. It was given in February when the inflation rate was 3.9 per cent, so in fact the overall deficit is £19.6 million. That is how much short the health services are this year. The Minister cannot come in here and, under the guise of facts and figures, state otherwise. The health boards are £19.6 million short. That is the situation and the Minister cannot deny it. But he is so arrogant and so conceited that he firmly believes this farrago of nonsense that he regurgitates ad nauseam about the health services and about the money he is providing. He is like the man with the sledgehammer. He feels that by hammering hard in any direction he can produce the desired result.

Health services are not like any other economic department. Cuts on the lines directed by the Minister cannot be brought about without producing the domino effect. What we do need is an orderly, rational approach to pruning, not the indiscriminate cutbacks that have been dictated by the Minister. Cutbacks on the lines suggested by the Minister cannot be introduced. They can only be phased in over a period of ten years. It will not work otherwise. There would be trouble in every single section of the health services. The Minister cannot expect to withdraw money from one area. He cannot operate like that. It does not work like that. Health boards cannot operate under a single annual budget. It is not in the interest of the patients to have such cutbacks. It must be done in an orderly fashion over a number of years. This is what the Minister fails to comprehend. I am afraid his B.Comm, or whatever he has, has not been of use to him in the operation of the economics of the health services.

What I see is a Minister pursuing monetarist, right wing policies and being used by his partner in Government, the Fine Gael Party. Fine Gael in Coalition have a habit of appointing Labour Ministers to Health. Traditionally doctors tend to vote Fine Gael. But by putting Labour Ministers in the Department of Health Fine Gael can hold up their hands, Pontius Pilate fashion, and say they are not responsible, that it was a Labour Minister who brought about all these cutbacks. I see the Labour Minister being used by his Fine Gael partners, and he is so tied up with Labour affairs that he fails to see what is happening. This is what is happening: the Labour Party and the Labour Minister are being used by their partners in Government and they can say it was not their fault. I am astonished that Labour have not seen what is happening.

I am wondering why the Minister, who was so adamant about not being moved from that Department and who threatened to resign if the Taoiseach moved him, cannot exert that same strength in winning more money for the health service. He should have told his colleagues and his adversaries at the Cabinet table that he would not accept cutbacks in his Department, that this could not be done, that he was prepared to stand by his principles and resign, if necessary, rather than be asked to implement such cutbacks. These are affecting the Leas-Cheann Comhairle's area as badly as those of any other Member. What he has failed to recognise is that we have an increasing population. The old and the young are on the increase and these are the people who need the health services most. This has not been taken into consideration in providing funds for the health services. There are ever greater demands on these services, by virtue of our ageing population.

No account was taken of the newer diagnostic methods, more modern operations and procedures which people are demanding. These new, sophisticated methods are being used in our services and being demanded by the public, but no provision has been made for them. They are using up the funds provided for psychiatric and geriatric services. This is what is happening and is causing today's problems. I ask the Minister if he would initiate a debate on this whole subject as to whether the public were prepared to pay for these new methods which are now available and expected by them. I would have thought that he would have initiated such a debate because it is necessary.

The Minister lost a glorious opportunity to initiate a crusade in regard to our health services, to win public support and bring about proper and more efficient health services, on an orderly, rational basis, perhaps of cutbacks over a number of years, with an input from the public, from the medical profession and others, who are actively involved in these services. Had this been done, we might have seen a proper approach, not the elephant in the china shop approach of the Minister.

He should have gone back to the Cabinet table and admitted that he was wrong. He should have said that the cutbacks proposed in the budget for the health services are unrealistic and cannot be implemented without untold harm to the public in general, to the patients, especially in the area of psychiatry and geriatrics. He should be courageous enough to do this. He should demand at the Cabinet table a supplementary budget to bring the health services at least up to the level of last year. He has an obligation to do this and anybody of principle would.

The people who are badly hit by these cutbacks are those whom the Labour Party, his party, purport to represent and it astonishes me that a Minister from that party would allow them to take effect. For some obscure reason he seems to take a perverse pleasure in bringing about these cutbacks. It amazes me when he tries to prove that what he is doing is right, that he is providing sufficient finance, that the services are better and that there is no diminution of them. This is what he has the audacity to do.

We cannot treat health services like any other economic Department. They are unique. One can judge a country by the quality of its health service. We spend some £1.274 billion on our health services. There are areas of waste and there is need for a rationalisation of these services; I do not deny that. However, it must be done over a long period. That area does not lend itself to cutbacks which take effect immediately. You are dealing with human beings who are ill and you can cause serious misery.

The Government brought in these cutbacks in the psychiatric hospitals, for example, at St. Dympna's Hospital, Castlerea. That caused much concern to many patients. You cannot act like this. Anyone approaching the subject of rationalisation of the health services must do so in a humane way. The Minister has been most inhumane in his approach; he has done much harm. A great many people will remember him as the Minister who dismantled the services and did almost irreversible harm to them. It will take a long time to bring those services back to normal, to restore the confidence of those working in the services and this is terribly important. Insecurity has been introduced among these people.

The Minister said the general medical services are normal. However, the pressure being put on doctors in the general medical services is unbelievable. The Minister would not have the courage to explain to the public about the cutbacks; he puts the onus on the doctors in the service, saying that unless they stop visiting patients they will be severely disciplined. Letters have gone out to doctors — this is a form of intimidation — telling them that their visits to patients or having their patients visit them are above normal and cannot be tolerated. How can the Minister say whether a patient needs more or less visits? How can he dictate this? With doctors having ever more geriatric patients, the demands on their services are greater. This has not been taken into consideration under the bureaucratic system which operates with the full connivance of the Minister. He should have the courage to tell the patients that they cannot visit the doctor. In this way, the public will know the real facts. If this were done, we might see a totally different approach to the health services.

Debate adjourned.