By agreement, and not withstanding anything in Standing Orders, Members shall be called in Private Members' Time this evening as follows: 7 p.m. to 7.10 p.m. a Fianna Fáil speaker. 7.10 p.m. to 7.37 p.m. a Government speaker, 7.37 p.m. to 7.42 p.m. a speaker from The Workers' Party, 7.42 p.m. to 8.10 p.m. a Fianna Fáil speaker, 8.10 p.m. to 8.15 p.m. a Government speaker and from 8.15 p.m. to 8.30 p.m. a Fianna Fáil speaker. Is that agreed? Agreed.
Private Members' Business. - Funding of Health Boards and Hospitals: Motion (Resumed).
The following motion was moved by Deputy O'Hanlon on Tuesday, 27 May 1986.
"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."
Debate resumed on 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."
—(Minister for Health).
Once again we in Fianna Fáil are forced to highlight the plight of the poor and the needy in our motion condemning the failure of this Government to provide funds to adequately run the health services. The total inadequacy of funding is reflected in every region in the country and in every hospital, be it health board or voluntary. Concerning the Minister's amendment, may I point to the presentation to the Dáil Committee on Public Expenditure recently where Donal O'Shea, chief executive officer of the North-Western Health Board, pointed out that the real value of spending on the country's health services had fallen by about 25 per cent during the past five years? He said that the constant cut-backs in the health budgets and the fact that new developments had to be funded from these reduced allocations meant that the real value of current health spending was now only about 75 per cent of the 1980 level.
I have said repeatedly in the past that what astounds me more than anything else is the fact that it is the Labour Party, and a Labour Minister, who are orchestrating this entire fiasco. They claim they represent that section of our population, the underprivileged, the poor and the needy, but surely it must be evident that by not providing adequate funds for our health boards it is this sector of our people who are going to suffer. Maybe we could understand it if it came from the Fine Gael Party alone, who have never claimed to represent this group or if it came from the newly formed Progressive Democrats whose commitment is to the higher income groups, but surely not the Labour Party.
A Leas-Cheann Comhairle, as I am limited to ten minutes in this debate I obviously can not dwell in depth in every area, but as I am a member of the South-Eastern Health Board — in fact I am the Chairman of the General Hospital Subcommittee — I intend to use that as an example of the hardship being inflicted because I know from reports from other areas the measures we are being forced to take by this Minister are also being inflicted on all other health board areas.
The allocation for the South-Eastern Health Board in 1986 is £85.55 million, which is £6.345 million short of the level of funding needed in 1986 to maintain expenditure and services at the 1985 level. We all know that the 1985 allocation was inadequate. We in the south-east had a deduction of £1.385 million because of our overrun last year. We are now expected to run the services with a shortfall of £6.345 million this year. It cannot be done. There will have to be cut-backs, there will have to be hardship. As a doctor and a consultant in one of our general hospitals in the south-east, it is my duty to say that there must be a danger to the health of the patients and that patients lives must be in jeopardy. I do not want to sound an alarmist, but when you hear what we have been asked to do in the south-east you will see what I mean.
We have been asked to save £200,000 on the reduction of locum costs at all levels. This is hoped to be achieved by closing beds during the holiday period. Now not only has this Minister invented the five day syndrome, but now we are being asked to get sick between the months of October and June, not during the summer. Let me give an example of what effect the cutting back of locum cover will have in most of our county hospitals. Most county hospitals operate a two man practice — in other words, we have two surgeons, two physicians, two anaesthetists, and so on. If we do not provide locum cover when one of these people is on holidays, the other person must be on call seven days per week, 24 hours per day. That must put both doctors and patients at risk.
In order to achieve further cuts the South-Eastern Health Board asked that Ardkeen close 50 per cent of its beds in the surgical, eye, ENT and orthopaedic units fully for one month. Maybe the Minister is not aware, but Waterford and the south-east in general is a seaside area, with Rosslare and Tramore etc. Our work and patients rather than decreasing show a marked increase during the summer months. Rosslare is, after all, the main tourist gateway from Britain and the Continent to the south-east, or has that fact escaped the Minister? Is he going to close off one of the few industries that remain viable in this country?
May I read you the first paragraph of a letter I got from the consultant staff at St. Luke's General Hospital, Kilkenny? It reads:
Stringent financial cutbacks are being imposed upon South-Eastern Health Board by the Minister for Health, Barry Desmond. Specific proposals have been made at Health Board level to implement these cut-backs. These proposals have centred mainly on savings occurring from Ward Closures. Any closure, partial or temporary, of a ward facility in St. Luke's General Hospital will have immediate and serious repercussions for the emergency health care of the people of the Carlow/Kilkenny area.
These are not my words, but the words of the people responsible for providing health care in the Carlow/Kilkenny area. What with the treatment already being meted out to St. Dympna's Hospital in Carlow, is it any wonder that Minister Séamus Pattison, who is not here this evening, should feel so worried at the moment?
May I also read to you a letter, I received from the Irish Nurses' Organisation on this matter, dated May 1986? I quote:
A Chara,
We, the members of the Irish Nurses' Organisation by our presence here today wish to highlight our grave concern at the reduced level of health care existing in the Boards area due to the continuing cutbacks in the hospitals and Community Care programmes. We ask you, members of the South-Eastern Health Board, to oppose any further proposed cutbacks that will reduce the present inadequate service to an unacceptable level. With the interests of safe patient care our top priority, we would appreciate your co-operation.
If we in the south-east were to live within our financial budget we would have a reduction of £1.5 million in the general hospital area. This would mean a saving of £500,000 at Ardkeen alone. To achieve this, does the Minister know what we would have to do? We would have to close 36 surgical beds for an equivalent of six months, we would have to permanently close the maternity unit and, wait for it, we would have to close the dialysis unit in that hospital.
Neither the Minister nor the Department paid one penny towards the setting up of this unit. It was funded by the people of Waterford and the south-east. They paid for the staffing and equipping of the unit. Now the Minister suggests, in the interests of cutbacks, that we close this unit. Somebody must be losing his mind.
On the psychiatric side, in the South-Eastern Health Board area we have been asked to achieve a saving of £500,000 in order to live within our allocation. This means — and I want the Minister to be clear on this — a loss of 50 jobs. It is also important to realise that the present long stay occupants of psychiatric hospitals are heavily dependent on nursing care by reason of age, mental handicap or general chronic deficits in their personal capabilities. It follows from this that if we are to reduce staffing numbers we must transfer these patients out of care and into the totally inadequate community service. Until we have adequate community care facilities we cannot expect them to cope with this additional patient load.
These are the measures we in the South-Eastern Health Board area are being asked to consider, and all the other health boards are being asked to perform similar miracles. The Eastern Health Board face a shortfall of £8.9 million and as a result they intend to leave one-third of all medical vacancies occurring after 1 June unfilled. The Midland Health Board will face a shortfall of £2.5 million and will have to close wards during the summer. The North-Western Health Board will face a shortfall of £3.2 million having received an additional allocation of £300,000 recently from the Minister. Among the issues they have considered is the abolition of the transport services to clinics and outpatients in Dublin and within the health board area. If we are not providing the transport to get to these facilities, why not close them altogether.
Today we saw a massive demonstration from the Irish Nurses' Organisation who braved the elements to express their condemnation of the Minister's actions. This is not a militant or crank organisation but a responsible body committed to providing the greatest possible care for their charges. They are not demonstrating for better conditions for themselves or looking for an increase in salaries. They were there simply to highlight the plight of their patients and to indicate to the Minister the dangers as they see them. They are not a vested interest group. They are aware that the patients will suffer.
In conclusion I appeal to the Labour Party——
Deputy, you are going over the time. I ask you to conclude.
——who claim to defend the poor and the sick, to support our motion here tonight. I ask them not to depend on their Coalition colleagues.
I wish in the first place to say a few words about the trends of health expenditure since the early seventies. In 1971-72 the non-capital expenditure on health services in this country amounted to a net figure of £86.6 million representing 4.54 per cent of GNP. This figure had increased to £701 million by 1980, representing 7.8 per cent of GNP. The figure for 1986 amounts to £1,194 million net, representing about 7.1 per cent of GNP. This net figure can be grossed up to £1,274 million, representing the amount available for spending when account is taken of receipts of the health agencies from patient charges and other minor income.
In the mid-fifties the highly industrialised countries spent about 4 per cent of their resources on health care. Estimates for the year 1977 show that some countries were spending between 9 per cent and 10 per cent of their resources on health care. When the economies were buoyant the increase in expenditure on health care at a rate faster than GNP did not seem to be a great cause for concern; but when the rates of economic growth slowed down in the early seventies, the continued rapid growth of health care spending gave rise to action being taken by most countries to try to contain or to reduce costs most of which had to be met from the public purse. Questions began to be asked as to whether the public were getting full value for the vast resources being devoted to health services. This gave rise to analysis of services, analysis of costs and an awakening of the need to eliminate any unnecessary services, to cut out wasteful practices and to establish priority areas of care. We are not, therefore, unique in our efforts to contain expenditure on health services. Despite the difficulties, the Government are concerned to maintain the fabric of the health services and to ensure that anybody who needs essential health care is provided with it, without delay, and without causing him or her any hardship. The Government's record in this regard is beyond reproach.
The overall gross amount of £1,274 million, which is available for health services, can best be assessed by looking at how it is divided between the various programmes and services. As has been mentioned by the Minister, institutional services of all kinds absorb about three quarters of the total. The percentages of the total which is spent on the various programmes are as follows:—
|
% |
|
|
Community protection |
1.6 |
|
Community health services |
13.3 |
|
Community welfare services |
7.7 |
|
Psychiatric services |
12.4 |
|
Services for the handicapped |
9.8 |
|
General hospital services |
50.3 |
|
General support services |
4.9 |
The thrust of the national plan and the Minister's policy is to bring about a shift in resources from the institutional setting to the community.
You must spend money to do that.
We gave the Deputy a certain amount of time to express his opinion and nobody interrupted him while he was doing so. By institutions I am referring in this context mainly to the acute general hospitals, psychiatric hospitals and long stay hospitals. In the case of acute general hospitals there is a need for a greater emphasis on outpatient and day care facilities and greater use of five day wards. If this shift can be effected to any significant degree, it should be possible to reduce the number of acute hospital beds. There is little point in increasing alternative forms of hospital care and leaving the bed stock untouched. This would only result in an increase in expenditure because available beds tend to be filled irrespective of the necessity for in-patient care in all circumstances. Redeployment of resources is essential in times of financial constraints if any progress is to be made towards the attainment of health policy objectives. In this connection it is interesting to note that if, say, a saving of 1 per cent could be made on general hospital services and the saving applied to the community welfare services, it would enable the provision for the community welfare services to be increased by about 6.5 per cent.
The Minister, when notifying health boards of their allocations for the current year, referred to the need to protect certain services. The boards were advised to maintain, at adequate levels, key services for the old and the housebound, such as community nursing services, home help services and meals on wheels; child care services, particularly day care and preschool services for deprived and disadvantaged communities; and the funding of boarding out payments for children in foster care. That the health boards are concerned about the need to protect the deprived and the disadvantaged is illustrated by an episode which occurred in the Southern Health Board area earlier this year. It was alleged that the elderly poor were being discriminated against in relation to admission to Cork city hospitals even when they were seriously ill. No evidence was produced to substantiate this accusation which, on investigation, was found to be totally unfounded.
Not so.
Commenting on the situation——
If the Minister had listened to what was——
If the Deputy wants to listen to this he can and if he wants to refute what the programme manager of that health board wrote to The Cork Examiner on 8 April 1986 he is entitled to do so. Also he should instruct his party members who are members of that health board to stop the scaremongering and get on with the job they were elected to do and they might be much better occupied.
As I said, no evidence was produced to substantiate this accusation, which on investigation was found to be totally unfounded. Commenting on the situation, the health board's programme manager wrote to The Cork Examiner on 8 April 1986, and I quote:
I submit that this (accusation) amounts to a degree of irresponsibility amounting to recklessness in the conduct and direction of a public controversy about a matter of serious concern to the public. I further submit that the use of the terms "well authenticated evidence" and "fully documented cases" in respect of unchecked scraps of allegations with no documentation whatever, was a deliberate attempt to deceive the public.
This is typical of many of the accusations levied against the Minister for Health in relation to the implications of the levels of funding for health care.
Are any of them correct?
Above anybody else in this House I would not like to get into conflict with Deputy O'Hanlon. Let me say that the accusations made in relation to that health board had been made by members of other boards and if investigated it would be seen that they were unsubstantiated also.
They are all wrong.
Of course, we are all out of step except Deputy Ormonde.
Tell that to the INO. They were here today.
I would like to turn now to a few of the comments by last night's speakers in the debate. Deputy O'Hanlon listed deficits in funding at mid-year as if they were actual, factual figures, despite the fact that last year the Southern Health Board claimed they were £9 million short, although they ended the year with a deficit of less than £1 million.
They cut half the services. They could save another £50 million by closing the hospitals altogether.
Deputy O'Hanlon mentioned ward closures in the summer months as if that was due solely to under-funding. As a doctor he should know better, because it has always been the case that when doctors and nurses went on summer vacations facilities were closed.
Specialist units were not closed.
As Minister of State in the Department of Health for the last two years, I have had occasion to visit more hospitals than I ever visited before. I remember being told in two hospitals about closures of wards although there were patients in the corridor.
Is the Minister saying that there are no closures?
I considered that it would have been much better to have patients in the wards instead of in corridors—
(Interruptions.)
It was a set-up.
They must have seen the Minister coming.
Deputy O'Hanlon was also critical of the opening of an acute psychiatric unit in Beaumont Hospital. Does he object to the provision of such facilitis in acute general hospitals — a major issue in the report on the psychiatric services, Planning for the Future? I should also like to remind Deputy O'Hanlon of what the Minister said about the numbers of nurses employed in the health services. In 1981 there were 26,100 nurses employed, by 1984 the number had increased to 28,000, and by 1985 it had increased to 28,200. Indications are that this trend has continued into 1986.
What about the 620 posts unfilled since 1983?
Furthermore, remuneration of nurses represents about 46 per cent of total remuneration costs. Where is the evidence here of dismantling the health services? Like the Minister, I am somewhat puzzled about accusations of the so-called dismantling of the health services.
Dr. O'Hanlon also referred to the allocations for the voluntary hospitals for 1986 and compared the allocation levels for some voluntary hospitals in respect of 1985 with those which have been approved for 1986. His comparisons are, however, erroneous because he compared the final outturn allocation for 1985 with the original allocation for 1986. For example, in the case of St. Vincent's Hospital, the original allocation for 1985 was £20.299 million. The 1986 allocation is £21.34 million, representing an increase of over £1 million.
In the case of homes for the mentally handicapped, the Deputy's comparisons are similarly distorted. The Minister has not adopted a stand-off attitude in relation to the budgetary problems of voluntary hospitals. For example, officers of his Department met representatives of St. Vincent's Hospital and agreed a series of adjustments which substantially improved their situation.
Because the Taoiseach waved the big stick.
A meeting will shortly take place with the Mater and other hospitals which have difficulty in coping with their financial situation. This is a small but perhaps significant point — Deputy O'Hanlon referred to St. Vincent's Hospital as the nearest to Sir Patrick Duns. Does he not know that Baggot Street Hospital is about 600 yards from Sir Patrick Duns?
The Minister does not have much left to argue about.
Deputy O'Hanlon also referred to certain restrictions imposed by health boards in relation to transport services. The demands on the transport services and the costs which health boards had to meet to provide this service have increased very substantially over the last ten years. For example, in the case of the North Western Health Board, total mileage for car hire service is now over three times the level it was ten years ago.
There has been a 25 per cent reduction since 1980.
I hope the Deputy does not treat his patients in that manner. It runs off me because I am used to people like him.
(Interruptions.)
The cost to the health board, if the 1985 levels were to be maintained, would be over £600,000. The health board, therefore, decided that they had to modify the service but will continue to provide for genuine hardship cases by refunding reasonable expenses incurred. The service to day hospitals and workshops is to be continued. Surely it is not contended that what has happened in the case of transport services amounts to a dismantling of the health services?
Deputy Conaghan referred to the developments carried out in the North Western Health Board and alleged that the Minister failed to provide the board with adequate funds. My understanding from the Minister is that the resources at his disposal were distributed by him equitably between all health boards and health agencies. There was no discrimination whatsoever in favour or against any health board. Indeed, the Minister tells me that the same arguments have been advanced by other health boards in relation to their share of the resources, but some, who shall remain nameless, were prompted by the political interests within them who were more vociferous than others.
They were all treated equally badly.
The Minister cannot win, no matter how he distributes the resources at his disposal.
What about treatment for cancer in the Regional Hospital, Cork?
When Fianna Fáil were in office 100 items to which medical card patients were entitled were taken off the list——
There was nearly a revolution then.
This Government took another 600 items off the list.
Deputy Woods was to blame for taking items off the medical card list and indeed, as far as I remember, he took 900 items off the list. Deputy Conaghan mentioned the extra funds provided for the board. A total of £310,000 has been provided so far and I understand that a further amount is to come in relation to the development of community psychiatric services.
Deputy Reynolds referred to decisions imposed by the Minister on health boards. It must be recorded that the Minister has not imposed specific cost saving measures on health boards——
What about the Southern Health Board?
I have already dealt with that, and it is a pity that the Deputy was not here. Last year the Southern Health Board claimed to have a deficit of £9 million——
What about the cancer unit?
One thing at a time. Although they claimed to have a deficit of £9 million it was closer to £1 million at the end of the year. I have already quoted from a letter written by the programme manager of the Southern Health Board to The Cork Examiner denying statements made by members of the Southern Health Board. He said that there was no basis for their allegations and they have been challenged openly to prove their statement. So far, they have refused to do so.
The measures to be adopted are basically for selection by the health boards themselves. In the case of the Midland Health Board, an extra £500,000 was made available to the board following their very sensible decision to close an old and outmoded hospital.
The report on the health services for 1983-86 which the Minister published recently provides ample evidence of his work for the period 1983 to the current year. I advise those who subscribe to the motion before the House to read it carefully. It provides conclusive evidence of the Minister's concern to ensure that the services are maintained, particularly services for the poor, the deprived and the handicapped. It refers to the many new initiatives——
Who are you kidding?
——particularly those in relation to measles immunisation, drugs control, substance abuse and so on.
You do not believe that yourself.
The general medical services guidelines were revised by the Minister with effect from 1 January to ensure that inflation did not give rise to a withdrawal of medical cards from those who already possessed them.
The CEOs were instructed to rigidly apply the guidelines.
They were not rigidly instructed to do so and, if they were, does the Deputy think they would do what the Minister for Health told them?
There was a drop of 5,000 in the number of patients.
There are quite a number who are consistently feeding their members with information, which is contrary to what Deputy Ormonde said.
(Interruptions.)
The Minister should withdraw that allegation.
What allegation? The Deputy should ask Deputy Ormonde to withdraw his allegation. I did not make any allegation.
Acting Chairman
The Minister without interruption.
(Interruptions.)
The present position is that a married couple are entitled to a medical card if their remuneration does not exceed £95.50 per week. There are allowances on top of that for children and other dependants, an age allowance together with allowances for outgoings, household rent and travelling expenses to work and these can increase the ceiling substantially. The general practitioner service now covers 1,319,000 people, representing almost 37 per cent of the population. The service is a valuable one and is a vital feature of the health service. The income ceiling for entitlement to hospital services will be increased from £13,500 to £14,500 as from 1 June 1986.
What is the point of that when there are no facilities in the hospitals for them?
As I mentioned earlier, all countries have found it necessary to impose some curbs on expenditure on health services. It was necessary for us, in the national interest, to curtail expenditure on health services in recent years. This has undoubtedly led to problems, but on the other hand it has focussed attention on the need to ensure that money is spent to the best advantage and on services which are absolutely essential to the well-being of the community.
Acting Chairman
The Minister of State has four minutes.
Perhaps he will tell us something reasonable in the four minutes.
It is incumbent on health agencies to come up with initiatives which would have the effect of achieving real control of expenditure without affecting the quality of patient care. International surveys have shown that there is a growing awareness about the need to control the resources input to health services. Personnel numbers and wage rates matter most. This is followed by equipment and various supply items, particularly drugs. As prescribers, doctors are critical in the effort to control costs and must be involved in limiting activity to the resources available.
Control is not tantamount to dismantling. The Opposition are continually critical of the Minister for Health and the manner in which the health services are administered. It was not so long ago since one of them was sitting over here as Minister for Health. He was a good Minister, but he still had to work within the resources that were available. The nicest time in the world to be Minister was during the seventies.
Napoleon made his own law.
It was no bother then. Money was plentiful and cost was not taken into consideration. Times have changed. The Opposition realised that when, with one stroke of a pen, Deputy Woods knocked 900 items off the list.
Did the Government restore them?
Do not talk about cuts. When in Government the Opposition took them off.
The Government deleted another 600.
In 1970, 40,000 people were employed in the health service. In 1986, 62,500 people are employed. The total cost of the health services in 1970 was £86 million. The total cost of the health service today is over £1,200 million.
It is 25 per cent less than in 1980.
By any criteria that is an enormous increase.
Are there too many people in the health service in Galway east?
I know the role of an Opposition. It is to criticise. If they have a criticism they should try to make the criticism constructive, because it is like this: when you are on the way up be nice to those on the way down.
I am glad the Minister of State admits it.
He recognises the fact.
You will be there again.
(Interruptions.)
The Minister of State should have stuck with football. He was good at that.
It was a good thing that there was an election and that the mature decision of the people determined that the squandermania which the Opposition envisaged would not be put into operation. The term "dismantling" is emotive and unreal and I recommend to the House that the motion be rejected.
It clearly will not be possible to deal at length with the points raised. We have no problem in supporting the Fianna Fáil proposal except that it is not specific. It does not indicate that there is any intention to restructure the health service, which, we would argue, is fundamentally required.
Our amendment condemns the failure of successive Governments to deal with underlying structural problems with the health services. We require reform of the VHI, abolition of tax relief on VHI premiums for luxury hospitals, separation of private and public care within the public hospital system, extension of eligibility for hospital services to all and a radical reform of the GMS in order to make it possible to extend eligibility to more of the population, It is not possible to do that simply by calling on the Minister to restore funding to the services.
Our health services have developed on an ad hoc basis. I know that the Eastern Health Board, which is supposed to be responsible for the provision of health services in the Eastern Health Board area, which is Dublin city and county, Kildare and Wicklow, has virtually no control over the development or provision of health services in a wide range of areas within their area of jurisdiction.
What all Ministers have failed to do is to tackle the vested interests in the Health services. No attempt has been made to take on the voluntary hospitals, who appear to be able to write their own cheques as regards expenditure, by this and previous Governments in what they see as the development of the health services. No Minister has taken on the medical profession, who seem to be a law unto themselves as regards how money is spent and how services are developed.
In answer to a recent question which I put to the Minister for Health he revealed that the tax relief on VHI premiums had increased from £6.5 million in 1981 to £30 million in 1985. There needs to be a very clear and precise analysis of why that has been. About 25 per cent of the population entitled to full eligibility in the hospital services are also on VHI and the reason is that consultants and the medical profession in general are dealing with people on the VHI in preference to people who are entitled to their services under the State system.
Many consultants are being paid twice, once by the VHI and once by the State, to see certain patients. This is an area that this Minister and previous Ministers have failed to tackle. They have failed to take on the vested interests of the voluntary hospitals and the medical profession. The money which is being spent at present on tax relief for VHI and which is now being given for the use of luxury hospitals would be better spent by extending eligibility under the GMS to general hospital services. It is a disgrace that at a time when money is being cut back in the public health services we have the development of private hospitals supported and funded by the medical profession themselves.
I am glad to have the opportunity to speak on this motion. At the outset I want to refer to what Deputy Donnellan said. There is a real crisis in the Southern Health Board and the Minister must be quite well aware of that from the representations made to his own Department by the Southern Health Board. It is alarming that there is a .3 per cent shortfall in the GMS. In the past three years the ad hoc schemes for optical and dental treatment have all been abandoned because of the lack of finance. Under the medical card scheme people between the ages of 18 and 65 cannot avail of treatment if they have no contributions or do not qualify under the social welfare code. This is creating great hardship and I find it very difficult to advise them what to do because they have not the means to finance their own treatment.
The primary school dental scheme has collapsed in the north Cork community care area. In my area, which is not very large, there are 215 people awaiting orthodontic treatment. One family in my area came to my attention. The husband was on unemployment assistance because of the appalling state of the economy but was anxious to get dental treatment for his child. He got an estimate from his dentist for orthodontic treatment for £700. He could not afford that. I got back on to the health board and got the standard reply that there was a waiting list and he could not be taken off the queue and would not be treated until July. That is unacceptable.
We had to look at cutbacks in the whole health area which have been of a penny-pinching nature. They have been quantified in the minutes of the health board meetings. There have been seasonal ward closures. There have been cutbacks in transport and this is alarming because people cannot afford to travel to the various hospitals so their health is being put at risk. The ad hoc community care service is vital and it cannot be highlighted enough. It is a serious indictment of the administration that people are put in a situation where they cannot avail of these services.
The situation in the geriatric area is alarming. In the Southern Health Board area there are 61,800 people all over 65 years of age and only one bed in 51 is available to such patients. In the Eastern Health Board area there are about 101,000 people over the age of 65 and the number of beds available there is one in 17. I appeal to the Minister to tackle this very vital and important area immediately. Geriatric patients in the Southern Health Board area are entitled to as good a service as those in the Eastern Health Board area and there is a gross inequality in the services of the two health boards when one compares like with like.
There is a grave shortage of public health nurses in the Southern Health Board. There are only 38 in an area where there should be 70. The present administration have failed the people in the whole health service area. Public health nursing is a vital component of community care. That shortfall has to be tackled immediately and people appointed in the southern region. We have had ward closures which are a national disgrace. No words of mine could describe the problems this is creating. As a public representative I visited a hospital recently to see constitutents and friends of mine and was alarmed and appalled at the overcrowding caused by the closure of wards.
Nurses cannot provide proper care and services because of the present situation. I have seen patients in narrow corridors; I have seen beds placed against fire exits and against windows. There is total overcrowding and a serious fire hazard, all because of cutbacks. I have seen the finest wards left vacant because of ministerial orders and directives to the health boards. I appeal to the Minister who represents the social element of the Government to influence his colleagues in the Cabinet to correct this situation so that we will once more have a health service that is worthwhile, the type of service we had under Deputy Haughey, the leader of Fianna Fáil, when he was Minister for Health and Social Welfare. People are thankful for the type of health service he gave them when he was in office.
There are no substitutes available for nurses who are sick, on annual leave or maternity leave. The whole system is stretched to the limit. There is definitely a risk, and patients are not getting the proper care. We had a very fine demonstration by the INO today on behalf of the hospital services. A very decent and honest group came here and I met the Cork contingent. They brought one glaring anomaly to my attention, that is, the closure of the Bantry Hospital in the Southern Health Board area and the closure of the maternity unit. They are still accepting patients. Babies are being delivered and nurses have been called from busy wards to perform that duty. They do not have the medical history of the patient. We have a very modern and fine maternity service here but I understand that, if one does not have the medical history of the patient, there is serious risk to both the patient and the infant involved. It is a glaring case of black-guardism by the Government not to have that situation corrected.
In regard to the staffing of intensive care units, in the past there were four staff nurses and now this has been reduced to two. There definitely is a serious anomaly there and a crisis in the intensive care unit of the hospital in my area because of the new low levels of staffing. At the maternity hospital two nurses have to care for 44 mothers and babies, where there always were four or five nurses. I appeal to the Government to come to the rescue of the health services, to give the Southern Health Board the £5.5 million they will be short this year and to get away from the penny-pinching attitude adopted and Barry Desmond——
Minister Desmond, please.
——is the sleeveen of the Government with regard to the health services.
We are all saddened by the wording of the amendment in that the Government are taking pride in the fact that they are providing more money for the health services. The stage has long since gone when our elderly and those unable to help themselves should be victims of a budget. We cannot accept this amendment or any suggestion that section 31 will be imposed to ensure that there is no additional expenditure on behalf of the health board.
I shall confine my remarks to the North Western Health Board region in general and Donegal in particular. We have found it necessary to reduce expenditure by £3.5 million. This is an area where all discretionary cuts have been applied prior to this financial year. Any further cuts in that region imposed by the Government can only cause hardship, as we say in our motion. They will put at risk the lives of many in that area. It has been necessary to reduce hospital expenditure by £2.6 million, community care by £700,000 and central management by £200,000.
I put it to the Minister that the north western region and Donegal in particular cannot be compared with other parts of the country. It is not new to us to find these heavy impositions by a Coalition Government, but I would have thought cuts such as these would not have been allowed because we had expected a socialist input into the policy. The removal of the transport facilities from people in my area effectively means that all those who heretofore availed of transport are now being denied secondary medical care. We live in an area which is without an adequate public transport service. The cost of transport to and from the general hospital at Letterkenny from our area, or the Sligo hospital regarding the Sligo-Leitrim area, is prohibitive. Furthermore, many old and infirm people who find it necessary to travel to Dublin for appointments cannot now do so. They are being denied this secondary care which is absolutely necessary for their survival.
Last week, I visited a patient in my own constitutency living on an island off the west coast, who had to pay £200 for the trip to and from Dublin. He has been called for a further appointment but has had to cancel it because he is not in a position to pay this money. He may be told that he can avail of the public transport at £10, but he is not in a position to travel to Lifford or Letterkenny and needs care and attention while travelling to Dublin.
In our region, people are cancelling their appointments and are even embarrassed to tell public representatives that they cannot afford the transport cost to the east of the county to pick up the public transport from there. If we cannot provide this means of transport, I put it to the Minister that there will be no difficulty caused by closure of beds and hospitals because our people will not be able to travel to them. No consideration is given to rural areas such as mine as against the urban areas. Donegal, a peripheral area, should be treated in isolation, but that is not so. This is discrimination against rural areas and it saddens me that a Minister of State from the west can come in and defend such policies.
The Government Deputies are conspicuous by their absence but when they speak in a constituency they are very critical of the Minister of Health. Where are they tonight? They will march through the lobbies as usual, not representing the interests of those whom they are supposed to represent. We have been told that, in order to achieve the proposed cuts amounting to £3.5 million, we must have extended summer ward closures. In effect, people are being told to become ill only between January and May and between October and December; between 9 a.m. and 6 p.m. from Monday to Friday. How ludicrous can the situation become? There is a reduction in bed numbers and the substitution for full hospitalisation of outpatient day care, an increase in single hospital rooms and the decentralising of weekend emergencies. Staff are quietly asked to take leave of absence without pay.
We look at the long term institutions. When the Minister announced the closure of a number of hospitals he quietly suggested that there should be a phasing out of St. Joseph's Hospital in Stranorlar. When questioned, he said there would be no difficulty, that this would be done over a long period. However, immediately we are told that 50 beds there must close before any community care centres are opened throughout the county. We would accept that many patients in St. Joseph's geriatric unit should remain there and that people from rural areas should stay in rural areas, but not until such time as the community care hospitals and day centres are opened for them. The people in St. Joseph's have been asked to leave, or be removed to district hospitals. St. Joseph's is their own environment. They were told coldly and callously on television by the Minister that, in effect, the roof was being taken from over their heads.
Any confidence or hope these people had remaining was dashed. That is a Minister who has no compassion and is not familiar with the problems of such people. The suggestion that they be put in district hospitals implies that such hospitals were serving no purpose. Those district hospitals have served well the communities over the years, as far as short term illnesses were concerned. There is a back-up and we will find that the short term patients will have no beds available in hospital. They must now stay at home and will not be provided with community care facilities or home help. I put it very bluntly that these people will be allowed by this Government to drown in their own excrement in their own homes, as a result of Government policies.
In addition, in our region the gynaecological wards are being closed down for a period of six weeks. There is no consideration for the women of that area and their health. These women must ensure that they do not become pregnant and deliver their babies during the summer months because there might be no hospital care for them.
The imposition of charges on the elderly has resulted in many of them not being in a position to pay, and care will be withdrawn from them. The Minister of State at the Department of Fisheries, Forestry and Tourism suggested tonight that we were only scaremongering and that we were implementing the policies of the Government. We or the health boards are not here to implement the policies of this Government, including section 31. We are here to look after the interests of the elderly and infirm and those who cannot afford to pay for medical care. There is no point in boasting about our excellent health services and the new hospitals in Dublin if we cannot look after those people. We will be judged by our health services.
We have been told we should be grateful that a payment of £310,000 was made in addition to the original allocation for the North Western Health Board. That is something that we should not be too proud about. It was to service an absolutely essential dialysis machine provided by the people of the north western region and not one penny of that capital expenditure was provided by the Government. It appears that this Government consider people in need of care to be a liability to the country. That is not our attitude. We ask many rural Deputies, who are fully aware of the serious impositions, to support us in our motion tonight.
At the outset, I am amazed at the absence of the Fine Gael and Labour Deputies, which shows what little interest they have in the health services. The Progressive Democrats are also missing. They are on record as saying they would do exactly what the Government are doing.
On 16 May 1985 Minister Desmond said the care of the elderly is an important issue facing the health and social services in this country. He said that he would accept that generally speaking the elderly are less well off than the rest of the population. He added:
As far as possible we must try to anticipate the needs of the elderly and develop the kind of services which we would like to see in existence when we grow old. It seems to me that we should plan our services on the basis of the principles of independence and dignity. We should place the emphasis on community care.
What a gap there is between this vision of an independent elderly population leading active and fulfilling lives in their old age and the squalid reality of undignified deprivation which the present Government's health cut-backs have achieved for the elderly.
There are at present some 369,000 people over 65 years of ago, of which 132,000 are under 75 years of age. About 65,000 of those live on their own. Professor Brendan Walsh estimated that by 1991 the number of elderly will increase by 10 per cent while the number of those over 75 will grow by more than 20 per cent. In rural areas 53 per cent of the elderly live in dwellings built before 1919 compared to 4.6 per cent of the population generally. The elderly suffer more frequently from health problems than the rest of the community. They are therefore bound to suffer more from cut-backs in the health service as a consequence.
In May of last year the Minister praised the public health nursing service. Nearly 70 per cent of all patients visited by the nurses are over 65 years of age. The Minister stated:
The importance of the public health nurse in the provision of basic health care for the elderly cannot be over-emphasised.
Why then, at a time when the number of elderly people in the community is increasing, does the Minister not increase the number of public health nurses? Indeed, he is even refusing to replace those who resign or who are on leave. It was reported recently that some nurses in the Cork area have up to 120 old people on their list. Why then have their petrol allocations and travelling expenses been reduced in real terms? Public health nurses nowadays cannot deal adequately with the patients under their care and yet the Minister stressed that this was one of the most important areas of health care.
The failure to practically encourage effective home nursing service, especially for the care of the aged, makes an absolute mockery of the commitment in the national plan to a health system based on community care. The Minister's commitment to develop more day hospitals as part of a more comprehensive service for the elderly in need of medical care has proved to be a very hollow promise, given his failure to secure the extra resources from the Government to honour this commitment.
In October 1984 Minister Desmond and his officials acknowledged that the national plan would have considerable implications for the health services. A reduction of between 2,500 and 3,000 health service jobs in the 1984-87 period was envisaged. However, the Minister insisted at the time that all the essential services now in the excellent fabric of the health services will be maintained. Despite the Minister's contention, financial cutbacks are adversely affecting health care. The public at large now realise that. The cut-backs are holding back achievements of the Government's stated aim of deinstitutionalising health care. They threaten nursing homes, day hospitals, welfare homes, meals on wheels, home help for the disabled, sheltered accommodation for the disabled — all services which are an integral part of any move towards a community health service.
In April 1984, the National Planning Board, when recommending an annual reduction of 4 per cent in real terms in health spending between 1985 and 1987, maintained that these savings could be made by good management without any sacrifice in the standards of services. But warned that there is a danger that this recommendation would be implemented in such a way that the costs are borne primarily by patients and the public in general rather than through increased cost efficiency in the health system. Patients and the public are now suffering more and more and many of their lives are in danger as a result. Institutional and community services are clearly suffering from cut-backs. Patient care must suffer as waiting lists in hospitals for major operations grow longer, as staff shortages worsen and as essential health services are eroded.
The Eastern Health Board, with a projected deficit of £14 million, envisage that they may be forced to close St. Brendan's psychiatric hospital and St. Ita's with over 2,000 resident patients, in an effort to achieve the major cuts in spending being sought by the Minister for Health. Can the Government seriously contemplate ejecting 2,000 patients from institutional care before the necessary framework is built up to care for them in the community? I say it cannot.
The professionals involved in health care have warned repeatedly that the health boards are incapable of effectively implementing a community-based psychiatric care service before the structure for such a service is firmly in place. This structure will not appear overnight. It needs careful thought and research. To coerce the health boards into accepting a community-based service before the necessary facilities are in place is criminal. It would assuredly have tragic results for hundreds of patients ejected from institutional care into a society that is unprepared to receive them and care for them in an adequate fashion. This whole reckless uncaring policy direction by the Government gives the lie to the Minister's asserton on 16 May 1985 when he said:
As Minister, I will do my utmost to maintain the various health services for those most in need of them.
By his own yardstick the Minister has failed. He has failed miserably to put up a solid and caring defence of the weakest and most vulnerable section in our society. It is ludicrous to think that the community care services can be expanded to adequately cope with a health service based in the community while the existing level of community care services are jeopardised.
The present community care services are carrying an increased burden, with the number of dependants growing all the time, expecially in the new suburbs. Funding is not keeping pace with the increased demand. The Eastern Health Board estimates that they will spend £50.2 million on the provision of community care this year as compared with £46 million in 1985. They say if they attempt to maintain services in line with departmental policy directions it is likely that the provision of new facilities will be halted in the new outlying suburbs and new growth areas most in need of the health infrastructure.
In the mid-west the Department have provided money to build a new theatre in Croom, new day centres in the region and new industrial therapy units at St. Joseph's Hospital in Limerick and Our Lady's Hospital in Ennis. Yet, if the present trend continues, the staff to operate these facilities will not be available. Last night the Minister said that at present there is no danger of lives being put at risk. Can he seriously believe this? Seriously ill patients are being accommodated in corridors because of ward closures. It is more difficult now to have elderly people admitted to hospital than heretofore because the beds are not available. If the Minister knows anything about what happens in the outside world he will recognise that there are not now enough beds in hospitals for old people.
I was pleased to see the members of the nursing profession outside the House today. They realistically understand how the health services are seriously being curtailed and how patients are suffering.
The present Minister for Health will go down in the history of this State as being the most callous, cruel and uncaring Minister who has ever held this office. The public at large are now frightened and concerned about the harrowing decisions which he has taken. He has an obsession with cut-backs and closures and history will record that, when his term of office is over, he will have created an unprecedented record of closure of hospitals and hospital beds, A record, may I say of a Minister who so often in the past espoused his socialistic views and shed crocodile tears so often about the inefficiencies of the then existing health services and how they should have been expanded and extended. We know now what a hollow cry that was and what a hypocrite he is. We know now that the Minister is a typical poacher turned gamekeeper who has himself and himself alone to blame for the crisis in the health services at every level.
I sincerely hope the Minister is ashamed of his performance as Minister for Health because the public at large are certainly ashamed of him. They clearly recognised that his arrogant authoritarian style of approach has devastated the health services. Morale has never been lower and the Minister has antagonised all those who work in the health services, — the administrators, the doctors, the nurses, community staff and others. Never was morale so low and it is high time the Minister changed his ways and showed a little kindness, care and compassion towards the sick and the elderly who are certainly deserving of better treatment than they are getting from the Minister and this Government.
I cannot understand all the charges that have been made this evening about the dismantling of the health services, realising that the cost of the services this year will be £1,274 million to provide a basic health service for the community and give employment to 62,500 people. The Minister has acknowledged that difficulties will arise in balancing the health budget. This situation is not unique to this country. Throughout Europe and, indeed, on a global basis the escalating costs of health services in the seventies gave rise to serious concern that, unless corrective action were taken, the situation could get out of control.
It is thus perhaps fortuitous that the Government's policy in relation to public expenditure generally, inevitably included the containment of expenditure on health services because health services revenue expenditure absorbs 19 per cent of overall public services revenue expenditure. Despite the difficult economic situation, however, the Government have clearly provided very substantial funds for health services in 1986.
I am pleased to note that, despite the difficulties, the Minister has found it possible to provide funds to enable certain improvements in services to be carried out. Even when resources are limited it is important to free up some funds to secure a forward progression, modest though it may be, in the development and re-orientation of services and in meeting new services. The health services are so extensive and diverse that inevitably situations requiring extra funds arise from time to time. I am sure the Minister will be prepared to respond generously within the resources available to him when he is convinced that funds are needed for a necessary health requirement.
In the past there appears to have been a dichotomy between the delivery and the development of health services and the costs involved. Persons directly involved in the delivery of health services such as doctors and nurses paid little or no attention to the question of financing the services. I am not blaming them for this. The system simply did not involve them in the management of hospital and health service budgets. Their reaction to any budgetary constraints is thus, perhaps, not surprising. This has got to change. Many countries throughout the world are considering new management techniques aimed at involving the main generators of expenditure in the process of aligning activities with the resources available. This would seem to be a fairly straightforward, and commonsense approach.
The motion before the House will do nothing to improve the health services or associated funding. As the Minister has said, the motion is extreme and emotive and should be rejected, primarily because it causes so much unnecessary upset and concern to people in particular, the old and the needy who require services and who are made fearful that they will not get them.
The Fianna Fáil spokesman on Health was more realistic recently when he addressed the Association of Health Boards. On that occasion he said that, even with a change of Government, he could not envisage additional increases to the health boards. He also clearly indicated that section 31 would not be removed. My information is that the words he used were: "He who pays the piper calls the tune". Deputy O'Hanlon, for whom I have tremendous respect, made the following clear, concise and praiseworthy statement:
The boards' elected representatives and professional persons working in this service have combined with good management teams to provide what is really an excellent health service.
In supporting this timely and realistic motion I should like to inform the House that the Southern Health Board are short £5.5 million. That amount of money is required to enable the board to run the services as the members, the CEO and the medical and administrative staff deem it necessary to run a decent health service within the area covered by the board. In County Kerry many serious problems have arisen due to the fact that the Minister either does not care or is so weak that he cannot get adequate funding from his Cabinet colleagues.
The Minister's amendment amounts to nothing more than waffle and the progress report on the health services from 1983 to 1986 is completely irrelevant as far as the people I represent, the people of south Kerry, are concerned. The health of the less well off people of south Kerry is suffering and, indeed, lives are at risk as a direct result of the failure of the Government, and the Minister for Health, to fund an acceptable level of health services. I shall give a number of examples to prove my point. In regard to medical cards I should like to state that no more medical cards are being granted on the grounds of hardship as was the case under Fianna Fáil Ministers for Health.
That is rubbish.
The eligibility limits for applicants, as laid down by the Minister, must be strictly adhered to and medical cards are no longer granted on the grounds of hardship alone, no matter what effect that will have on the well being of patients who through hardship and family circumstances find it impossible to pay for regular visits to the family doctor as well as paying the first £28 of the cost of medicines each month.
There is a complete lack of funding for the payment of the cost of the transport of medical card holders to clinics or hospitals. This year's budget for this service will mean that many medical card holders who are ill will miss out on visits to clinics or hospitals. Those people cannot afford to pay the cost of car hire. There are long waiting lists for the following services in Kerry: spectacles and glasses — up to two and a half years; dental extractions, six months; dentures, 18 months; and children in the ten to 14 years age group who require and are entitled to orthodontic treatment must wait four to five years. The Minister must be aware that by then permanent damage is done to those children. There is an upward limit of 136 people who can be facilitated with joint and hip operations in the Tralee Regional Hospital in 1986.
The Minister may not have to deal with many such cases in his constituency but I can assure him that I meet many people seeking those services on my visits around south Kerry. Little can be done to help those people due to the inadequate funding to the Southern Health Board. I should like to tell the House that for the want of £500,000 to repair sophisticated equipment which has broken down in the Cork Regional Hospital it is necessary for a certain category of patients to travel from Kerry and Cork to Dublin for tests. That is disgraceful. When will the Minister provide that money to repair the equipment in Cork?
The unkindest cut of all in relation to the operation of the health services in Kerry arose from decisions taken, following presdure from the Minister for Health, to close down hospital wards. This has caused serious problems for the medical profession to have to take tough decisions in the towns and rural areas of Kerry as to what to do with patients they consider to be seriously ill and for whom hospital beds are not available. Indeed, some of those patients may be ill because they could not afford to pay for their medication and went without it.
The Minister's decision to close the Killarney Isolation Hospital, and to reinforce that decision by a majority vote in the Dáil, caused panic and confusion among the people of South Kerry. The people of that area have lost confidence in the Minister. I am aware that following representations by public representatives, nurses and other caring people in Killarney, the Minister eased the situation somewhat and backed down to some extent. However, I am convinced that he will pass on the ultimate decision as to how this serious error of judgment on his part is to be resolved to the Southern Health Board, a board who are in financial diffiuclties to the tune of £5.5 million. This exercise has had the effect of creating a very serious division between the staff of the Killarney Isolation Hospital and their next door neighbours the staff of St. Columbanus' Home.
It now appears that the Minister wants the Southern Health Board to close down wards and 41 beds at St. Columbanus' Home in Killarney and transfer 25 of these patients to the isolation hospital. Would the Minister tell the House what will become of the other 16 patients? I am warning the Minister that the continuation of the embargo on the employment of hospital staff will lead to the closing of more hospital beds, due to the lack of sufficient staff to run the hospital services. I can assure this House that the people of County Kerry want the Minister to provide the necessary funds for the Southern Health Board or else to resign.
In answer to the Minister of State, Deputy Moynihan, I did say at the Association of Health Boards that section 31 would remain if Fianna Fáil were in Government as it has been operated by successive Governments for the past ten years. The problem is that the Members of the Government party who were there believed that the implementation of section 31 means that we would not provide adequate funding for the health services. That is not correct. I did not say that there would not be more money available. In fact, we are committed to ensuring an adequate level of service. I am sure that Deputy Moynihan, who is Minister of State for Tourism, never envisaged he would be in here defending, as a Labour Deputy in this House, the most savage cut-backs in the history of the State. The Government speakers who spoke in this debate spoke in figures all the time mainly in percentages without any sensitivity to the needs of people. Every one of our speakers one after another spoke about the practical realities on the ground and about the hardships people are suffering. Neither the Minister nor the Minister of State answered any of the points that were raised, except one.
The only thing I heard which in any way one could apply practically to the health services was that Baggot Street was nearer to Sir Patrick Dun's than St. Vincent's Hospital. We heard that from the Minister of State, Deputy Donnellan, tonight. If the Minister of State believes that because Baggot Street is nearer to Sir Patrick Dun's it will be able to cope with the 4,500 admissions to Sir Patrick Dunn's and the 12,500 outpatients, the reality in Baggot Street is that last year they had an outturn of £5.165 million and their allocation this year has been reduced to £5 million. Yet they are expected to cater for the needs of Sir Patrick Dun's.
No mention was made of the problems in the acute hospitals. Letterkenny, Sligo, Longford and St. Vincent's were referred to. St. Vincent's Hospital, one of the largest voluntary hospitals in Dublin, had a decrease in real terms and closed 100 beds last year. The Minister of State told us that the Southern Health Board had an estimated deficit last year of £9 million and ended up with a deficit of £1 million. We heard from Deputy O'Keeffe tonight the reality in the Southern Health Board. It is no credit to any health board that they had a deficit of £9 million at the start of the year and reduced services to an unacceptable level and ended up with a deficit of £1 million. The Eastern Health Board last week had to introduce proposals to save £9 million this year, £8.95 million to be exact. We are going to have ward closures. The Minister of State said that that was the usual thing. Specialist units were closed in this city last summer and consultants will tell us today that as a result of the closures for six weeks of some of these units there is now a backlog which is causing chaos. If that happens again it will put more lives at risk. The problem with the Government is that it is all percentages and figures with no knowledge of what is happening out there in the country. The effect of the ward closures is that there are longer waiting lists for admissions and outpatient departments along with early discharge of patients.
The Minister of State said tonight that it was unfair to compare the outturn with the original allocation. The outturn is what is important because that is what it cost the various health agencies to run their reduced services in 1985. Their allocations are down this year and their outturn for last year. This means further serious problems. As Deputy McCarthy said, the nurses came here today to express their concern, not about their own conditions of service or about their salaries — although the Minister, in this House last night and in a statement released to the Press, comment on their salaries and how the nurses were remunerated — but because they were anxious, first of all, to meet the Minister to explain the situation to him and, secondly, they were concerned at the cut-backs. They wanted to highlight that and did so here today. The Minister said he was puzzled at the fact that they were coming here. It does not surprise any of us on this side of the House that the Minister was puzzled because he and the Government are totally out of touch with what is happening, as was highlighted by my colleagues on these benches over the last two nights.
We dealt with the psychiatric services last night but no reference was made tonight on the points which were raised. Since last night I am informed that a further communication has gone to the Western Health Board telling them that they have got to close Castlerea Hospital and that the order to close it stands. The Minister last night referred to capital developments for the mentally handicapped. He referred to Cheeverstown but he did not refer to the fact that there is no staff for part of the hospital. There is a hostel for the mentally handicapped in Cootehill for which over the last three years the Minister has not provided the funds for staff. There is a decrease in real terms, for example, to the Order of St. John of God's in the nature of £500,000 this year. This is going to cause very serious problems. In the Midland Health Board area there has been a reduction in the rehabilitation allowance to those in receipt of the allowance by as much as £10 a week.
I cannot understand how any Minister can come in here and tell us we have a good service when the most vulnerable in the State are suffering. The Minister of State, Deputy Donnellan, referred to the general medical service and said that there was no reduction. In Mayo 5,000 fewer people were eligible for general medical services at the end of 1983 than at the end of 1982. A letter from the Minister's Department on 12 December last to the health board stated:
Accordingly, there should be no increase in the number of patients covered by medical cards during 1986. Any increase in demand for cover should be offset by the uniform, rigorous application of the guidelines.
Does the Minister for State, Deputy Moynihan, agree with that sentiment going out from the Department to the health board telling them, in regard to people who cannot afford to provide medical services for themselves, that under no circumstances are they to receive a medical service if it is going to mean that the number of people covered by medical cards will be increased?
The Minister told us last night that we should have the co-operation of the Western Health Board instead of "spurious, appalling, political point-scoring, more concern about keeping the name of the Minister for Health off a foundation stone." That is what the Minister is concerned about. When he was referring to the CATT scanner in Galway, that is the only reference he could make — about a foundation stone that his name was not on. The Minister should recognise that there are any amount of precedents where Ministers were big enough to go along and make their contribution at a foundation ceremony without first having to have their name on some sort of stone. The Minister also told us last night that he had issued unambiguous policy decisions after seeking, and for the most part accepting, the professional medical, administrative advice of the senior staff of the Department of Health. He is now trying to blame the Department of Health for his decisions.
What about his U-turn on Monaghan Hospital, where he wrote to the hospital telling them they had to close the whole hospital and dispose of it before he would sign the contract for Cavan Hospital? Then, he did a U-turn and was going to keep the medical and surgical units and close the maternity unit until a court case decided he could not do that. We have the same situation with the psychiatric hospital in Carlow and the isolation hospital in Killarney, where he said that was to be closed by the middle of this year. He has done another U-turn on that. Where is the Health (Amendment) No. 2 Act which was going to give power to the Minister to close anything he liked without any reference to health boards or the Green Paper he promised us on the health services in May 1983 and again in this House in 1984? We are not now going to have a Green Paper. Where has it gone to? Why is he not going to introduce it? I believe that the services are now in such chaos as a result of the Government's administration that the Minister would be afraid to produce a Green Paper in this House.
In the Minister's amendment we are asked to note that the level of resources provided is sufficient to ensure the delivery of essential health services to the community and it commends the Minister of Health for his radical reform. We reject that. It all depends on one's interpretation of "essential". There has been radical reform in the wrong direction. Fianna Fáil are conscious of cost: we are concerned, naturally, at the cost of any public service. We will act responsibly in Government and we promise the people that we will deliver an adequate level of services. The Government are either unaware of what is happening or they will not admit what is happening. We ask them to go out and see for themselves. Even in their constituencies they should admit the problems that exist and cooperate with the health boards and the health agencies. We appeal to the Government, and we are asking the House tonight to vote to ask the Government to provide sufficient funding to ensure that there will be adequate and proper levels of health services for the people of this nation.
Question put: "That amendment No. 1 be made".
The Dáil divided: Tá, 67; Níl, 54.
Tá
- Barnes, Monica.
- Barrett, Seán.
- Barry, Myra.
- Bell, Michael.
- Bermingham, Joe.
- Boland, John.
- Bruton, John.
- Bruton, Richard.
- Burke, Liam.
- Carey, Donal.
- Cluskey, Frank.
- Conlon, John F.
- Connaughton, Paul.
- Coogan, Fintan.
- Cosgrave, Liam T.
- Cosgrave, Michael Joe.
- Griffin, Brendan.
- Harney, Mary.
- Harte, Patrick D.
- Hegarty, Paddy.
- Hussey, Gemma.
- Kavanagh, Liam.
- Keating, Michael.
- Kenny, Enda.
- L'Estrange, Gerry.
- McGahon, Brendan.
- McGinley, Dinny.
- Manning, Maurice.
- Mitchell, Gay.
- Mitchell, Jim.
- Molloy, Robert.
- Molony, David.
- Moynihan, Michael.
- Naughten, Liam.
- Coveney, Hugh.
- Creed, Donal.
- D'Arcy, Michael.
- Deasy, Martin Austin.
- Desmond, Eileen.
- Donnellan, John.
- Dowling, Dick.
- Doyle, Avril.
- Doyle, Joe.
- Dukes, Alan.
- Durkan, Bernard J.
- Enright, Thomas W.
- Farrelly, John V.
- Fennell, Nuala.
- Flaherty, Mary.
- Glenn, Alice.
- Noonan, Michael. (Limerick East)
- O'Brien, Willie.
- O'Keeffe, Jim.
- O'Leary, Michael.
- O'Sullivan, Toddy.
- Owen, Nora.
- Pattison, Séamus.
- Prendergast, Frank.
- Quinn, Ruairí.
- Ryan, John.
- Shatter, Alan.
- Skelly, Liam.
- Spring, Dick.
- Taylor, Mervyn.
- Taylor-Quinn, Madeline.
- Wyse, Pearse.
- Yates, Ivan.
Níl
- Ahern, Bertie.
- Ahern, Michael.
- Aylward, Liam.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Mattie.
- Brennan, Paudge.
- Brennan, Séamus.
- Briscoe, Ben.
- Burke, Raphael P.
- Byrne, Seán.
- Conaghan, Hugh.
- Coughlan, Cathal Seán.
- Cowen, Brian.
- Daly, Brendan.
- De Rossa, Proinsias.
- Doherty, Seán.
- Fahey, Francis.
- Faulkner, Pádraig.
- Fitzgerald, Liam Joseph.
- Flynn, Pádraig.
- Gallagher, Denis.
- Gallagher, Pat Cope.
- Geoghegan-Quinn, Máire.
- Haughey, Charles J.
- Hyland, Liam.
- Kirk, Séamus.
- Kitt, Michael.
- Lenihan, Brian.
- Leonard, Jimmy.
- Leonard, Tom.
- Leyden, Terry.
- Lyons, Denis.
- McCarthy, Seán.
- McEllistrim, Tom.
- Mac Giolla, Tomás.
- Moynihan, Donal.
- Noonan, Michael J. (Limerick West)
- O'Connell, John.
- O'Dea, William.
- O'Hanlon, Lory.
- O'Keeffe, Edmond.
- O'Kennedy, Michael.
- O'Leary, John.
- Ormonde, Donal.
- O'Rourke, Mary.
- Power, Paddy.
- Reynolds, Albert.
- Treacy, Noel.
- Wallace, Dan.
- Walsh, Seán.
- Wilson, John P.
- Woods, Michael.
Tellers: Tá, Deputies Barrett(Dún Laoghaire) and Taylor; Níl, Deputies V. Brady and Barrett (Dublin North-West).
Question declared carried.
Motion, as amended, put and declared carried.