Skip to main content
Normal View

Dáil Éireann debate -
Tuesday, 18 Nov 1986

Vol. 369 No. 11

Private Members' Business. - Health Service Allocations.

By agreement, I am calling on an Opposition speaker who will have until 7.20 p.m. to make a contribution.

Has an order been made in relation to the speakers?

Between whom?

Between the Minister of State at the Department of the Taoiseach and the Fianna Fáil Chief Whip.

I hope Deputy Molloy is not going to waste time.

No, we want the right to move our amendment and speak in the debate.

I move:

By agreement, and notwith standing anything in Standing Orders, Members will be called in Private Members' time this evening as follows: 7 p.m. to 7.20 p.m. Opposition speaker; 7.20 p.m. to 7.40 p.m. Opposition speaker; 7.40 p.m. to 8.10 p.m. Government speaker; 8.10 p.m. to 8.20 p.m. Opposition speaker and 8.20 p.m. to 8.30 p.m. Opposition speaker.

It is not agreed unless the Chair can indicate that the Progressive Democrats will be given time to move their amendment.

The debate will continue tomorrow night for a further one hour and thirty minutes and I presume another order will be made at 7 p.m. tomorrow night.

Do the discussions referred to by the Chair relate to tonight's business?

There has been agreement for tonight only.

At this stage I should like an indication that we will be allowed time to move our amendment.

At this stage I cannot guarantee anything. The Deputy will have to wait until tomorrow night.

In that event we do not agree to the motion before the House.

I am putting the question in accordance with the order of speakers announced by the Minister of State.

Vótáil.

Can we have an amendment on the allocation of time for tonight on the understanding that we will discuss the times for tomorrow night later?

Yes, on the understanding that we will be given time to move our amendment. I want an understanding from Deputy Brady that he is prepared to offer us time in the debate. Is Deputy Brady prepared to offer us time?

As we have done in recent weeks, the Government Whip and myself will get together to see what can be done.

Will the record show that the Progressive Democrats will be allowed to move their amendment and contribute to the debate? Is that what Deputy Brady is saying?

The procedure is that if the Government's amendment is moved and carried the Deputy will not be in a position to move his party's amendment. Will the Deputy leave this matter with the Whips until tomorrow night and let us proceed with the debate?

What is before the House is a motion allocating times for tonight and not tomorrow night.

The motion concerns the number of speakers for tonight and that has been made clear to the Deputy.

We would like an indication as to whether we will be allowed to move our amendment and make a contribution. I appreciate the Chair does not have any control over this but can I get an indication from the Government Whip and the Fianna Fáil Whip that we will be given time to move our amendment and make a contribution?

So far we have lost four minutes and it is possible that time would have been given to the Progressive Democrats. If we are to continue to lose more time there will not be any left to talk about.

Is the Deputy prepared to indicate we will be given some time in the debate on the motion?

We will discuss the matter with the Deputy.

I will accept that on the basis that we will get some time.

We have lost four minutes and we must get on with the debate.

I do not wish to delay the House but this is a most unsatisfactory arrangement. I hope at a later stage we will have more Members and we will be able to exercise more influence on the Order of Business.

I suggest to the Deputy that he leave this matter until 7 p.m. tomorrow night. The Deputy is holding up the business of the House.

I will leave the matter over until tomorrow night on the understanding, as Deputy Brady has indicated, that time will be given to the Progressive Democrats, as Opposition speakers, to move their amendment and to contribute.

Motion agreed. I am calling on Deputy O'Hanlon who has 15 minutes.

I move:

That Dáil Éireann condemns the failure of the Government to provide essential health services for the old, the sick and the handicapped, and calls on the Government as a matter of urgency to ensure that the necessary level of services is provided.

The Government will go down in history as the most uncaring Government since the foundation of the State. This week, for example, thousands of families are feeling the effects of the massive reduction in social welfare payments which the Government imposed following the introduction of the equality legislation. Their lack of concern can be seen in the dismantling of the health services that have taken place in the past four years. When the Government took office the health services provided for the needs of the people but since then there has been an unprecedented reduction in the level of service and financial chaos exists. Those problems are the result of Fine Gael policies being implemented by a Labour Minister. In 1975 seven of the health boards had a deficit but in 1986 all health boards will have a deficit amounting to a sum between £15 million and £20 million.

The Minister, when asked a question in the House on 23 October, refused to say if health boards will have a deficit on the basis that he did not think it appropriate that Members should have that information because health boards might feel that he, the Minister, was going to take responsibility for the deficits. The major voluntary hospitals will have a deficit of £1 million although in some cases it will be more than that figure. It is unprecedented that one major hospital had a cheque for £500,000 returned to them from the bank. That is an indictment of the policies the Government are pursuing.

All health boards have had to seek increased overdraft accommodation this year and that will affect charges. Is the Minister aware that the banks are putting pressure on the health boards to impose increased charges to cover the increased overdraft facilities?

What does the Minister intend to do about those deficits? Does he intend to allow the health boards and the voluntary hospitals run up massive deficits? Is it his intention to spend millions and millions of pounds and leave the bill for the incoming Government, as appears to be happening in other Departments? The Minister will tell us that there has been an increase in gross current expenditure since his term of office began of the order of 29 per cent but in answer to a question of 15 February last he told me there was a decrease in the allocation in real terms to seven of the health boards, the exception being the Eastern Health Board which received a small increase, 0.5 per cent. It is easy to understand the need for that increase, the rapidly expanding population in the Dublin area and the fact that the Eastern Health Board provide national services for all health boards. That would seem to indicate there has been a decrease in the allocation to the health boards as was confirmed in the most recent report of the National Economic and Social Council issued last week.

The cutbacks are causing serious problems for many people. Wards have been closed for up to four months. In other years wards were closed for one month during holiday periods or for renovation but now they are being closed for four months because of the cutbacks. Would the Minister tell us how the Taoiseach could say in the House on 23 October that there was no need for ward closures at all? Did the Minister or his officials recommend to the health boards that there should be ward closures.

The waiting time has been extended for out-patient appointments and for admissions to hospitals and it is now at an unacceptable level. I am aware of a man who possibly had a brain tumour. He had an appointment to see a neurologist on 5 August 1986. A week before this he received a letter form the hospital stating:

I regret your appointment to be seen on Tuesday 5 August has been cancelled.

A new appointment has been arranged for Tuesday 21 October at 2 p.m.

Trusting this arrangement will suit your convenience.

That was a delay of 13 weeks, entirely due to the cutbacks for which this Government are responsible.

Would the Deputy care to name the hospital and the neurologist and I will have an inquiry made?

The letter is there. Further, on 9 October the man received a letter from his employers, who happened to be a local authority. A quotation from that letter went as follows:

I regret that your state of health does not allow of your continuing to be a member of the Council's staff and on behalf of the Council I wish to thank you for your valued service while in the employment of the Council.

Would the Deputy make the data available?

The man attended the neurologist and I am glad to say that he is now in good health and fit for work, but he has no work to go back to. By any standards that is wrong.

A public authority?

A man with a potentially serious illness had his appointment delayed for 13 weeks and his employment terminated.

I would say that if the man were a private patient he would have been seen on the following morning.

The longer waiting period means that the Department of Social Welfare are paying disability benefit, not alone to this man but week after week to people awaiting out-patient appointments. There is more attendance with the family doctor through the GMS and the visiting rate is going up. The cost to the GMS is going up and the Minister wonders why. I believe it is above budget at present, although the Minister did not tell us so in the House when asked. Can he defend, on human terms, the fact that a person with a potentially serious illness would have to wait so long for his appointment that his employment was terminated? In economic terms, would he explain the cost-effectiveness of the cutbacks in the manner in which they are operated?

The Western Health Board are sending people to Dublin and Cork for a CAT scan but on budget day the Minister for Finance announced, as reported in column 944 of the Official Report, that money would be available for the commissioning of the CAT scanner in Galway. We are now half way through November and that has not yet been done. On 30 January the Minister announced the closure of eight hospitals. The first that patients, administrators and staff heard of this was on their car radios when they were driving home. The Minister promised that when Sir Patrick Dun's hospital closed, facilities would be available in St. James's Hospital. Are those facilities available? I am aware of a doctor who was unable to get an urgent appointment in St. James's Hospital with a consultant from Sir Patrick Dun's something that would have been very easy to come by when Sir Patrick Dun's was open and working.

The Minister believes in the shift from hospital to community care, both in terms of emphasis and of resources, and we fully support that policy but the community care services have also been run down. There is now no dental service for any adult except an expectant mother, a handicapped person or somebody awaiting an operation. There is no optician service for the elderly, people living alone who like to read or watch television. There is no replacement for public health nurses, even though more people are being discharged earlier from hospitals and in need of community care.

The general medical services guidelines, according to reports that I am getting from all around the country, are now a rigid cut-off point for the medical card, irrespective of need. This, again, is the direct result of the cutbacks imposed by the Government and the Minister knows that. He knows that there is hardship being created and that his colleague, the Minister for Social Welfare, Deputy Hussey, introduced payment for school buses based on the medical card, which is adding further burdens to unfortunate people who are unable to pay for their own health services. Still the Minister asks us in his amendment to commend him for the way in which he is administering the health service.

Cutbacks relating to the mentally handicapped are of 2 to 3 per cent, although I have been told that in some institutions they are as high as 7 per cent. Every Member of this House must be concerned to ensure that we have adequate and proper services for the mentally handicapped. Last week in the House I raised the matter of the number of physically healthy young mentally handicapped adults who are going home to elderly parents who are unable, through age or infirmity, to look after them. They are being sent home because the institutions are unable to maintain them due to lack of funding. I appeal to the Minister to provide this funding. He promises more beds for the mentally handicapped. We want the places which are already there to be funded so that elderly people around the country need not live in a state of anxiety because young strong adults are being sent home to them and they are not able to manage them.

Beaumont Hospital should have been opened two years ago. The Minister now tells us that he will open the out-patients' department before the end of the week. Is he serious? The people from the north city who will be using the out-patients' facilities will go to the out-patient clinic at Beaumont and then have to go to one of the centre city hospitals, the Richmond or Jervis Street for x-rays and blood tests. Their files will be scattered between many hospitals. What sort of service does the Minister expect to be provided if that is to happen? Would the Minister as a matter of urgency open Beaumont Hospital properly as a major teaching hospital for the north city?

The Taoiseach talked here about CEOs hyping up the problems of the health services and of the CEO of the Southern Health Board as producing knowingly fictitious figures. That is not what we would expect from a responsible Government. I shall leave the paper read at Dromoland Castle for another time.

The amendment to our motion, on behalf of Fine Gael and Labour in the name of the Minister for Health, accuses Fianna Fáil of exploiting the fears and concerns of the sick, the elderly and the handicapped. The Minister is wrong. Fianna Fáil have a long tradition of a caring social philosophy which they cherish and of which they are justly proud. The present Leader of our party, as Minister for Health and Social Welfare, was responsible for the development and improvement of many of our health services and some of the most radical and enlightened social welfare legislation in Europe. In Government, we will abandon the present Minister's policy of confrontation and instead we will have consultation. We will discharge what is the responsibility of any civilised Government, that of ensuring that the necessary level of health services is provided.

We in Fianna Fáil have a caring social policy. We are committed to the promotion of good health and the prevention of illness; the development of community services; more opportunities for the elderly to be cared for and treated in their own community; the provision of an adequate dental and optician service; the implementation of the recommendations of the document on psychiatry Planning for the Future— this to be carried out in a phased programme of development over ten to 15 years. We shall start with the first page, not with the last page as the Minister did. We will carry out a review of the various drug schemes, the long term illness schemes, the refund of drugs scheme and improved out-patient facilities. Much of this could have been done during the past few years without any major increase in expenditure had the Minister not adopted his policy of confrontation. The members of our party are sensitive to the needs of the sick, the elderly and the handicapped. We know that health care is expensive to provide and we are concerned at the high level of taxation. In Government we will provide a proper and necessary level of services for the people.

Once again we in Fianna Fáil are forced to highlight the plight of the poor and the needy and to put down a motion condemning the failure of this Government to provide essential health services for the old, the sick and the handicapped. Our motion calls on the Government as a matter of urgency to ensure that the necessary level of service is provided.

The total inadequacy of funding is reflected in every region and in every hospital, be it health board or voluntary. This is the fourth time we have tried to highlight the situation and prevail on this Government to make some effort to cater for the needs of the sick. We are trying to draw attention to the plight of the poor and underprivileged and to the hardship being inflicted on them by this Government and — more astonishingly — by the Labour element of this Government. The Labour Party and this Minister for Health would claim to represent the poor, the needy and the underprivileged, but surely they must realise that they are not making adequate facilities available to this sector, which must suffer as a result. Perhaps we could understand this if it came from the Fine Gael Party alone, since they never claimed to cater for this group of our society, or from their potential partners of the future, the PDs, who cannot be seen by any stretch of the imagination to be committed to the underprivileged. All of this coming from the Labour Party and a Labour Minister for Health is almost unbelievable.

Can the Minister not see that he is being made a scapegoat by this Government? I and many others on this side believe the Minister was perfectly right to resist the Taoiseach's attempt earlier this year to remove him from his present portfolio. The Taoiseach was at that time, as now, trying to saddle the Minister with the collective Cabinet decisions in relation to health, hospital closures and many other issues. The Minister is still being made a scapegoat but he cannot see it.

I would refer in passing to the outlandish statement made recently by the Taoiseach in this House when he suggested that the South Eastern Health Board and the Western Health Board had indulged in political hype. Hype was the charge levied at the health boards for their efforts to provide a comprehensive medical service within their allocation. Members of the Western Health Board can speak for themselves but as a member of the South Eastern Health Board I should like to give the Minister and the Taoiseach a few facts in relation to the funding of that health board and their performance to date.

The annual aggregate cost to run the acute hospitals of the South Eastern region is £2.5 million less than the national average. In spite of a shortfall of £4 million in the allocation for 1986, there were no permanent ward closures in the South Eastern Health Board region. The acute bed numbers in the South Eastern region are below the Department's norm, while I understand that all other health boards exceed the norm. The South Eastern Health Board has one of the lowest consultant staffing levels in the country. We have 20 consultants per 100,000 population, while the national average is 33 consultants per 100,000. The staffing levels for junior hospital doctors is also one of the lowest in the country with 23 doctors per 100,000 while the national average is 53. That information is sufficient evidence to prove that the Taoiseach's statement was an untruth and warrants an apology to the South Eastern Health Board and the Western Health Board. I may add that we are still waiting for such an apology.

I now refer to the situation which prevails in some of the health boards and voluntary hospitals throughout the country. In my health board region we are facing the most disastrous year of all time. That is not political hype. The original net expenditure needed for 1986, based on 1985 levels of service plus the residual effects of 1985 pay and allowance increases and estimated inflation, was £93.718 million. This original figure was subsequently adjusted to take into account 1986 increases in pay and allowances approved and increased to £94.270 million. When compared with needs, this allocation represents a shortfall of £4.780 million. This is not hype but fact.

Let us look at some of the measures taken by the South Eastern Health Board to try to live within the allocation from the Department. They have saved a figure in the region of £80,000 on travelling expenses. I would like to clarify that those travelling expenses do not, as the Taoiseach implied, refer to board members travelling to and from meetings. These expenses are incurred due to travelling by doctors, social workers, community care workers and many other workers in the health board going about their daily chore of catering for the poor and the ill in the community. We have had to cut back on those expenses this year. The Minister has always insisted that the emphasis should be changed from the hospital to the community. How can we achieve that under these circumstances?

We in the South Eastern Health Board hope to save about £400,000 on energy. All I can say is that we must hope for a good winter in 1986, otherwise we may have to advise our patients and their visitors to bring in extra blankets. We have reduced subventions to nursing homes by £250,000. This is surely counter-productive when one considers the fantastic service these homes provide for the poor and needy. We will be forced to save about £50,000 on transport costs and the health board have been forced to designate pick-up points for patients travelling to hospital. These people have to travel to a specific point to be picked up by an ambulance. The people who are availing of the ambulance service are those who cannot afford any other mode of transport. Some of them may have to travel five or six miles to the designated pick-up point. Since they do not have transport of their own, they will have to hire a taxi to bring them as far as the ambulance. Many of them cannot afford this and as a result they will not be able to attend hospital. This will create the required savings but the Minister knows this is not the right attitude to health care.

We also have to introduce another cost saving measure as a result of the inadequate allocation. We had to abolish the free milk scheme. A Labour Minister for Health has forced this step.

At what cost?

I have not the exact figure but is is about £50,000.

And £1 million in travelling expenses.

We should be proud of ourselves. There were many other attempts at savings but we are still faced with a shortfall of £4.780 million at the end of 1986. That is fact, not hype. We approved at our October meeting an overdraft limit of £3 million. This facility had to be raised to £7.5 million at our November meeting. To date we have had no correspondence from the Minister in relation to this matter but if he does not agree to this overdraft facility the salary cheques of the workers of the South Eastern Health Board will not be cashed by the banks in December. That is the situation we find ourselves in and we are still awaiting a response from the Minister. Maybe we will have that response tonight.

May I read the first paragraph of a letter sent earlier this year by some of the consultants in St. Luke's Hospital, Kilkenny? It states:

Stringent financial cutbacks are being imposed on the South-Eastern Health Board by the Minister for Health, Barry Desmond. Specific proposals have been made at health board level to implement these cutbacks. 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 Carlow-Kilkenny.

These are not my words; they are the words of the people responsible for providing the health care in the Carlow-Kilkenny area. The letter also states:

If we are to live within our financial allocations in the South-Eastern Health Board, we would have to have a reduction of £1.5 million in the general hospital area. This would require a saving of £500,000 in Ardkeen Hospital alone. To achieve this we would have to close the maternity unit permanently, close 36 of the surgicial beds for an equivalent of six months of the year and we would have to close the dialysis unit.

That unit was provided and paid for by the people of the south-east. Neither the Minister nor his Department provided one penny towards that facility but now, as a cost-saving exercise, he suggests we close it.

The only reference to Waterford in the budget speech last January was a statement that funds would be made available to open, staff and equip the geriatric unit at Ardkeen which has lain idle since 1984. No pre-conditions were laid down, just those facts. The Minister said he would open, staff and equip the geriatric assessment unit. It is now mid-November and we still have seen nothing, but two months after the budget a condition was imposed. We were told these facilities, the staff and the financing would be provided conditional on the closure of St. Dympna's Hospital.

Let us have a quick look at the other health board areas and see how they have fared. Let us take the Minister's constituency of Dún Laoghaire. Here I have a headline "Hospital cutbacks worry Dún Laoghaire doctors". The article reads:

Dun Laoghaire doctors are to ask the Board of St. Michael's Hospital to meet with local politicians to explain to them the cutbacks situation at the hospital...

... The hospital has announced that it can no longer provide physiotherapy treatment and has cut back on pathology tests. Eighteen beds have also been closed. It was pointed out at the meeting that these restrictions while saving money in the short term could lead to more money being spent in the long term through increased morbidity.

Local doctors have already joined with the hospital board in rejecting Health Minister, Mr. Barry Desmond's claim that St. Michael's Hospital was "blackmailing" him for extra funds.

Let us see what can be said about the Midland Health Board. The newspaper heading reads: "Cash shortage blocks the second phase of hospital plan". The article reads:

The Department of Health says it doesn't have the resources to enable the second phase of the major development at Mullingar General Hospital to proceed as planned.

The article dealing with St. Vincent's Hospital, Dublin, has the heading "Hospital shouts beds for good". It states:

St. Vincent's Hospital, Elm Park, has been forced to close down 45 beds indefinitely because of its continuing shortage of money.

The Mater Hospital have been told to borrow £5 million. The position is the same in all the health board areas.

In the final few minutes available to me I would like to highlight the findings of a survey carried out on my behalf recently. First, I will read the questions asked and then I will tell the House the results. The questionnaire read:

Over the last two years has underfinancing in the health area affected your patients' welfare?

Taking the following headings as guidelines comment briefly — using statistics where possible:

(1) Decrease in the general level of GMS facilities.

(2) Access to general hospitals in your area (both in and out patient services).

(3) Access to teaching hospital and sub-speciality services, e.g. cardiac, paediatric and neuro-surgical, etc.

(4) Community care facilities.

(5) Administration, e.g. serious slowness in the processing of claims.

(6) National averages too rigidly applied at a cost cutting exercise, e.g. visiting rates, late calls, etc.

(7) Backlogged processing of drug refund claims.

In this survey a sizeable number of doctors in the GMS were contacted and the following was the result. In relation to the decrease in the general level of GMS facilities, 66 per cent of those who replied indicated a significant decrease in the level of GMS facilities over the past two years; 62 per cent replied indicating there had been a decrease in access to general hospitals in their areas; 55 per cent complained about difficulty in gaining access to teaching hospitals, and 64 per cent maintained that national averages were too rigidly applied as a cost-cutting exercise. These are not my figures. These figures were the response I had from a survey conducted on my behalf. What surprised me most in this survey was the number of doctors using unbelievable terms to describe what is happening such as, "catastrophic", "frightening degree", "health services crumbling" and "disaster". These are just a few of the words to describe the degree of dissatisfaction felt by doctors throughout the country.

Let me give a synopsis of some of the replies I received:

If you look at the number of patients seen in our Out-Patient Departments, this was steadily increasing over a period of time, from the early eighties. However, due to cutbacks, we have had to cut back on the number of new patients to see us in general surgery, and also increasing the wait to have something done about their surgical condition. The Board of Management of the hospital in its attempt to save money, has closed beds and quite simply the result of this is longer waiting lists, and a greater time spent with patients suffering.

Another reply reads:

The attempt by Administration to cut down on the number of admissions to hospital and also the overall stay of patients in hospital, has caused considerable difficulty, particularly the premature discharge of patients from hospital who are, sometimes, re-admitted within a few days with a recurrence of their symptons because they have not fully recovered on discharge...

I am also aware of an attempt to reduce the number of patients seen in the Out-Patients. This is a contradictory type of policy as the Department of Health wishes to have as many patients as possible investigated as out-patients.

I feel that the whole situation is utterly chaotic and unless more money is provided for the health services, the present chaos will become worse and the situation will become totally unmanageable.

I have an in-depth reply from a GP in Dún Laoghaire-Rathdown who encloses a reply he got from St. Michael's Hospital in which they outline measures to reduce the level of hospital expenditure, such as the reduction in pathology services, a reduction in physiotherapy services and many other reductions. Finally, I should like to read the final paragraph of a reply I got from a doctor in the south-west. It reads:

The real question is — Is underfinancing (Fact), compatible with maintenance of standards?

In reply to that I have to say emphatically no.

I appeal to the Labour Party members of this Coalition to realise who they are and who they are supposed to represent in this Administration. They could regain some self-respect by opposing any further effort to inflict misery on our old, our sick and our handicapped.

I move amendment No. 1:

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

"Dáil Éireann commends the Minister for Health for continuing to provide comprehensive health services for all persons in need despite the severe overall limitations in exchequer resources; notes that the Fianna Fáil Government in 1982 provided £999 million for such services compared to £1,300 million, the estimated approved out-turn for 1986; further commends the Minister for Health's repeated assurances that the current resources allocated to the health services are sufficient with effective management to ensure the delivery of essential health services to the community as a whole; deplores the constant exploitation by the Opposition of the fears and concerns of the sick, the elderly and the handicapped about these services; and notes with concern that there has been no attempt by the Fianna Fáil party to be constructive about health issues in these difficult economic times."

I wish to deal with a number of points raised by the proposer and seconder of the motion put down by the Opposition. First, Deputy Dr. O'Hanlon raised a question that — presumably — a constituent of his had been unable to have a neurological examination between 5 August and 22 October 1986 which he urgently required. If I receive the relevant information from the Deputy — presumably in his possession as a member of the medical profession — I can assure him that I will have carried out a full departmental inquiry. Also since the person concerned is a public employee — as was indicated by the Deputy concerned — and has, allegedly, lost his job as a result of his failure to have medical treatment this would warrant a departmental inquiry on the part of the Minister for the Public Service and the Minister for the Environment, on the assumption that he is employed in that area. The Deputy may rest assured that a very detailed examination and a report to him of that case will be carried out, in public if necessary. That sort of allegation should be dealt with immediately and put to rest.

It was suggested by the same Deputy that the Mater Hospital had a cheque for £500,000 returned. We met with the authorities of the Mater Hospital and discussed that incident in depth. I do not think I could be accused of in any way betraying departmental discussions with a hospital when I say that the hospital, to say the least, was embarrassed about the situation. To say the most, the hospital are now fully in accord with the cash management departmental system of the Department of Health. That incident is not likely to recur and is unlikely, to say the least, to be manufactured again for particular purposes.

So they will have no deficit this year; is that right?

Lest it be the view of the Deputy that the activities of the Mater Hospital have declined in any way, I should say that when his own colleagues, Deputies Haughey and Woods were looking after the matter, the total bed days in that hospital in 1981 were 151,574 whereas the total number of bed days last year was 151,694. I quote from the annual report of the Congregation of the Sisters of Mercy who are not known for putting erroneous data in their reports.

Regarding Deputy Ormonde's view about the South Eastern Health Board this is more of the same thing. Really I do think that consultant radiologists should stick to radiology and let finance be dealt with by those who know something about financial procedures. The existing overdraft of the South Eastern Health Board is £3 million, not £7,500,000. That figure of £3 million has not been exceeded to date.

At last Thursday's health board meeting they took a decision to ask the Minister's Department to have that facility raised to £7,500,000.

Dublin North-West): Will the Deputy please allow the Minister to continue?

On a point of order, I am entitled to make my contribution and I did not interrupt the Deputy. If one distils all the propaganda from what the Deputy said, the South Eastern Health Board have requested that we fund them to maintain an overdraft level of £3 million.

Seven and a half million pounds.

I want to put on record that we have a formal request from the South Eastern Health Board that we maintain their overdraft level up to the end of November 1986 at £3 million. That overdraft level has not yet been exceeded. If, in the coming month, there is an excess required on that overdraft level, we shall discuss the matter with the board. I am surprised that a consultant radiologist from the South Eastern Health Board area would come into this House and say that cheques will be dishonoured for several thousand staff in the month of December. That is not true. That is the kind of vilification and abuse of an extraordinary nature I have had to tolerate from the Opposition over the past three or four years. The South Eastern Health Board will be looked after. It is reminiscent of the kind of reply I had to give in the House to Deputy Denis Lyons only a few weeks ago in relation to the budgetary position of the Southern Health Board. On 12 November Deputy Lyons posed a question about the overdraft of the Southern Health Board. I should say that last year the Southern Health board said they would be £9,500,000 short. Deputy O'Hanlon spent a couple of days hitting the Minister over the head because the Southern Health Board would be £9,500,000 short. The Cork Examiner positively bled blood and lacerated the Minister because of the £9,500,000 last year that the Southern Health Board would be down. I was the devil incarnate, putting old people out into the streets of Cork without a shilling being paid to the hospitals concerned. What is the reality? The eventual excess for last year, as recorded in the abstract of accounts of the Southern Health Board, was £0.825 million.

The Minister should finish the answer he gave Deputy Lyons because he cast a slur on the CEO; the Minister and the Taoiseach did.

I really question the extent to which our health board system seems to have a capacity to throw up data as if it were the truth and subsequently try and embellish that into absolute truth. It is not true just as, for example — if I may finish this point before getting into more serious business — the survey conducted by Deputy Ormonde. Who in the name of God would take that seriously?

That is the problem, the Minister takes nothing seriously.

It is as if one sent a circular to every husband in the country asking him when he last stopped beating his wife, making quite sure that one put the Fianna Fáil Party after it, asking that the appropriate response be sent urgently because they wanted it to have a go at the Minister for Health.

There was reference to St. Vincent's Hospital. I can assure the Deputies here that I met the medical board of St. Vincent's Hospital last week. I made very substantial funds available to that board. I do not propose to disclose the amount because it probably would not be believed, but the Deputy could go and ask them.

Will they have very substantial deficits?

I made a very substantial amount of capital moneys available to St. Vincent's Hospital because, with the closure of Sir Patrick Dun's Hospital, we were concerned that there might be some additional activity in St. Vincent's. That hospital too is, so to speak, line ball in terms of its budget. In fairness to St. Vincent's Hospital I should say that they have always co-operated extremely well with the Department of Health. Their deficit position in 1986 is well and truly looked after. The Deputy need have no concern in that regard.

What about St. Michael's, Dún Laoghaire?

St. Michael's Hospital is well and truly being looked after. As the Deputy knows, I am not responsible for the fact that there has been an upsurge of some private development in the Blackrock area which has affected the St. Michael's Hospital VHI income. That is not my responsibility. That is the reality there.

I hear that patients from Mountjoy are going there now.

Acting Chairman

Order, please.

The Fianna Fáil Party have continually criticised me for allegedly failing to provide sufficient funds for the health services. Yet the same party propose to have an overall 35 per cent tax band. Equally that party have a view that the current budget deficit must be substantially reduced. They come into this House and, time and time again, put forward proposals which are totally unsustainable in terms of the health services themselves. Time and again the party trot into Leinster House and, like a chameleon, change their colours according to the way the wind is blowing. One day we have Fianna Fáil Deputies claiming credit for a new hospital in Arklow. The next day they want to have a fully fledged new maternity unit in Bantry. Then they change track and, depending on who the leader of the party may have met in what hospital corridor, they want a new paediatric unit in Roscommon. The day after that they must have another three surgeons and another two physicians in Monaghan. The following day they want an extra £3 million for the Mater Hospital, money which was never even asked for but it does not matter because it is perceived to be a hospital of special concern to the leader of the party and he sheds public tears for the hospital, and then off it goes.

Tonight we had it again. Deputy O'Hanlon is a very sane, sensible and, without patronising him, an excellent spokesperson for his party when he is not under pressure. That is the problem facing the Opposition these days. Nobody knows who will get what job in the event of any change, and the longer it goes on the less likely it is that these jobs will materialise. Therefore, today we have a proposal that we should extend the long-term illness scheme by allocating £10 million for asthma sufferers and about £16 million for treatment benefit and dental and optical benefit for the spouses of insured workers. All of that is done while Deputy Michael O'Kennedy, the totally separated member of the party from Tipperary, tells us in Success magazine — a rather minor magazine but a rather major prospective Minister for Finance — that he is going to slash the current budget deficit, cut public expenditure. Here we go, a party of multiple contradictions who have received over £700,000 in taxpayers' money to do basic fundamental research for policy, with not a shred of policy document yet in terms of real healthcare in the community. I do not blame Deputy O'Hanlon for that. His party leader does not want policy documents. He only proposes to expose them to the light of day for about three weeks of a general election; that precious flower can only bloom for three weeks and is not allowed to be examined or admired by any other politican on this side of the House for any longer period because it might wilt under the gaze of those who critically examine it.

Dublin North-West): I am sorry to stop the Minister but there is a motion down here about the health services and I would like the Minister to keep to the motion. I do not want party politics brought in to it. There is a motion down here and the Minister has an amendment and I would like him to speak to his amendment.

For a moment I thought I was at a flower show rather than in a political forum. I want to get back to another allegation made by the Deputy here. It is alleged I am cutting back on services for the mentally handicapped. This is a glorious one. Nothing could be more emotionally contrived. We have the friends of the mentally handicapped, the parents of the mentally handicapped, the unfortunate persons themselves, a caring Irish society, a political party with a long tradition of care for the development of the health services, and the big bad Minister with the finger of Fine Gael on him, and he himself at this stage almost related and married into Margaret Thatcher's family, here cutting the services for the mentally handicapped.

(Interruptions.)

This accusation must be put to rest. When the Deputies over there left office there were in residence about 5,800 people in residential centres.

Does the Minister remember the motion that put us out of office? It was his motion for health cuts.

Today the reality is — and Deputy O'Rourke knows perfectly well what happens down in Athlone — that there are 5,872 mentally handicapped persons in accommodation.

They are being thrown out because they have no money.

I will give the Deputies the facts. The figures are that when the Deputy left office in 1981 expenditure on the mentally handicapped was £56.5 million or 6.6 per cent of total State expenditure. In 1986 I have provided £110 million or 8.5 per cent of total expenditure.

What a good boy you are.

If the Deputy does not want to believe it he can put down another Dáil question and I will tell him, blow by blow, how it is done. To give a breakdown, at this stage we are giving about £73 million a year for care in the special homes for the mentally handicapped. For those in day care centres we are spending £8 million a year. For the care of the mentally handicapped by health boards we are spending £29 million a year. Throughout the country we are making very substantial contributions towards those who are mentally handicapped.

Why are they being thrown out of homes?

They are not being thrown out.

They are being thrown out.

I will take the Deputy on a tour of the institutions throughout the country. In fact, I will give him the loan of my beloved State car which the taxpayer has provided me with and send him on a tour and he can visit every one of them himself and talk to every sister and every mother. He can, if he wishes, come with me when I meet the Brother's of St. John of God in a fortnight's time and I will include him at the meal which we usually have every year. They can tell him this Government have been exceptionally sensitive and caring and exceptional in providing money for those who suffer from mental handicap.

The parents will not say that.

I can assure the Deputy that I can stand over any facility in any part of the country whether it is in Cork, Dublin, Galway or Sligo. Let the Deputy come with me and I will open the budget books to him to read, and I extend that to any Deputy in this House.

(Interruptions.)

It is expensive to care for a mentally handicapped person in a residental centre. It costs on average £12,000 a year, although that can be substantially higher. I do not propose to spend much more time on this because I find it nauseating that I have to pass through the city of Dublin and see, on a very costly Fianna Fáil poster, that the health cuts are hitting the handicapped. That is scandalous in terms of the upset it causes to the mentally handicapped who live in hostels in the Greater Dublin area who pass by such posters and may be able to perceive them; above all else, it is desperately upsetting to the families of those concerned, and it is a gross political travesty of the truth.

It also says there is a better way.

Fianna Fáil would be better to desist from that kind of activity.

I should like to remind the House that there has been a spectacular growth in expenditure on the health services over the past decade. In 1973-74 we were spending only about £144 million or 5.2 per cent of GNP. Today, we are spending £1,300 million or well over 7 per cent of GNP. We are spending 20 per cent of out net State expenditure on the health services. For practical purposes there has been a reduction in real terms of 1 per cent, and that is all. We have kept up the level of services and rather than a failure to support the services it represents a very firm basis for a rational development of the services in accordance with Government policy. If the Deputies do not believe me, I will give them the straight figures. In 1982 it was £999 million; in 1983 it was £1,091 million; in 1984 it was £1,156 million; in 1985 it was £1,245 million and in 1986 £1,300 million is the estimated outturn figure.

This is a real level of funding of the health services — we have extended them in a real sense. I have provided a new centre for a national transplant unit in St. Vincent's in Dublin. We have renal dialysis centres, which will not be closed down, in Ardkeen and in Sligo General Hospital, in the Limerick Regional Hospital and the Letterkenny General Hospital. I have seen the outstanding work being done by the staffs in these hospitals. We have had a 100 per cent increase since 1982 in cardiac procedures in the Mater Hospital, accommodating 1,000 a year. As Deputy Wyse well knows, in Cork Regional Hospital under an outstanding cardiac surgeon they have done about 140 cardiac procedures in a new unit.

What will the Minister do in Athlone?

We are providing an additional £600,000 for Cork. If the Deputy wants to talk about her area, we have rationalised the whole health system there under the Midland Health Board. With Tullamore now established, with Athlone being developed — they got a letter from me the other day there for £600,000 for a new health centre——

That has been coming since 1976.

With an increasing ageing population we have new orthopaedic centres, one in Croom, one is being developed in Cappagh, one in Cork and a new regional unit in Tullamore. We never hear a word about them because at grassroots level Fianna Fáil are grovelling with chagrin at the fact that we can produce that in a recession. We have provided major geriatric and psychiatric units in Dundrum. I will bring the Deputies to the hospitals in which we have spent tens of millions of pounds in magnificent new psychiatric and geriatric units. We have transformed the campus at St. James's Hospital. Any Deputies who visit St. James's Hospital will bear me out about the transformation there.

Last year we spent £1 million on a successful measles vaccination programme through which 90 per cent of the targeted children were covered. We have provided services for the mentally handicapped. We commenced the new St. Michael's Hospital and did major work in redeveloping St. Patrick's. We have commenced the building of new residential accommodation for St. Joseph's. In the past four years I have spent £220 million in capital expenditure, and if Deputy O'Rourke would like to come on a visit with me——

No, thank you.

——I will bring her to her own constituency, to Mullingar——

Come to Athlone.

I will bring her to the new extension in Portiuncula, to the new maternity centre in Galway. The new facility in Portiuncula is a magnificent development. I will bring her to my home town of Cork; just across the road from where I was born she will see the result of the £1 million spent on the extension to the Victoria Hospital. I resent the allegation that we are not providing money. Fianna Fáil tried to make a few jingles in relation to Ardkeen, Sligo and Wexford——

Wexford was all right.

Work has been done on those hospitals, in planning, design and site work. A sum of £3.5 million has been spent in Ardkeen, £800,000 in Wexford and £3.5 million in Sligo. During my period in office I have not indulged in off-the-cuff cuts. However, I have cut much waste, much unnecessary expenditure on drugs. I have tried to cut the £11 million on travelling expenses with health board ambulances criss-crossing county boundaries. I have tried to control some of the unnecessary overtime. I can turn to Our Lady's Hospital in Cork where I tried to reduce expenditure to rational levels. I have organised a system whereby I know from day-to-day the exact bank balances of each hospital, whether they be voluntary or health board hospitals. I have cut out the cant and the hypocrisy.

The Minister has cut out the dental service.

The Deputy's effort was to be seen handing out 200 tooth brushes——

At least we had a dental service.

I have kept up the level of funding and have made major changes. For instance, I tried to change the system in St. Patrick's in Castlerea, and admissions have dropped from 258 to 197.

The Minister was going to close it.'

We are extending the general community care and have turned the psychiatric service around from the appalling situation in which I found it. I have no apology to offer to the House in that regard. We have closed hospitals, of course, Patrick Dun's——

It will be open, not by caving in, as Fianna Fáil would have done, to certain construction interests. I have done all I could to promote health and prevent illness, by the introduction of smoking regulations and other methods. I am far more concerned with the corpus of social legislation. During my period in office I have put several such Bill on the Statute Book. We now have the Adoption Bill and I would trade everything I have done for that Bill alone, which will care for legitimate, abandoned children.

In addition, I introduced legislation to cover the nurses, a dental Bill, the setting up of a National Social Service Board, clinical trials legislation and children care and protection legislation which is now before the House. I have not been dominated by monetarism or any other "ism". All this needed to be done. It has been done, it is being done and I will continue on doing this work certainly in the next 12 months and then I think we can do an even better job. Fianna Fáil should take down those posters.

Minister, your time is up.

They besmirch a republican party, making cheap political capital out of the health of the people. They should tear them down. They are on their uppers long enough.

There is a better way.

They will be well beaten anyway before the next election.

Deputy Briscoe, and he has until 8.20 p.m. to finish.

I have to hand it to the Minister. Talk about a person being immune from reality.

The Deputy has been up in St. James's. He knows what it is like.

Yes, I know what it is like and I am on the Eastern Health Board and I know what it is like. The Minister gets into his State car at night and drivers off to another planet. He is not living in the same land as any of us because we are dealing with reality as we find it. The Minister never answered any of the questions raised by our spokesman, Deputy O'Hanlon, or our Deputy spokesman on Health, Deputy Ormonde. He answered nothing about the banking facilities, the overdrafts, the Taoiseach's statement that there was no need to close hospital wards. Talk about Stonewall Jackson. This is stonewall Desmond. How that man can stonewall, and he comes out looking great.

However, the realities are that the people outside this House, the unfortunate people who are trying to keep up the services for the mentally handicapped, are not feeling so great. I am identified closely with many of the organisations of which he spoke in such a despairing manner, saying "the friends of this", "the friends of that", this parents' association and so on. It is quite disgraceful because I, working on some of these committees, know how earnest the people are in trying to raise the standards for the mentally handicapped under the institutional care that they are identified with. For example, I am on the finance committee of Cheeverstown House. Cheeverstown House is what I would call a dream come true. It is a magnificent accomplishment. Our then Minister for Health, Deputy Woods, turned the first sod for Cheeverstown House. I venture to say that there is not a mentally handicapped complex anywhere in Europe, and you would be hard put to find one in the USA, that would measure up to this magnificent complex, but there are five units, five houses, and only two of them are open and three are still closed because of lack of finance from the Department. They are taking people in on a daily basis, but there is a great need for full time care for many young mentally handicapped people. The facilities are there for them. Those of my colleagues who visited Cheeverstown House said when they saw it that these were the minimum standards required for the care of the mentally handicapped. The people there cannot even get off the ground for lack of funds, while the Department of Health passes the bill over to the Eastern Health Board, gives them the same amount they gave last year and tells them to run it, there is no extra money to open up these units. I am glad that none of them was here tonight to hear the Minister describe the friends of Cheeverstown and the parents' committees in the disparaging manner he used.

I remind the Minister that when he came into office he assured NAMHI — the National Association for Mentally Handicapped of Ireland — that there would be no deterioration in the services for the mentally handicapped. He gave that assurance to the top people there. I have spoken to some of those people and they say that he has reneged completely on that pledge, that the services for the mentally handicapped have declined. In this House in answer to Deputy O'Hanlon some time ago the Minister admitted that even in the grants to the health boards there had been a decline in real terms and he said that the only health board who had got an increase over and above what they got in the three years previously were the EHB who had got 0.5 per cent. Our spokesman assures me that that is correct. Yet the Minister has the gall to come into this House and say that they are all in real terms much better off than they were, when he knows that this is not true.

I have been appointed to an association of health boards made up of representatives of all the health boards with the exception of the Southern Health Board, the only health board who did not join this. The seven health boards who formed this association requested a meeting with the Minister, Deputy Desmond. He has refused on all occasions to meet those health boards. Our deficit on the EHB is £6 million and we do not know how high that will be at the end of the year. We have had to make cuts at every level. One does not mind economising where one does not affect the services available, but even on that very valuable little service, the home health scheme, we had to introduce charges on people who found it difficult in the majority of cases — not in every case — to come up with money to pay for their home health service, which they had been getting free because they needed it badly.

We have seen other wonderful organisations affected. I do not have to tell any Member of this House about the wonderful work which organisations like the St. John Ambulance Brigade, the Order of Malta and so on do in a voluntary capacity. If the State had to pay for them we just could not afford it. They ferry people to and from premises and train young people in first aid. In my constituency the St. John Ambulance Brigade were asked to pay £14 a night for the use of the health centre where they had been practising first aid. The health board had no alternative but to make up the money somewhere. I have made representations and I think the amount was cut down to £7 per night. We should make facilities available to these people for nothing. Now they are paying for the privilege of giving their voluntary services to the community. This is wrong.

I listened to the Minister decrying the advertisements which we have. He can always refer them to the Department of Industry and Commerce to see if we are infringing any of the Acts in regard to wrongful advertising. I am certain he would like to take us to task on this. If he took us to court he might find that those advertisements which we have placed are quite justified and in accordance with the facts.

The Minister comes in here and brazens things out. Because he makes so few appearances maybe, he funnels all his courage into one great big front that he puts up. In Dromoland his Secretary had to announce the policy of his Department. Never in my life before had I heard of a Secretary of the Department announcing policy in relation to the Department of Health. I do not know if it was embarrassing for the Secretary of the Department, but it appeared to me and many others that the Minister was reneging on his responsibilities as a Minister. The author of that policy document was the Secretary of the Department. The document announced the prospective closure of the health boards, again a matter that the Minister should take up. I had the feeling then that maybe the job was becoming too much for him and he was beginning to run away from it and leave it to others to do. Certainly he has shown absolute contempt for the public representatives, for the health boards and for the members of the health boards. It is disgraceful that he can come into this House and behave with such effrontery.

I have covered most of the points that I had to cover. I said to Deputy Ormonde that I would repeat for the record that a decision was made at last Thursday's South Eastern Health Board meeting to raise the overdraft facilities for £7.5 million and that this request had been passed on to the Minister. The Minister denies any knowledge of this. The facts are there and can be checked out easily enough.

Please conclude, Deputy.

I have covered most of the points. The health of the country has deteriorated under this Minister who may claim to be Labour but who cannot claim to be socialist.

I admire the tenacity of the Minister and the way he can stand up and defend the policy he is pursuing. I have my doubts about the Minister being fully aware of the consequences of the policies he is pursuing. It appears that he is is not living in the world in which the rest of us live as far as the health services are concerned. We all know that there have been shortfalls in the services in the last number of years. If one goes back to 1981 and looks at the allocation provided and compares it with the allocation provided in 1986 it shows that in real terms the cutbacks in health have amounted to 25 per cent. We cannot sustain a cutback of 25 per cent in the health services and maintain that the health services today are better than they were in 1980.

I fully subscribe to the Minister's introduction to the report on the Health Services 1983-86 in which he says that the policies relating to community services place a major responsibility on the services provided in the community, that it is freely recognised that with this responsibility must go the funding to enable it to be born, that this is being done to an increasing extent and that what is expected is a return to the concept of caring and a cure in the community as far as possible. Nobody would dispute that, but what is the present policy? People are being pushed into the community from acute hospitals, and there are no community services to provide for the needs of the people that have been taken out of the acute hospitals.

As a member of the North Western Health Board I am fully aware of the difficulties being experienced by the board's management and employees because of the cutbacks that have taken place over the last number of years. The funding to the health boards must be reconsidered. The funding to the eight health boards is not equally reflected in each area. The funding arrangements pursued in relation to the North Western Health Board have militated against the North Western Health Board. The emphasis in cuts pertain in particular to the non paying section. We in the North Western Health Board have not the number of acute hospitals they would have in other areas and therefore the pay section must suffer. That has created a serious strain on the resources of the North Western Health Board. This has led to great difficulties in a board which followed the policies advocated by the Minister. We were ahead of most of the health boards in developing community services. Now we have to cut back on the community services, the service which the Minister claims should be developed. The Minister says that we must cut back on the general hospitals and the acute hospitals and we are expected to transfer that money to the community services. That is not happening. It cannot happen in the system of administration currently being pursued.

In the community services, field worker services are more developed in our area than in others. The cuts which took place last year in the central services was 10 per cent which affected the board of management which in turn affected the return and flow of information. The geriatric services had reduced bed numbers and staff numbers. The district hospitals had to be partly redesignated as geriatric units to allow a reduction in the geriatric hospital budget. We had to discontinue all transport to the clinics which had a major effect in the north western region, because we depend on transport to bring patients to Dublin. That service had to be scrapped because there was no money to provide that service. That is causing major hardship for many people in north Donegal, north Leitrim and north Sligo. In the general hospitals they had to reduce by over 100 whole time equivalent staff; one-third of the beds had to be closed for up to three months and whole departments had to be closed for three months resulting in longer waiting lists. The standard of medical and nursing care and hygiene was reduced and we had to suspend the GP training scheme. There were major cuts in the hospital staff in psychiatric hospitals — over 60 whole time equivalents. We had more patients and fewer ward units in order to cut nursing and staffing levels. We had reduced catering and maintenance staff, all special services within this section were suspended and there was no development of community services.

We all appreciate that there is a scarcity of money and that certain things have to be reduced but when we are dealing with health we wish to provide the best health service possible. Unless there is a change of policy within the Department of Health many people will suffer. Unfortunately, in the region which I represent there will be serious consequences for the people who depend on the health services. I would refer the Minister to the Dale Tussing Report which states that in the Republic there are 5.59 beds for every 1,000 persons, that only the North Western Health Board is significantly short and that the additional 59 beds in Letterkenny Hospital, assuming no reductions elsewhere in the north western area, will have raised the area's bed total to 786 leaving the percentage ratio at 3.78 per 1,000 of the population. The report goes on that the North Western Health Board have the largest proportion of population aged 65 years and over, which normally implies a higher demand on hospital resources and that therefore the north western region in spite of recent expansion is still underserved in hospital services. The North Western Health Board area has the largest population over 65 and also has a large population of young children. Unfortunately under the system which has been operated by the Department of Health over the last number of years, the north western region has suffered the most. Their overrun this year will be £1 million. We were not able to contain the budget within the cut handed down from the Department. I would ask the Minister to review the financing of the health boards. It is criminal to penalise people in the north western region in this way having regard to the fact that they have developed the community services and have operated to a fair degree within their budget. Unfortunately the only recompense they have from the Department is continual cuts, to the extent of 25 per cent since 1981.

Debate adjourned.
Top
Share