Vol. 369 No. 12
By agreement, I move:
That notwithstanding anything in Standing Orders, Members will be called in Private Members' Time this evening as follows: 7 p.m.-7.08 p.m., Fianna Fáil speaker; 7.08-7.12 p.m., Progressive Democrats speaker; 7.12-7.30 p.m., Government speaker; 7.30-7.40 p.m., Government speaker; 7.40-7.50 p.m., Fianna Fáil speaker; 7.50-8 p.m., Fianna Fáil speaker; 8.00-8.10 p.m., Fianna Fáil speaker; 8.10-8.15 p.m., Government speaker; 8.15-8.30 p.m., Fianna Fáil speaker.
On a point of order, I note that there is no provision in the list read out by the Minister of State for a speaker from The Workers' Party. I have an amendment down to the motion and it is normal practice to allow time for the proposer of the amendment. I would ask that the order which has been read out by the Minister be amended to allow time for me to contribute on my amendment. That is the normal practice. It is unfortunate that I have to stand up here on every occasion when orders are being made to request that this be done.
We are losing valuable time.
Are the arrangements agreed?
I have risen to say that I do not agree with the arrangement as it stands. I am asking either the Government Whip or the Fianna Fáil Whip to agree to give me time to move my amendment to the motion. This is the normal practice that has been adopted here and it should not be necessary for me to stand up and plead in this way for time to speak on my own amendment.
We lost five minutes due to this type of situation yesterday evening and I had hoped that it would not be repeated today. If Deputy De Rossa had come to me earlier I would certainly have tried to accommodate him. We have already lost five minutes and we have given two minutes of our time to Deputy Wyse.
I appreciate what the Deputy is saying but why should I as a Deputy of this House have to plead for time on every occasion when I have an amendment to a motion? If I wanted to be bloody minded about it I could call a Vote on this matter and far more time would be lost than the three or four minutes which might be allocated to me. One or both of the Whips should allocate some time to me tonight.
I am putting the question: "That the motion moved by the Minister of State, Deputy Fergus O'Brien, for the allocation of time for tonight's Private Members' Business be agreed to."
Vótáil.
Will those who are demanding a division please rise in their places?
Deputy De Rossa rose.
As fewer than ten Deputies have risen, in accordance with Standing Orders I declare the motion lost. The names of those demanding a division will be entered in the Journal of the Proceedings of the Dáil.
I now call on a Government speaker who has untl 7.30 p.m.
On a point of order, I wish to protest most strongly because we have lost 15 minutes of Private Members' Time——
I suggest that we do not waste any more time.
If Deputies wished to participate they could have made their intentions known much earlier.
On a point of order, anything I have done here tonight is within the rules of this House——
From now on it is out of order.
I do not intend to plead for time to speak to my amendments any more. If the Whips want to include me fine, but, if not, I will challenge——
I am calling the Minister of State, Deputy Pattison.
I was allotted four minutes——
But that has disappeared now, I am sorry.
Will I get my four minutes?
This afternoon I negotiated with the Whip of the——
I will concede three minutes of my time to Deputy Wyse.
The Minister of State is prepared to concede three minutes of his time to you, Deputy Wyse.
Will the Minister show the same indulgence to this side of the House because we have lost eight minutes?
Knowing the Minister, he would be very glad to do that.
Will the Minister——
I am calling Deputy Wyse.
Is the Minister giving some time to this side of the House?
The Opposition have the right of reply.
I am calling Deputy Wyse.
Deputies are being unreasonable. They are not behaving maturely.
In moving the amendment by my party, The Progressive Democrats, I wish firstly to share and support the concern of Fianna Fáil in relation to the absence of suitable and relevant health and social services in our society for the elderly and for the chronically sick.
The Deputy may speak on but may not move his amendment. The Deputy's amendment is amendment No. 2 and amendment No. 1 is before the House.
Our sympathy and concern are also with the families of many of these people because the burden and anxiety placed on them in trying to provide support and care 24 hours a day, without adequate help or support from the State, is a very difficult problem.
I would also like to take this opportunity to express my admiration for the various community health services provided by family doctors, public health nurses, and community welfare officers, but taking care of the sick requires manpower and little else. Surely in a society where up to 250,000 poeple are unemployed, no one can try to justify the present state of affairs.
The Government have failed in this most important area, not because of lack of money but because of a lack of ideas and lack of courage in confronting the inefficiency which is rife in our health care system. It is wrong to tackle ineffiency in the vague and ambivalent manner being conducted by this Government. The only real and effective path to efficiency is to recognise that the present system of delivery of health care is inherently inefficient. It is subject to erratic and directionless interference by Ministers for Health and by bureaucrats, resources are inefficiently used often to provide services no longer relevant to the needs of the community. Priorities change at a whim and what we have ended up with is very much a smash and grab approach to health care.
The present system of health care in this country is deficient in two key areas. Firstly, it is not selective. It does not give priority to the needy. No matter how often the present Minister says that the poor and needy should get priority, the fact is that they do not. The system is wrong and health care workers are often unjustly blamed. The health services are also inefficient because of poor and under-developed management structures. There is too much bureaucracy and too little decision making.
The Deputy's time is up. I am calling the Minister of State.
I am very glad to have an opportunity to speak in this debate and to refute the inaccurate statements which have been made regarding the current state of the health services. I would like to concentrate on two important areas of our health services where there have been significant achievements since this Government took office.
In Ireland we have built up a wide range of specialised services for our mentally handicapped people. The quality of our service is recognised internationally. There is no doubt that this is due, in no small part, to the magnificent contribution which the many non-statutory organisations have made. Their attitude of sharing and caring has ensured that the highest standards are afforded to our mentally handicapped people in keeping with their dignity and worth.
There are, at present, some 326 units or centres which provide 9,834 places for our mentally handicapped people. Some 5,800 of these are residential places, the remaining 3,000 are day care places. These figures exclude the 2,000 mentally handicapped people inappropriately placed in psychiatric hospitals. They also exclude the provision made by the Department of Education for the handicapped in schools and classes throughout the country. In 1986 over £100 million will be spent by the Department of Health on services for the mentally handicapped. This is about 100 per cent more than was spent in 1980.
I must say that I took grave exception to Deputy Briscoe's rather vindictive and untrue remarks made during the course of this debate in relation to the Minister's attitude to voluntary groups who look after the mentally handicapped.
The Minister for Health has, on numerous occasions, discussed the present state of the mental handicap services with representatives of the non-statutory organisations and impressed his commitment not only to maintain the existing level and high standard of our mental handicap services but to improve these. We, in Government, recognise that mentally handicapped people must have a particular priority within the health services.
Since becoming Minister for Health, the Minister has clearly demonstrated that this was no false promise. Since he came to office, projects have been completed at: Cheeverstown House; St. Michael's House, Belcamp; Swinford; Cootehill; St. Patrick's, Upton. Major improvement schemes have been completed in St. Mary's, Drumcar and funds have been given to facilitate the development of community-based services by the Brothers of Charity and the St. John of God Brothers. Expenditure on these projects amounted to £27.1 million.
In addition, between 1983 and 1985, almost £3 million was provided to enable minor improvement works to be carried out in mental handicap centres.
He has also initiated a scheme to enable a planned programme of maintenance works to be undertaken in centres for mentally handicapped people over a 3-year period. A sum of £600,000 was spent in 1985, £400,000 in 1986 and at least £400,000 for further improvements will be allocated in 1987. In addition, in 1986, the Minister has provided capital grants totalling £710,000 towards the development of community-based services.
One hundred and fifty new posts have been created in the programme which has enabled 14 new projects to be commissioned including developments at Cheeverstown House, St. Mary's, Drumcar, Pope John Paul II Centre, Galway, St. Michael's House, Dublin; Sunbeam House, Bray and Galway County Association.
Of course the Minister is conscious that much remains to be done to bridge the gaps and eliminate the weaknesses which exist in our mental handicap services. There is an urgent need, particularly in the current economic climate to evaluate existing information at our disposal and to draw up guidelines for the future development of all aspects of the mental handicap services. For this reason he has initiated a review of the mental handicap services. This task will be carried out by way of consultation with the persons and organisations involved in the provision of the service. Despite the onerous task, it is expected that the review will be completed quickly.
I would hope that from what I have said it will be perfectly clear that the Minister is determined to continue to give our services for the mentally handicapped the highest possible priority and to ensure that the present standards for the care of the mentally handicapped are maintained. He looks forward to continuing to work in partnership with the many non-statutory agencies in establishing comprehensive services throughout the country for a very special group of our people.
The Minister has also been accused of being uncaring in his approach to services provided for the mentally ill. Nothing could be further from the truth as is clearly evident in the developments which are taking place in the psychiatric services. The report Planning for the Future has pointed the way for the future organisation of our psychiatric services based on a comprehensive community-oriented service which will cater for the varying needs of people with mental illness. The components of such a service include prevention and early identification assessment, diagnostic and treatment services, in-patient care, day care, out-patient care, community-based residences together with rehabilitation and training. These facilities are being provided in the community so that they are close to where people live and work. They will provide an alternative to the largely institutional services now in existence which were planned at a time when more modern treatment methods were not available. The great advantages of this reorganised service will be that most patients will be able to continue to live in their own homes with the necessary psychiatric support being provided locally.
Each of the eight regional health boards have drawn up plans to implement the report Planning for the Future in respect of the psychiatric services in their respective functional areas. The Minister's Department is actively following up the implementation of these plans with the individual health boards and considerable progress has been made to date. The Minister has allocated considerable capital resources to enable the health boards to develop facilities in the community such as mental health centres, day facilities, supervised and unsupervised hostels, high support hostels, rehabilitation units etc. A considerable effort is being put into the reorganisation of the psychiatric services in this country which will result in significant improvements for people suffering from mental illness in so far as a comprehensive psychiatric service will be provided in a community setting without the need for admission to large psychiatric hospitals.
In my own area, the South Eastern Health Board have drawn up a comprehensive plan for the reorganisation of psychiatric services in the region based on the principles which I have already outlined. This plan provides for the organisation of the service on a sector basis which means that a comprehensive psychiatric service will be provided for a population of known size who are resident within a clearly defined district. This service will be provided by a multi-disciplinary psychiatric team with a consultant psychiatrist as its leader. The plan provides for the provision of acute psychiatric units at Kilkenny and Wexford and the upgrading of existing units in Ardkeen and Clonmel together with the development of mental health centres in Waterford, Wexford, Kilkenny, Carlow, Clonmel, Dungarvan and Enniscorthy. The services to be provided in these centres will include assessment, diagnostic and treatment clinics, nursing care, rehabilitation and activation facilities and will be the location of key sector headquarters and administrative facilities where necessary. In addition, centres for day care and clinics are being considered in association with community care facilities for smaller urban areas such as Thomastown, Clogheen, Kilmacthomas, Tipperary, New Ross, Mullinahone, Gorey, Bunclody, Carrick-on-Suir, Bagenalstown, Cashel, Castlecomer, Tullow, Lismore, Callan and Cappoquin.
In the context of the development of psychiatric services in the South Eastern Health Board area I would like to refer to the position of Carlow Psychiatric Hospital. A lot has been said about the present Carlow hospital this year, some of it mischievous.
In the plans drawn up by the South Eastern Health Board for the development of psychiatric services, it is proposed to transfer back to the Eastern Health Board the services in respect of County Kildare. These have traditionally been provided by Carlow. A new catchment area will be created which will have as its hospital base a new unit at Kilkenny General Hospital. When the Minister published the report on the psychiatric services —Planning for the Future— he said Government had accepted the recommendations. Subject to any changes as a result of discussion of the report he proposed to implement it. The report was very widely accepted and to give impetus to its implementation he chose two hospital areas in which the recommendations should be implemented without delay. He was criticised for that. No doubt he would have been criticised even more strongly if he had decided not to implement the report. He was in a no-win position. Despite a slow start, progress is now being made and I expect that that will become clear very soon. Here again, despite the pressure on resources, funds will be made available to enable the plans to be implemented.
I would like to congratulate the Minister and, indeed, the South Eastern Health Board for their enlightened approach to the care of people suffering from mental illness.
Since he was given the health portfolio, the Minister has given priority to the reorganisation and development of the psychiatric service. The development of this service along the lines which I have indicated is a further indication of the steady improvements which have taken place in the overall health services since this Government took up office.
That is a change from the Taoiseach attacking him last week.
I might refer also to the very high rate of activity on the payment of disabled persons' grants. I have a table before me indicating that in 1985 alone — and it should be remembered that these grants are devoted solely to people who are either physically or mentally disabled in some way — already there has been made available over £3,500,000, through the local authorities and recoupment from the Department on that scheme. That is another £3,500,000 of public money that has been spent. Full recoupment has been made on those grants. I notice that in Deputy O'Hanlon's county of Monaghan 12 projects only were carried out in 1985 whereas in a much smaller county, Carlow, in the same year 49 projects were carried out. It is a pity that the Opposition, when in office, did not devote the same attention to the improvement of facilities for psychiatric patients and for the mentally handicapped, the disabled and disadvantaged. I congratulate the Minister on the progress he has made in that respect.
As somebody who has taken a special interest in the history of the development of the State I believe the present Minister for Health will be seen, among all the Ministers for Health over the past 60 years, as the one who did more than anybody else to rationalise our health service, to put it on a sound footing and to make it relevant to present and future needs. When the history of this period is written the contribution of Deputy Barry Desmond as Minister for Health will be seen to have been constructive, at all times courageous and to have been far-sighted. He will be seen in retrospect as one of our most significant Ministers for Health. I join with the Minister this evening in reminding the House of the very spectacular growth in spending on health services over the past ten years or so. In 1973-74 net spending on health was about £143 million, representing just over 5 per cent of gross national product.
There were more people employed then.
The approved gross expenditure level available for 1986 will be of the order of £1.3 billion or an estimated 7.1 per cent of GNP. This figure represents almost 20 per cent of total Government spending on current services. During the period 1982-86 total Government spending on health has increased by 30 per cent and has kept pace with the increase in the consumer price index during the same period.
What about the employment figures for the same period?
This level of funding by the Government has ensured that essential services have been maintained and that much needed developments have been implemented despite the serious financial difficulties which the country face. I will illustrate these gains by concentrating on Dublin where some very significant developments have taken place during the Government's term of office. For example, the national liver transplant centre has been opened at St. Vincent's Hospital; there has been a 100 per cent increase in the level of cardiac surgery in the Master Hospital; there has been a major expansion in orthopaedic services at St. Mary's Hospital, Cappagh and there have been developments in geriatric services at the new St. James's Hospital and at the Royal Hospital.
Sir Patrick Dun's Hospital was closed down.
On the community care side we have seen a most successful measles vaccination campaign which achieved a 90 per cent coverage of the children targeted. In regard to services for the handicapped, an area which was much maligned and much overlooked by Governments in the past, we have seen the commissioning of the St. Michael's House adult special care unit at Belcamp in my own constitutency. We have seen the commencement of the building of new residential accommodation for the deaf at St. Joseph's and St. Mary's schools for the deaf in Cabra. These latter developments are particularly welcome because they have been left so long on the long finger by so many administrations.
In addition to the increase in current spending there has also been a considerable increase in the capital resources devoted to the health services during the period of the plan, despite the very obvious financial constraints. Between 1982 and 1986 capital expenditure increased from £49 million to over £58 million and considerable progress has been made during that time in the development of our general hospitals.
Try to convince the people in the south-east of that.
Since 1983, among a large number of capital schemes, we have seen major developments at St. James's Hospital and the Mater Hospital and a number of the Dublin voluntary hospitals have also featured prominently in this list of developments. I agree with the Minister in focusing the debate on future resources and future developments. Nobody on any side of this House can honestly claim or expect that in the present financial climate the growth in spending, which has been a feature of our health services in the past, can continue. In fact, it should be obvious to everybody that we will have difficulty even in maintaining the existing level of funding in the short term. It is imperative, therefore, that a rationalisation of the use of the very significant amount of resources, in financial and personnel terms, be achieved to eliminate unnecessary and wasteful expenditure if we are to ensure that essential services are maintained and developed. The only way forward for our health service in the immediate future is to create a rational, cost efficient and integrated service which will be able to respond to the reasonable health needs of the community within the existing level of financial provision. This sound approach, indeed the only approach, has been adopted with evident success in the greater Dublin area with the support of the Government. It must, and I know it will, be continued by the Minister despite the opposition which will be generated for sectional or political reasons.
I am very pleased in the short time I have this evening to welcome the report, Planning for the Future, which points the way for the future organisation of our psychiatric services based upon a comprehensive community-oriented service which will cater for the varying needs of people with mental illness.
To be implemented over ten years.
The great advantage of this reorganised service will be that most patients will be able to continue to live in their own homes with the necessary psychiatric support being provided locally. I am delighted to see that a start has been made in the Eastern Health Board area and I wish them continued success with this development.
I will conclude by returning briefly to the general hospital programme which accounts for over 50 per cent of non-capital spending. Nobody on any side of the House can claim that this service is now being provided in the most effective or efficient way possible. Part of the blame for this is due to the proliferation of small hospitals which, because of their age, their condition and their location, are not in a position to meet the needs of the total population who need modern acute hospital facilities. It has been recognised by all the major political parties in this House that a haphazard development of our hospital system can no longer continue and that an overall planning framework should be devised to ensure the delivery of an efficient and an effective service at the most modern standards available.
It is further agreed that this plan would result in the closing down of many of our existing old, cost inefficient hospitals and that a lesser number of larger sized, well equipped new hospitals located in the major population centres is preferable. It would be more efficient and it would respond better to the needs of all the population than was the case in the past. It is clear that much of the Minister's efforts in the acute hospital area have been concentrated on implementing this overall rationalisation strategy. In Dublin this plan provides at present for the development of six major acute hospitals, St. Vincent's Hospital, St. James's Hospital, and the hospital in Tallaght to serve the south side and Beaumont Hospital, the Mater Hospital and the James Connolly Memorial Hospital to serve the north side. The plan for the north side is well on the way to completion. At present the State is investing considerable resources in this programme. This network of major acute hospitals will be more than adequate to meet the needs of the total population in Dublin, both in the inner city and the suburban areas.
As was mentioned by Deputy Ormonde, there have been closures, as was planned, of Mercers Hospital, St. Patrick's infant Hospital and Sir Patrick Dun's but without reducing the level of services. The other closures which are planned will be implemented in the way outlined.
The Deputy should check on the ENT facilities in St. James's Hospital.
The Deputy should be allowed to proceed.
The Richmond Hospital, St. Laurence's Hospital and Jervis Street Hospital should be closed by 1987. This last move will put into place once and for all the new hospital at Beaumont. We all want to see this happen as soon as possible. The Minister has not spared himself in his efforts to achieve this. This major transfer of resources will provide fitting evidence of the Minister's sound plan to rationalise our hospital services and to provide and fund an improved service. In conclusion, the Minister is to be commended for continuing to provide a comprehensive health service despite the overall necessary limitations on cash. As I said at the beginning, he will be seen in history as one of the most significant Ministers for Health over the past 60 years.
This motion is most timely. It 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 or urgency to ensure that the necessary level of services is provided.
Health boards are finding it virtually impossible to cope with the health cuts due entirely to lack of funding by the Minister for Health which results directly in a most serious cutback in the following services, to mention just a few instances:
1. Medical cards can no longer be granted on the grounds of hardship alone; 2. There is an early discharge of patients out of hospitals into the community, without any resources by way of cash or otherwise to improve the community services; 3. The dental and ophthalmic services are totally under-financed, particularly the orthodontic service; 4. No effort is being made to enable health boards to operate a decent scheme of refunds of cost of transport to medical card holders.
It is now a well known fact, whether the Minister knows it or not, that it is virtually impossible for a person to get a medical card on hardship grounds. There was a time when this was possible. Has the Minister issued instructions or guidelines to the health boards on this matter?
There was a time when medical cards were granted on hardship grounds to persons in a bad financial position and marginally outside the eligibility guide scale as laid down by the Minister for guidance to health boards. Now all this has changed and I know from my own personal experience in making representations to the health board for such persons that this is so.
For example, it is now virtually impossible for a married man with two children, with a take-home pay of £99.50 per week and paying £7.50 per week rent for his house, to get a medical card. This is a disgrace in this day and age and shows clearly what the full impact of the Minister's health cuts are like on the ground. It is now time that the Minister should tell the health boards to take net income into account instead of gross income for employees seeking medical cards.
Net profit only is taken into account in respect of farmers and profit, after deductions, is taken into account from other categories who must produce a certificate of assessment from the Revenue Commissioners in support of their application. Why then is gross income taken into account for an employee like my example of the married man with two children in receipt of £99.50 net, per week who had his application rejected?
There is confusion among the public regarding the discrepancy in means testing applicants for services as between the health boards and the Department of Social Welfare when the latter consider applications for unemployment assistance. This should not be the case. The system of means testing small farmers in particular should be uniform right across the board. For example, why cannot a recipient of a non-contributory old age pension automatically qualify for a medical card? I am saying that because of the health cuts there are many ill persons in this country who are doing without medical treatment because they cannot afford it and the health boards have not got the finance to provide it for them.
I also ask the Minister to allow health boards to grant medical cards to unemployed persons between 16 and 25 years of age, in cases where the parents have not got a card. This would be a welcome step if the Minister would permit it. I would like to inform the House that there are so many prescribed items off the medical card list now that a card is not worth anything like what it was. This results in some cases in doctors being forced to prescribe more expensive brands of medication.
Due to lack of funding the health boards cannot develop the community services, particularly at a time when there is pressure on health boards to provide a faster bed turnover in their hospitals. This means that patients are being discharged from hospitals if they no longer require supervised medical and nursing treatment in the hospital. They are discharged into the community where there is an inadequate and a completely underdeveloped community service. The few public health nurses and social workers on the ground who work long and hard hours cannot possibly cope with the transfer of hospital and institutional care to the community.
If the Minister for Health is serious and if he has care and compassion for the less well off sections of our community, he will make up the huge financial deficit in the Southern Health Board and allow the community services to be properly staffed and developed before people who are still very ill are discharged from hospital.
I would also like to see relatives who live near elderly people who are ill and who reside in remote rural areas to be eligible for payment of care allowances. As the Minister may be aware, relatives, particularly those living nearby, are debarred from payment of care allowances. An unanswerable case can be made for the payment of such allowances in these circumstances as I have mentioned.
The dental and ophthalmic services are certainly underfinanced. This is a clear example of where the weak and less well off sections of our community are suffering as a result of the health cuts.
In County Kerry there is an 18 month waiting period to get an examination for spectacles. That is disgraceful. There is now a five to six year waiting period for children for orthodontic treatment. I believe this is equally shameful. It is very worrying for parents, and indeed for the children themselves, to know that when an application is made for orthodontic treatment for developing young persons aged ten or 11 years they must wait five or six years before the necessary treatment can be afforded, and both children and parents know that by then permanent damage will be done. On the other hand, those who can afford it can have the treatment carried out within a matter of a few months for about £1,000. This to my mind is the unfairest cut of all to the young people of this country.
Due to the failure of the Government to adequately finance the Southern Health Board, there is a lack of funds to refund to medical card holders the cost of transport to and from hospitals and clinics. Medical card holders, who are not ambulance cases, always had this type of transport organised by the local community welfare officer but such is no longer the case. The old, the sick and the handicapped must now provide and pay for their conveyance to hospitals and clinics, apply to the health board for a refund and, after exhaustive investigations into family circumstances over a period of months, a refund ranging from 40 to 60 per cent of the cost is then made by the health board. Is it any wonder then that the less well off, the weakest section of our community, miss out on vital visits to clinics and hospitals and thereby put their health at a greater risk, in the very same way as a certain category of persons to whom I have already referred are forced to put their health at risk, because they cannot afford to pay for the necessary medication as prescribed by their family doctors?
I wish to take this opportunity to publicly ask the Minister for Health to help the Southern Health Board to set up a unit to cater for mentally handicapped adults in County Kerry by sending down a letter of approval to the health board's application for the revenue costs of operating such a unit which is so urgently required. The proceeds of the sale of the Old County Hospital in Tralee to Kerry County Council will provide the capital costs of this project which is to be built near Killarney.
This proposed unit will cater for the adult mentally handicapped who are now being catered for in St. Mary's of the Angels, Beaufort, and are occupying accommodation which should be available to handicapped persons under 16 or 17 years of age. There is, therefore, no centre now in County Kerry to which this handicapped section of our community can be admitted.
To state the case briefly, St. Mary's of the Angels is full. There is no further accommodation for adult mentally handicapped in Kerry other than St. Finian's Psychiatric Hospital which is completely unsuitable for the purpose, and consequently, also, there is no further accommodation for the young mentally handicapped.
I am asking the Minister to help the handicapped, the parents and the voluntary organisations concerned, by approving of this application from the Southern Health Board for the revenue costs of operating the proposed new unit near Killarney. This is a fair and reasonable application and I am calling on the Minister to issue the necessary approval as a matter of extreme urgency.
In conclusion I am asking the Minister for Health to provide the necessary funds through the Southern Health Board to enable them to adequately finance the services I have referred to here tonight and to help the old, the sick and the handicapped. If he cannot do so he should step down.
Week after week we have had to put down Private Members' motions in an attempt to deflect this Government from pursuing the cruel objectives they are trying to achieve. We have had cutbacks in every area, in social welfare, health and education. When the Government are not cutting back on what people are entitled to they are closing down factory after factory, and I have no doubt that they will go down as the Government who have specialised in liquidations and closures.
Fortunately, as a result of the enormous pressure which we have put on the Government from this side of the House in attempting to steer them in the right direction, they have made some attempt to rescue themselves from the cruel problems they have got themselves into. In relation to social welfare where there were problems with equality and where there was a major public outcry because thousands of families were going to have reduced payments, this evening the Government announced they would review the situation because of the difficulties in the light of the 1987 Estimates. While we achieved this change, the pressure we have exerted on the Government has made them look at what they are doing and realise they are doing it very badly.
However, the announcement which they made this evening in relation to social welfare is only a half-hearted attempt to limit some of the hardships they have caused to 20,000 families. It will not in any way compensate the 20,000 for the huge reductions they will suffer particularly before the Christmas period. This Government are now specialising in U-turns, twisting and turning like political gymnasts and they do not know whether they are going forwards or backwards. In their document Building on Reality 1985-1987 the Coalition stated that the main thrust of health policy would be, “a shift towards prevention of disease, and an emphasis on community care ensuring that scarce resources are directed more specifically towards those in greatest need.” That document stated further that, “The provision of an effective home nursing service, especially in regard to care for the aged, will be a priority...”. This apparent concern of the Coalition for the health of the aged was voiced again by the Minister for Health on 16 May 1985 when he stated, “Generally speaking the elderly are less well off than the rest of the population and the care of the elderly is an important issue facing the health and social services.”.
This rhetoric is mere humbug, as the Government's health cutbacks have ensured that many elderly people are plunged further into poverty and deprivation. At a time when the number of elderly people is increasing the Minister should increase the quota of public health nurses. At present the public health nursing service is stretched to breaking point. It is a vital service in the care of the aged with almost 70 per cent of all patients over 65 years of age visited by the nurses. Yet, the Minister has cut back on the travelling expenses of public health nurses to ensure they cannot visit all the people as often as they should be visited and need to be visited. It will become even more important in relation to the care of the aged over the next few years because by 1991 there will be an increase of some 10 per cent of people over 65 years from the present level of 369,000 old people. It is ludicrous when the Minister is refusing not alone to increase the number of public health nurses but to replace those who resign or are on leave. It is totally contrary to the commitment in the national plan to a health system based on community care.
The Coalítion have failed to provide the resources necessary to develop more day hospitals which are a vital prerequisite if a more comprehensive medical service for the elderly is to become a reality. At the end of 1984 the Minister, while acknowledging that job losses would occur in the health services as part of the national plan, stated that all essential services would be maintained. How wrong that commitment and that promise have turned out to be. This pledge turned out to be meaningless. Financial cutbacks are damaging health care and have led to a total dismantling of the health services. As far as the Minister's aim of furthering community care is concerned, the cutbacks have proved a disastrous step backwards. They have threatened the basic services on which community care must be built up. Instead of an expansion of these basic services they are contracting, as is evident from the cutbacks in nursing homes, day hospitals, welfare homes, meals on wheels, home help for the disabled and sheltered accommodation for the disabled. Community services and patient care clearly are being affected adversely by the policy pursued by the Minister and his colleagues in Government.
Clearly, the Government have failed to heed the advice of the National Planning Board who, when recommending an annual reduction of 4 per cent in real terms in health spending between 1985 and 1987 pointed out that these savings could not and should not be made and that certainly there should be no sacrifice in the standard of services. However, the board warned of the danger unless the recommendations were implemented so that the costs were borne primarily by patients and the public in general rather than through increased cost efficiency in the health system. The Minister has failed to heed this warning.
This helter-skelter approach to closing down hospitals before devising a community care framework in their place reflects a thoughtless and dangerous attitude to the provision of health care. The Minister has consistently ignored the advice of health care professionals who have warned repeatedly that the health boards cannot effectively operate community-based care services until such time as the machinery for such services is in place. The folly of deinstitutionalising care before the necessary facilities are in place is clear from the example of the UK where many patients have suffered tragically in a society which was unprepared to receive them. Under the Minister the level of community care services, is going down while the burden on such services has increased as the number of dependants has grown, especially in the new suburban areas.
Patient care has suffered enormously under the present Government. Cases of seriously ill patients being accommodated in corridors have been documented, as have cases of elderly patients being discharged too early to the care of overstretched community health nurses and day care workers. The Minister said on 24 September last, "The transition to community care could not be made if we skimped on resources." It is sad the Minister refused to take his own advice. It is clear from the GMS reports during 1985 that there has been an alarming increase in the level of illness which is attributed to unemployment.
The Minister has also washed his hands of the homeless young. Since the closure in the spring of this year of the HOPE hostel there has been an alarming increase in the number of young homeless people in Dublin. Yet, the Minister closes his eyes and will not furnish the EHB with the modest resources required to establish a shelter for homeless young people and to contribute towards their reintegration into society.
As regards the future direction of health policy under the present Minister, it seems unlikely that trends will be reversed during the lifetime of this Government. The Minister indicated last week that further cutbacks in next year's health budget were on the way. It was stated also that while money was needed in order to implement the proposed policy of moving people out of institutions and back to their communities it was unlikely that this money would be provided. Therefore, it is clear that the Government have reneged on the central priority of their health policy, just as they have failed to fulfil their pledges on job creation, the public finances and the boosting of investment in the economy.
I have no doubt that history will record that the present Government and the present Minister for Health have an unparalleled record in relation to failures. The health services which we were justly proud of are being dismantled and torn apart. Hospital wards are being closed down and unfortunate patients are being subjected to inferior treatment. These are not just my views but the views expressed by responsible medical organisations. They have also been endorsed by the insurance companies who insure doctors against claims for negligence and who have warned doctors they should not be seen to support or condone any attempt to diminish the quality of our health services. Unfortunately, the quality of our health services has deteriorated enormously in the reign of this Government and this Minister. Imagine now that medical card holders are supposed to be able to travel from their own homes to pick-up points if they need transport to a far away hospital. How in the name of God can an old woman who has not even a bicycle travel six miles to the nearest pick-up point for transport to a hospital? It is disgraceful.
This Government advocated to health boards during the past year that moneys allocated from the European Social Fund should be misappropriated: they suggested they should be used to defray the overrun in the costs because they were not provided with money. This is a disgrace because those moneys from that European Social Fund should be used to provide workshops for those who are handicapped. This Minister, in his usual cavalier fashion, has pursued his unworthy objectives. He even seems to take pleasure in closing institutions. He has condemned patients to inferior patient care. He has closed down hospital wards. He has rendered the community health care services more inefficient. He has specialised in confrontation with medical and paramedical organisations. He has failed to take the expert advice of those organisations committed to providing the best possible health care service. Yet, without thought and without any show of concern he proceeded coldly and callously in the interests of fiscal rectitude to punish those who are ill. The sick and the old will never forget the reign of this Minister.
The Minister, Deputy Barry Desmond, is four years in the Department of Health and in those four years he has done more to undermine the health services and to cause anxiety and distress to poor unfortunate patients than any other Minister in the history of the State. The Minister is the most hated and despised Minister in the eyes of the public. Everywhere I go I see patients in distress and old people waiting in queues for attention and they say "God forgive that heartless Minister, Barry Desmond". By the time the Minister relinquishes this Ministry he will have earned the dubious honour of having added a word to the English language — to desmondise, meaning to destroy, to dismantle or to wreck. What a mark to leave. The Minister's attitude is a callous uncaring attitude. He sees the problem purely as a bookkeeping problem and considers that services should be extensively pruned regardless of the misery and hardship that might bring. We are lucky that the Minister's tenure of office will shortly come to an end and that at long last the public can look forward to a more humane approach to the health services.
It is regrettable that the Minister lost a unique opportunity to make his mark on the Department. The Minister lost the opportunity to show that he was a concerned, caring Minister prepared to fight his corner in the interests of those in need. One might compare his abysmal record with that of another Minister for Health, Dr. Noel Browne, a totally inexperienced administrator who took over that Department as Minister in his first day in the Dáil. With a sense of dedication and concern and a humane approach, in the short space of three years Dr. Browne built or renewed 7,000 hospital beds throughout Ireland and revolutionised the quality of health care here. The Minister could not understand such concern. What would he know about illness, hardship, pain or suffering? The Minister had the audacity last night to castigate one of our members and say that a consultant radiologist from the South Eastern Health board had no right to speak about the economics of the health board services. The Minister can only see a health board or hospital demand as a deficit bookkeeping entry that upsets the balance sheet and which must be rectified irrespective of the hardship likely to be caused. He had an opportunity to apply political muscle at the Cabinet table but he might have offended his Fine Gael colleagues and the Fine Gael transfers were more important to a Labour Deputy in Dún Laoghaire than winning more money for patients' needs. I read what the Minister said last night and I have never read such nonsense in my life. Rather then explain his case he castigated this party.
I will not waste the time of the House enumerating the deficits in each health board. There was an overall deficit of up to £20 million in all the health boards up to October 5 last. The GMS is expected to be £4 million in the red and the voluntary hospitals face overruns by as much as £6 million. That amounts to a deficit of £30 million no matter what the Minister may say. The Minister has not explained how the hospitals and health boards can carry out the new high-tech life saving operations impinging on the other less glamorous essential care services.
The Deputy has five minutes to conclude.
Regardless of whether the Minister acknowledges this fact these services have suffered and the Minister has not attempted to seek the funds to rectify the situation. It takes four or five months to get an appointment at a hospital's out-patients service. If a man is in acute pain he will have to wait four to five months to be seen by an orthopaedic surgeon. I challenge the Minister to say otherwise. I have medical cases that require urgent attention and who cannot be seen in an out-patients' department until January or February. Old people in need of hospital care and in need of nursing care have no hope of receiving care in any of the health board hospitals in the Eastern Health Board area. The doctors are frustrated because the beds are not there and there are no homes available for the elderly who cannot manage for themselves and who require urgent attention. Many old people who have broken their hips have been put into an orthopaedic hospital as an interim measure and then have been discharged but there is nowhere else for them to go because the Minister has done irreparable harm to the health services. I am asking the Minister, just as he asked any Deputy in the House to come around with him to see the situation, to come on a tour with me around the hospitals and the home care services. If I am proved wrong I will publicly apologise in this House and through the press.
There is no point in the Minister saying that everything is all right, that he gave funds to St. Vincent's Hospital last week. The Minister refused to disclose the amount given. St. Vincent's Hospital got funds because they were in dire need. The Mater Hospital was put in an embarrassing position because a cheque for £500,000 was refused by the bank when the Department of Health refused to supply the money. It never before happened in the history of the State that a hospital the size of the Mater should have its cheque for staff wages, social welfare and PAYE dishonoured by the bank. All the talk of the Minister will not refute this fact. It only happened under this Minister. The sooner he is removed from office the better so far at the interests of the country are concerned. There are many things which the Minister could have done for the hospital services without money, but he antagonised the medical profession and indeed the whole hospital services. Everywhere he went he created carnage; he cannot touch anything without destroying it. The Minister talks about community care and then closes down the hospitals without making community care available. He has done more harm to this country than any other Minister. When I wrote to the Minister detailing a very serious case of a man with irreparable brain damage he did not even afford me the courtesy of a reply until I said three months later, that I would expose him in the Dáil. Then I got a reply from the Department saying they would look into the case.
The Deputy's time is up.
I am sorry I am speaking about a colleague of the Leas-Cheann Comhairle but I hope that he is equally ashamed of the Minister.
The Minister for Health appears to have raised the hackles of the major Opposition party but men of courage tackling difficult Departments run that risk. On behalf of the Minister I should like to dispel any fears about the funding of our health service. We have the youngest population in Europe and in 1973-74 the expenditure on health was of the order of £143 million or about 5.2 per cent gross national product. The approved level of expenditure in 1986 is of the order of £130 million, the vast majority of which is paid by the taxpayer. That represents 7.1 per cent of GNP which puts us practically at the top of the European league. For many months we have been bombarded with statements that a cash crisis is looming in the health service, if it is not already here. One forecast indicated that one health board would run out of money in October. This has not happened. Opposition Members also said that certain agencies would not be in a position to pay people in December but this has not happened——
It is not yet December.
It will not be allowed to happen in December. In relation to the claim by Deputy O'Leary regarding orthodontists, we had the same difficulty in the west. We got approval from the Minister on several occasions to advertise for the appointment of an orthondontist but we could not get one. In many cases the fault does not lie with the Minister and in certain urgent cases private practice was used to deal with certain queries. The doomsday forecasts are ill informed and the crisis cited by the Opposition does not exist.
The Minister must be living on another planet.
Health expenditure is funded by cash and approved overdraft, periodically requested, as Deputies are aware. In the current year, by means of a more efficient cash management system, the Department have monitored the funding requirements of health boards on a daily basis. By proper management of the system, health board overdraft levels, which were at a peak on 31 December 1985, were brought down to sustainable levels in January of this year and maintained at that level since. As late as last Thursday, health boards were working at less than half the current approved levels of overdraft. These are very modest levels which are rarely reached.
I share Deputy McCarthy's concern about the HOPE hostel in Dublin. I also worry about young people. They are my particular responsibility in the Department of Education. The Minister for Health appointed a task force with a month's time limit a fortnight ago because delays were experienced in this area by the Eastern Health Board. Money has been assured in respect of the setting up of a hostel and it is hoped to establish it within a month.
Every night without shelter means a lot to a homeless child.
I understand that and it was because of delays experienced by the health board that a task force were set up with a specific time limit on it. The Department will continue to monitor funding on a daily basis and they know what is needed between now and the end of the year. They have a package in place which will meet the demand. The position in relation to voluntary hospitals and other agencies has also been covered. Where, therefore, is the Armageddon put forward by members of the Opposition in relation to the health service? I know they have tried to portray Minister Desmond as the hate figure of the Government.
The Minister referred many times to the need for a shift in emphasis in demands and expectations of the health service. The essential thrust of the service in the immediate future will be directed towards measures to promote health and to prevent illness, the provision of suitable services on a community or outpatient basis to bring about a redistribution away from institutional services and the closure of outmoded institutional facilities in tandem with the commissioning of large, cost effective flagship hospitals which will be in a position to respond to the acute hospital needs of the population. I refer to places like Mullingar, Longford and Castlebar.
The maintenance of a range of care and welfare services is required with particular reference to children at risk, the needs of disabled and other disadvantaged persons and the increasing of the efficiency and effectiveness of all services. Sufficient resources are available and will be used to meet whatever demands the health service have. Therefore, I have no hesitation in commending the motion to the House.
I understood that I was to be allowed three minutes from 8.15 p.m. to 8.18 p.m.
You must have been misinformed, that is not the case according to the list in front of me. I am sorry.
After the vote earlier, the Whip of the Fianna Fáil Party told me that I had three minutes in which to speak, from 8.15 p.m. to 8.18 p.m.
I am calling Deputy Browne.
The essential health services for the poor, the old, the sick and the handicapped are no longer available because of the wholesale cutbacks in allocations to the health boards. Over the past four years the Government made a callous, vicious and cowardly attack on the less well off sections of society. The health service is in a shambles and the South Eastern Health Board are in such a serious financial position that they are seeking overdraft facilities for £7.5 million from the Minister. If they do not get this approval many services in their area will have to close.
There is an 18 months to two years wait for dental treatment in the area and those on medical cards or who are unemployed are forced to take their children to private dentists at a cost per visit of £13 which they cannot afford. The children of the poor, the unemployed and the underprivileged are neglected by the Government. Medical cards are being withdrawn from people despite the fact that they may be only slightly over the income limit. The PAYE sector, the backbone of the economy, are being victimised. The amount of take home pay and not gross pay should be taken for medical card purposes. There is a two to three year wait for hip operations. The facilities are inadequate.
Asthma sufferers are the forgotten people. No one seems to care about them. In my four years in the House Deputy O'Hanlon is the only person I heard referring to them. Asthma sufferers should be automatically entitled to have, under the medical services, whatever medication they need. In many families two or three people are suffering from asthma and, as a result of the high cost of drugs, find it very difficult to make ends meet. It is the greatest scandal of all time that such families are not entitled to free treatment. Asthma is a long term illness and should be included in this context. The Minister stated recently that it would cost £10 million to include such sufferers in the long term scheme. However, I contend that his figures are not accurate as he is not taking the refund scheme into account. It would cost a very small amount to include asthma sufferers in the drug card scheme.
The case has been well made for the motion on this side of the House but the Minister failed to deal with any of the serious issues raised. The two Ministers of State and Deputy Manning also failed to deal with any of them tonight.
Deputy Kenny said — and I am sure he is correct — that only half the current level of overdraft is being used at present by health boards but he did not say that the health boards doubled their overdraft facilities in the past year. Indeed, when Deputy Ormonde referred to that last night he was abused by the Minister. Deputy Ormonde told us that the South Eastern Health Board now needed facilities of £7.5 million where formerly a sum of £3 million was sufficient.
The fundamental issue is the funding of the health services at present and the huge deficit which the Government have allowed to arise — £30 million. I challenge the Minister to state that there is not a crisis looming in that health board. Will he also say if there are any difficult negotiations taking place with the banks at present if the banks have been to the Government in recent times and if some banks have written to the health boards to say they are no longer interested in being treasurers of their accounts? I should like the Minister to come clean in this House and tell us if that is so.
I should like to know the cost of the increased overdraft facilities and what they are going to cost each year. It is easy for the Minister to talk about how he monitors cashflow on a Monday but how does he monitor what is happening to the people about whom we are concerned? He told me last night when I informed him about the case of a man who has a potentially serious illness and who has lost his job that he would set up an inquiry. He uses a big stick if we raise any of these cases. Not alone will he have an inquiry in his Department but he will have inquiries in the Departments of Labour and the Public Service. The Minister knows, I know and every Member of this House knows what will be the result of that inquiry. It will be that due to the cutbacks that man has had to wait 13 weeks more than was necessary for his outpatient appointment. That is not an isolated case, as the Minister would have us believe. I will quote to him tonight another letter dated 28 May 1986 which says:
As your name has been on the waiting list to see the County Surgeon since September 1985, please let me know if you still need this appointment or if you wish to cancel it.
That is what is happening as a result of the cutbacks. Neither the Minister nor any of the Deputies who spoke from the Government side dealt with that matter. Each of them in turn told us there was an increase of 29 per cent in the current allocation over the past three years. The Minister in reply to a question in this House on 12 November stated that there is no evidence of any disimprovement in services during the period in question but he gave me information on 15 February last year that there has been a real decrease in the allocation to health boards. This was confirmed in the most recent report by the NESC which stated that in 1985 the real level of spending was below the 1982 level. It is quite clear there has been a decrease in real terms in the amount of money allocated to the health services. It is a "whitewash" to tell us there has been a massive increase in spending on services. Despite the fact that there has been an increase in the population and an increase in demand for services, there has been a decrease in real terms mainly because of the Government's economic policies.
There have been ward closures. The Taoiseach in this House said there was no need for ward closures. I should like once again to ask the Minister whether he or his officials went to the health boards to tell them they had to close wards? Staff who have gone on holidays or sick leave have not been replaced. Nurses in the community are doing double duty despite the early discharge of patients from hospital. The Government give only lip service to the development of community care services. Both the Taoiseach and the Minister have complained in this House about travelling expenses. They must realise that if we are going to have proper development of community care services there will be increased travel expenses as there will be more nurses and personnel working in the community.
No one on the Government side of the House referred to the dental services. I should like to quote a letter I received dated 4 November which states as follows:
I wish to refer further to your representations on behalf of ...... who is awaiting dental treatment. The situation at the moment is that there is no dental treatment for adults or secondary school children due to the suspension of the ad hoc dental scheme.
That is an indictment of the Government and of the Members who sit behind the Government who have accepted that situation. The Minister did not explain the logic of people having their x-rays and blood tests carried out in the city centre and then having to travel out to Beaumont Hospital to be seen by a physician or a surgeon. Where is the logic in that decision? If the Government open a small unit in Beaumont for the purpose of appointing a new hospital board composed of the Minister's friends and election workers, Fianna Fáil in Government will disestablish such a board. Beaumont is a major general hospital and the board must be composed of properly qualified people.
I agree with the Minister of State when he says we have built up over the years an excellent service for the mentally handicapped. No one on that side of the House dealt with the serious issue I raised last night which is that young mentally handicapped adults are being sent home day after day to parents who are unable to cope with them because of age and infirmity. I am aware of a case where a girl had to give up her job as a manageress in a firm in this city to go home to look after her mentally handicapped adult sister because her parents were unable to cope. That is only one case and I could quote many others. The only thing I learned from the Minister last night was that he did not like our posters. The reason he does not like them is because they tell the truth. There is a better way than the way the Minister is behaving.
Deputy Briscoe last night raised the major policy statement which was made at Dromoland Castle, on the abolition of health boards and the centralisation of services but the Minister did not deal with these matters. I understand we are going to have one health board from Carlingford Lough to Carnsore Point, that the Department are going to have a more pivotal role. What is going to happen to the traditional input of the local statutory bodies and the voluntary bodies in the decision-making process? Is it Government policy to centralise administration? Is it Labour policy? Is it Fine Gael policy to devolve administration for local authorities and for education? All this is an indication of the confusion which exists between the parties in this Government. The Minister when talking about the health boards last night said he questioned the extent to which our health board system seems to have the capacity to throw up data as if it were the truth and subsequently tries to embellish that into the absolute truth. It is a disgrace for the Minister for Health, as it was a disgrace for the Taoiseach, to come into this House and cast a slur on officials of the health boards. The politics of confrontation which have been the hallmark of this Minister since he came to office is a disgrace. Health board members, the CEOs, and all those working in the service have made great efforts to deal with the difficult situation created by the Government over the past four years. What thanks did they get? All they got was abuse from the Taoiseach when he talked in this House about the hyped-up politics of the Western Health Board and the South-Eastern Health Board. He went on to say that the CEO of the Southern Health Board had produced fictitious figures and knew they were fictitious. What way is that for a Government to treat their officials around the country?
The morale of the personnel of the health boards is at its lowest ebb at every level of the service. With Fianna Fáil in Government consultation and not confrontation will be the order of the day. Fianna Fáil have a caring social policy. We are committed to the promotion of good health, the prevention of illness, the development of community services, more opportunities for the elderly to be cared and treated in their own communities, the provision of an adequate dental and optician service and the implementation of the recommendations in the document on psychiatry Planning for the Future. It was very interesting to listen to the Minister of State, Deputy Pattison, talking about that document tonight but the Minister on 30 January announced in this House that he was going to close the hospitals in Carlow and Castlerea. The first time the people involved heard this was on their radio at home. The Minister started on the last page of the document and he discredited what is an excellent document. That document states that there should be a phased programme of development over ten to 15 years. That is how Fianna Fáil will approach that document and not as the Minister did by first announcing in the House that he was going to close the hospitals.
We will carry out a review of the various drug schemes, the long-term illness scheme, the refund of drugs scheme and we will look for improved out-patients facilities. Much of this could have been done over the past few years without any major increase in expenditure. It would have been done if the Minister had 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 and we are concerned with the high level of taxation in the State but the people who are paying taxes are not complaining about providing essential services for the less well-off.
In Government we will discharge what is the responsibility of any civilised Government, to ensure that the necessary level of health service is provided. I call on the Minister to take the necessary action now to ensure the survival of our health services. I should like to ask the Deputies opposite to vote with us on this issue. They will not bring down the Government if they vote with us on a Private Members' Motion but such an action will show that there is some concern on the Government side of the House for the less well-off who are now feeling the harsh and savage effects of the cutbacks brought about by the Minister.
