Deputy Allen has ten minutes left.
Private Members' Business. - Health Services Expenditure: Motion (Resumed).
The following motion was moved by Deputy Molloy on Tuesday, 19 May 1987:
That Dáil Éireann wishing to remain within the 1987 Revised Estimates for Health.
(i) notes that there is widespread public concern about the provision of health services throughout the country, notwithstanding an increase this year of £13.082 million;
(ii) condemns the failure of the Government and the Minister for Health to set guidelines for expenditure on health this year that would ensure an acceptable level of service, which failure has resulted in threats of closure of numerous hospitals, and curtailment of services in others causing inevitable deep public concern;
(iii) calls for a reduction in the size and cost of the bureaucratic machine administering the health services, including the health boards; the abolition of local Health Advisory Committees; greater accountability by consultants, and a retention of such numbers of persons supplying health care direct to the public as are necessary to provide a reasonable level of service, given the country's financial circumstances.
Debate resumed on Amendment No. 2:
2. To delete all words after "Dáil Éireann" and substitute the following:
"wishing to remain within the 1987 Revised Estimates for Health
(i) notes that there is widespread public concern about the provision of Health Services throughout the country;
(ii) condemns the failure of the Government to plan the impact of the extra cut of £22.8 million imposed in the Estimates to Health Boards and Health Services of March, 1987 compared to January, 1987 as well as the accelerated phasing out of the Health Board deficits and propose that the Government in consultations with the partners in the Health Services devise a strategy for staying within the overall budget allocations embracing a review of
(1) Health Boards structures and administrative overheads in the Health Services,
(2) the charges for prescriptions in order to make more funds available for the delivery of services to the public,
(3) a review of the common contract".
—(Deputy Allen.)
Last night I said I would point out certain areas where appreciable savings could be made in our health services and I dealt with the health boards and the need to rationalise their position. I put forward a suggestion in this House some time ago that the number of health boards should be looked at and I expressed disappointment that the Minister had closed his mind against reducing the number of health boards. The administrative costs within the service have to be looked at. Last night I mentioned the common contract and expressed disappointment that the IMO have failed to date to come to the negotiating table with the Minister. It is ironic that the IMO are criticising the cuts that have been made. Junior hospital doctors have been seriously affected by the cutbacks but the IMO, who represent the consultants in our hospitals, are refusing to renegotiate a contract which is allowing serious abuses to occur within our health services.
In a previous debate in this House I said we must deal with the computerisation programme, look at the fee per item and the purchase and use of drugs. The purchase of drugs by the health services was dealt with comprehensively in a recent newspaper article which raised many serious questions. The Minister has a responsibility to look at this area. Much of the contribution made by the PD spokesman was based on the very excellent report of the Committee on Public Expenditure published last January. That committee highlighted and pinpointed many defects in our health service, and I urge the Minister to study that report in detail. We took a lot of time to study the health services and the report does justice to the time given by the committee.
Since last night a serious matter has come to my attention in relation to vocational training for general practitioners. As the Minister knows, the proper training for general practitioners is a key factor in reducing hospital costs. Everybody agrees that the development of our vocational training for medical students before they enter general practice is vital. At present there is a scheme in Dublin and Cork with Dublin training ten prospective GPs per year. I have been informed from authoritative sources that because of the embargo on the appointment of temporary general practitioners, this training scheme will be abolished. This is a serious matter because under EC legislation by 1992 every general practitioner must be vocationally trained before he enters general practice. I ask the Minister to tell the House how he proposes to deal with a threat facing the vocational training scheme for general practitioners in Dublin and Cork.
I know this debate is limited, but we could pinpoint many areas where huge savings could be made in the health services if the Minister had the political will and the courage to take on these issues instead of picking easy targets. Allowing for the urgent necessity to bring our expenditure on health into line with the current availability of taxpayers' money, it is difficult nonetheless to visualise a more hamfisted exercise than that on which the Government have now embarked. The cuts are being implemented, at the behest of the Government with the insensitive crudeness of a battering ram. To put the health budget into balance, it was necessary either to make cuts or to increase revenue. A careful and considerate merging of both elements, as we in Fine Gael have constantly asserted, would never have resulted in so many hospitals being closed, staff disillusioned and patients victimised in a way that has caused chaos, strife and resentment. These hammer and anvil strokes are not the way forward. Bludgeoned by Government policy, health boards are now being forced into making decisions which are demoralising in their impact on the community at large.
Coming from a Government whose "caring concern" was the cornerstone of their election policy, the dictatorial policy we now see being implemented, on health cuts in particular, is insulting, not only to those directly affected but to those of us who have consistently pointed to a better way of doing things.
Imposing a prescription charge, which would greatly ease the burden, would be part of that better way and would not have resulted in the morale-shattering experiences being witnessed through the cries of anguish of people from all parts of the country. Last night I outlined the broad based protests which are taking place.
These cuts are insensitive and are aimed for the most part at the soft options which effectively affect the poorer, and consequently, the most vulnerable section of our community. It is not too difficult to comprehend why this line of action is being taken, why hospitals are being forced to close down, why workers have been forced out of their jobs in droves, why entire communities have been left to suffer and why lives have been put at serious risk.
It results more than in part from a reluctance bordering on a fear to take on the powerful and influential groups who appear to be immune from any dictation. I ask the Minister to take on these groups which are resisting change.
The people, as taxpayers, who are now suffering are left again to pay a piper who is all the time playing the expensive tune that only a select few can afford to hear. There have been a number of totally unnecessary decisions at Government and at health board level that carry the conviction of a scared rabbit. In a number of communities these decisions have had a destabilising influence that should have been predicted.
As I said last night there is a need for a cooling off period before further irreparable damage is done to the health service and before any decision is copperfastened. Other options must be carefully looked at and examined. By doing so, the Government would be given an opportunity of looking at the fundamental issues and problems that originally brought about these draconian decisions. I am sure this cooling off period would have the effect of forcing the Government to look at other viable options which Fine Gael, over the last few months, have pressed them to examine, but the Government have failed.
That, as we see it, is the way forward which would bring about a consensus to a problem which, because of the way it is being handled, is bringing discord, divisiveness and hardship to all communities. I ask the Minister to look at the issues which have been cropping up in all areas and expecially the problems which have arisen in the most deprived areas.
The time has come to call a halt to the devastation which is being caused in our health services. I am glad the Minister has acknowledged that he has lost his way. I am pleased he is bringing in the experts for consultation. This should have been done a long time ago and the Minister failed in his duties by not bringing them in to advise him.
In the debate which has been going on over the past two evenings, many vital points have been raised. Unfortunately, there have also been a considerable number of negative and unhelpful comments.
It was very reassuring to find that the Progressive Democrats and Fine Gael agree we cannot afford to put any more resources into the health services at present. That represents a good base from which to proceed. The task now is to plan well and manage constructively the considerable resources that remain available and to do that we must be positive, we must apply imagination and deal with reality.
The Minister, Deputy O'Hanlon, has already outlined a comprehensive and positive approach to this task. It is a great pity the same cannot be said for all those who have spoken, particularly the main proposers of the motion. I will deal later with some of the points which have been made. It was interesting to watch Deputy Allen's attempts to substantiate his claim that the provision made by the Government was £28 million less than provided by the previous Government. This is not in accordance with the facts.
I did not say that.
Deputy Allen may wish to withdraw his allegation.
I am not withdrawing anything. I referred to the health boards and other health institutions and I have the figures.
The figure is not £28 million less than that provided by the previous administration.
There is a time limit to this debate and Members must be allowed to speak without interruption. Deputy Allen got a very good hearing and I insist on the same courtesy for the Minister. Please desist from interrupting.
I was just correcting the Minister.
The Government's gross provision is £1,295 million compared with a proposed gross provision of £1,294 million by the previous Government. In addition, the new income measures introduced will reduce the need for service reductions. The previous Government sat on the issue of allocations for two months for narrow political reasons. It is scarcely believable that their spokesman should now bemoan the problems which arise from this delay and from the failure of a Government who were in office for well over four years to come to grips with the job of putting in place an effective and efficient service which could be afforded. It was very cynical not to announce the allocations before polling day in February. They were not prepared to inform the health boards of their allocations which will be very similar to those made by the Government. That is why the former Minister for Health, Deputy Desmond, Deputy Spring, Deputy Kavanagh and Deputy Quinn all resigned from Government. They could not stand the heat——
They resigned to defend the health service.
When they could not stand the heat they had to get out of the kitchen.
(Interruptions.)
They should have informed the health boards in January of the allocations which would be made to them instead of allowing them to live in a fool's paradise which could not be sustained.
The allocations to the health boards for 1987 have been increased as the following table makes clear:
|
1986 Original Allocation |
Revised 1986 Allocation |
1987 Original Allocation |
|
|
£m |
£m |
£m |
|
|
Eastern |
172,625 |
177,600 |
183.210 |
|
Midland |
52.070 |
54.900 |
54.300 |
|
Mid-Western |
70.450 |
72.600 |
72.760 |
|
North Eastern |
51.400 |
52.900 |
53.300 |
|
North Western |
66.480 |
68.700 |
68.750 |
|
South Eastern |
85.550 |
91.200 |
91.260 |
|
Southern |
129.790 |
133.900 |
134.000 |
|
Western |
102.780 |
107.400 |
107.620 |
|
Total |
731.145 |
757.900 |
765.200 |
Deputy Molloy made accusations about the lack of co-ordination and direction in relation to computer systems. His contribution is a distortion of the factual position. The charges made by the Deputy, who seems to be relying for much of his material on a flimsy consultants' report submitted to the Committee on Public Expenditure, were comprehensively refuted by officers of my Department who appeared before that committee. The Deputy has deliberately chosen to ignore the facts which were made available to the members of the committee. I can understand why commercial interests would choose to deliberately misrepresent the factual position on the systems front and put forward interpretations which most favoured their own interests.
There is still a big can of worms——
Deputy Allen, please.
However, those who have no vested interest — clearly Deputy Molloy and his PD colleagues fall into this category — could reasonably be expected to establish the accuracy of their facts before arriving at public conclusions.
The Department of Health have a coherent, comprehensive and well-documented policy on systems development. There have been significant developments in this area in recent years and, contrary to what Deputy Molloy alleges, these developments, spearheaded by the Department, have taken place in a planned and co-ordinated manner. Progress to date, however, has been hampered by inadequate funding and the Department are also affected in this regard. Since going into the Department, I found out that there are only roughly 300 people working there and that they administer over £1,300 million per annum. This is a considerable success for a Department of its size.
The former Government, despite the rhetoric, made very little provision for systems development. This Government, however, are committed to more rapid progress in the development of cost effective computerisation within the health service. We see progress in this area as a prerequisite to the development of more effective and efficient management, greater cost control and better patient management.
Deputy Molloy also chose to make statements about the lack of accountability in voluntary hospitals. Statements of this kind had also been made by the Committee on Public Expenditure but were found to be totally invalid. Voluntary hospitals are funded on a budget basis directly by my Department on behalf of the health boards. Their accounts are not only audited by private commercial auditors but are examined in detail by my Department's auditors to ensure compliance with specific guidelines. Such matters as the numbers and type of staff, pay rates, arrangements for the replacement of equipment and for competitive purchasing of materials are all examined. Control is also exercised on the range and extent of specific specialities. Of course some improvements can be made in the working relationships between voluntary hospitals and between those hospitals and the health boards. The Minister, Deputy O'Hanlon, has already outlined the initiatives which he proposes to take in this regard.
Deputy Quill launched a direct attack on the hospital planning office in the Department and on the engineers, architects and quantity surveyors who staff it. She seems to have overlooked the fact that the operations of this office, and in particular the control measures they exercised in relation to major capital works in the health services, have been subjected to quite minute study by the Committee on Public Expenditure and have been commended. This study was carried out before Deputy Quill became a Member of this House and in the circumstances she may not be aware of that fact. It is a specialist office providing a fine service in a most efficient and effective way.
Are you for or against them?
The Minister to continue without interruption.
As they are two former Ministers I am sure they are well aware of the Minister of State's responsibility to defend the Department at all times against unwarranted attacks by Members of this House.
You are defending it, anyway.
A great deal of activity has been going on for a number of years on rather dramatic changes in a wide range of services. Major studies have been carried out in the psychiatric area, the general medical services area as well as in the general hospital area. The fact that we are faced with the current financial problems should not be used as an excuse to slow down or stop those initiatives. Rather there should be an increased motivation to speed up these necessary changes which are designed to achieve a more effective and efficient service. For example, one of the essential features in the development of our psychiatric service is that acute psychiatric in-patient treatment should be provided as a normal function of a general hospital. This means that the acute psychiatric unit should be located in the general hospital in the same way as other specialised hospital services. Such units are already in operation in a number of general hospitals. This is an enlightened view of psychiatric care and services. Mental illness is the same as any other illness and it should be treated in the environment of a general hospital instead of being isolated in a separate hospital. It is planned to provide them in a number of other hospitals, such as Ennis, Roscommon, Portlaoise and Kilkenny. This will be done by transferring the acute psychiatric service from the mental hospital to the general hospital.
The current reduction in activity in general hospitals provides an opportunity to transfer the acute psychiatric service to the general hospital much earlier than had originally been anticipated. Health boards should seek to avail of this opportunity. Roscommon hospital, for example, could be provided with a unit which would meet the acute psychiatric needs of County Roscommon and which would have the support of their consultant-staffed services in the hospital which should be retained.
That is a good effort, Minister.
As far as staffing reductions are concerned——
Did you write that line yourself?
——it is understandable that those directly affected should make their feelings clearly known.
I know that for the individuals involved the need for reductions is going to cause hardship but in looking at the reductions in an overall context, it must be borne in mind that the last decade saw a huge upsurge in the numbers employed in the health services of about 20 per cent. It would be very difficult to justify that level of increase simply in terms of development of services. A curtailment of expenditure on health services must involve a curtailment of staff bearing in mind that approximately 70 per cent of the total costs of the health services are pay costs.
I would also like to comment on statements made by Members of this House and others about the application of the restrictions to various categories of staff. It has been naively suggested that all that is necessary is to do away with virtually all clerical and administrative staff and this would solve the problem. It is implied that such staff are inessential to the operation of the services. It is not as if the clerical and administrative staff were being left untouched.
In the instructions to the health agencies it was asked that the restrictions be applied evenly across the grades. The information supplied to the Department of Health since the issue of those instructions confirms that the boards and hospitals have endeavoured to carry through those instructions.
Have they succeeded?
There is no evidence that the clerical and administrative grades are being specially protected. We must realise again that total expenditure is £1.3 billion. That is a considerable amount of public expenditure. We are now paying for an overrun of £55 million by the previous administration. We should also bear in mind that Deputy O'Hanlon is the third Minister for Health in 1987. The first was Deputy Barry Desmond who resigned his ministry when he could not face the difficulties ahead. He was followed by Deputy John Boland. I recall he was the Minister who proposed to do away with the dispensing of drugs in rural areas in an announcement made during the general election campaign. Deputy Desmond resigned because he could not contemplate staying in office with his Fine Geal partners due to the measures proposed by that party. In particular, he could not tolerate the proposed charge of £1 per item prescribed for those people who were deemed eligible to hold a medical card and who by definition are the very poorest in our community. The prescription charges proposed by Fine Gael would have imposed undue hardship on the least well off in our society. We decided to dispense with those charges because we felt they were not in order or suitable for the most deprived people in our society who are eligible for a general medical service card.
You have deprived them of full services.
Are you anticipating a fourth Minister in 1987?
He is the fourth Minister.
A third Minister in 1987 is quite adequate and when the job has been done well he will be seen as having done the right thing for the country.
There will be a four-year waiting list for operations instead of two.
Deputy Desmond, the former Minister, should clarify this position as he was in the Department for a considerable time. In fact, he was there for over four years and he should clarify exactly why he allowed the overrun by individual health boards who were on bridging finance and who had overdraft facilities. He either gave permission, he was aware of the position——
He answered that slur last week.
——or he allowed the health boards to carry on without any control and that is totally unacceptable.
You cannot trot it out every week.
The position is that we have now to carry on the overrun of £55 million which will have to be paid from a limited taxation base.
The boards are dominated by Fianna Fáil.
It must be borne in mind that we did not increase taxation. We were limited in the amount of money we could raise through extra taxation and the only alternative open to us was to restrict public expenditure. I would also like to point out that we allocated an extra £25 million for the general medical services in 1987. The charges we have imposed are far less severe than the £1 prescription charge proposed by the Fine Gael administration.
Have you been out to visit the hospitals recently?
You only speak by way of interruption these days.
Order, please.
I welcome the fact that the £10 out-patient charge is being collected and has been accepted by the general public. We must bear in mind that a visit to a general practitioner would cost at least between £8 and £10 and one would not have the benefit of the back-up services which are available in an out-patients department in a general hospital. The VHI have introduced an extremely attractive scheme, very moderately priced. I recommend that those who are not eligible for free out-patient and in-patient services should avail of the extremely attractive offer which has been made.
The Minister in issuing the 1987 letters of allocation to the health boards and voluntary hospitals laid down clear and specific guidelines on how they should frame their budgets. His concern was to ensure that the basic fabric of our health services should remain intact while, at the same time, ensuring that the best possible service was delivered within the amounts available. The specific instructions to the agencies required that they should seek to make the necessary reductions in the institutional area and in particular in the acute hospital sector. The overall bed provision in our acute general hospitals is widely accepted as more than adequate to meet all needs and this is by reference to international standards. The administrator directed agencies to protect community care services as far as possible including, for the old and the housebound, such key services as community nursing services, services for the mentally handicapped, home help services, meals on wheels, child care services and——
All affected.
——particularly day care and pre-school services for the deprived and disadvantaged communities and after care programmes for children leaving long term residential care. Adequate provision should be made also for boarding out payments to reflect the trend towards increased numbers in foster care. The Minister asked the health boards to maintain their expenditure on these services, at least at the 1986 approved levels in real terms.
The Minister is acting as Pontius Pilate, washing his hands, blaming the health boards. It is dishonest.
Deputy Flaherty, please desist.
This approach is an expressed departmental policy to protect primary care within the community as opposed to hospital based treatment. The guidelines I have referred to have regard to the over-riding need to maintain a full time staff to provide a service at an acceptable level directly to the sick in our community. Indeed, the Minister did not think it unreasonable that the letter of allocation should require the health boards and the voluntary general hospitals directly funded from the Department to face up to the harsh reality of the need to bring their expenditure into line with what their allocations should realistically support——
Closure at Roscommon.
——instead of, as often in previous years, incurring overruns which went unchecked. In 1985 the overrun was £19 million. That was not corrected in 1986, when there was a £36 million overrun. This was the responsibility of the Fine Gael-Labour Government who were in office during those years. We are now paying the price for the irresponsible behaviour of an irresponsible Government.
With Fianna Fáil health boards.
Tell that to your colleagues in the Western Health Board and Southern Health Board.
We are now paying the price. Leadership must come from the top and leadership in the health services——
The Government have made all these cuts.
——comes from the Department of Health and the Minister and the Minister must take responsibility for the overrun in the health services.
He must, indeed.
He cannot shirk that responsibility and transfer the blame for an overrun of £55 million to the health boards. He should have laid it on the line at that particular stage. He should have been prepared to have the courage of his convictions and not run away when the heat became too severe in 1987, when he with Deputies Spring, Kavanagh and Quinn made a staged and dramatic walk-out from the Cabinet table. They were not prepared to do that in October or November of 1985; they felt that it would be more effective to walk out in 1987.
Principle, Minister.
After four and a half years — not being cynical about it — they secured their good pensions.
Shame.
Disgraceful.
Is the Minister of State going to walk out?
They walked out of the Cabinet room in 1987——
The Minister of State is staying in, regardless.
He is not in the Cabinet.
——when all the damage was done. They were then prepared to walk away from the ruins of their mismanagement of the economy and their mismanagement of the Department of Health and the irresponsible approach they adopted, leaving a massive 250,000 unemployed.
Are you going to overthrow Roscommon?
The biggest increase ever in the history of the State was created by that discredited Coalition Government.
Your Government have added 2,000.
We are prepared to take the decisions, irrespective of how unpopular they are and how hard they are.
That is not true.
Fantasy.
We are saying that the situation could not be sustained with 250,000 people unemployed, left by that discredited Coalition Government.
There are 2,000 more out of work.
It was total irresponsibility that the TDs at that time and the Ministers——
On a point of order, I thought we were talking about health services here, not unemployment. Would the Chair clarify the situation? The Minister was talking about unemployment, not health services.
That is not a point of order; it is a point of disorder. The Minister of State to continue.
I just wanted to keep the Minister on the straight and narrow.
To clarify the position again the situation is that I must put the responsibility back with the people who created the problem.
Tell us about Roscommon.
Those who created the problem were the Fine Gael-Labour Coalition who allowed an overrun of £55 million in the health services.
That is not true.
And Fianna Fáil had to pick up the tabs in 1987 and pay for the mismanagement of this economy by Deputy Desmond, former Minister for Health and his Fine Gael colleagues in Cabinet.
Are you going to support Charlie Haughey, or are you going to support Sean Doherty?
Could I have your attention, please, Deputy Deasy? I want you to behave in a fashion that would do justice to the House and to the debate. I do not know whether you will get an opportunity of contributing later but I would appeal to you to get away from a fashion that seems to have developed, that Private Members' time is a time for comical relief. It is not and it will not be while I am here. The Minister to proceed.
It is the Minister's responsibility.
This applies to you, too, Deputy Kenny. If you are not happy to listen to the speaker, you know what to do.
The House should welcome the announcement by the Minister last night that a team from the Department of Health would meet the management of each of the health boards and voluntary hospitals. They met them in the past fortnight to discuss their proposals and the Department now are analysing the agencies' proposals with a view to ensuring that overall the service plans are co-ordinated and rational. This will require new arrangements for co-ordinated action between health agencies locally and my Department. Those arrangements are being put in place.
An examination of the public service generally by the Government led immediately to the conclusion that to a very significant extent the problems of the numbers employed in the public service have not been tackled in recent years. For instance, when I took office there were 62,000 people employed in the health boards and other agencies to provide health services. Ten years ago there were 51,000. I find it difficult to accept that this increase in numbers has produced a corresponding improvement in that time in the quality of the service delivered to the patient.
Did you not squander the last four years?
Given the financial difficulties facing the economy at present, this clearly is a situation which could not be allowed to continue. In his budget speech the Minister for Finance announced that no public service vacancy could be filled without the express approval of the Minister for Health and the Minister for Finance. Following discussions with the Department of Finance a package was agreed. Because of the late stage in the financial year and the random effect on services by closing down all vacancies as they occurred, this package was, first, the non-filling of some vacancies; secondly, a reduction in the number of current temporary employees and, thirdly, a reduced scale of local cover to achieve an overall reduction of 2,000 posts by 31 December 1987.
The setting up of a specific target for each agency gave the management of health agencies flexibility to allow for the effects of the hardships of a total embargo on the filling of vacancies and on the provision of local cover. At the same time it involved agencies taking a much stricter approach——
On a point of order, could I enquire why it is that the Minister of State at the Department of Health has come in here this evening to read out word for word the script which the Minister for Health read out here last night? We are now coming towards the end of page 12. We have just had pages 11 and 10——
Deputy O'Malley is wrong in that that is not a point of order.
Was it not a futile exercise to have the Minister for Health reading out the same speech on Tuesday night?
I am afraid Standing Orders do not provide for the Deputy's interpretation of futility. Deputies will have to put up with the rules as they are and allow Deputy Leyden, who has one minute left, to conclude.
May we inquire about the level of productivity in the Department of Health and whether it is possible for the Department to produce two scripts on this subject?
The Deputy should resume his seat and stop interrupting the business of the House.
They call it an overrun.
I should like to remind the Minister of State that he is at the last sentence on page 12.
I am asking Deputy O'Malley to resume his seat. I have had to do so on three occasions.
I have done so.
It should not have been necessary for me to ask the Deputy more than once to resume his seat.
If the Chair asks that the Deputy be named the Minister will not remember his name.
On a point of order, I should like to know if it is in order for Deputies to make repetitive statements in the House. Deputy O'Malley was drawing the Chair's attention to the fact that a junior Minister was reading the same speech his senior Minister read last night. Is that repetition?
I will decide what is repetition without any assistance from Members on either side of the House.
The Chair is rushing to the defence of the Minister of State.
We have given the facts during the debate and they will be repeated tomorrow. It is important that they are repeated so that Members like Deputy O'Malley can realise how serious the position is and what we have to do to deal with the problem.
The Minister was caught out.
In conclusion I should like to ask the House——
The Minister should be allowed injury time.
The Minister should sit down.
The Minister is running out of excuses.
Has the Minister any good news for the people of Roscommon?
The Minister has exhausted his time.
With the permission of the Chair I should like to share my time with Deputy Desmond and to give five minutes of my time to Deputy Sherlock.
I gather there was some disagreement about this earlier.
In the last Dáil there was a rigid rule in regard to the sharing of time which was agreed at 7 p.m. each evening. On this occasion we do not have any objection to the Deputy's proposal but it would be better when time is being shared that it is included in the order of the House.
That is a matter that should be dealt with by the Whips.
I understood ten minutes before the debate began that there was agreement on the division of my time. I understood that the Government were conceding five minutes to The Workers' Party but I have heard since that that has been withdrawn and that that party will be given the five minutes I am conceding. The Chair expressed the view that Private Members' Business was degenerating into comic relief but the Labour Party do not regard the position of the health services as a matter for comic relief. The population do not regard it as comic relief. At last we are having a debate on an issue that is causing great public disquiet, concern and controversy. The debate has come about not by the Government conceding time to allow the issue to be debated in a proper manner but by a party tabling a motion to be debated in Private Members' Time.
The basis for the debate is a motion from the Progressive Democrats the first line of which indicates the schizophrenia that exists in that party on this and other issues. They wish the Dáil to remain within the 1987 revised Estimates for Health and note the widespread public concern notwithstanding an increase this year of £13.082 million for the health services. What increase are the PDs talking about? The increase alluded to is the money it is expected to collect from charges, £6 million from charges to outpatients and £6.5 million from charges to in-patients. Those charges were levied by the Government with the collusion of Opposition parties. The Labour Party have resisted those charges and tabled a motion to rescind them because we consider them to be fundamentally unjust. Those charges were supported by the Progressive Democrats. It is time all parties in the House behaved in a responsible manner rather than trying to have it both ways; supporting a general strategy while making political capital when the details are unveiled at ground level. Other parties created a rumpus in the House and in the constituencies, and that provides a neat smokescreen to avoid the public glare of their support for the budget. It should be remembered that these provisions were included in the budget.
The real issue for those who are not afraid to address it is the net provision by the Department of Health, and the House, to run our health services. The Labour Party have tabled their own Private Members' motion to deal with this issue and we will press it to the limit. The real issue is the reduction by the Fianna Fáil administration of the net Exchequer provision for Health from £1,115 million in 1986 to £1,111 million in 1987. It is worth noting that 70 per cent of that provision will go on salaries and pensions which will rise this year by a minimum of 3 per cent. An increase of that magnitude is required if the boards are to stand still, at a minimum. The de facto cuts of £50 million-plus are causing the havoc we are witnessing throughout the country. They are causing fear and anguish among the population, particularly the elderly, and uncertainty and anger among those who are working in our health services.
What is causing this pandemonium? Is it being caused by a modest cutback? I should like to spell out in detail what the cutbacks mean in the South Eastern Health Board area which covers my constituency. I listened with amusement to the Minister's statement that he is seeking to protect key services. Perhaps he does not regard the propositions of the South Eastern Health board as affecting key services. How does he regard the closure of five support hospitals? In the auxiliary hospital in Kilkenny 36 beds and 19 jobs are to go resulting in savings of £280,000. At Bagenalstown, County Carlow, 35 beds and 17 jobs are to go with an expected saving of £260,000. At Brownswood in Enniscorthy, County Wexford, 112 beds and 64 jobs are to go saving £780,000 despite the fact that £14 million has been spent on improvements in that hospital in recent years. In fact, last week £25,000 was spent on a new lift. At Lismore in County Waterford 21 beds and 12 jobs are to go resulting in a saving of £140,000. In Tipperary town 42 beds and 24 jobs are to go resulting in a saving of £90,000.
With regard to the hospitals with acute units, Waterford Regional Hospital is to lose 45 beds, ranging from maternity to ENT, and 26 jobs. At Wexford General Hospital 30 beds in the surgical and gynaecology wards and 16 jobs are to go. At Saint Lukes in Kilkenny 35 beds — the children's ward is being halved — and ten jobs are to go. At Our Lady's Hospital in Cashel 20 beds and six jobs are to go while at Saint Joseph's in Clonmel ten beds and three jobs are to go. The orthopaedic hospital for the region, Kilcreene in County Kilkenny, will lose 30 beds and ten jobs despite the fact that elderly people in the region have been waiting months for vital hip operations. Clearly many of them will not live to have the operation.
That is in the hospital area. What are the effects in the other areas of the Southern Health Board? The psychiatric service will lose 312 beds in the region and 100 jobs. The dental and opthalmic service will lose £500,000. This will effectively end proper dental and ophthalmic services for the region. In the area of chiropody there has been a loss of £65,000. The child care service area has lost £100,000. Transport services have been reduced. The ambulance service has been reduced to cater for emergencies only to transfer people between hospitals or to bring people in for dialysis. I spoke to ambulance drivers this week who had to break the news to patients who have regular treatment that there was not the money to bring them into hospital, that they must hitch or find a neighbour to bring them in. This affects elderly people in remote areas who will now have no prospect of continuing with treatment because the ambulance service is gone. The appointment of locums has been virtually eliminated.
The litany of disasters is pages long. That is the real effect of protecting essential service as per the present Fianna Fáil administration. We cannot lop £6.3 million off one health board area painlessly. Delicate surgery was required and measures were being implemented by the previous administration who received the anger and bile of the Opposition at the time. Instead of using a scalpel to prune any excess fat the Minister, nudged by the Department of Finance, has chosen to use a chainsaw. Very little will be left after this administration. The Minister is so concerned about the health services that on 19 November last he said in this House:
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 now call on the Minister to take the action he urged a few short months ago to protect the basic fabric of our health services.
The issues we address are of prime importance. Politics has been played with the health services and a cruel deception was perpetrated on the electorate by the Fianna Fáil Party in February. The charade continues now, with Fine Gael and the Progressive Democrats making capital by mouthing against the inevitable consequences of a strategy which they support. Local TDs say one thing at home but another thing in the House. I stood on a platform last Saturday with a local Fianna Fáil Deputy who did not mind being rapped on the knuckles by the Taoiseach when he said he would support the local hospital. That is all right in Enniscorthy but in Dublin we are so isolated from reality one can do the opposite. One can say one thing for the local paper and another thing for this House. Enough is enough. The people can see through that form of hypocrisy. The reality is that there is a grand coalition now in operation, a coalition of Fianna Fáil, Fine Gael and the Progressive Democrats, who fundamentally agree with the strategy of these cuts. They have said so. Both in the PD motion and in the Fine Gael amendment they say: "wishing to remain within the 1987 revised Estimates for health". They accept the strategy.
What is yours?
We gave that in very great detail last week and I would give it again if I had the time.
Run away.
The Labour Party will resist that view and if we have the opportunity we will put into force the alternative strategy which we spelled out last week which showed where we can get the funding we need for our services. We refuse to allow in a few short months the creation of a health service where the thickness of one's wallet dictates the quality of service, where private medicine thrives as never before, while people who cannot afford the basic essentials are expected to pay £10 on turning up in an outpatients department. We indicated where we can get the money. The Revenue Commissioners could be directed to collect a modest £14 million extra VAT this year out of the £700 million due. The Government could look into their heart again and rescind their decision to abolish the land tax which would raise £6 million this year. They could collect money due in health levies from the self-employed, including farmers. We put forward in detail the amount of money we could raise from these sources to do away with this savagery but that will not happen because 90 per cent of the people voted for parties that wanted those cuts. We, in the Labour Party will resist it, and we will put forward the alternative every step of the way so that when it comes to the next election there will be no cruel deceptions and no misapprehensions. The people will know where they stand on issues of public expenditure and on issues of prime importance such as the Health and welfare of our people.
For the first time since 1927 the national collection of the Fianna Fáil party was not taken up in Ennistymon. We know the reason. Fifty years later, in 1977, the then Minister for Health, Deputy Haughey, moved a supplementary Estimate of £25 million, £9 million of which was for additional staff. Deputy Haughey told Deputy John O'Connell, in a proud voice that in 1977 he took on 4,200 extra health staff. In 1978, Deputy Haughey moved a supplementary Estimate of £36 million. In 1979 Deputy Haughey moved a supplementary Estimate of £72 million. In 1980 Deputy Woods moved a supplemenary Estimate of £36 million and in 1981 Deputy Eileen Desmond, stating that the Estimates did not provide for the original allocation, had to move a supplementary Estimate of £91 million.
That is the legacy of the Fianna Fáil Party. Yet that party have the nerve to suggest that because in the years 1982, 1983, 1984, 1985 and 1986 I refused point-blank to bring in any supplementary Estimate as I obliged the health agencies to live within their allocations in those years there was an overrun in the health boards during that period. Deputy Haughey could not even get the figures correct on budget night when he said the figure was £80 million. Then it became £55 million. Last night for 1985 it became £19 million and for 1986 it became £36 million. They do not know how to add up overdrafts incurred by the Fianna Fáil health boards at local level. They were told in no uncertain terms by me that a supplementary Estimate would not be brought into this House under any circumstances and that if they had an overrun it would be their responsibility. With due respect to the Minister, he should not try to hang things around the neck of an outgoing Minister based on a threadbare apologia which is being trotted around by the Fianna Fáil health boards.
I turn now to the major development which this crisis in the health services has brought about. In effect we are forcing our national health system, which is overwhelmingly a system based on income taxation and health contributions, into a two-tier public and private system where a person who has a VHI code number will get priority in an operating theatre. A person who has a VHI number will be given a bed in a hospital but anyone who has not will have to wait and wait whether he or she is in pain or in need or one of their family is in need of medical care.
Blackrock Private Clinic have submitted a planning application to Dún Laoghaire Corporation looking for two additional floors, 58 more beds costing £3 million. For what? More private hospital beds with public consultants creaming it off inside getting £38,000 from us and another £70,000 out of the private hospital, collecting it on the basis of a transfer payment, supported by the PDs in relation to VHI taxation.
Wrong.
They and other Deputies will defend giving £30 million in income tax relief to private medicine while public beds in other public hospitals are to be closed down and starved of funds because the people who go into them have not a shilling in their pocket. On top of that, these people have the ignominy and humiliation of having to pay £10 every night for a child of only seven weeks old until they reach £100 in a year. That is the double standard.
In Cork the Bon Secours Hospital are pouring £4 million into a private hospital and using the VHI to amortise their capital investment, with the support of the Government. We are heading for a two-tier system of public and private health care. We are privatising a national health system which successive Ministers, including the then Minister for Health, Deputy Haughey, endeavoured to build up on a national basis. We must stop and examine our health system. I have no objection to legislation being brought in to give the Minister control over the building of facilities for hospital beds, public and private, health board and voluntary, and control over the specialities. We must do it or the system will slip out of control. I will support the Taoiseach if he brings in the legislation. I proposed such a measure in the Health (Amendment) Bill, No. 2 which I am sorry to say the previous Government decided not to go ahead with. There was opposition from particular interests in that regard.
We can ensure we have a public system but we have to point out that the mad rush started in August 1986 when the CII, with spurious analyses, stated that this country was grossly over-endowed with hospital beds and acute hospital beds. They do not even know the difference between a consultant covered bed and an acute hospital bed. This country is not over-endowed with consultant covered beds, which are the beds that matter, or with geriatric beds. There is a fond belief fostered by the CII and adopted holusbolus by the PDs that we have 12,000 beds too many. There is another fond belief that because we have a young population we do not need the health services we have, but if one examines basic dependency statistics we have 41 persons per 1,000 under the age of 14 and over the age of 65 and these are the people who predominantly occupy these beds. We must compare like with like.
I am infuriated by so-called health economists who are examining data which relates to 1976 and 1979 which has no application to the health system. I urge the Minister to bring some rationality into this area. Certain health economists and other so-called economists decided we were spending far too much on health and that it should be cut down to 6.5 per cent of GNP rather than 7.5 per cent of GNP, which we should rationally have. They decided to take out the shotgun and virtually abolish the health service. Certain other people decided we should go for the privatisation of the health service and finish up with a completely private service which would in due course destroy the public system. The private system is based by and large on how much the investors can get out of it, with no concern for real health care and a real assessment of people's actual needs on an objective basis.
Then we come to the spurious proposals to abolish health advisory committees. That suggestion would yield a lousy £300,000. They say we should control the consultants — if we shot the lot of them we would not save £4 million a year in actual public service payments and we would have no system. These are the kinds of alternative policies which are put forward. It is also suggested we should raise money by imposing prescription charges but it could not be done. The reality is that the Health Vote was savagely reduced to 6.7 per cent of GNP.
On a point of order, there was agreement that I should have five minutes to speak.
My apologies to the Deputy. I will finish now. I promised to give the time. The Health vote has been cut by £60 million. That sum should be restored to the Health Vote. I must also assert that the personalised attack on the Minister for Health is wrong. It is typically Irish, typically political and wholly objectional. We must deal with policy issues rather than individual personalisation. I urge the staff who will march through Dublin tomorrow to take down their posters about the Minister for Health. Let them put up posters about Fianna Fáil if they want to — that is their privilege in a democracy. We will deal with the policy issues and not the excessive personalisation of Irish politics. We must deal with this issue in a mature, political, democratic and parliamentary way. Only in this House can the fundamental shortage and underfunding of the health services be dealt with.
Deputy Sherlock, your time has disappeared. Do you think you could encapsulate your thoughts in one minute? That is all the time you have.
The Minister of State stood here for 40 minutes and the manner in which he spoke on such a serious issue, while the people are up in arms about the cuts in health services, is deplorable, as is the fact that I will not be allowed even five minutes to speak. I will speak for five minutes.
Deputy, you will resume your seat.
I am a public representative——
Deputy, you will resume your seat.
A Leas-Cheann Comhairle——
I will ask you to leave the House if you do not resume your seat.
A Leas-Cheann Comhairle——
Deputy Sherlock will leave the House if he does not resume his seat.
I was to be given ten minutes——
Please resume your seat. I will send for the Ceann Comhairle if you do not resume your seat immediately.
It was an insult to offer me just less than one minute to speak on this. I am a representative of the people of Cork East and I want to speak on this vital matter.
If the Deputy does not resume his seat I will send for the Ceann Comhairle.
On a point of order——
Send for the Ceann Comhairle.
Can I raise a point of order at this time?
A Cheann Comhairle——
Sorry, Deputy Sherlock, you will resume your seat. I understand the occupant of the Chair asked you to leave the House.
He did not.
Deputies
Yes, he did.
He asked me to sit down. He asked me to resume my seat.
A Deputy
Or leave the House.
The Chair in such circumstances hears only the occupant of the Chair, the Leas-Cheann Comhairle. I understand the Leas-Cheann Comhairle asked Deputy Sherlock to leave the House so he must now leave the House.
At no time did the Leas-Cheann Comhairle ask me to leave the House. He asked me to resume my seat and I protested at the fact. As you will agree, I did not——
Sorry, Deputy Sherlock, I said previously I heard only the occupant of the Chair in such matters. The Deputy must now obey the Chair and leave the House, otherwise I shall have to put the question.
Deputy Sherlock withdrew from the Chamber.
Deputy Desmond O'Malley.
On a point of order——
Let me dissuade Members from raising points of order having regard to the short duration of time.
The point I wish to make was that Deputy Sherlock was offered five minutes of Government time with five minutes from the Labour Party and that was not acceptable. It should be on the record of the House that he was offered time to speak but it could not be agreed with the Labour Party.
That is not a point of order. Deputy O'Malley.
On a point of order, that is not true. It is important that——
Order. Deputy Desmond O'Malley.
On a point of order——
I cannot entertain any more points of order having regard to the fact that this is a debate to which a time limit applies and Members cannot waste the time of Deputies in possession.
Let me ask permission to move the amendment which is on the Order Paper because Deputy Sherlock was not allowed to do it. I wish to move the amendment in our name on the Order Paper.
It cannot be moved now. There is an amendment before the House. The Deputy may get an opportunity later.
I would like to avail of the very short time left to me to reply to what has been an unusual debate, unusual not because of what happened in regard to Deputy Sherlock but unusual in that for the first time for many years that I can remember there was no Government amendment to this motion in Private Members' time. Secondly, this debate is taking place because it is in Private Members' time as the Government in the past several weeks have daily refused resolutely to allow any form of debate on the health services and are now reluctantly in the aftermath of this debate, allowing some kind of debate tomorrow in such a way that there can be no vote and there can be no decision made or any expression of opinion by this House.
There is a difficulty in expressing an opinion tonight in relation to the motion which we put down and to which the Government have put down no amendment. There is an amendment put down by the Fine Gael Party which is one of the most unusual amendments I have ever seen because it proposes to delete all the words in our amendment and then to substitute nearly all of them again with the addition of a few words of no great consequence one way or another. What precisely that is supposed to achieve I do not know, but a great deal of manoeuvring goes on in relation to amendments. Apparently the amendment, strangely enough because of the unusual rules that are here, seems to take precedence over the motion. What will happen when it comes to voting I do not know but it seems a strange thing to have done.
The main point that we sought to make to the Minister for Health last night was the apparent absence of guidelines in relation to the way in which the health services were being administered this year. The Minister referred to the fact that the Secretary of his Department wrote a letter, a copy of which I have to various health boards and voluntary hospitals telling them that they would have to do different things. I have read the letter and it certainly does not contain anything but the vaguest of guidelines which would be on no assistance to a health board or to the management of a voluntary hospital. That seems to be borne out by the fact that the Minister, in his reply last evening announced that next week officials of his Department will start touring the health boards and voluntary hospitals, consulting with the people concerned, advising and suggesting what they might do. Then, when all that is over, there is to be further consultation at national level with various experts and so on and then a review group — the great panacea when things are not really being done — is to be set up.
All of these things would be hardly necessary if there were meaningful guidelines. Looking at the figures involved, where in this year we have an increase in the gross Estimate for Health of £13.082 million — that is there is black and white in the Estimates volume for anybody caring to read it — we have an extraordinary position with regard to voluntary hospitals. I have here the list of 40, 50 or whatever is their number in the country. The way in which they are treated cannot be the subject of any guidelines of any coherence or meaning at all. For example, one receives an increase of 19.1 per cent, that is at one extremity and quite a number of others receive increases on last year's allocation while most have their allocations decreased. The highest level of decrease — where the average is approximately 15 per cent — is no less than 47.4 per cent. What coherence is there in that? Or is it saying to those who get more money, "we want you to stay in business" and to those who get less, especially those who get a lot less, "we really want to put you out of business because we cannot close you down unless we have a public sworn inquiry and we do not want to go through the hassle of all of that". If that is what is being done the Minister would be better off to come and tell that to the House, change the law and avoid this kind of charade because its effect is to terrify large numbers of people, patients, potential patients and staff.
It is worth looking at the manner in which staff are now being let go. Staff are being let go on the basis that those who have no come-back will be the first to go, that is those engaged on a short-term basis who have no permanent contract or who have acquired no statutory or redundancy rights. They are all being let go. Tragically, for patients and for the country, they are the people who are in the front line, mainly nurses and junior doctors. The Minister gave what might appear to be a very plausible explanation last evening in regard to what is called administrative staff, that was that 10 per cent only of the staff of health boards and so on were administrative. That may be true in the sense of administrative staff as people sitting behind desks but I believe that the percentage of non-medical staff of hospitals and health boards is really more in the region of 50 per cent. But it is all people on the therapeutic or medical side and particularly those who have not acquired rights in terms of their employment who are being let go. The result is that there is a totally distorted and disproportionate effect on the sick, on the patients. It is only right that this House should protest at that situation because it is quite indefensible. A plausible explanation was given but it is far from the reality.
In his speech, the Minister of State this evening, or at least in the part of it given to him to read out first, went to great lengths, about two and a half pages, strangely enough in a debate of this kind, to justify what the Department of Health had done over a number of years, and long before he ever came on the scene, in relation to computerisation. Deputy Molloy made the point here last evening that there was an appalling waste of money in relation to that. I happen to know something about it because I addressed a question on that topic about two years ago to the then Minister for Health who gave me a very inadequate and rather evasive answer. I can see that the Department are no less concerned today than then. As an example of waste in the health services we have the incredible scenario of all that money, over £10 million, having been spent. Yet we have not even the beginnings of a computerisation service when that, in itself, would be invaluable in reducing the cost of our health services. A lot of explanation is called for in relation to that. I noticed that the Committee on Public Expenditure failed to get any explanation from the Department as to why this extraordinary system from America was used, a system that simply did not work in Irish hospitals and had no application whatever to them.
There is the spectacle of incredible waste in that the Government have decided, since the budget, to expend £7 million in dental benefit on the spouses of insured workers, many of whom are in very comfortable circumstances. At the same time they cut back on dental expenditure on school children and other people who already have a statutory right to dental benefit. This has outraged anyone who knows anything about the position, not least the dental profession itself. It seems to me to be an extraordinary waste of money when we are already in the position that we cannot provide the services we are supposed to provide.
On the question of equipment it is as well to remember that we already produce more dentists than we need. Apparently it is now the intention of the Minister for Health — perhaps he will change his mind on it and I would hope he would — to build a second dental hospital in this country at a cost to the taxpayers of more than £20 million to produce even more dentists when they are already in surplus.
That is not true, it is not even £4 million.
Apparently this is being done for reasons that have to do with some kind of academic politics going way back for the last ten or 15 years when some sort of promise was made to a particular university. Equipment is very important in modern medicine, it is much more important than beds alone. Beds are necessary for the limited number of uses to which they are put at present. Obviously they are necessary for people who are seriously ill. They are not necessary for people who go to hospital for tests of various kinds, who do not need to remain in hospital as in-patients over a period. On that question of equipment, which should be directed by the Department in the national interest with an overall view being taken in regard to it, we have the extraordinary position in Dublin city at present where two machines for the purpose of crushing kidney stones without the necessity for any surgery are being purchased. These machines take something like 15 minutes only to perform this very necessary task which in the past required major surgery. Although the demand, not just in the Republic of Ireland but on the island as a whole is for one of these machines only, two are being purchased.
The second one in a private hospital deliberately designed to destroy the Meath Hospital.
Order, please.
Three quarters of a million pounds is being spent totally unnecessarily.
We were given all kinds of assurances last evening by the Minister for Health that there would be great emphasis placed on community care, community medicine and so on. Something that happened in the last few days under directions from the Minister apparently under these guidelines, such as they are, is that a training scheme for young doctors — to train them as general practitioners, 30 of them in the country as a whole — has been terminated. Their view on the matter is that this makes a total nonsense of the Minister's suggestion in the House last evening that he is trying to orientate the service towards the community.
A bad joke.
I do not deny that there is need for control. I fully support the need for control particularly where there has been so much waste, duplication and unnecessary spending in the past, but I seriously question that it should be done in the way it is. I blame the Minister to this extent, not so much for his intent but for the careless way in which he is going about it without specifying exactly what should be done in a way that would prevent people worrying, becoming distressed both about their health and their jobs, to the extent that is now the case all over the country. It is a matter for which the Minister and the Government must accept full responsibility and it is a matter which they should rectify at once. It is pathetic that in a debate of this kind we have, as some other Deputies have already mentioned, the extraordinary performance from the Minister of State at the Department of Health who came in here tonight and read out word for word, page after page, the script that was delivered by the Minister for Health in this debate last night.
The Deputy often did it himself.
Question put: "That amendment No. 2 be made".
The Dáil divided: Tá, 40; Níl, 62.
Tá
- Allen, Bernard.
- Barnes, Monica.
- Barrett, Seán.
- Boylan, Andrew.
- Burke, Liam.
- Carey, Donal.
- Clohessy, Peadar.
- Colley, Anne.
- Cooney, Patrick Mark.
- Cullen, Martin.
- Deenihan, Jimmy.
- Doyle, Avril.
- Dukes, Alan.
- Enright, Thomas.
- Farrelly, John V.
- Fitzpatrick, Tom.
- Flaherty, Mary.
- Flanagan, Charles.
- Gibbons, Martin Patrick.
- Griffin, Brendan.
- Harney, Mary.
- Harte, Paddy.
- Hegarty, Paddy.
- Higgins, Jim.
- Keating, Michael.
- Kennedy, Geraldine.
- Kenny, Enda.
- Lowry, Michael.
- McCoy, John S.
- McDowell, Michael Alexander.
- McGahon, Brendan.
- McGinley, Dinny.
- Molloy, Robert.
- O'Brien, Fergus.
- O'Malley, Desmond J.
- O'Malley, Pat.
- Quill, Máirín.
- Sheehan, P.J.
- Taylor-Quinn, Madeline.
- Wyse, Pearse.
Níl
- Abbott, Henry.
- Ahern, Bertie.
- Ahern, Dermot.
- Andrews, David.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Matthew.
- Brennan, Séamus.
- Briscoe, Ben.
- Burke, Ray.
- Calleary, Seán.
- Collins, Gerard.
- Connolly, Ger.
- Cowen, Brian.
- Daly, Brendan.
- Dempsey, Noel.
- Dennehy, John.
- de Valera, Síle.
- Doherty, Seán.
- Fahey, Frank.
- Fitzpatrick, Dermott.
- Flood, Chris.
- Gallagher, Denis.
- O'Hanlon, Rory.
- O'Keeffe, Batt.
- O'Rourke, Mary.
- Power, Paddy.
- Reynolds, Albert.
- Smith, Michael.
- Stafford, John.
- Treacy, Noel.
- Gallagher, Pat the Cope.
- Geoghegan-Quinn, Máire.
- Gregory, Tony.
- Haughey, Charles J.
- Hilliard, Colm Michael.
- Hyland, Liam.
- Kemmy, Jim.
- Kirk, Séamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lawlor, Liam.
- Leonard, Jimmy.
- Leyden, Terry.
- Lynch, Michael.
- Lyons, Denis.
- McCartan, Pat.
- McCarthy, Seán.
- McCreevy, Charlie.
- Mac Giolla, Tomás.
- MacSharry, Ray.
- Mooney, Mary.
- Morley, P.J.
- Noonan, Michael J.
- (Limerick West).
- Tunney, Jim.
- Wallace, Dan.
- Walsh, Joe.
- Walsh, Seán.
- Wilson, John P.
- Woods, Michael.
- Wright, G.V.
Tellers: Tá, Deputies F. O'Brien and Flanagan; Níl, Deputies V. Brady and Briscoe.
Question declared lost.
I move amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"deplores the financial cutbacks which have led to such chaos in the health services and are resulting in hospital and ward closures, the withdrawal of essential services, and the loss of many jobs, and which have caused such widespread distress to the sick and the elderly; calls on the Government to halt the cuts and the job losses; believes that the provision of an adequate and humane health service requires that the percentage of GNP spent on health must not be allowed to fall below the 1986 level; recognises the need for an efficient and economically run health service and urges the Government to effect savings and increase revenue for the health service by:
(1) making the health contribution payable on all income,
(2) ensuring that the outstanding health contributions are collected, and that interest is levied on arrears, as is the case with income tax,
(3) abolishing tax relief on extra VHI premiums for luxury private hospitals,
(4) reforming the GMS, particularly by ending the fee-per-item system of payment, the drugs refund scheme, and the consultants common contract."
Question put: "That amendment No. 1 be made".
The Dáil divided: Tá, 12; Níl, 72.
Tá
- Bell, Michael.
- Desmond, Barry.
- Gregory, Tony.
- Higgins, Michael D.
- Howlin, Brendan.
- Kavanagh, Liam.
- Kemmy, Jim.
- McCartan, Pat.
- Mac Giolla, Tomás.
- O'Sullivan Toddy.
- Stagg, Emmet.
- Taylor, Mervyn.
Níl
- Abbott, Henry.
- Ahern, Bertie.
- Ahern, Dermot.
- Andrews, David.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Matthew.
- Brennan, Séamus.
- Briscoe, Ben.
- Burke, Ray.
- Calleary, Seán.
- Fitzpatrick, Dermott.
- Flood, Chris.
- Gallagher, Denis.
- Gallagher, Pat the Cope.
- Geoghegan-Quinn, Máire.
- Gibbons, Martin Patrick.
- Harney, Mary.
- Haughey, Charles J.
- Hilliard, Colm Michael.
- Hyland, Liam.
- Keating, Michael.
- Kennedy, Geraldine.
- Kirk, Séamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lawlor, Liam.
- Leonard, Jimmy.
- Leyden, Terry.
- Lynch, Michael.
- Lyons, Denis.
- McCarthy, Seán.
- McCoy, John S.
- McCreevy, Charlie.
- McDowell, Michael Alexander.
- MacSharry, Ray.
- Clohessy, Peadar.
- Colley, Anne.
- Collins, Gerard.
- Connolly, Ger.
- Cowen, Brian.
- Cullen, Martin.
- Daly, Brendan.
- Dempsey, Noel.
- Dennehy, John.
- de Valera, Síle.
- Doherty, Seán.
- Fahey, Frank.
- Molloy, Robert.
- Mooney, Mary.
- Morley, P.J.
- Noonan, Michael J.
- (Limerick West).
- O'Hanlon, Rory.
- O'Keeffe, Batt.
- O'Malley, Desmond J.
- O'Malley, Pat.
- O'Rourke, Mary.
- Power, Paddy.
- Quill, Máirín.
- Reynolds, Albert.
- Smith, Michael.
- Stafford, John.
- Treacy, Noel.
- Tunney, Jim.
- Wallace, Dan.
- Walsh, Joe.
- Walsh, Seán.
- Wilson, John P.
- Woods, Michael.
- Wright, G. V.
- Wyse, Pearse.
Tellers: Tá, Deputies Mac Giolla and McCartan; Níl, Deputies V. Brady and Briscoe.
Question declared lost.
I am putting the question: "That the motion in the name of Deputy Molloy be agreed."
Question put.
The Dáil divided: Tá, 41; Níl, 62.
Tá
- Allen, Bernard.
- Barnes, Monica.
- Barrett, Seán.
- Boylan, Andrew.
- Burke, Liam.
- Carey, Donal.
- Clohessy, Peadar.
- Colley, Anne.
- Cooney, Patrick Mark.
- Cullen, Martin.
- Deenihan, Jimmy.
- Doyle, Avril.
- Dukes, Alan.
- Enright, Thomas.
- Farrelly, John V.
- Fitzpatrick, Tom.
- Flaherty, Mary.
- Flanagan, Charles.
- Gibbons, Martin Patrick.
- Griffin, Brendan.
- Harney, Mary.
- Harte, Paddy.
- Hegarty, Paddy.
- Higgins, Jim.
- Keating, Michael.
- Kennedy, Geraldine.
- Kenny, Enda.
- Lowry, Michael.
- McCoy, John S.
- McDowell, Michael Alexander.
- McGahon, Brendan.
- McGinley, Dinny.
- Molloy, Robert.
- Naughten, Liam.
- O'Brien, Fergus.
- O'Malley, Desmond J.
- O'Malley, Pat.
- Quill, Máirín.
- Sheehan, P.J.
- Taylor-Quinn, Madeline.
- Wyse, Pearse.
Níl
- Abbott, Henry.
- Ahern, Bertie.
- Ahern, Dermot.
- Andrews, David.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Matthew.
- Brennan, Séamus.
- Briscoe, Ben.
- Burke, Ray.
- Calleary, Seán.
- Collins, Gerard.
- Connolly, Ger.
- Cowen, Brian.
- Daly, Brendan.
- Dempsey, Noel.
- Dennehy, John.
- de Valera, Síle.
- Doherty, Seán.
- Fahey, Frank.
- Fitzpatrick, Dermott.
- Flood, Chris.
- Gallagher, Denis.
- Gallagher, Pat the Cope.
- Geoghegan-Quinn, Máire.
- Gregory, Tony.
- Haughey, Charles J.
- Hilliard, Colm Michael.
- Hyland, Liam.
- Kemmy, Jim.
- Kirk, Séamus.
- Kitt, Michael P.
- Kitt, Tom.
- Lawlor, Liam.
- Leonard, Jimmy.
- Leyden, Terry.
- Lynch, Michael.
- Lyons, Denis.
- McCartan, Pat.
- McCarthy, Seán.
- McCreevy, Charlie.
- Mac Giolla, Tomás.
- MacSharry, Ray.
- Mooney, Mary.
- Morley, P. J.
- Nolan, M. J.
- O'Hanlon, Rory.
- O'Keeffe, Batt.
- O'Rourke, Mary.
- Power, Paddy.
- Reynolds, Albert.
- Smith, Michael.
- Stafford, John.
- Treacy, Noel.
- Tunney, Jim.
- Wallace, Dan.
- Walsh, Joe.
- Walsh, Seán.
- Wilson, John P.
- Woods, Michael.
- Wright, G.V.
Tellers: Tá, Deputies Harney and McDowell; Níl, Deputies V. Brady and Briscoe.
Question declared lost.
The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Thursday, 21 May 1987.