I should like to inform the House that the Chief Whips have agreed that the motion in Private Members' time tonight will be adjourned at 8.30 p.m. and will resume on Wednesday night next. Any time lost tonight may be picked up on Wednesday next.
Private Members' Business. - Health Care: Motion (Resumed).
Is that agreed? Agreed. The Members will not be disadvantaged. All the time lost will be picked up next week.
Injury time.
Debate resumed on the following motion:
"That Dáil Éireann, sharing the serious public concern about the quality of health care, calls for a fundamental re-organisation of the delivery of health services, in order to free resources which could then be used selectively to improve the quality of service and expand the provision for priority needs. The following reforms are required:
1. The establishment of An Bord Sláinte, a semi-State body, to replace the Health Boards and stremline the management and delivery of health services.
2. Cost-cutting reforms in the areas of administration, the purchase of medical and non-medical supplies, certain consultants fees, the rationalisation of laboratory facilities, the greater use of computerisation and better property management.
3. A revision of the method of funding voluntary public hospitals by the introduction of clinical budgeting and separate ear-marked allocations for National Tertiary Services.
4. The appointment in each hospital of a general manager.
5. Hospital managers and An Bord Sláinte should be specifically charged with ensuring much greater co-ordination between hospitals and Community and Primary Care Services.
6. An Bord Sláinte should draw up and implement a National Hospital Plan for acute services, including the concentration of the most modern equipment and advanced skills in regional centres of excellence, where they can be fully utilised to the benefit of the community. These centres should be backed up by the complementary provision of local hospitals with specified levels of care.
7. Improved medical management through greater development of General Practitioner Services including improved access to Hospital Diagnostic Services and Consultant opinion.
8. The re-examination of methods of payment for health care on the basis of giving incentives to preventative medicine and positive health activities."
—(Deputy Yates.)
I should like to reiterate some of the points I made last night. The first important one is that we must always remember that the health services are about people and patient care. When people criticise our health services it is important to remember that in 1987 500,000 people were inpatients in hospitals and 1,500,000 people attended hospital as out-patients and that those people had a quality service available to them.
I accept that there are gaps in the service. During my 25 years in general practice and my 16 years as a member of a health board there were always gaps in the service and the same gaps were there which are there now — waiting lists for orthopaedic surgery and the unavailability of orthodontists in the dental service. I should like to reply to something Deputy Yates said last night. Five health boards advertised for orthodontists but because they did not make themselves available only one health board was able to recruit an orthodontist from that competition.
On the question of Bord Sláinte, we heard last night about local managers, regional managers and general managers in hospitals. This is a whole new layer of bureaucracy that would cost quite an amount of money and more increased administration. I should like to know how many frontline staff would have to be displaced to allow for this administrative structure.
There was no word of what would happen to community care. I believe that there must be a local health board to provide community care for people. The health services are totally different from commercial organisations such as the ESB or Bord Telecom which are in the main providing one product and a uniform supply. Health services are totally different and I think the Deputy has fallen into the trap of seeing the delivery of health care in a very simplistic fashion. In this way one does not take account of patient needs and of the vulnerability of patients when they are ill. I believe that must be of prime consideration and I do not believe it is possible to run a health service similar to a big commercial organisation which responds to the forces of the marketplace.
I am satisfied that we have a first-class quality service which compares favourably with any other country in Europe. I am also satisfied that the Government will ensure that they continue to make that service available to the people who need it.
I should say at the outset that in order to facilitate additional speakers I will not be taking all my time in this important debate.
With whom does the Deputy wish to share her time?
Is it not possible to simply move things on and allow other Members to join in as we conclude?
If the Deputy does not indicate with whom she wishes to share her time on the Opposition benches, I will be obliged to go to the Government benches.
I intended to give some time to Deputy Sherlock.
Deputy Sherlock, is that satisfactory?
Yes.
Unfortunately, I think that inconveniences my colleague, Deputy Howlin, who is entitled to come next.
Is it possible for us to amalgamate our allotted times——
We could do it by agreement.
——and allow Deputy Sherlock in after us?
Deputy Harney has half an hour at her disposal. I am asking her to indicate now with whom she wishes to share that time. It can be with one or two Deputies.
May I amalgamate my allotted half hour as well so that we can share the hour between the three of us? May we share our time jointly with the Deputy from The Workers' Party?
After half an hour I shall have to call a speaker from the other side of the House.
Does that mean that, following Deputy Harney's contribution, I will be called?
Yes, provided the Deputy does not take up all of the 30 minutes available to her.
I move amendment No. 3:
To delete all words after "priority needs" in the fourth line and substitute the following:
"Recognising that it is now estimated that in excess of 10,000 public patients are on waiting lists for hospital admission, many of whom are awaiting hospitalisation for over 12 months, calls on the Minister for Health to:
1. Introduce a new funding system for hospitals which would guarantee equality of access to essential services for public and private patients.
2. Alter the present arrangements whereby a large number of hospital beds are currently occupied by long stay patients at a cost of up to £1,400.00 per week, many of whom could be more appropriately cared for in properly regulated nursing homes for a quarter of the cost.
3. Improve the incentives for General Practitioners to become more involved in many diagnostic services and thereby releasing much of the unnecessary pressure on hospital services.
4. Promote practical proposals for the development of community health care, involving an expansion of the home-help and community nursing services, and
5. Rationalise the number of Health Boards given that one of the existing eight, the Eastern Health Board, caters for 41 per cent of the population."
I have to say at the outset that, by and large, I agree with 90 to 95 per cent of what Deputy Yates had to say in his opening contribution last evening. It is extremely important, at a time when this country is spending over £1.2 billion of public expenditure on the provision of health care, that we do everything we can to ensure that the health services are delivered in a cost-efficient and effective manner. This year we will spend double what we spent six years ago on the health services. If that rate of expenditure continues by 1994 this country will be spending something in the region of £2.4 billion on the provision of health care. Nobody in this House or country could argue that the doubling of expenditure in six years has resulted in our population being twice as healthy or in the quality of the service being twice as good.
I was interested to read in the first page of the Minister's contribution last evening that he rejected utterly the comments of those who say that the quality of care in the health service is not up to the highest standard. He drew a distinction between what he called the quality of the health care available and the gaps obtaining in the service. While I respect the Minister's right to do that, to those who cannot get health care when they need it very badly, the high quality of the health care available to those who can get it is irrelevant.
The main problem in the health service is not a lack of resources but rather a total lack of direction and leadership, as the Minister for Health abandons his responsibility and watches public money being squandered by refusing to put in place the procedures necessary to ensure that all our citizens have essential health care when it is required.
This Government rightly have received the support of the public in their efforts to curtail Government expenditure and restore order to the public finances. Indeed there was scope for public expenditure cuts in areas like health. But in the implementation of the more cuts approach to health, this Government and Minister have gone about it in advance of setting in place the kinds of procedures and management structure that would ensure that our citizens would have easy access to a caring, high quality health care service. The Government's approach to health has resulted in many people being subjected to unnecessary hardship. I refer in particular to the old and to sick children. We have now arrived at the point — it is difficult to get accurate figures on exactly how many people are on waiting lists — that I am told reliably there are 10,000 people awaiting essential hospitalisation today, many of whom have been a hospital waiting lists for over 12 months.
The present position in Dublin is so bad that, generally speaking emergencies only can now be admitted to hospital. For example, there are 4,000 people on a waiting list at the Mater Hospital and 2,000 at St. Vincent's. In the Mater Hospital a total of 390 of the 450 beds have been put at the disposal of the accident and emergency services. Even the 20 beds in the coronary care unit frequently are filled by accident and emergency cases. What is particularly worrying is that the position should be so bad at the onset of the winter. With the bed shortages affecting accident and emergency services and resort to trolleys to accommodate patients overnight the position is likely to worsen as the winter unfolds with its inevitable unbelievable increase in illness and hospital admissions. At this time the really vulnerable people are the elderly and children. When we see such appalling problems — with elderly patients being detained overnight on trolleys — we must ask what will be the situation in the months of December and January next.
Equally it is appalling and insensitive that children should have to be detained overnight on trolleys, as has happened in Temple Street Children's Hospital. The position in children's hospital in Dublin has become so critical that, on several nights in the month of September, there were no beds available in Temple Street Hospital, Harcourt Street Hospital or Our Lady's Hospital for Sick Children in Crumlin. As a result sick children were accommodated on trolleys in casualty at Temple Street Hospital even in cases where they were on intravenous drips.
There is now a three year waiting list for ear, nose and throat operations at Temple Street Hospital. That hospital now has to function with two-thirds of the beds and staff they had two years ago. Although Temple Street is the busiest children's casualty hospital in Ireland or Great Britain — dealing with over 56,000 casualty patients last year — a detailed report submitted to the Department by the hospital still awaits action. I am pleased that some of the professional medics working in Temple Street Hospital saw fit to speak out. To those who tell them that they must remain quiet in order to remain open I say they are being responsible when they make the public, and particularly politicians, aware of the chronic conditions under which they have to work and the serious implications for sick children in this country.
In any re-examination of the future role of Temple Street Children's Hospital — and there is much speculation about its future — the Minister for Health must realise that that hospital is situated in a deprived part of Dublin city. There are virtually no general practitioners living in that huge catchment area. I believe the expenditure of the £3 million necessary to refurbish Temple Street Children's Hospital is urgently required. I hope the Government will see their way to approving that expenditure. It is wrong that this Government, or any Minister, should see fit to allow a situation develop in which many children are now being referred to adult hospitals that have no paediatricians, no paediatric nurses, with expert knowledge in the area of child care. That is inappropriate. It is also bad for the development of the health services in this city.
That happens all over the country outside of Dublin.
It is a tragedy if it does. Another matter that deserves to be brought to the attention of this House is something that has been brought to my attention. Recently, I understand that two women gave birth in the casualty ward of Ennis General Hospital. They did so while male patients lay in adjacent beds. In my view that is a disgrace and is totally unacceptable. Regardless of the position of our national finances I do not believe it is necessary for women to give birth in circumstances in which there are male patients in adjacent beds in the same ward.
I drew attention also in the course of the Estimates debate in this House some months ago to the difficult position obtaining in the surgical wing of the Coombe Hospital in Dublin. That position appears to have deteriorated since I drew attention to it in this House. Many public patients' appointments are being cancelled by telephone on the morning they are due to attend or to be submitted for vital operations. One can imagine the way women feel who are subjected to such treatment — the trauma of the operation alone, the kinds of arrangements they must make to have their children cared for, all of the planning that goes into preparation for a stay in hospital. One can imagine how they feel when appointments are cancelled not just once but, in some cases, twice or even three times.
It is obvious that more and more of existing hospital beds are being preempted for accident and emergency cases reducing continuously the number of beds available for elective admissions. The accident and emergency services are so disorganised, with no overall direction or plan, they require urgent attention particularly in the Dublin area. Some months ago when this problem was brought to the attention of the public by the national media the Minister promised to set up a committee and I believe it is only this week that committee are to meet and to get down to work. In addition I am told they have been given no time limit to their deliberations; if they sit forever it will not make any difference to this Minister.
It is my belief that one of the main problems vis-à-vis the crisis that has arisen in relation to hospital admissions results from the manner in which our hospitals are funded. At the beginning of each year hospitals are allocated block grants. There seems to be little or no control over how they use this money and there seems to be no direction from the Department or the Government as to which area of the hospital service various amounts of money are to be applied. The result is there is no incentive for hospitals to treat public patients, in fact there is a clear disincentive to treat them. Every public patient costs them more, every private patient brings them in more money. That is why St. Vincent's Hospital recently converted one whole floor from public to pay beds. It is wrong to have instant hospital treatment for those who can afford it and a long waiting list for the less well off. This two-tier approach to essential health care is unacceptable and it is only by introducing a fundamentally different method of funding hospitals that the current conflict between public and private patients will be resolved.
Many hospital beds are currently occupied by long-stay patients at a cost of up to £1,400 per week but many of whom could be more appropriately cared for in private nursing homes for as little as £200 to £300 per week. We need to introduce new and comprehensive regulations for private nursing homes and fund the placement in such homes of those long-stay patients who do not require beds in high tech hospitals. Families too, if given a little incentive, could be encouraged to take home many of their elderly relatives. There is a tendency on the part of some general practitioners to refer patients to hospital for treatment which could be carried out in a well organised doctor's surgery. Recently, when visiting a GP friend, I noticed that somebody came to his door asking for a letter of referral to a hospital. It seems to be too easy to write the letter and send the person off to a hospital.
The tax incentives currently available to GPs need to be more widely publicised to encourage them to improve the facilities in their surgeries. Many routine diagnostic tests, cardiographs, blood, urine and chest tests can be conducted in a surgery for about 20 per cent of the cost in a hospital. Movement in this direction would greatly relieve much of the pressure on the hospital service.
I want to refer to the situation in relation to Cavan Hospital which was built at a cost of £26 million to the Exchequer and is costing £500,000 per annum to maintain and heat. I understand that perhaps overnight the Minister may be allocating some money for the opening of the hospital, which would be a good thing. However, I wonder if he will bite the bullet in relation to a decision that needs to be made regarding Monaghan Hospital. I am sorry that the Minister has left the House. When Deputies in other parts of the country saw fit to criticise decisions made in their areas, the Minister has always been very brave and courageous in telling them how cowardly they are and so on. I look forward to seeing whether this Minister will take his courage in his hands and take the necessary decisions in his own constituency.
In a debate like this it is appropriate to refer to the present problems being experienced by the VHI. I understand that the annual report for February 1987 to February 1988 which is currently before the Minister for Health and which he has taken a long time to lay before the Dáil, will show an underwriting loss of approximately £15 million. If this is the case it is an alarming figure and one which threatens the viability of the company. The underwriting losses for 1986-87 were £5.3 million and if the figure of £15 million is accurate for 1987-88, it is almost a threefold increase in their underwriting losses in one year alone. This comes in a year when the VHI subscription increased by over three times the rate of inflation. These losses have occurred because of the increased demand for VHI cover. People heretofore entitled to free hospitalisation have opted for VHI cover in order to get the much needed hospital bed. The increased cost of private beds in public hospitals is also a contributory factor and, of course, the huge cost of de luxe health care in the Mater Private Hospital and Blackrock Clinic. The combination of the above three reasons have resulted in the VHI facing a serious financial crisis and that is why they have applied to the Minister for an increase in the premium. They are also trying to get the private hospital to agree to a new average daily cost payment system. The VHI subscriber will obviously now be asked to pay more money for less cover. The problems are urgent and require immediate Government intervention. I also ask the Minister to make available to the Members of the House the VHI report for the year 1987-88.
I also want to briefly refer to the new capitation system which the Minister proposes to introduce for the GMS scheme. This new system will replace the present fee per visit method. While I agree that it was time for a review of the present way of remunerating doctors participating in the GMS scheme, we are going from one extreme to the other. The present openended system, whereby doctors were paid for every time they visited their public patients was aften an incentive to see a patient when it was unnecessary to do so. However, to go to the other scheme is equally wrong and will cause a lot of hardship, to medical card holders in particular. The GP scheme in general works very well; it is the one area of the health service about which I never get a complaint. People have easy access when required to their GP. It is interesting to note that fewer than 40 per cent of GPs in the GMS scheme have voted in favour of the new proposals and only 58 per cent of doctors voted in the recent IMO ballot on the proposed new scheme.
There is widespread concern among GPs about the new proposals and particular concern in areas like my own constituency where a high number of people are dependent on the GMS scheme and where there are many medical card holders. It is not just the reservations of the GPs themselves; their own professional college of general practitioners, the body who are concerned about professional standards in the GMS scheme, have expressed their concern at the lack of specific incentives to continue domiciliary visiting of the terminally ill, the chronically ill, the elderly and the handicapped in the community. Their criticism is worth taking on board and the Minister must look again at his new proposals.
On examining the memorandum, I note that there are many unanswered questions. For example, the doctors operating the scheme will be expected to work for 40 hours per week but, an additional payment will be made to them if they see a patient between 10 p.m. and 8 a.m. I wonder what kind of remuneration doctors will get for people they see after their normal finishing hour and before 10 p.m.
There are also problems in relation to the doctors who will not agree to go into the new scheme. Does the Minister propose to end their present contracts? What action does he propose to take in that regard? I also note that women working in the GMS scheme will be entitled to only 14 weeks paid maternity leave if they have lists of over 500 patients, yet study and other leave will be available to those who have only 100 patients.
Earlier this week there was a lot of publicity about the introduction of the new MMR vaccine. The level of publicity led to a huge flow of interest and many GPs were contacted by their patients inquiring if they could avail of the new vaccine. Doctors in the Dublin area have informed me that, on making inquiries, they were told they could only have three vaccines for both this week and next week. I know there are difficulties in introducing such a scheme but if it is widely publicised it is important that all the necessary back-up facilities are available because if people demand something like this and do not get it they lose interest. It is a question of better organisation. That seems to be the problem throughout the health services. There is great scope for a reduction in the amount of people working in administration. The Minister criticised Deputy Yates's call for various managers. I might not necessarily agree with Deputy Yates but we badly need a new management structure throughout the health service.
I have reservations about the introduction of a Bord Sláinte recommended by Deputy Yates. I cannot see what role a semi-State body such as a Bord Sláinte could carry out which the Department of Health could not undertake. I agree that there is great scope for an amalgamation or a reduction in the number of health boards. If one health board can cover one-third of the population, surely we do not need seven health boards to cover the remining two-thirds of the population? There is scope for rationalisation there, although I am not sure if the abolition of all the health boards is the answer.
I am pleased that the Minister took on board a suggestion made by my party some time ago to abolish the local health committees. I served on a local health committee for quite some time and I could never understand its relevance. It unnecessarily tied up administrators and professional people who should have been involved in other levels of the health service. We have come to a time of great opportunity and we must all reassess the manner in which public expenditure is used and the manner in which health care services and others are delivered. The Government should not miss the opportunity to set in place the kind of structure and to take on board the many suggestions that have been made by many people for change.
I accept that making changes in the health service because of the power of vested interests is fraught with difficulties in relation to vested interests. Everybody wants to protect their own corner, but at a time of financial restraint it is imperative on all of us who are responsible and realise there is not a limitless pond of money to come up with practical suggestions for change to take on board many of the difficulties that could be resolved if politicians showed a little courage, a little leadership and gave a little bit of direction. Many corns may have to be stood on if the right decisions are to be made, and if this Minister sets about doing that he will have my support and that of my party. Above all else we must ensure that the citizens of this country, the sick and those who are vulnerable and cannot afford to pay for health care, are not deprived and do not have to put up with an inferior or second class health service.
Deputy Joe Sherlock. I understand the Deputy has ten minutes.
I am glad of the opportunity to contribute to this debate. The amendment proposed by The Workers' Party reads:
To delete all words after "health care" in line two, and substitute the following:
"and while noting the need for a fundamental re-organisation of the delivery of health services, recognises that the immediate crisis in the health service and particularly in our public hospitals, arises from the cutbacks imposed by the Government, and therefore calls on the Government to end its policy of indiscriminate cutbacks and to ensure that hospitals and other areas of the health services are provided with the finance and resources necessary to provide an acceptable and effective level of health care."
The whole issue is that the level of health care being provided is not adequate, therefore, perhaps resulting in the death of people who should be admitted to hospital at a much earlier date.
The first thing I would like to refer to is the inequity in the distribution of the funds in present circumstances when the health board get their allocation. In regard to the Cork area, whoever would have thought about the planning of a 600 bed regional hospital just a few years ago while at the same time we were told there was a need for a second general hospital on the north side of Cork city? This is where the planners of our health services have wasted public money, resulting now in the level of service provided not being adequate by any means. In that regard, lack of equity in distribution, I mention our own hospital, Mallow General Hospital, a 101 bed hospital which £2.5 million would run for a year. In the Cork city area the voluntary hospitals can get their allocation. I refer to this because of the duplication of services. I am sorry the Minister is not here to hear me because the present Minister for Health said to the Southern Health Board and the hospitals in Cork in 1987: "In the duplication rationalise the services." I am talking about the Regional Hospital, the Bon Secours, the Mercy Hospital, the South Infirmary, the Victoria Hospital, all providing duplication of service. The proof of that is that the Minister's Department approved the expenditure for a CAT scanner for the Mercy Hospital in Cork and one month later he had to provide the finance for the same service, a CAT scanner for the regional hospital. I ask the Minister to tell us when he is replying what he was doing about the policy he had insisted on, that is rationalisation of the services in the Cork city area.
At the same time our general hospital in Mallow was cut in a non-pay budget by 25 per cent. Where is the equity? We were advised that that was attributed to the amount of work of the previous year. Months ago the Minister said it was not beds that were necessary, and the volume of work, the amount of day care work provided at that hospital was not provided for. Let me say from this position that if the Southern Health Board, the Minister, or the executive of the Southern Health Board think that by stealth they are going to reduce Mallow hospital to provide a lesser service than is required for that 72,000 population, they have another think coming.
I understand that 954 people have accepted voluntary redundancy within the health service. We have 7,000 temporary workers in the health services, and the offer of 850 permanent jobs has no significance in the light of that fact.
The Minister has previously stated his concern about community care. I understand that in Cork we would need at least 50 district health nurses to bring the figure in the Southern Health Board area up to meet the national average. Is community care being provided there? People cannot be provided for at home when they reach the stage of needing constant care and attention and instead of getting them from the Southern Health Board they are getting them from private institutions which are springing up all over the place in the towns and villages where families of working class people have to pool their resources to pay for their relations who cannot be catered for at home. That is the level of service in community care.
A most iniquitous system of this State is the fact that the PAYE sector's tax is not deductible before assessing eligibility for medical cards. What justice does the Minister see in that system? The eligibility is based on the gross income which bears no relation to the net pay. That is resulting in the mothers of small children going to the doctor only if they can afford to pay the doctor. Very often they do not and end up in hospital. In many instances they will not go to a chemist simply because they cannot afford to pay. That is scandalous. I am giving those examples to highlight the inadequacy of the level of health care being provided as a result of the cuts that are taking place.
I take this opportunity to mention again what is now tantamount to a scandal. Consultants are paid a salary by the health boards, but because there are no beds or maybe not sufficient beds they are treating certain people as private patients and forcing people to take out VHI. Last year the estimated loss for VHI was £18 million. That went to subsidise private medical care. We should not have any doubt about that because the consultants who were forcing people to take out VHI and treating them and being paid by the VHI are the same people who are being paid a salary and should have been treating those people in the public service. That must not be allowed to continue. For all patients to have the right of access to treatment and control over their care the role of the VHI must be changed. The consultants' contract must be changed to ensure that consultant doctors have an economic interest in seeing and treating all patients on the same basis. A charter of patients' rights should be agreed, introduced and promoted, and democratic accountability of the health services should be strengthened at national and local level.
First, I wish to take this opportunity of welcoming Deputy Ivan Yates as Opposition spokesman on health for Fine Gael and I wish him a very long stay in that august position. Indeed, I wish Deputy Allen the best in his role as mayor of Cork which is the reason he cannot be here as spokesman.
I must confess to being somewhat mystified as to the source of the Labour Party's figures for GNP. I am not sure whether the 1986 figure used relates to the approved expenditure for that year or if it takes account of the unapproved excess expenditure which occurred in that year, due to the mismanagement of the health services by the Coalition Government.
As the Minister has already stated, over-expenditure of £55 million was allowed to accumulate by the end of 1986 in the health agencies by this mismanagement and the annual level of recurring over-expenditure had reached a figure of £35 million. The defence presented last night that health boards simply overspent is admission of a complete reneging by Government of their responsibility to govern. This led to the walk out of that Minister at that time because he was not prepared to grasp the nettle and manage the Department of Health in a proper way.
The result of this irresponsibility was that, in regularising the expenditure position, Exchequer funds, which should have been used to provide services, had to be used to meet interest charges and to reduce overdrafts. We are still paying for that over-expenditure which was not authorised and would not have been approved by any other Minister. The factual position in relation to 1989 is that total public expenditure on health will be 7.1 per cent of GNP and not 6.2 per cent. This is a most acceptable figure for a country at Ireland's stage of development, and particularly in the context of our current financial difficulties.
The amendment refers to Ireland's position as regards other OECD countries. International comparisons of health expenditure can be misleading. Expenditure classified as health expenditure varies widely from country to country. For example, cash allowances such as the disabled person's maintenance allowance are classified as health expenditure in Ireland but not so in the UK. It is also extremely difficult to measure expenditure on health outside the publicly funded services. The OECD recognises that analysis, based on public expenditure only, will not provide a complete picture of overall health expenditure. In at least seven OECD countries the privately funded element accounts for over 25 per cent of total health spending.
The OECD also recognises that analysis of changes in real expenditure relative to real GDP "cannot be used to compare real quantities of health services across countries". The amendment also refers to our dependency ratio in the context of international health expenditure comparisons. Yet, the OECD admits that detailed spending weights for the very old and very young are not generally available, and that these are necessary for better estimates.
If, however, the Labour Party insists on using these comparisons, let me point out that Public Health Expenditure expressed as a percentage of gross domestic product, which is one basis of comparison used by the OECD is higher in Ireland than in countries such as Denmark, New Zealand and the United Kingdom.
As I mentioned earlier, we will spend about 7.1 per cent of GNP on public health services in 1989. This is a decline in the level obtaining in the earlier part of this decade. However, it is in line with the international trend. The OECD confirms that for all countries, over a four year period real health expenditure increased only half as fast as real gross domestic product.
Having said that the provision now determined for 1989 is the most we can afford, let me add that this Government are making every effort to ensure that this provision, which will allow expenditure of over £1,350 million to be generated, is used with maximum efficiency. I know that the word "efficiency", in the context of the health services, is viewed with scepticism by many. Efficiency is not, and should not be, the overriding consideration but is foolish to imply that it is irrelevent.
If services are less costly in inevitably follows that scarce resources can be freed up for other areas. Realistically, more efficient management of existing resources is the only way in which future developments can be funded. The Department are engaged, with the full co-operation of the major health agencies, in a comprehensive cost containment exercise. This pooling of knowledge and resources will be or great importance in the achievement of value for money. In addition, detailed work is underway in examining the allocation process, again to ensure that resources are so distributed as to gain the maximum benefit.
The Labour Party amending motion refers specifically to receipts from the amnesty scheme. These receipts are very welcome indeed. However, it must be clearly recognised that they are once-off boost for the Exchequer and will result in a lower Exchequer borrowing requirement this year. This is something that the Coalition Government, and particularly the Labour element of it, were not prepared to tackle. We have succeeded where they failed. I wish to take this opportunity to congratulate the Minister for Finance and his staff on their excellent results in collecting £500 million as a result of the amnesty.
While an easy option would be to spend this once-off source of funding we simply cannot afford to do so. Notwithstanding this revenue, we are still borrowing huge amounts this year to meet day-to-day spending — too much of our resources are still going to pay debt servicing costs, about £2 billion in 1988 and even with the lower Exchequer borrowing requirement the ratio of debt to GNP will continue to increase this year. One can realise what we could do if we had £2 billion available for job creation at this stage. It would be dramatic and remarkable. Nevertheless we must point out that the national debt increased from 1972 to 1977 by about £12 billion, an extraordinary increase in such a short time, more than the total increase in the previous ten years.
The national debt currently stands at over £24 billion. Even taking into account the results of the amnesty, the opening budgetary position for 1989 is well above the range of 5-7 per cent of GNP needed to stabilise the debt GNP ratio. The determination of this Government in meeting their financial and economic targets and improving the economy and employment projects have rightly received widespread praise throughout the community. If we do not carry on with the present policy then the whole health service will be undermined. It is in the national interest that we have decided to use the £500 million from the amnesty to reduce our borrowing requirements. We are not prepared to slacken in our efforts and indeed the general public do not wish us to do so. While I may criticise aspects of Deputy Yates' perspectives on our health services and his proposed solutions, I acknowledge that his motion is realistic to the extent that he, unlike the Labour Party, accepts that the additional resources over and above those which have been approved are not the answer to the present difficulties.
I admit to a certain level of puzzlement arising from the references in the printed media this morning to a speech delivered by Deputy Harney on the debate on health care in this House last night.
Do not criticise the media.
To my certain knowledge, the Minister and Deputy Yates were only designated speakers and yet while Deputy Harney was in the Chamber she did fot speak on this debate. The phantom speech will, I am sure, be given the recognition it deserves in the Dáil debate. Therefore, I would recommend that she would first deliver the speech——
I do not write what is contained in the newspapers.
At this point there is no coverage but I am sure that the Irish Independent will be more cautious when receiving speeches from Deputy Harney in the future to ensure that the speeches had been delivered.
Get on to page 14.
We received the edited version.
I would recommend that because in fairness it is misleading to the public——
On a point of order, when I am going to make important speeches, I circulate copies in advance.
Even if they are not delivered? That is why I am delighted that RTE record the deliberations here for rebroadcasting on radio because at least they realise——
Talk about the health services.
It is important that I correct this. At least RTE realise who make speeches and who do not make speeches in this House. It is very important that I make that point. My colleague, the Minister for Health, Dr. O'Hanlon, spoke on this debate here last night in great detail but I do not think his speech got the coverage it deserved in the Irish Independent this morning. In fact he made an excellent contribution to this debate but it was a speech which was not made which received coverage it did not deserve.
The necessary measures which have been taken and which the Minister for Health referred to last night are clearly aimed at achieving the maximum efficiency in our health care system, including our hospital sector. I would like to place on the record at this stage my admiration for my colleague, the Minister for Health, Dr. O'Hanlon, and the work he has put in in the Department over the last 18 months. It is extraordinary what he has achieved in that period. It is only fair that I should say that because I appreciate more than most, having worked with him since March 1987, the amount of effort he has put into his portfolio in the Department of Health. He has been an outstanding success and I would have to go back some years to be able to name another very prominent Minister in this field.
This very rationale is underpinned by the fundamental truth that the greater the level of efficiency and effectiveness in the system, the greater the benefits to patient care, the greater the number of patients who can be treated and the greater the response can be to non-urgent elective interventions. It is true that if we do not provide medical care efficiently we are actually depriving potential patients of care from which they could benefit. This truth is not a conceptual issue which has no basis in the reality of how we manage and determine the direction of our health services.
The message of this Government not only in the area of health resources but in general economic and social policies is that we should strive to become more productive and more efficient, not as an end in itself nor as an objective divorced from a wider strategy, but rather as a part of the strategy in the health services, for example, which ensures that a procedure or process can be performed better and this means that more people within the system will benefit. This message is beginning to become part of the everyday actions of our health sector managers; clinicians and para-medical staff and this is directly as a result of the Minister's and the Department's initiatives in the positive management and discretion which has been applied to the system as a whole. It is very important that the public realise that the system is far more efficient and that efficiency is vitally important in the delivery of health services.
We cannot live under the idea that we can give everybody all the health care they demand. Rationing of health care is inevitable as society cannot nor will not pay for all of the services modern medicine can provide. The burden on society would be too great. This truth has emerged, not fully and not universally, I hasten to add, in our approach to the health services.
At the macro-political level there is little difficulty with what I have said. The consensus which has emerged in political opinion ensures its success. It must be emphasised that limited resources actually means a limitation of services and on the capacity of the State to intervene in the manner and, more importantly, to the extent to which society would ideally wish. In the democratic process, the parameters of society's investment in its health services is as approved by the Dáil. In deciding on the financial resources allocated to health, Dáil Éireann, on behalf of the citizens it represents has set the parameters beyond which it is not prepared to go in the interests of services generally. The overall figures approved, despite what Deputies have said, are sufficient to provide a quality service to those most in need and this is accepted by the major political parties.
A global figure for health services approved at national level has emphasised in recent years that there is a unity in the diversity of health services in that additional resources devoted to specific services in reality means an equivalent reduction in other areas. The concept of opportunity cost has been given a very real and practical expression in the last two years. I am convinced that there are still many further practical lessons to be learned in properly applying this concept. The Minister and the Department at the centre have a particular responsibility to the health services as a whole and in the equitable manner in which they ensure a balanced development throughout the services generally. The Minister and the Department have exercised their responsibilities admirably. I must say that we, in this country, are fortunate to have the level of services we have; we compare favourably with any other country in the world. We should keep that fact in mind at all times when people criticise the health services.
A consequence of limited resources is that there are greater demands to determine priority services and an acceptance that meeting priority needs implies that services cannot be provided in areas of marginal need. This is so in order to ensure that those most in need of care receive such care in an appropriate and timely manner. In addition, it is imperative that those who avail of health care that arises from investment by the State and can afford to pay for such resources should make an appropriate contribution. This contribution on those who can reasonably afford to pay is used primarily to improve hospital services, expand their development and ensure that sufficient income is available to hospitals to continue to provide services for those who are unable to pay. In that regard it should be noted by the House that the Labour Party when in Government did not levy charges sufficiently on the categories of persons who could and should make a greater contribution to the use of State funded facilities.
Has the Minister of State reread his Minister's statements of that time?
The extensive reorganisation of the acute hospital services undertaken in the last 18 months or so was badly needed. We must recognise that the problem had to be tackled and we were prepared to take the appropriate action, which we have taken over the last 18 months. It was simply not possible to sustain all the hospitals and all the beds which we had in the system within the level of the resources which this House accepted as being adequate to fund a viable and effective health care system, in particular, it was not possible to meet the demands which advances in medical science and technology make at the scarce resources at our disposal.
The motive for initiating the review was positive. This was to ensure the provision of a hospital service which could cope in a caring way with all the genuine demands placed upon it which is efficient and effective and which is in line with our ability to fund it. Unfortunately, much of the debate and media coverage centred on what were perceived to be the negative aspects such as bed and hospital closures. This I can well appreciate since the public at large and in particular local communities can be alarmed if they see hospitals being closed and bed numbers being reduced. I can fully sympathise with their concerns and worries at particular times and can appreciate the trauma which these closures cause in a community.
In a period when funding has to be restricted in the interests of the economy as a whole it is necessary to concentrate the available funding to maximum effect. For example, it is more efficient and effective to ensure that the number of beds in the system are adequately funded rather than to spread the available funding too thinly over the greater number of beds. What is important is the quality of the care and attention provided in hospitals.
I am now satisfied there are sufficient hospital beds to meet all genuine demands apart from a few cases where there have been traditional long waiting lists, such as orthopaedics and ENT. I am very well aware that our hospital services have had a difficult two years and it is now necessary to consolidate and capitalise on the initiatives which had to be taken — particularly in areas where large-scale reorganisation has taken place.
As the general hospitals' programme consumes approximately 50 per cent of all spending in health, it is absolutely necessary that these services are organised in a way which enables us to deliver an adequate and acceptable level of service at reasonable cost so that funds can be made available for the necessary strengthening of the other services.
A point which is frequently overlooked is that the delivery of health care in hospitals is a dynamic rather than a static system. Advances in technology have had a huge impact on hospitals and thus have, in turn, forced hospitals to critically evaluate their methods of operation. There is a greater emphasis now than in the past on concentrating resources on out-patient and day facilities.
I am greatly heartened to see that practically all hospitals are now adopting this approach with the result that far more patients than heretofore can be treated at a substantially reduced cost. Also the developing technology and improved management of patients means that the length of time patients spend in hospital has been considerably reduced.
I think it is very significant that, while practically all hospitals reduced their bed capacity in 1987, very many of them in fact treated more patients than in 1986. That is a fact of life and should be recognised. These innovations indicate that the actual bed complement of a hospital is not in itself the critical factor. Other factors, such as diagnostic support facilities and improved patient management, can be and are of greater importance and these are the areas on which our attention should be focused rather than on bed numbers as such.
Deputies mentioned the situation in my own constituency. The rationalisation which took place ensured the survival of the county hospital in Roscommon. I had to face great difficulties in relation to that issue.
There will be ructions over the regional, and the CEO will be back on that.
I understand the concern of Deputies in relation to facilities——
As does the Minister's colleague, Deputy Doherty.
The steps taken have ensured the survival of that hospital, a fact about which I am delighted.
(Interruptions.)
There are many other positive developments which are generally overlooked in the publicity which the mere mention of closures attracts. The new Beaumont Hospital opened its doors in November 1987 and we can now be proud that we have one of the most modern and advanced hospitals in Europe.
I think the media have concentrated too much on bad news. They have not recognised the excellent work that has been done in the health area. In my view, they have been used by others for their own ends. Unfortunately, good news does not make the headlines. I hope the media will be more responsive to good news.
Frank Dunlop is doing a great job.
I refer to the phenomenal success of the new Beaumont Hospital which Fianna Fáil opened, but which had been left idle during the Coalition's period in office because of an unseemly squabble——
What about Cavan?
No squabbles, fundamental principles, about which the Minister knows nothing.
There were more private beds opened when the Coalition were in power and Deputy Barry Desmond was Minister than at any other time.
(Interruptions.)
I do not object to Deputy Mitchell, Deputy Yates or Deputy Harney making their point on this subject, but let us be honest and cut out this hypocrisy.
We did not close public beds but the Minister is closing public beds right, left and centre.
Deputy Howlin, please. I regret we do not have some form of anaesthetic here with which to put some Deputies to sleep when others are speaking. Deputies should recognise that there is a time limit and they should listen to the Deputy in possession.
The Minister is bereft of any worthwhile contribution.
The same applies to the unrealistic policies of The Workers' Party. They do not worry where the money comes from.
The Minister is inviting comment.
They make irresponsible statements and grab the headlines.
What about the old, the sick and the handicapped——
Deputy Howlin, please.
Funds were also provided which will enable other new hospital developments to be commissioned at an early date. These include the new hospital at Cavan and the new developments at St. James's, the Mater, Mullingar and Castlebar, all positive developments which have not been recognised at this stage. These facilities will add greatly to the hospital services in these areas and are further evidence of the commitment of the Government to ensure that we will continue to have a strong and vibrant general hospital service in which the people of Ireland can have confidence and pride.
Particular attention has been given to the long-standing problems concerning elective orthopaedics. I would point out that the recent rationalisation of services in the Dublin area has allowed the Minister and the Department to greatly improve the elective orthopaedic services previously at Dr. Steevens Hospital now provided by the Meath and Adelaide Hospitals.
A development programme has been agreed with the hospital authorities in Cappagh and the Arthritis Foundation by which the theatre facilities in the hospital can be improved. This will further enhance the services available. I can sympathise with the people involved, but this problem did not arise under this Government. It has been there for some time, but we are committed to improving the situation.
We are moving towards shaping a health service which is affordable and sustainable. Two critical areas are being addressed. We must have an acute hospital system which is geared to our ability to pay, which is effective and caring and which is efficient. Alongside it and linked to it at all vital points, we must have a primary health care system which is capable of doing many of the things now done in hospitals.
In adapting the acute hospital system to our present circumstances, we must take a number of important decisions. We must decide on the level of funding we are prepared to devote to this sector of the service. In making this decision, we must ensure that there are adequate funds for other services, including primary health care. We must organise the system so that each hospital within it is medically viable and gives a quality service in a businesslike manner. We must also quickly develop a form of primary health care which provides a real and available alternative to hospital care.
Specific guidelines were set down for health agencies on how they should frame their budget to ensure that the basic fabric of our health care system remains intact while at the same time ensuring that the best possible service is delivered within the amounts available.
We are now telling the health boards their funding for 1989. This is efficiency, and will ensure that they can plan ahead. They will have plenty of opportunity to meet and discuss the allocations which will be decided by the Minister, the Government and the Department and which will be notified to the health boards in early November.
Substantial increases?
When?
The health boards will be notified early in November. This will give an opportunity to decide on their strategy for 1989 well in advance. When we came into office in March 1987 the allocations were not made, the budget was not in place and there was total inefficiency in Government at that stage. The country was being very badly managed.
With your help.
As I said, we took over in March 1987 and had to produce a budget for the remainder of 1987, and we made the allocations in April of that year. That has changed dramatically. Since I was elected to the Dáil in 1977, I cannot recall, up to now, Estimates being discussed in the House in October. The Government are now giving Members an opportunity to put forward positive viewpoints on the Estimates before the budget. I am delighted that we are getting an opportunity to discuss in the House the health services on a regular basis. We are being given an opportunity to outline future strategy. I am satisfied with the work being carried out by the Minister and the Department of Health. I should like to pay tribute to the officials of my Department for the work they are doing. Everybody in the Department is working hard to ensure the best possible delivery of health services.
I should like to advise the House that I will be seeking the same interruption-free audience for the next speaker, Deputy Howlin, as I endeavoured to seek for the Minister of State.
There is some limited scope there.
In an earlier comment the Leas-Cheann Comhairle asked for an anaesthetist for the House but the contribution we heard from the Minister of State endangered the health of all Members; certainly, it was bad for the blood pressure of any Member with a modicum of concern for the health service.
It certainly did not put me to sleep.
I hope my contribution will have a similar effect. The amendment in the name of the Labour Party reads:
To delete all words after "care" in the second line and insert the following:
"(i) notes the Exchequer expenditure on the health services has been progressively cut back each year, from 7 per cent of GNP in 1986 to 6.6 per cent of GNP in 1987, 6.4 per cent of GNP in 1988, and to an expected 6.2 per cent in 1989;
(ii) further notes that as a consequence, health expenditure in Ireland, which was higher than the OECD average until 1986, is now substantially below the OECD average, particularly having regard to the high dependency ratio in Ireland;
(iii) believes that there is now a major crisis in the health services, which will, in the absence of emergency action, cause loss of life and very considerable hardship throughout the community;
(iv) believes also that there are gross inequalities in the delivery of care, as a result of the emergence of a two-tier system of health care, which has already been condemned by many organisations including the Churches;
(v) asserts that these crises must be resolved immediately, and cannot be resolved in the short term by improvements in administration, however desirable they may be in the longer term;
(vi) notes that the Government, in addition to making substantial savings as a result of underspending (in overall terms) in the current year, has also received substantial amounts of revenue over and above expectations, through the Tax Amnesty and other sources;
(vii) resolves therefore that a proportion of those savings and additional revenue, at least sufficient to restore health expenditure to its 1986 level of 7 per cent of GNP, should be set aside and allocated to the Health Estimate for 1989, and instructs the Government to make this additional allocation immediately."
It must be clear from the framing of the motion before the House that there is a fundamental difference between us and the parties of the Right about how the present crisis in the health services should be resolved. We believe that the crisis is fundamentally a problem of resources and that it cannot be resolved by a kind of tinkering around with the system or a sleight of hand proposed by Fine Gael in their motion. Last night we heard a long and detailed speech by the Fine Gael spokesman on health in support of his party's motion. I can think of no more damning indictment of that speech than that it enabled the Minister for Health of all people to point out that the Health Estimate was about people and patients and that it was impossible to talk at length about health care without mentioning people. The Minister repeated those comments tonight and similar comments were included in the contribution of the Minister of State. How bereft Fine Gael are of compassion if they allow the Minister to point that out to the House. The major difference between them, so far as I can see, is that Fine Gael are able to ignore the whole concept of care in everything they say about the health services while Fianna Fáil ignore that concept in everything they do.
I read with amazement the opening lines of the Minister's speech last night. He said that we must reject utterly the suggestion that there is a problem about the quality of health care. Where does the man live? Later, the Minister said we have an excellent service and that it was unfair and alarmist to suggest otherwise. I should like to suggest to the Minister that it is not alarmist politicians who say that we have a crisis in the health service.
The Irish Independent of 8 October last reported that:
Delegates to the fifth Irish Medical Organisation conference in Galway heard of the chronic situation in hospitals caused by lack of beds, difficulties in admitting patients, early discharges and inexperienced temporary nursing staff.
The Irish Independent of 5 October reported:
In a major development, the Irish Association of Hospital Consultants entered the debate to highlight its "grave concern" at what it described as the "accelerating" fall-off in patient care.
The serious deterioration in patient care was now "evident throughout the country" and the people mainly affected were "those least able to provide their own medical care", it said.
The Irish Independent of 6 October stated:
INO general secretary, P.J. Madden, said last night they would be seeking immediate action from matrons on a resolution at their recent conference aimed at bringing home to the public the scale of the cuts.
"We want matrons to take a stand by refusing accommodation to people left waiting on trolleys. They should not attempt to set up extra beds of temporary accommodation."
The Irish Times of 7 October carried a statement from the Irish Matrons' Association and added:
The group which represents hospital matrons yesterday called on everybody in the care of patients to make a stand on what it called "the worsening situation in our hospitals".
"We feel, therefore, that a stand must be taken by everyone involved in the care of patients — including nurse managers — to ensure that resources are made available to cope with the worsening situation in our hospitals — brought about by the drastic reduction in hospital budgets — and the restrictions on the employment of staff", the statement ends.
I have a full folder of statements along similar lines and I quoted four moderate, conservative and responsible organisations representing those at the front of the delivery of our health service and every one of them underlined one fact, we have an unprecedented crisis in health care. For the Minister, and the Minister of State, to say in the House that we do not have such a crisis, and to tell us that to say there is a crisis is alarmist represents to me a gross dereliction of duty. The Minister is either irresponsible and does not care or he is out of touch with what is happening.
We need to get back to some basic facts. The last time international comparisons about health spending were gathered was in 1984 when the OECD published a major study on the subject. At that time they found that Ireland spent 6.9 per cent of GDP on health when the OECD average was 5.6 per cent and the UK spent 5.5 per cent. It might appear from those figures that Ireland is well up in the league of health spending but the truth is that the only reason we are spending a higher proportion of our national wealth on health care is because our national wealth is considerably smaller. When per capita figures of spending are looked at the true picture emerges. The per capita figure for Ireland in 1984 in US dollars was $514; the OECD average was $722 and the UK figure was $585. In other words, we spent less on health than the Government of Mrs. Thatcher which had been systematically dismantling the national health service for four years at that time. We spent about 75 per cent of the average of OECD countries. Whatever else can be said about health spending, no one can convincingly argue that we spend too little by comparison with other countries in the western world.
Throughout the years that Deputy Barry Desmond was Minister for Health, spending on health services was kept absolutely constant at 7 per cent of gross national product. He was not just criticised for that; he was pilloried by the Members — I do them an honour in saying that — on that side of the House who now grace the Government benches. Day after day they came into this House, led by the present Minister for Health, and predicted the direst of consequences if health spending was not significantly increased. When Deputy Barry Desmond resigned from office rather than implement the draconian cuts insisted on by Fine Gael, they got their first opportunity to undo the damage that Fine Gael were proposing to inflict on the health services in the budget of 1987. What did they do? Did they take that opportunity?
They cashed the cheques.
They put into practice all that Fine Gael had promised in their own budget. They adopted the Fine Gael budget in toto. There was one slight difference. Instead of charging the poorest sections of the population for each prescription, as Fine Gael proposed to do, they decided to charge them instead for each hospital visit.
My blood pressure was raised again during the contribution of the Minister of State earlier when he talked about the over-expenditure of the last number of years, over-expenditure of £55 million. Every single health board with their Fianna Fáil majority ignored the directions of the Minister for Health and decided to run deficits that were illegal, instructed of course by the chief attacker of the Minister in the House, the present Minister for Health, Deputy O'Hanlon——
That is not true.
——who encouraged Fianna Fáil to over-spend in every Department. It is an outrage for the Minister of State to come in here tonight and say that there is a new discovery, that Fianna Fáil over-spent by £55 million. I think the Minister would blush with shame if I re-read into the record again his statements of the last four years in which he attacked the Minister for an under-expenditure in health. But of course everything changes and immediatley after the election health cuts no longer affected the old, the sick and the handicapped because Fianna Fáil were in power and they could turn everything on its head.
What have Fianna Fáil done in their 18 months in power? Eighteen hospitals with a total of 1,470 beds, have been closed; 3,617 beds have been closed throughout the country — 2,659 acute beds, 349 geriatric beds and 609 psychiatric beds. Up to the end of 1987 the staffing of health baords had been reduced by 3,163. The voluntary hospitals have lost 1,936 staff and specialist agencies have had to suffer the loss of 113 staff, 10 per cent of their total. The only area of the health service where staff was increased between 1984 and 1987 was in the mental handicap area and all of that increase occurred between 1984 and 1986. Between 1986 and 1987 there was a reduction in staff of 143 in this vital area.
It is a bottomless pit.
These statistics convey only a cold impression of the impact, in terms of human suffering, that these cuts have had on the people. The Labour Party, in statement after statement, in a motion that I put before this House and in press conferences over the last 18 months, have warned of the dangers inherent in running down the health services.
Scaremongers.
The Minister set out to scaremonger when I talked about what the Government were going to do with the drug refund scheme. It proved to be true and we forced them into reversing on that matter. I am sick listening to this scaremongering. Everybody who criticises Fianna Fáil is a scaremonger now.
You broke the country.
I am sorry, I did not recognise the Fianna Fáil chief rabble rouser coming in. I have a quote from him because I knew he would be here. In The Irish Times of 7 October Deputy Roche blamed our hospital crisis on excess drinking. He stated: “Overcrowding and long waits at hospital casualty departments are caused by people inflicting injuries on themselves due to drunkenness”. That is the contribution of Deputy Roche——
Now read the correction carried in The Irish Times on the following Saturday.
The health services of our people do not need another review. What is needed is resources. A two-tiered health service of the kind favoured by Fianna Fáil and Fine Gael is one that will further disadvantage the poorest and the weakest in our community. What is happening now in our health service is not just a scandal; it is a series of scandals piled one on top of the other. We know about the deaths that have been publicised and about the elderly patients who have had to lie on trolleys for hours on end, only because they have relatives who are willing and determined to speak out about them. We can never be sure about the legion of old people who have died alone or the patients who suffer in silence. In too many cases there is no-one to tell us about the real human dimensions of the tragedy that is unfolding and being inflicted by this administration on the Irish people.
One of the most serious aspects of what is happening in our health services is the scandal of the way in which some of our hospitals are being forced by cutbacks to treat people. Only today I have come across evidence of a most disturbing kind concerning one of our major hospitals, where patients are being subjected to a practice which is little short of theft. I am told that in this hospital pensioners admitted to public wards — patients with full medical card entitlements — are forced to give up their pension books. The pension is drawn for each week of their stay in the hospital and kept in the hospital. I intend to suppy full details of this practice to the Minister for Health, since it is in clear contravention of the Health Acts. I will be pressing him to ensure that not only is this practice fully investigated but that full restitution is made in any case where this contribution has been extracted. What is unique about this case, in my experience, is that it is happening to public patients in acute beds for relatively short stays. We all know there are instances where long-term patients are forced to pay for the services provided to them in county hospitals by yielding up their pension books. In many situations old age pensioners are left with £5 per week or less after these deductions to provide themselves with the basic necessities not provided by the health boards.
Would the Deputy supply the information to the Department as soon as possible?
I will provide full details to the Minister, as I have indicated, and I will be expecting him to act on it. Indeed, I will be pressing the Minister in this House to do that.
Indignity and cruelty are features of the service that Fianna Fáil have created. I know the Minister for Health will attempt to dismiss this charge as being emotive and alarmist. Both he and Fine Gael are much happier arguing about the arithmetic than they are about the devastation and the cost in human terms. It is time we cut through the smokescreen they want to build around this subject. All the talk about pathologists earning £250,000 a year is just that — talk.
But it is true.
If these pathologists were fired in the morning it would not produce one extra bed, although the lack of their expertise might fill another few coffins.
Debate adjourned.