Deputy Rabbitte is in possession and he has ten minutes left of the time available to him.
Estimates 1989. - Vote 42: Health (Revised Estimate) (Resumed)
Debate resumed on the following motion:
That a sum not exceeding £1,144,905,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1989, for the salaries and expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain services administered by that Office, including grants to Health Boards, miscellaneous grants, and a grant-in-aid.
—(Minister for Health)
I want to make some definite proposals to deal with the gross inequities I referred to earlier of the two tiered health service in a way that the provision of finance alone cannot do. I would like to believe that this Minister, unlike his counterpart in Britain, does not believe in the two tiered health service as a means of controlling public expenditure on health, but everything that happened during his first term office would seem to indicate that he does.
As I said, class and privilege are evident in the stratification of our hospital population and in the delineation between public and private which is sanctified by legislation here. I want to deal with two major reforms — the need to recast the consultants' common contract and the need to reform the VHI. As we are aware, the common contract emerged in the mid-seventies where consultants were paid a salary for their commitment based on the number of hours spent in public work. This should have brought about a greater commitment to public patients, and in some individual cases and specialties it did. However, since the salaries for those in public commitment are assured, consultants in general have an economic interest in maintaining the status quo in order to boost their income from private practice by forcing eligible patients who can afford private insurance to take it out in order to get the service they should be getting as entitled patients in the first place.
Half of the people in the VHI have cover for services to which they are already entitled. Therefore, the economic interest of consultants is to ensure that access to these services for private patients is considerably superior than for public patients. Under this Minister the VHI have become a promoter of private health care per se and have encouraged the multi-tiered health service. The VHI must become the body through which the State can ensure equity and quality of care for all patients, public and private. If all, or part, of the consultants' salaries were channelled through the VHI and paid on a fee per item basis, it would break the present disincentive to care for entitled patients and establish a similar or same economic relationship with all patients. Why should not the VHI payments to hospitals and consultants be dependent on certain standards of access and facilities being achieved? I am not overly concerned about how much money consultants actually make, but I am appalled at the fact that public and private patients are not treated equally.
The Catholic Bishops and Superiors of Religious Orders in their report published today entitled Health Care — Let's Look Again point out that the burden of health cutbacks have “very definitely fallen disproportionately on the poorer section of our society”. The report goes on to say, “the current policy emphasis seems to focus on ensuring an expanded role for private medicine in Irish health care. Evidence suggests that the present policy is drawing people into private insurance which they can scarcely afford”. I submit that the VHI should have one premium system which allows private care in publicly funded hospitals.
Successive Ministers have disowned any responsibility in this area but, in fact, the 1957 Act gives the Minister a central role in the matter of directing the VHI. He can give directions that would implement some of the reforms to which I have referred. For example, it is absurd that fees charged for back X-rays to private patients should vary in the five or six hospitals I have taken as a random sample as follows: in St. Vincent's public hospital it costs £16 for a back X-ray, but in St. Vincent's private hospital it costs £37.70; in St. Colmcille's hospital, in the Eastern Health Board area, it costs £50; in St. Gabriel's private hospital it costs £35; in the Charlemont Clinic it costs £28 and in the Blackrock Clinic it costs £38. It was reported in today's The Irish Times that the council for the Royal Victoria Eye and Ear Hospital have claimed that patients are becoming legally blind on waiting lists and cancer patients are having to wait for surgery. It is most unusual that the council of a hospital would make such a grave statement.
This problem has been exacerbated by the retirement of three ENT consultants who have not been replaced, and one consultant anaesthetist who has not been replaced also. Indeed, during the interruption of this debate I had contact on a particularly harrowing case which is typical of the incidents the eye and ear hospital refer to. This harrowing case is a little boy who has been waiting for 18 months for access to the eye and ear hospital to have a tonsillectomy and an operation on his nose. This is multiplied thousands of times.
Under the proposals I have made for the revision of the common contract it would be necessary to increase the number of consultant posts. This would partially be paid for by a reduction in the number of NCHDs thus allowing, indeed ensuring, a greater direct input by fully qualified specialists into the day to day management of public patients. This would also help to reduce the career bottleneck for junior doctors who suffer from the closed shop mentality of their elders. It is interesting that the eye and ear hospital say in their statement today that "specialist junior doctors cannot get enough experience in the management and surgery of more common eye conditions".
Of course, it is true that the supervision, management and in-service treatment of private patients is at present carried out by the consultants themselves with little or no input from non-consultant hospital doctors. Most of the day to day management of public patients is carried on by the non-consultant hospital doctors supervised, presumably, by the consultant. The proposals I have made would increase the number of specialists and reduce the number of NCHDs. Consultants must have the same economic relationship with public and private patients. The new role proposed for the VHI in channelling part or all of the consultants' remuneration on a fee per item basis would help to bring this about.
I would also like to take this opportunity to ask the Minister to comment on the current controversy surrounding the Adelaide Hospital and to specify what measures he proposes to take to preserve the ethos of that hospital and to protect the procedures that are available in that hospital, and not available publicly in any other hospital in the city or in the rest of the country.
There are a number of aspects of the Minister's speech to which I would like to refer, but time does not permit it. For example, the reference to mental handicap displays a completely inadequate appreciation of the suffering inflicted on many people in the community in this area.
It is nothing short of a scandal that the tremendous facility available at Cheeverstown House is still only half used when there are several patients in the community awaiting access to that institution, and similarly in the area of the psychiatric services. Lip service is paid to implementing planning, but we know that for all the professional arguments that may be offered for decanting our psychiatric hospitals, no commensurate provision is being made for the development of our community services.
I would have liked to refer to the necessity for a free GP service, but time does not allow for that. I hope the experience in the general election has nailed the lie that we spend too much on our health services. At 6.4 per cent of GNP, it is well lower than the average of the OECD countries. In real terms, it is lower than other developed countries generally.
Finally, with the caveat I entered earlier, I would impress on the Minister the necessity to reverse the damage he did at the Custom House during his first term in office and to commence that process immediately. I would recommend that he put more reliance on his professional and dedicated advisers and civil servants, rather than permitting the mandarins of the Department of Finance to continue to run our health services as they have done for the last two and a half years.
I should like to join with my colleagues in congratulating the new Minister of State on his appointment. I wish him every success in his new portfolio. At present the health services and the cutbacks are a source of great concern. Indeed that was evident during the election campaign. However, what we fail to realise is that there are adequate finances for the health services and, contrary to what Deputy Rabbitte has said, we are spending more per head of population in this area than Britain, for instance, in spending——
Britain is no example.
We spend between 6.4 per cent and 6.9 per cent of GNP and in Britain they will spend exactly 5.1 per cent for this year.
5.5 per cent.
There is enough money there. It is the utilisation of that money that is involved. We are not getting value for the money we spend. We should bear in mind that throwing more money into the health services does not necessarily mean we will get better health. Extra money would not have prevented the tragedy of the 776 perinatal deaths that occurred a couple of years ago; antenatal health education would. Family planning might help a lot more and, indeed, nutrition and general physical health would go a long way towards improving the health of the people, rather than throwing more money into hospital services.
Would more money being spent on the health services improve life expectancy at the age of 50 years? It would not. When you realise that £1 in every £5 spent by the Government is spent on health that puts matters into perspective. What is wrong is that, first, too much reliance is placed on the hospital services and tertiary care and not enough attention is paid to primary care. Too many patients are being referred to hospital. Of patients presenting at primary care, 50 per cent are referred to hospitals and their admission rate is 18 per cent as compared with 12 per cent or less in Britain. That is a lopsided approach. We place too much importance on this tertiary care and on the hospital services. This is where we have fallen down and it is a very costly service. The diagnostic services associated with that service are extremely costly and are using up too high a proportion of the funds devoted to the health services. We must put the matter into perspecitve first.
We find that patients are referred to consultants in hospitals and being kept there by consultants, returning there week after week. This chokes the system, so that few if any new patients are being seen by consultants as these patients who should be referred back to their family doctor are still being retained by the consultants.
The next point is that patients are being detained too long in hospital. Their bed occupation is higher than in any country in Europe. We find that patients are being admitted on a Friday and tests do not commence until the following Tuesday. This is unnecessary. We must look properly at things from the initial stages.
Tackle the consultants.
A sum of £50 million or £100 million will not solve our problem.
Tackle the consultants.
Deputy Rabbitte is new to the House, I know, but——
I would be prepared to be fearless about it.
——it is not normal when another Deputy is in possession to attempt to have dialogue with him. You have had your contribution, Deputy Rabbitte, and you are obliged to listen patiently while other people do the same. Go raibh maith agat.
I shall be as patient as possible.
Deputy Rabbitte has very rightly said "Tackle the consultants." They have a common contract which allows them to provide 33 hours per week of public health service. That is an ideal situation but what is wrong is that there is no monitoring. Like any trade union members — and they are the same as anybody else — they have a contract which is copperfastened and they will not very readily change that. Deputy Rabbitte, who until recently was a union executive or secretary, knows quite well what contracts mean for workers.
That should be so.
The consultants regard themselves in the very same light. I do not agree with that; I would like to see a more magnanimous approach. Perhaps they might work a little harder and for longer hours. I would very much like to see that. However, we are now dealing with human nature and when people have a contract they are not very willing to let it go. I agree very much with what Deputy Rabbitte says. I am delighted that he said it, many more should be saying it.
I was very impressed with his knowledge of the health services. He is very well informed on them and I do not mean to be patronising. The money that we spend on the health services is being wasted. All the Deputies here are experiencing the same kind of problems I am experiencing in trying to have patients seen as out-patients or to have patients admitted to hospital. A lady from Cork, suffering from a very painful condition, told me recently that she cannot be seen until the end of next January and that irked me, I got in touch with the hospital involved and I cannot understand why she cannot be seen sooner. The consultant sees the patients only once a week. There is something radically wrong there.
I ask the Minister if he would give serious consideration to the question of a standing committee of the Oireachtas, drawn from both the Dáil and the Seanad, with terms of reference which would allow the committee regularly to monitor delivery of health care, to assess the adequacy and appropriateness of funding, to debate the setting of priorities in the health services and to establish, right from the top down, the question of accountability. It would be of great significance if we were to have such an Oireachtas committee. They would have the power to cross-examine anybody who carries responsibility in the health services, from the Minister down. They would not try to usurp the function of the Minister for Health, but would be a constant watchdog on the health services. It could play a very useful role and I hope the Minister will give favourable consideration to establishing such a committee. I am sure all Members of the House would welcome the idea as a committee of this kind would work with the Minister in the interests of the health service.
Deputy Yates favours the abolition of the health boards and I agree with him. However, he and indeed all Members should realise that the health boards will resist any attempt to do away with their powers. This would particularly apply to rural areas and this is what we are up against. We will have to initiate a public debate on priorities in the health service. At the moment high-tech medicine is going at such a pace that it can absorb all the health funds because there have been breakthroughs in medicine which could not have been envisaged 50 years ago. I am thinking of hip replacements, kidney and other transplants. People are aware that these transplants are possible and they demand them. However, the public must realise that these services are very costly and that extra funds and skilled people are necessary to ensure that the demand is met.
We must establish priorities because I am worried that the high-tech medicine will absorb all the funds with the result that the unglamorous side, the psychiatric and the geriatric, will be deprived of a service or relegated to the bottom of the queue. Who will decide whether a person should get a kidney transplant or whether the money should be devoted to the care of geriatric patients? People could well be deprived of essential medical care because the high-tech medicine has absorbed all the funds. A medical council, with lay participation, should decide these issues. The decision should certainly not be left to doctors. Indeed, at the rate of progress in medicine, it could absorb the whole GNP. In Europe they have corrected this by establishing long waiting lists, that is how they are curtailing the costs. Efficiency in hospitals is not necessarily the answer, it is often more costly as there is a greater throughput of patients.
In regard to the dental service, it should be compulsory for graduates to serve one year in the public dental service——
Deputies
Hear, hear.
Such a scheme would be of great benefit to the State as at present they emigrate as soon as they are qualified. However, they have an obligation to the State, which has paid for their education. This would relieve the burden on other dentists and it would not be too costly. Deputy Yates referred to dental hygienists, a post which should be established as quickly as possible. Basic dental work could be undertaken by a person who had been trained for two years. It would be a very nice career and would relieve the burden on dentists. I ask the Minister to look at this because it is the only way to tackle this very serious problem.
I should like to share my time with some of the Deputies on this side of the House.
Perhaps you will indicate what is involved? Are you giving five minutes to another Deputy or Deputies?
I will go ahead and we will see what time is left when I have finished.
As long as you do not expect me to stop you until your 15 minutes are up.
The last speaker put his finger on the problem and perhaps he will be kind enough to stay for a couple of moments to hear my diagnosis. He said we have not been getting value for money in the health service but I can suggest ways of getting better value for the money already committed.
I wish to refer to the problems concerning children in Counties Westmeath and Longford. At present they do not have a paediatric service in their own area because of the non-availability of the paediatric unit in Mullingar General Hospital. So far, in excess of £12 million has been spent on an extension to Mullingar General Hospital but it is lying idle. It is a little bit like buying a new car and not having money to put petrol in it. The paediatric unit in the hospital is fully equipped down to cots, nappies and so on. The rest of the hospital will be open on 1 August but the paediatric unit will remain closed because it would cost £900,000 to run it for one year. That is the figure given by the health board and I am sure it is right. They will need staff for the hospital to look after our children. However, by the prudent use of the unit we could recover some of the money and get better value for it. At the moment well informed parents are going to hospitals where general services are available as well as a maternity unit. They are paying for these services which are outside their own areas and this money could be used by the Midland Health Board to open the paediatric unit.
At present our area is served by a paediatric unit in Portlaoise which, as the Minister is probably aware, was built to cater for Counties Offaly and Laois. At present it is catering for four counties with resultant overcrowding and other difficulties. Last Saturday we experienced a not uncommon problem which I hope will not arise again. A child was hospitalised in Mullingar before 3 o'clock in the afternoon. A doctor then decided that the child should be sent to Portlaoise to the paediatric unit there. This was against the wishes of the parents as the child had previously been hospitalised in Crumlin and they had expected that the child would be sent back there. However, the doctor insisted that the child should go to Portlaoise. The long trek ensued, an ambulance, a driver and a nurse went with the child to Portlaoise and on arrival it was found that some person needed to look after this child was not available. However, the ambulance had departed when it was decided that the child should go to Crumlin. However, because of some other emergency the child could not go to Crumlin until 11 p.m. that night. Is that the kind of treatment we want for our children? Is that value for money? Could not a lot of that money be saved and go towards the cost of the unit we are talking about? The parents of that child are acutely aware of the problems in the health service. They did not need an election to be told that the Government were not aware of the problems, they know it at first hand.
The Minister may not be aware of the location of Portlaoise in relation to the two counties I am talking about. Portlaoise is 45 miles from Mullingar and 70 miles from Longford and a most important aspect is that it is not accessible by public transport from either town. You cannot get a bus or a train from either Mullingar or Longford direct to Portlaoise. In order to go to Portlaoise you must first go to Dublin and then back down to Portlaoise. This is causing a great many problems. Some people have not the time to make this long journey by public transport to visit their children, as they would prefer to be with their child than travel on public transport. They have to hire a car or a taxi in order to visit their children. Unfortunately, many people have to borrow money from the moneylenders to do that and thus they are running into debt to visit their child in hospital. This problem could be solved.
Another problem associated with the distance is that only one parent can be so far away at any given time and the other has to stay at home to look after the other children. If we had a unit in our own area this would mean that both parents could share the responsibility of looking after the family. Surely this is a worthwhile suggestion. The cost to the health board of ferrying children up and down to this hospital and occasionally ferrying their parents could be set off against the £900,000 needed to open this unit. We have also to consider the parents' need for beds in Portlaoise Hospital. We have seen examples of parents who cannot get home sleeping on the floor so that they can be with their children. If we had a unit in our own area, the people in the area could be in and out and would not need to sleep there overnight.
The Midland Health Board have been very responsible over the years. They have responded to all the calls for rationalisation. They cut back when asked to cut back. A hospital in Longford was closed down on the understanding that a unit would be completed in Mullingar. Part of that unit will be opened on 1 August but the Minister is letting down the people in the area and the health board — one of the few health boards who lived within their means. It will be thrown back in their faces. The health board have made this their priority and I ask the Minister to respond to that.
Up to 50 new jobs would be created by opening this new paediatric unit. Many of the young people, the nurses and attendants would have to otherwise emigrate. I beg the Minister to include in the Estimates the sum of money needed to open this unit.
In the limited time available, I wish to confine my remarks to the health services in County Clare, my own constituency, as Deputy Ivan Yates has dealt in fine detail with the situation at national level. I would like to put on the record of the House, for the benefit of the Minister, in case he is not so aware, that there is a major crisis in the health service in County Clare.
Over the past two years the health service has degenerated to such an extent that a poor service is being provided in County Clare. Since February 1987 when Fianna Fáil took office we have suffered very gravely from the inaction by Fianna Fáil on the health service. We have seen a reduction of 90 nursing posts in the county. The number of hospital beds has been reduced. We have lost 47 beds in Ennis General Hospital, 200 beds in Our Lady's Psychiatric Hospital, 50 beds in St. Joseph's Geriatric Hospital, and in addition the very fine maternity facility that was opened in Cahercalla Hospital has also been closed. At present we have absolutely no maternity facilities in County Clare. No babies are now born in County Clare and their mothers have to go to either Limerick or Galway. If they are fortunate enough to get to hospital their babies are born there but babies have been born on the road to both of those hospitals and that is a very serious situation. The health of both mother and baby is being put at risk. This is just a synopsis of the intolerable things that have happened over the past two years.
I am appealing to the Minister, now that he has taken up a new term of office, to seriously investigate the health service in County Clare and to have his officials carry out a serious examination of what is happening. I ask the Minister to improve the service at Ennis General Hospital, to provide a maternity service in the county and to take an over-view of the situation in the county.
I was interested to hear Deputy McGrath refer to transport in his area. He is fortunate that there is some form of transport available because the reality in Clare is that there are almost no transport facilities. It is very serious to see in the middle of winter pregnant women or sick people who have to attend outpatient departments hitching on the road from west, north, or east Clare into Ennis General Hospital or to the hospital in Limerick. That is what is happening.
The Government propose allocating an additional £15 million to alleviate the situation. That is totally inadequate. Prior to the general election, the Fine Gael Party proposed that an extra £30 million would be provided for two years in order to relieve the immediate difficulties until an overall view was taken of the health service and a plan put in place. Deputy John O'Connell suggested that a committee of the House be set up to deal with the health service. That is a good idea and is something that the House should support. However, of itself that will not solve the health problem. Deputy O'Connell also suggested that many people would agree to the abolition of the health boards; that is quite true, but the boards would not give up their power. I put it to the Minister that we in this House have the power and we must have the will to ensure that priority is given to providing the people with a proper health service. Bureaucracy must suffer in the interests of a good health service for the people on the ground. Sick people and not the administrators should be given priority. I ask the Minister to examine that seriously. In many instances it is a case of life or death.
My colleague, Deputy Bernard Allen, wishes to have a few minutes of my time. With your permission a Leas-Cheann Comhairle, I wish to give him the remainder of my time.
Deputy Allen has two minutes.
I was over at the Committee of Public Accounts and thus lost my place in the queue. I congratulate the Minister on his reappointment. I was surprised that the Minister was reappointed because he is personally responsible for the crisis that exists in the health services. The crisis has deepened since the election. I was expecting to hear the Minister give some hope to the health services in the course of his speech but we were treated to more of the same, a totally unimaginative contribution. I accept that £15 million is being added to the Estimate but that is like pouring water into a leaking bucket. The health service is full of holes, inefficiencies and problems and the Minister has not made any attempt to deal with them.
The Minister has uttered the same phrases about a commission on funding considering the issue and so on but that commission has been in operation for two years. It was said that the purpose of their work was to deal with a crisis but I understand there is deep disagreement among the members of the commission. Fine Gael, in their health policy document, suggested ways of dealing with the fundamental problems of the health services. It appears that the Minister is a prisoner of the powerful groups who had been referred to, that he is a prisoner of his own profession and of the politically based health boards. It appears he does not have the willingness or the courage to tackle them. Until such time as we have a Minister who has the courage to take on the powerful groups who operate in the health services and to make real changes we will have a crisis in the health services. We are not talking about pouring in more money but about tackling the fundamental problems that exist. I regret the Minister has not the ability or the courage to do that work.
I congratulate the Minister on his appointment but I regret that a fresh face has not been appointed to the Department of Health. We need new ideas in that Department but instead we will have more of the same.
I should like to share my time with Deputy Callely. I congratulate Deputy O'Hanlon on his reappointment and Deputy Noel Treacy on his appointment to the Department of Health. Contrary to what the last speaker said, there will be a fresh face in that Department. While I do not intend to respond to the remarks of Opposition Members it is important that I should draw attention to the fact that in the election campaign they promised £60 million for the health services, money that was not in the coffers. They failed in their efforts to hoodwink the electorate on that issue.
It went down very well.
I take from that comment that the Deputy is admitting that he tried to hoodwink the electorate.
We told the electorate we would put money into the health services.
The electorate knew the money was not there. Like other speakers, I intend to be parochial in my contribution. In particular, I want to refer to the Louth County Hospital in Dundalk. In recent newspaper report, particularly in the issue of The Sunday Tribune of 2 July, it was stated that an executive officer of Comhairle na nOspidéal said that it was intended to close 16 small hospitals around the country, including the hospital in Dundalk. When I read that report I contacted the then acting Minister for Health, Dr. O'Hanlon, and I was glad that on the day following the publication of that report he denied the story. He said that no more hospitals would be closed and that there would be no change in the position of the Dundalk hospital.
Subsequently, the person who wrote the newspaper report had a letter published in The Sunday Tribune in an effort to clarify what he had said. He tried to convey that his report had been misconstrued and had been blown out of all proportion. However, that person, according to my local paper, reiterated his original claim in the course of a conversation with a local action group. The people of Dundalk will not allow their hospital to be closed. I am pleased the Minister has made it clear it will not be closed and I appeal to him to reiterate that statement today for the benefit of the people of Dundalk.
The Louth County Hospital caters for a catchment area with a population of 50,000 people. Other hospitals would have to be closed before a decision could be made to close the Dundalk hospital. I was interested to hear other Members, including Deputy O'Connell, call for the abolition of the health boards. I am not so sure that their abolition would be a solution because if matters were left to the members of Comhairle na nOspidéal and others, all our local hospitals would have been closed. The involvement of members of the medical profession and local representatives in health boards has guaranteed the survival of those hospitals and we should all welcome that. Those who suggest that the Government should abolish the health boards should put forward alternative proposals. I would not like decisions in regard to hospitals and so on to be made by officials of the Departments of Health or Finance.
I note the Minister has allocated £9 million for summer bed closures. The position in the Dundalk hospital following the closure of wards has been catastrophic. Men, women and children with varying types of complaints have been sharing the same wards. That is not right. Money may be saved but a lot of distress is being caused. Savings could be made in other areas, particularly on administration.
Deputy McGrath complained that the paediatric unit in his local hospital had not been opened but I should like to tell him that he is very lucky. The paediatric unit in our hospital has been closed. I should like to ask the Minister to consider reopening that unit or providing specialist services for children in the Louth County Hospital. I do not think it is right that there is not such a unit in a town with a population of 30,000 people.
I am pleased the Minister is making every effort to appoint a speech therapist for the area. It is unfortunate that the official who retired was not replaced. As a result patients have to travel to Dublin for treatment. A local man whose wife had a stroke told me he has to bring her to Dublin periodically for treatment.
It is important to record that the staff of the Louth County Hospital provide an excellent service. We have one surgeon, one gynaecologist and one physician but hospitals of a similar size have two specialists in those fields. The hospital continues to provide an excellent service due to the dedication of the medical staff. I have no doubt they are providing a service beyond the call of duty. We should do everything possible to provide the funding necessary to employ extra staff. I am proud to be able to say that the hospital is providing the best service of all hospitals in the region. It is the most efficient hospital in the region.
I congratulate the Minister on his reappointment and Deputy Treacy on his appointment as Minister of State at the Department of Health. I welcome the decision in regard to accident and emergency services in the Dublin area. To have those services operating on a 24-hour basis was a logical move. There has been a great need for that change and I have no doubt it will be welcomed by patients. The unfortunate people who are injured in accidents or need emergency medical attention will be able to avail of a first-class service within minutes at a hospital near their home. The change is in accordance with the views I expressed at a recent meeting of the Eastern Health Board.
Other Members, particularly Deputy McGrath, were parochial in their contributions. I appreciate the problem highlighted by Deputy McGrath in regard to the 50 paediatric beds. When his colleagues were in Government the same problem existed in my constituency, and again I am being parochial with regard to Beaumont Hospital, where 730 beds, fully equipped and partly statted, were closed. I am pleased to say that a very short period of time after the present Minister came into the Department of Health the hospital was opened. I hope he can do the same in the case referred to by Deputy McGrath.
I welcome the move by the Government to carry out a comprehensive examination of hospital waiting lists to identify where the major difficulties exist. Of course, some of the lists are questionable, and I have no doubt there will be ghosts on some of them. It is totally unacceptable that elderly people needing hip replacements or cateract operations should have to wait long periods for these operations. With regard to ENT services, I am concerned that people, especially young children, should have to wait many months for treatment. A child who is slightly deaf and who has to wait up to seven to 12 months, or even longer, for an operation may be deprived of hearing during his early learning years. I have no doubt this will cost the State extra funds in the long term. These areas must be tackled without further delay.
I welcome the move, in line with the next phase of national recovery, the Government are making to tackle these problems. I look forward to the development of the new agreement between the Department of Health, the health boards and the Irish Medical Organisation in relation to the payment of capitation to doctors participating in the general medical scheme. However, I want to express my anxiety in relation to medical cards, long-term illness categories and the drug refund scheme. I look forward to the new initiatives outlined here today by the Minister in relation to the first £28 and the rebate, via the GMS payments board, directly to pharmacists. I do not fully go along with the opinion that generic drugs will be the answer to the rising costs of the general medical scheme but I look forward to when the national drugs formulary will be announced. I hope I will be able to participate at that stage.
In the past number of years there have been a number of welcome developments in the health services. I should like to mention some of the developments which have taken place in regard to psychiatric services, planning for the future, and the care of the mentally handicapped in the community. Further developments are badly needed in these areas particularly in relation to autistic children who require long-term nursing and independent care. These are just some of the areas of health where I hope to make an input in this Chamber or at committee level. I am concerned about the long and unacceptable waiting lists for orthodontic treatment. I welcome the additional funding of £600,000 which has been allocated to the Eastern Health Board area to deal with these waiting lists. I hope to have an opportunity of coming back to the Minister to let him know exactly what kind of waiting lists there are when the additional funding has been allocated in this area.
There is another area I should like to touch on, and again I am being somewhat parochial, with regard ambulance cover in the north Dublin area. I welcome the change-over from the Dublin Fire Brigade to the health board in the manning of the phones but I ask the Minister to consider funding a cardiac ambulance base for the north Dublin city and county. A cardiac ambulance is badly needed on the north side.
I conclude by congratulating the Minister who courageously tackled the problems he inherited in 1987. I intend to help to develop the framework which has been put in place over the past two years so as to ensure equality and the right of all to avail of a proper health service.
As I have indicated to Deputies, I am now calling Deputy Foxe; who will be limited to five minutes. He will be followed by Deputy Michael Moynihan, who will have a similar amount of time.
At the outset I should like to contratulate the Minister on his reappointment and Deputy Noel Treacy on his appointment. I wish both fruitful days in their respective offices.
I know it is not unique but it is most unusual for a person to be elected to the Dáil on one particular issue, and that is exactly how I have come to be in this House. I was elected by the people of Roscommon on the health issue. When a third of the electorate of any area cross the political divides to vote for a person who represents one issue they must regard it as a very real problem. I should like the Government to take note of this. These people are merely expressing their feelings on the state of the health services.
I welcome the Minister's statement that he is to investigate the waiting lists in the hospitals throughout the different health board areas and the difference in practice between the treatment which private patients and public patients receive. In the past few days the Taoiseach has been quoted as saying that no one in this country should be more than 30 or 40 miles removed from a hospital. That is very good thinking and I hope the Government put it into practice. When people in the city talk about visiting people in hospitals it may have a different connotation to people who live in the country. If a person has to travel 70 or 80 miles to a hospital, especially when transport is not the greatest, it could mean a day's work to travel that distance and spend some time with a patient. Because of the present condition of some of the roads it could be a rather hazardous day's work. I welcome the Taoiseach's comments about the 30 to 40 mile limit.
I have been told that the composition of the new governing body of hospitals is to be comprised solely of public representatives. I do not think that is a very good idea. There should be some room on that body for medical people. Perhaps 50 per cent of the board could be comprised of public representatives and the other 50 per cent comprised of representatives of the nursing and medical staff. This would give better representation. After all, doctors and nurses are the people who meet patients and who have to deal with day to day problems in hospitals. They are also the people who must bear the full brunt of the criticism when it is discovered that certain patients have to remain for seven or eight hours in a corridor waiting for a room when, at the same time, wards in a hospital are closed. The general public find it very difficult to understand this.
I know we should all be forward thinking and looking.
I do not know whether we are forward-looking or backward stepping in Roscommon but we have reached the stage at which male and female patients are being accommodated in the same ward. At the initial stage of illness there might not be too much wrong with that but, as one expects to recover health and vigour in hospital, it is not very practical — to say the least — to have male and female patients accommodated in the same ward.
Some weeks ago a representative of the Western Health Board arrived at Roscommon County Hospital and informed the staff that the hospital were overspending on bandages and drugs and, in order to effect a saving in that regard, it would be necessary to close the hospital for one month. However, common sense prevailed and that step was not taken. Certainly it does not make much sense that there should be such restrictions in one area while there appears to be none on capital spending. There are now moves afoot to reconstruct a building erected during the Famine years — in 1843 in fact — to provide accommodation for psychiatric patients while at the same time closing down the existing psychiatric hospital built 100 years later in the forties.
I must advise the Deputy that he is now poaching on Deputy Moynihan's time.
I understand that money is scarce but we should not effect savings by inflicting hardship on the most vulnerable sector of our community, namely, the sick and the elderly.
I must ask Deputy Moynihan to conclude before 4.55 p.m.
I am glad that you have found at least those few minutes for me at the end of the day. I should like to welcome the Minister and his Minister of State and wish them well in their onerous and responsible duties. I hope their policies will be aimed at alleviating the hardships and sufferings imposed by the cutbacks of the past two years.
With the few minutes at my disposal it would be impossible to range across the whole series of cutbacks and say how they have impacted on the standards of health services formerly available. Suffice it to say what has happened in the Southern Health Board, the area with which I am most conversant. In that area, in the period May 1987 to May 1989, 1,200 staff have been removed from the health service. This has led to a very serious void and has made an enormous impact on the level of services there. We are now faced with huge waiting lists in respect of adults needing surgery or investigation and children with normal illnesses requiring hospitalisation and/or investigation. I can assure the Minister and his Minister of State that we in this party will be monitoring very closely the programme enunciated today to ascertain what progress is made in this area between now and 31 December next.
Deputy O'Connell has said there is ample money available if only it were properly utilised. For example, a patient on the western seaboard, say, on one of the peninsulas off south Kerry, receiving a notification that they must attend the Regional Hospital in Tralee, fasting, at 9 o'clock on any morning must hire a car to get there. They will be refused transport, even though they may be medical card holders. Indeed having spent two, three or four hours in that hospital they will then be told that, unfortunately, they cannot be treated that day. That is a common occurrence, something that the Minister and his Minister of State must investigate. That constitutes another serious instance of hardship on medical card holders who heretofore had been provided with transport by their health board or who received a subsistence allowance in relation to the hiring of private transport. All of that has been abolished. I have heard examples of patients living 60 to 80 miles from a hospital to which they might be directed for investigation or treatment and who could not keep their appointments because they did not have the resources from their unemployment assistance or disabled person's allowance to enable them hire a car. This constitutes real hardship that must be tackled and abolished.
Surely we have not abandoned the principle that the nature and severity of a person's illness must determine his or her admission to treatment, not whether he or she has or has not the requisite money. That is a principle I hope will never be abandoned by our society.
I am afraid the Deputy's time has now expired.
I will abide by your ruling, Sir.
I should like to thank all Members who contributed to what has been a very worthwhile debate. Indeed any Members who have been present and who listened to all the different speakers will have gleaned that there is a wide range of opinion on how the resources available for the health services should be spent. A number of Members were anxious that additional money would be spent on the hospital system. Deputy O'Connell made the point that we could spend too much money on the high technology hospital system to the detriment of community services. We encounter the same problems as every other developed country, that is, that there is a finite resource, choices have to be made and priorities decided. It is a matter for Government to decide those priorities.
I accept that there are problems. Indeed, Deputy Moynihan highlighted one when he referred to the case of a patient going to the General Hospital in Tralee at 9 o'clock in the morning, fasting, only to discover that the service was not available on that day. That highlights a major problem, which is the urbanisation of health services at local level. That is certainly one problem that needs to be addressed. We have accepted that there are a number of problems remaining to be resolved and we are addressing them through spending another £15 million on the service.
It is very important that we maintain a balance. The Labour Party and The Workers' Party would have us believe the service is in crisis. I was surprised at Deputy Rabbitte, a former member of a trade union who had been very much involved with their members in the delivery of services in this country because nobody should be better equipped than he to know the very high level and quality of service provided for so many public patients. That is a fact. Having said that, I accept that there are problems but we are addressing them. We are providing £15 million in the current year, which will be used mainly to reduce the long waiting lists in a number of areas — hip replacements, ear nose and throat complaints, the removal of cataracts and on the various hospitals where, for one reason or another, there are long waiting lists.
We also intend to have the accident and emergency service opened in the five major Dublin hospitals in September. We believe that not alone will that be beneficial to the people in the neighbouring areas but will also help to reduce the backlog of elective admissions. It is important to recognise that over 50 per cent of admissions to hospitals are elective.
Deputy Yates said that the Fine Gael Party intended to provide £30 million rather than the £15 million we are providing, and I was very interested to hear Deputy Yates saying that they had costed this £30 million at VHI rates. I would have expected — and I believe Deputy Yates in the terms of the last Dáil accepted — that VHI rates would be much higher than what we in the public sector would expect to pay. Deputy Yates complained here on many occasions about the right rates charged by places like the Blackrock Clinic. In the light of what Deputy Yates said, I feel the £15 million we are providing is adequate for our needs in the current year, as distinct from the £30 million proposed by the Fine Gael Party, which would be costed at that very high rate.
Deputy Howlin referred to the mentally handicapped and the lack of planning. The mentally handicapped have been protected over the last number of years and indeed the allocation to those looking after the mentally handicapped has been maintained above the rate of inflation. A number of co-ordinating committees in each health board area have been established for the purpose of co-ordinating activity between the health boards and the voluntary bodies who play such an important role in the delivery of service for the mentally handicapped, and our Department are also involved.
It is not possible to go through all the points that were raised but I want to assure the House that the Government are committed to ensuring that there is in place, and continues to be in place, an effective, efficient and caring health service for all who need it.
Question put: "That the Estimate and the Supplementary Estimate for Health for the year ending 31 December 1989 be hereby agreed to".
The Dáil divided: Tá, 77; Níl, 72.
Tá
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, David.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Mattie.
- Brennan, Séamus.
- Briscoe, Ben.
- Browne, John (Wexford).
- Burke, Raphael P.
- Calleary, Seán.
- Callely, Ivor.
- Clohessy, Peadar.
- Collins, Gerard.
- Connolly, Ger.
- Coughlan, Mary Theresa.
- Cowen, Brian.
- Cullimore, Séamus.
- Daly, Brendan.
- Davern, Noel.
- Dempsey, Noel.
- Dennehy, John.
- de Valera, Síle.
- Ellis, John.
- Fahey, Frank.
- Fahey, Jackie.
- Fitzgerald, Liam Joseph.
- Fitzpatrick, Dermot.
- Flynn, Pádraig.
- Foxe, Tom.
- Gallagher, Pat the Cope.
- Geoghegan-Quinn, Máire.
- Harney, Mary.
- Haughey, Charles J.
- Hillery, Brian.
- Hilliard, Colm.
- Hyland, Liam.
- Jacob, Joe.
- Kelly, Laurence.
- Kenneally, Brendan.
- Kirk, Séamus.
- Kitt, Tom.
- Lawlor, Liam.
- Leonard, Jimmy.
- Leyden, Terry.
- Lyons, Denis.
- Martin, Micheál.
- McCreevy, Charlie.
- McDaid, Jim.
- McEllistrim, Tom.
- Molloy, Robert.
- Morley, P.J.
- Noonan, Michael J.
- (Limerick West).
- O'Connell, John.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Keeffe, Ned.
- O'Kennedy, Michael.
- O'Leary, John.
- O'Malley, Desmond J.
- O'Rourke, Mary.
- O'Toole, Martin Joe.
- Power, Seán.
- Quill, Máirín.
- Reynolds, Albert.
- Roche, Dick.
- Smith, Michael.
- Stafford, John.
- Treacy, Noel.
- Tunney, Jim.
- Wallace, Dan.
- Wallace, Mary.
- Wilson, John P.
- Woods, Michael.
- Wyse, Pearse.
Níl
- Ahearn, Theresa.
- Allen, Bernard.
- Barnes, Monica.
- Barrett, Seán.
- Barry, Peter.
- Bell, Michael.
- Bruton, Richard.
- Carey, Donal.
- Connaughton, Paul.
- Connor, John.
- Cosgrave, Michael Joe.
- Cotter, Bill.
- Creed, Michael.
- Currie, Austin.
- D'Arcy, Michael.
- Deasy, Austin.
- Deenihan, Jimmy.
- De Rossa, Proinsias.
- Doyle, Joe.
- Dukes, Alan.
- Durkan, Bernard.
- Enright, Thomas W.
- Farrelly, John V.
- Fennell, Nuala.
- Ferris, Michael.
- Finucane, Michael.
- FitzGerald, Garret.
- Garland, Roger.
- Gilmore, Eamon.
- Gregory, Tony.
- Harte, Paddy.
- Higgins, Jim.
- Higgins, Michael D.
- Hogan, Philip.
- Howlin, Brendan.
- Kavanagh, Liam.
- Belton, Louis J.
- Boylan, Andrew.
- Bradford, Paul.
- Browne, John
- (Carlow-Kilkenny).
- Bruton, John.
- Kemmy, Jim.
- Kenny, Enda.
- Lee, Pat.
- Lowry, Michael.
- McCartan, Pat.
- McCormack, Pádraic.
- McGahon, Brendan.
- McGinley, Dinny.
- Mac Giolla, Tomás.
- McGrath, Paul.
- Mitchell, Gay.
- Moynihan, Michael.
- Nealon, Ted.
- O'Brien, Fergus.
- O'Shea, Brian.
- O'Sullivan, Gerry.
- O'Sullivan, Toddy.
- Pattison, Séamus.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Reynolds, Gerry.
- Ryan, Seán.
- Shatter, Alan.
- Sherlock, Joe.
- Spring, Dick.
- Stagg, Emmet.
- Taylor, Mervyn.
- Taylor-Quinn, Madeleine
- Timmins, Godfrey.
- Yates, Ivan.
Tellers: Tá, Deputies V. Brady and D. Ahern; Níl, Deputies J. Higgins and Howlin.
Question declared carried.
I am now required to put the following question in accordance with an order of the Dáil of 18 July 1989: "That Votes Nos. 1 to 18, inclusive, 31, 33 together with a Supplementary Estimate, 34 to 36, inclusive, 39, 40 together with a Supplementary Estimate, and 43 to 46, inclusive, for the year ending 31 December 1989 are hereby agreed to".
Question put and agreed to.