I move:
That Dáil Éireann has no confidence in the Minister for Health.
The first thing that should be said in this debate is that it is and must be a matter of regret that any Member of this House should have to stand here to declare that they have no confidence in another Member. It is a matter of regret in a personal sense because I have never been treated in a discourteous manner or in an unpleasant way by the Minister for Health. He has struggled with a difficult and onerous brief and has done so with a degree of personal dignity and courage. Many of the decisions he has implemented were decisions involving collective Cabinet responsibility and in that sense the motion I have moved and the debate that will follow today and tomorrow represents a declaration by many Members of this House that the handling of our health services not alone by the Minister for Health but by the Government and their immediate predecessor has been disastrous.
The Minister for Health was effectively disowned by the Taoiseach during the last general election campaign when he admitted on national radio that he had no idea of the impact of the health cutbacks in the community. In effect what the Taoiseach was saying to the entire community was that as far as he was concerned the crisis in health was the Minister for Health's fault. Either the Minister had not told the Taoiseach about the pain, suffering, and anger caused or else he was falsely reassuring him that all this talk of pain and suffering was just hype and propaganda from the Opposition parties and individuals. That was the message the Taoiseach set out to convey in his notorious radio broadcast in the midst of the last election campaign. The people did not believe it then and they do not believe it now. They do not believe that the crisis in the health services is a figment of my imagination or those of the Members on the Opposition benches. Why should they? In virtually every home there is a story of individual hardship, delay, pain, and inconvenience.
Every Member of this House in regular contact with their constituents can tell a fresh story week in week out about the real crisis that plagues the health services. I could tell this House tonight about the ten years old little girl living in Dublin who needs orthodontic care, but who was told this week that at the present rate of progress through the waiting lists in the Eastern Health Board they will reach her when she is 28 years of age. That makes it an 18 year waiting list. I could tell this House about the middle-aged woman looking after two elderly relatives who developed an eye infection which became so bad that eventually she had to have her eye removed. That woman was sent home within 24 hours of the operation having received no counselling about the traumatic effects of the operation and no back-up to help her cope with the trauma subsequently. The hospital needed the bed for another urgent case. They calculated that since the woman in question had been a nurse in her younger years she would be able to cope.
I could tell this House about people who are getting letters from debt collection agencies hired by health boards to collect the £10 hospital charge which was introduced by the Government from those who did not have it when they came into casualty. There is now a new breed of vulture working on commission extracting money from people who are poor and frightened and who used to believe that they had a right to health care. They do not believe that any more. Even charitable organisations, such as the Society of St. Vincent de Paul, are now reporting to me that in some cases they have given money to people who need it to pay for casualty treatment. I could, as could all of us, tell sensational stories for the duration of this debate, all of which are true. They add up to two things. First, they point to the extent of the failure of this Government to preserve the right to health care. Second, they point to the fact that failure exists in our health services today.
Every Fianna Fáil Deputy and every Progressive Democrats Deputy who will vote in favour of the Minister's position, who will vote against our no confidence motion tomorrow night, know they are supporting a Minister who has failed. At the end of the day this debate is all about the failure of the Minister and his Government to understand certain fundamental things. The first thing he has failed to understand is that access to health care is a basic human right. He is a decent man, a kind and courteous man, but he does not understand it is his job, given by the Oireachtas, to protect that right and to protect it for every citizen in the land regardless of class or income.
The second thing the Minister has failed to understand is that you cannot do the job he is supposed to do without a health policy. This Minister for Health understands and accepts the need for a financial policy. Indeed, he has been one of the most ardent advocates of Fianna Fáil's conversion in recent years to financial rectitude. He has lectured everyone from consultant surgeon to patients' groups about the need for balancing the books, having less debt and smaller borrowings, and about the current budget deficit. No doubt he has lectured the poli-cy-makers in health along the same lines. The consequences have been that the only health policy he has ever followed has been to ask the Department of Finance how much they can afford to give this year and then to force the rights of Irish citizens to fit into whatever parameters the Department of Finance lay down.
The Minister for Health, Deputy O'Hanlon, had a health policy when he was in Opposition. When he was on this side of the House he had a view. Speaking in this House in 1986 he said it would be wrong and unacceptable to have any more cutbacks in health care and that people could die if the then policy was continued. He was talking at the time about a Minister for Health who was attempting to rationalise the service without increasing expenditure but who always refused to agree to cuts in overall health expenditure. The Minister was the former Deputy Barry Desmond.
Deputy O'Hanlon, now Minister for Health, led the campaign of vilification Deputy Desmond had to endure, even though Deputy Desmond never closed a hospital bed without opening another one close by. Recently when Deputy O'Hanlon, Minister for Health, was asked about the campaign he then led, he replied he had done so because Deputy Barry Desmond was too confrontational in his approach and that he would not engage in dialogue; this from the Minister for Health who sent one of his civil servants to sack a health official in Cork Airport, who spent £300,000 of public money to fire one of the foremost consultants from Beaumont Hospital and who last week told me at Question Time that he could not meet the parents of people with a mental handicap. Those are the fundamental things the Minister for Health has failed to grasp about the job he was charged to do. Those are the reasons this House must declare it has lost confidence in him.
At the end of the day it is the Minister for Health and he alone who must carry the responsibility for losing sight of the right of every Irish citizen to enjoy equal access to health care. It is no longer good enough for him or anyone else to argue that our health service can be treated as one might treat a beggar in the street. We cannot approach the provision of health care by saying we will allocate to health what we can afford as if it were throwing loose change out of our pocket. In this sense, while it would be easier to argue that the Minister for Health is a victim of collective Government decisions, that has to be seen from the health perspective as a whole.
The first fundamental role of the Minister for Health is to inform the overall philosophy of the Government. It is abundantly clear that this Minister for Health has failed signally to do just that. Instead, his philosophy has been informed by the Department of Finance and their mandarins, and the rights of our people have been thrown out of the window. In the recent past I published a detailed analysis of the financial repercussions of this philosophy, the philosophy of going cap in hand to the Department of Finance, of telling us what we can afford and then deciding to carve the health services into those parameters. I spelled out in detail the repercussions of this lack of philosophy. The Minister responded by calling this analysis false propaganda without indicating where it was false.
It is essential that we examine and understand the facts and the scale of the financial cutbacks before we begin to have a picture of the damage that has now been done. Before examining and outlining again these facts, I have to point out to the House and to the Minister that the only sources I have used or ever used to assemble the data I have published in statements or referred to in speeches in this House have been official sources. Figures for Exchequer health spending are published annually in the revised Book of Estimates and expressed therein as a percentage of GNP. Figures for spending on individual programmes are published annually in the comprehensive public expenditure programmes. Inflation statistics are made available to anybody who inquires from the CSO, and the figures on the size of our national wealth are available from the same source. The financial statistics I intend to set out are all drawn from official sources and the Minister, therefore, cannot honestly deny their accuracy.
Of course, Ministers use figures to suit themselves. When the Department of Health were asked recently to supply health spending information to a national newspaper for a major article they supplied data which were misleading in the extreme. As a result the figures published by that newspaper reflected total spending on health, including spending by bodies like the VHI and private spending and, as such, are totally unreliable measures of change and cannot be used for comparison. The fact is that Exchequer health spending has been cut by 1 per cent of our GNP since the Fine Gael budget published in 1987. According to the 1988 and 1989 Book of Estimates, health spending was 7 per cent of GNP in 1984, 7 per cent of GNP in 1985, 6.9 per cent of GNP in 1986 and it was cut to 6.6 per cent of GNP in the 1987 Fine Gael budget subsequently adopted by Fianna Fáil, it was 6.3 per cent of GNP in the 1988 budget and 6 per cent of GNP last year. No official figure has been published yet for Exchequer health spending as a proportion of GNP for this year. It is reasonable to assume that health spending will not rise, particularly having regard to the expected increase in GNP itself. The value of 1 per cent of GNP is approximately £190 million. To put it another way, if we were spending the 7 per cent of GNP that we held for so many years up to the end of 1986 we would be spending almost £200 million extra on our health services this year. That is the true dimension of the cut this Minister has visited upon the health services.
The way in which that cut has been reflected in each of the health board programmes and the health programmes between 1986 and 1989 must also be considered. The figures I now intend to read into the record again all come from official sources. I take account of the official increase in the rate of inflation between the end of 1986 and 1989 as being 10.8 per cent. Let us look at where the cuts were made.
In the general hospitals area the total was a 5.3 per cent real cut. For voluntary hospitals it was a 6.1 per cent real cut; for regional hospitals — a real cut of 2.1 per cent; district hospitals — a real cut of 2.8 per cent; county hospitals — a real cut of 6.7 per cent. The ambulance and transport service has been cut by 5 per cent. The services in health board long stay hospitals and homes have been cut by 5.7 per cent. The contribution to patients in private homes has been cut by 10.8 per cent. Capital expenditure has been cut by 20.8 per cent.
Let us look at the community health services area. The total expenditure on community health has been increased by 8.5 per cent. The drug subsidy scheme has enjoyed a massive increase of 46.2 per cent, which accounts for the general increase. Nursing home services were cut by 6.1 per cent; the dental, ophthalmic and aural services, which are facing a crisis, were cut by 10.8 per cent in real terms.
The total expenditure on psychiatric services was cut by 7.1 per cent; the cost of administration was cut by 44 per cent while services were cut by 11.8 per cent. The total expenditure on services for the handicapped was cut by 2 per cent, but there was an increase in the provison for administration and support services of 29.2 per cent. There was an increase in the provision for care in special centres of 4.4 per cent, but provision for care in psychiatric hospitals was cut by 10.8 per cent. The provision for the assessment and care of blind, deaf and otherwise disabled persons was cut by 10.8 per cent; the provision for the rehabilitation services was cut by 10.8 per cent and capital expenditure in this area, which is crying out for residential places for the handicapped, was cut by 76.8 per cent in real terms.
In the community welfare area total expenditure was cut by 3.4 per cent in real terms. Cash allowances and grants were increased by 0.3 per cent but the provision for community social services was cut by 5.6 per cent, by 0.8 per cent for child welfare services and by 10.8 per cent for welfare homes for the aged. That is the litany. It is important to put the statistical facts on the record.
There is a number of points that must be made about the figures before they can be fully understood. Increases in spending on community care are accounted for by the increased expenditure on drugs and the new contractual arrangements for general practitioners within the GMS scheme. However, it is the Government's intention that ultimately the GMS will cost less as a result of the changes that were instituted last year. It must be remembered that the VHI drug refund scheme was abolished so that the increased Exchequer spending does not imply any additional relief for poorer sections of the community. Indeed, although the Minister promised some considerable time ago that he would bring in a replacement drug refund scheme, we have yet to see sight or light of it. Many organisations, in particular the Asthma Society of Ireland, are appealing to him to put in place the reformed drug subsidy scheme, which they were firmly promised last summer. Seven or eight months later, they are still waiting and trying to cope with the horrendous bills involved in treating young children with this condition.
An aspect of community care that has caused a great deal of controversy is the dental, ophthalmic and aural services. The reason is that funding for these services has lagged behind inflation to the tune of 11 per cent.
The services for the elderly have been decimated. It is clear that under such headings as district hospitals, ambulance-transport services, nursing home services and all services relating directly to elderly people, there has been a systematic cutback. I welcome, and I make no bones about it the extra provision announced in the budget for this area and tonight I hope to hear details of where that money is to be spent. The reality is that there are fewer permanent residential places for the elderly as more of our geriatric and county hospitals have closed since 1987. Increasing numbers of people have to remain in the community without a hope of a permanent bed and are dependent on the support services that can be provided. One of the boasts of the last few years has been that whatever else has happened to the health services, the services for the mentally handicapped have been fully protected. The figures show that the opposite is the case. The virtual abolition of any capital expenditure in this area is a direct cause of the present crisis in residential facilities for the mentally handicapped. Facilities for the physically handicapped have been frozen at their present level in cash terms, for three years, after several years of improvement and in real terms that represents a further cut of 11 per cent.
One area not covered in these figures is the area of community protection. The Minister for Health has repeatedly stressed that this is his personal priority. In 1986 we spent a total of £22 million on this area — in 1989 that figure was increased to just £23.5 million — in other words a real cut of 3 per cent when we take account of inflation. That figure accurately describes the Minister's commitment to community protection especially when set aside his decision to abolish the Health Education Bureau and replace it with a bureau operating under the constraints of his own Department.
All of these figures take account of the recent Supplementary Estimate, which injected an extra £33 million into health care but without that injection that picture would be even bleaker. Despite the 1990 Estimate, health spending this year will decline still further as a proportion of our national wealth. All of this financial information, no matter how devastating, is only a part of the picture we must paint. In themselves they only tell one aspect of the story. We must also examine what hospital closures have meant, the consequences of the removal of the beds, the sacking and non-replacement of staff. I have had the opportunity in the past week or so to update the information available on some of these issues.
When I said in my most recent statement that the Minister had closed 20 hospitals he reacted with outrage, "false propaganda,""untrue and malicious," he said. So I put down a parliamentary question to ascertain the Minister's position. I asked him to name each hospital which had been closed. The Minister's answer will surprise many Members of the House. He told me that only a few hospitals had closed under his tenure of office, but 19 hospitals, in his phrase, "had changed roles." Some had been sold to private developers, some were day care centres, some were health clinics and so on but none of them — and this is something that has not yet apparently dawned on the Minister — is still a public hospital.
I have to say that I find it incredible that this Minister is prepared to close hospitals but not prepared to admit it. It is simply unbelievable that the Minister for Health is prepared to hide behind this type of language and to use it not only to defend himself but to accuse others of distorting the facts. In the same parliamentary question I asked the Minister to give an up-to-date account of the bed numbers of our hospitals. He was unable to do so. Since the collation of such statistics is apparently a very complex and time consuming job he said he was not able to provide the answer. I have to say that I find that extraordinary. When I wrote to the health boards, several were able to supply the information immediately and the others promised to supply it as soon as possible. Within the past few days the Southern Health Board said in reply that since 1986 they have had to close 325 acute beds, 171 long-stay beds and 322 psychiatric beds, a total of 818 beds in three years.
The Midland Health Board have lost 508 beds, the Western Health Board 615 beds and the North Eastern Health Board 147 beds but they have recently opened a 64-bed facility for people with a mental handicap. The North Western Health Board have lost 331 beds and 30 per cent of their acute beds are closed for six to eight weeks each year. Those five health boards between them have lost 2,500 beds since the present Minister became Minister for Health. That is the most up-to-date information available. I believe that when the figures for the other health board areas and the major voluntary hospitals are available to me, they will show that the total number of bed closures under the Minister's tenure as Minister for Health is quite alarming.
The final figures to be considered are those relating to staff. There has been a certain amount of controversy about the figures I have used in the past. The Minister has frequently accused his opponents of inflating the figures published. In a statement I issued on 11 January I said to the Minister that he had got rid of 5,212 staff across all areas of activity in the health field. The Minister appears to think this is an over-estimate. Parliamentary replies dated 29 July 1988 and 30 January 1990 yielded the following information: total staff employed in 1986, 62,481; in 1987, 58,091 and in 1988, 56,357. In other words, according to the Minister's own figures, there were 6,124 fewer staff working in the health services at the end of 1989 than there were when the Minister took office. The recitation of these statistics is essential. It is impossible to understand the root of the crisis without appreciating the extent of all these statistics. I might reiterate that all of these statistics have been drawn from official parliamentary questions or from official reports.
However, statistics alone convey only the cold back-drop to the problem. We cannot forget that conditions have been worsened for people who suffer from spina bifida and hydrocephalus, mental handicap or psychiatric illness and to asthmatics, AIDS victims and a host of other particularly vulnerable people. To their suffering must be added the hardship and indignity caused to the elderly and the infirm. What all of these groups have in common is that they are, to a very considerable extent, defenceless. It took a general election to bring home the reality of people's suffering to the politicians who caused it. The politicians who caused this suffering are those who proposed the Health Estimates of the last three years and those who refused to oppose them. For three years, three budgets, and three sets of Estimates, the Labour Party have sought to bring home the extent and depth of this crisis to the previous Government and the other parties who were part of the consensus of the last Dáil. It was not until that Dáil was dissolved and its members started to knock on people's doors, they began to realise that what we had been saying was true.
I find that all the more remarkable, especially given the Taoiseach's extraordinary admission during the campaign that the response of the new Government to the crisis had been so pathetic. It can only be described as even more pathetic in the light of the publication of the document Let's Look Again by the Joint Health Commission of the Catholic Church. That document unequivocally describes health care as a basic human right, so basic a right that there is an explicit obligation on the community to discriminate positively in favour of the poor. This view has been endorsed by the recently published report of the Commission on Health Funding.
In the few minutes remaining to me I want to reflect on the reality of the impact of these cuts. It was important to stitch in the figures for the Minister's attention but the consequences on the ground are being faced by all of us in our clinics, more especially by those unfortunate enough to be dependent on our health services. An example that has struck every Member of this House, that has moved every Member of this House, was the story of Samantha Webb, the 22-year old handicapped woman who was left alone by the death of her mother and the long illness of her father, for whom no place could be found in any of the caring agencies in the Dublin area despite the repeated assurances of the Minister for Health — on one occasion in the debate on mental handicap in this House just prior to Christmas — that there would be a place for all people in that position. After all the publicity, the Minister told us that a place had now been found for Samantha by St. Michael's House and that the risk that she would have to be sent to Monasterevan had been averted.
What the Minister did not tell us was that a place could be found for Samantha only because one of the St. Michael's House residents died last week. What the Minister did not tell us was that St. Michael's House have 22 other Samantha Webbs on their waiting list, profoundly handicapped adults in desperate need of residential care. What the Minister did not tell us was that St. Michael's House have a priority list of 90 people whose need is almost as great as that of Samantha Webb. What the Minister did not tell us was that the only additional residential accommodation in St. Michael's House since he became Minister for Health was the provision of one hostel capable of accommodating five people.
Neither has the Minister told us that there are 260 severely handicapped adults in the Dublin area with no day service whatsoever available to them and that there are 100 children in the same position. He has not told us that St. Michael's House have lost 36 staff since he assumed office. Neither has his colleague, the Minister for Education, told us that all of the teachers' aides have been removed from the special national schools run by that agency even though those schools are now catering for more severely handicapped pupils than ever before. Neither has the Minister told us that independence training, physiotherapy and speech therapy have almost ceased to exist as part of the services provided by St. Michael's House.
St. Michael's House is only one of the agencies providing services for people with a mental handicap. All of the others have similar tales of crisis management to tell if only there was an ear to listen. If that is his legacy is it any wonder the Minister is afraid to meet the Parents' Association for People with a Mental Handicap?
If we are looking for an indictment of this Minister perhaps it is to be found in the story of the 14 people who travel three times a week from his constituency for urgent kidney dialysis treatment in the already over-crowded and over-worked unit in Beaumont Hospital. His failure to provide a treatment facility in the North Eastern Health Board area — one of only two health board areas where dialysis is not available locally in a special unit — has compounded the severe problems faced by the renal unit in Beaumont Hospital, supposedly the national facility.
The renal unit in Beaumont caters for three types of patients — those who have just been diagnosed, those who are acutely ill from renal failure and those who have just had transplants. It is essential in a unit of that kind that facilities be of the highest standard since every patient in the unit is more than usually prone to infection. For the last two years that unit has housed an average of 41 to 45 patients each night in St. Peter's Ward, which is the designated ward. But St. Peter's Ward has 31 beds only. As a result some patients sleep in the treatment unit on trolleys each night, spending the rest of their days on chairs because there are not sufficient beds for them. The best description that has been coined for the way in which these patients I have just mentioned are being treated was coined by one intimately involved with the unit, a patient himself, who described it as a "battery hen unit".
Perhaps one could find one's best indictment of the Minister in the recent history of just one of our general hospitals. The treatment of the Clare County Hospital in Ennis is typical of that of many other hospitals. In the 1989 General Election both Fianna Fáil and Fine Gael gave a commitment that that hospital would be maintained at a minimum of 100 beds. There are now 78 beds along with a six-bed intensive care unit in that hospital. In 1987 the complement of beds in that hospital was reduced. There is a 26-bed ward closed at present in the hospital. During January 1990 the number of patients was 100 and the average number in a six-bed day care unit during January was 12 to 14. Occupancy in the hospital on selected days in January was as follows: January 1, 112 patients; January 3, 103 patients as well as 15 patients in the six-bed day care unit; January 13, 95 patients as well as 14 patients in the six-bed day care unit; January 21, 95 patients. The health board estimate that it would cost £500,000 per year to reopen the 26-bed ward. The local Fianna Fáil organisation have asked the Minister for Health to provide a 100-bed hospital in Ennis and have sought a meeting with him to pursue this objective but they have not had much luck so far in getting the assistance that is so obviously needed.
When gathering the information I wanted to present to the Minister, I really did not know where to start or end. I have files on every aspect of medicine and they all add up to a litany of dreadful hardship and suffering. It is very hard to encapsulate into 40 minutes here the full degree of that suffering. The last phone call I received from my constituency before I left Wexford this morning was from a mother who had hoped to get her mentally handicapped son who is 31 years old into Dawn House in Wexford, which the Minister opened last week, but unfortunately there is no room for him. When I said I was going up to the Dáil to move this motion tonight she said: "Go get him and tell him the extent of the suffering that is here".
