I understand that the Minister of State has a statement to make.
Financial Resolutions 1990. - Confidence in the Minister for Health: Motion (Resumed).
Debate resumed on the following motion:
That Dáil Éireann has no confidence in the Minister for Health.
—(Deputy Howlin)
An order of the House was made last evening for this debate that speakers may not share time. However, there was agreement this evening that speakers may share time, within the allocated times, but otherwise the debate will go from side to side as agreed last night.
Is that agreed?
In relation to this matter. I raised a number of questions on the time allocation motion last night and I requested the Government Chief Whip to look at the issue of the closing of the debate. I pointed out that four parties had appended their names to the motion — the Fine Gael Party, the Labour Party, The Workers' Party and Jim Kemmy's Party — but that only two parties were being enabled to reply to the debate tonight and were given 15 minute slots. On the understanding that the question of the sharing of time would be addressed today I asked that time be allocated to both The Workers' Party and Jim Kemmy's Party along with the other two parties closing the debate. I understand from the arrangement arrived at that time will be shared but it has not been agreed that we will be given an allocation of time to close the debate. We are in a position now, although I took only 25 minutes last night, in which even though we were entitled to 40 minutes on the understanding that we would be enabled to share our time and on the understanding that we would be considered for a slot at the end of the debate, we now have no slot except on the good offices of a number of other speakers in this House, namely, Deputy Kemmy and a Fine Gael spokesperson.
The Deputy has done very well.
I will not delay the House as this is an important debate but I want to put a marker on this matter. The private negotiations that took place last week in relation to this debate excluded The Workers' Party, the arrangements that were made in relation to the allocation of time initially excluded The Workers' Party, the arrangements which were made for tonight exclude The Workers' Party.
They were discussed with Deputy Gilmore last week.
I do not want to get into an argument with the Deputy.
I think Deputy De Rossa has made his point.
I am addressing the remarks made by the Chief Whip. I intend to sit down very shortly. I want to put a marker on the record that in future when matters similar to this arise we will be as bloody-minded as everybody else in this House.
The only comment I would make is that as yet Deputy Kemmy has not taken his time.
He has 40 minutes which he is good enough to share with us tonight.
Why then is the Deputy so unhappy?
No thanks to the Deputy, whatever.
That is our position.
Deputy Boylan was in possession and has 20 minutes remaining.
I wish to share my time with Deputy J. Higgins and Deputy Taylor-Quinn.
Is that agreed? Agreed.
I do not want to hold up the proceedings. I had ten minutes last night and it was important that I made the points I did make as they related to the same constituency of the Minister for Health. I highlighted the shortcomings of the Cavan hospital, the taking away of beds, the locking up of wards. This is unacceptable.
Not true.
I have made my statement in the House and I stand over it. I hope it will be remedied immediately. I was dealing with the paediatric unit which is still not operable. Children are being brought into the hospital and transferred to Drogheda, Dublin and to Ballinasloe in County Galway. This is totally unheard of and is unacceptable. I have no doubt that the Minister would be willing to address the problems I highlighted last night but I believe he does not have the commitment of his Government or the Minister for Finance.
I hope that by bringing these matters to the attention of this House the Government will have a change of heart. If a Government can afford to send a Minister of State on a winter holiday to South Africa so that he can improve his complexion, at enormous cost to the taxpayers, and if a Government can afford to hire or lease a jet to take the Taoiseach and the Ministers on glorified trips to the capitals of Europe, and if a Government can afford to hire a press secretary to bolster their own image, surely to God they can afford to provide the people who have given a lifetime of service — the aged in our population — a decent and reasonable health service at the end of their days, places to which they can go to be treated?
It is not beyond the bounds of possibility that these problems can be dealt with. I am leaving it now in the hands of the Government, the Minister and the people on this side of the House. It must be remembered that the division has not yet taken place and it is not too late for people to change their minds when they fully realise the problems that confront us and to do the right thing when they walk through the lobbies tonight. When they have done that they will have done a service to the country.
An equal division of the time remaining now would give to Deputy J. Higgins and to Deputy Taylor-Quinn approximately eight minutes each.
I must say, in common with Deputies on the Opposition sides, I listened with total incredulity to the Minister last night. After all the evidence, after all the graphics, after all the details, all the facts and the figures had been produced, the Minister still came into this House last night not with any new response, not with any positive gestures, but the same stale, jaded, jargon, bureaucratic answer, saying "What crisis? No crisis". At the end of the day the Minister's theme was essentially the same: "I will do it my way". The Minister said that in his health career he had learned a lot from his patients. He had learned a lot from his practice, he had learned a lot from involvement. I think he used the verb "learned" on 12 occasions but the one salutary lesson the Minister did not learn is the salutary lesson of the last election. It was his refusal to listen to facts that lost Fianna Fáil the last election. It is his refusal to listen now to the problems facing the health service that will cost them the next election.
I have here a letter from nurses in the Sacred Heart Home in my county. It states:
We, the Nurses in the Sacred Heart Home, are desperate for extra nurses and staff. We find that we are unable to carry out our duty adequately.
At the moment we are working at times at a nurse patient ratio of 1-58. The teacher ratio is 1-18, one person, aged 23, has 58 patients.
We cannot accept responsibility for patient care or security any longer.
The type of patients we are now nursing are dependent, 70 per cent bed bound, 30 per cent ambulant with assistance. We have the same number of staff now as twenty years ago when the dependent rate was 30 per cent and independent rate 70 per cent.
We have brought our case to the Western Health Board and they are sympathetic towards us, but we will need public awareness to change that to money as extra staff are badly needed. This is where we need you to help to highlight the situation for us.
That letter was not invited or solicited. That was soliciting on the part of nurses who simply cannot give basic nursing care, which means even washing. On one night, two nights before that letter was written, one nurse had to look after 58 patients most of whom were incontinent and some of whom were doubly incontinent. During the course of the night two patients died. She had to lay out both patients, contact the relatives, comfort the relatives, make various arrangements and at the same time bring bed pans to the other patients.
I would ask the Minister tonight if that is the standard of care he would desire for his grandmother or his grandfather? Is that the type of care one would prescribe or stand over for one's mother? He would not, and he could not, because it is not an adequate standard of care for a person to whom we ascribe human dignity. Each and every one is entitled to a certain independence in his or her own right. They have come through life and they have the right to expect at least the minimum standard of care. It is bad enough to be old, sick, handicapped, lonely, but to be made to feel guilty about it is not good enough. In that hospital not alone is there not the basic nursing care but there is no chiropodist and there has been no occupational therapist for the past two years. That is one geriatric home in this county. That is the situation that prevails throughout the length and breadth of the country and it is simply not good enough. It is a scandal. It is a dereliction of duty and it is one of the main reasons we have this motion before the House tonight. There are people in mental institutions who should not be there; there are people with Alzheimer's disease in psychiatric homes who should not be there; there are people with mental handicap mixing with people suffering from dementia in psychiatric institutions and they should not be there. There are square pegs in round holes all over the medical service.
In Mayo alone we have 1,600 people who suffer from mental handicap and 600 of them cannot get service. Some of those are severely mentally handicapped. Last year application was made by the Government for a grant from the European Social Fund. This grant, according to the new structures, is on a basis of 65 per cent ESF and 35 per cent local or national contribution but because the Government were not able to come up with the 35 per cent contribution we lost the maximum rate due to us. Thereby hangs a tale and that is what constitutes the neglect we see in the medical service.
The mentally handicapped do not have a vote. They are very handy when it comes to slogans and posters. It is all very well to depict them on the top of billboards and shout that health cuts hit the old, the sick and the handicapped; but when it comes to delivering basic services they simply do not count. They are grand on posters, but shun them. In Galway Regional Hospital there are 919 people waiting for urology treatment going back as far as 1987. There are cancer patients waiting who will not and cannot be called back because the consultants do not have the resources, and some of these people will die. In ophthalmology alone there are 646 people on waiting lists since 1987. There are 370 awaiting cataract operations, 90 of whom have gone blind and are beyond redemption. That is a sad testimony to the type of health service we have.
Last night the Minister derided Deputies Howlin and Yates saying that they were jumping on the backs of the patients. We are not jumping on anybody's back. Collectively, as Opposition parties, we are putting before the Minister the reality that when he was in Opposition he derided Deputy Barry Desmond day after day and made him the bete noir of the Coalition so that at the end of the day he was seen as “Dr. No” or “Dr. Bad Man” or even, “Dr. Death”. The Minister in Opposition said he would introduce changes to make painless savings and bring about radical improvements in the health service. We have seen some painless savings in the past two years under the jurisdiction of the Minister, Deputy Rory O'Hanlon. The Minister stands over a whole monololith of bureaucracy in administration.
We have a population of 3.2 million, a little more than the Greater Manchester area. We have eight health boards from Manorhamilton to Waterford, from Dundalk down as far as Killarney. There are eight CEOs all drawing about £40,000 per annum. There are deputy CEOs and a plethora of managers of programmes. Underneath we have a whole list of senior staff officers and thousands of community welfare officers. There is a dual system of assessment for basic necessities such as medical cards and social welfare entitlements. There is duplication, triplication, quadruplication. We have eight times the structures we need, and we have a health bill that is costing £1.3 billion and all the Minister can offer by way of solace to the people on the health lists and on the corridors of the hospitals is two committees, one of which is presided over by somebody from Aer Lingus; it is possible he is familiar with aeroplanes but it is doubtful if he has the necessary sensitivity to untangle the difficulties in the health service.
He is not in Aer Lingus any more.
We have £10 million divided eight ways by eight health boards. That is the answer the Minister has. People have died who need not have died. People will die who need not die and yet the Minister refuses to listen. That is the rationale behind this motion before the House this evening. If the Minister thinks it is going to end here then he has heard nothing yet.
I would like to thank Deputy Boylan for sharing his time with me. Having listened to the Minister I am compelled to rise to say that he seems totally unaware of what is happening to the health services. I want to put on the record the situation in my own constituency, recognising that what is happening in Clare is happening throughout the country.
The manner in which the Government have treated the health service is absolutely disgraceful. The people of Clare are appalled at the way the Government have failed to deliver a health service to them. County Clare has been stripped of a health service since the last Fianna Fáil Government and the present Coalition Government took office. Since 1987 the number of beds in Clare has been reduced from 1,100 to 543. Clare has been stripped of its maternity service and its psychiatric service, and its geriatric service has been greatly reduced. The general hospital had its number of beds reduced from 127 to 78. All the flesh has been taken off the health service in County Clare. We are left with a skeleton health service and this Minister has supervised that abysmal situation.
In addition to that we have no community services. The effect on the county has been disastrous. Let me cite one incident of a person 70 miles from Limerick, west of Carrickaholt, who got sick some time after Christmas. When the local GP contacted Ennis General Hospital he was told that not alone was the hospital full but it was overcrowded with every stretcher full and that there was an accident a few miles outside Ennis and patients were on their way into the hospital that night. Despite the fact that the man was suffering from respiratory failure and had severe chest pains he could not be admitted to Ennis General Hospital. Despite the pleadings of the GP, that patient had to be send down to Limerick, 70 miles from his home, that night. On New Year's eve a nephew of an old woman in another part of the country contacted me at 12.45 p.m. to say that his aunt had just been returned from Ennis General Hospital having lain on a stretcher all day hoping to gain admission to that hospital. She was eventually sent home because there was no bed, not even a stretcher to accommodate her for the night. She was sent back to an empty, cold house where she lived by herself.
These are just examples of what is happening right across the county. In addition, nurses in the general hospital in Ennis find it impossible to manage in the circumstances in which they are forced to operate. The admissions nurse is under terrible strain and is forced to make extremely difficult decisions. The nurses in the ward are working in terrible conditions. Beds are squashed up against beds and it is almost impossible to work. At one stage over the Christmas period there were 13 beds squashed into a six bed ward in the day centre with none of the facilities necessary in a regular ward. This is some of what is going on in County Clare.
There is one consultant who, for the first time in eight years had no surgery in the general hospital in Ennis during one week, and absolutely no elective surgery has taken place in the past month in Ennis General Hospital. All that has taken place there is acute surgery and emergency surgery, with the result that an excellent team of professional consultants in Ennis General Hospital are totally frustrated by the present circumstances. This is totally unacceptable.
The people of County Clare are tired of the overall situation and they are sickened by what was said in this House last night about the provision of another committee. They are sick and tired of committees and the buck being passed between the Department of Health and the health board. There are over 200 patients in County Clare now awaiting surgery. Can the Minister tell those people when they will be called for their operations in order to give them some hope? Can he also tell them when he will open the ward that should be open in Ennis General Hospital? I should like to bring to the Minister's attention that during the course of the last general election his party promised — I have this document with me — that they would increase the number of beds in Ennis General Hospital from 78 to 100. This promise was contained in the document presented by the Fianna Fáil Party at the time of the general election. I hope the Minister will stand by that promise and will deliver those extra beds now and not a week before the next general election. I can guarantee the Minister that the people of County Clare are not a crowd of shoneens; they will not fall for that kind of politics. Too many families will have been hurt and too many people in the county will have been affected for the Minister's promise to have any political effect at that stage.
The Minister's party are the people who in 1984 were calling for 200 beds in Ennis General Hospital but they now have the audacity to tell us that 78 beds are adequate. I should like to know how the Government can justify this claim when the population in some parts of County Clare has remained the same and increased in other parts. This does not make any sense to me. The same situation pertains in every other county and it is totally unacceptable to tell the people of County Clare that they can go to the hospitals in Galway and Limerick.
I am pleading here this evening with the Minister to reopen the ward he closed in Ennis General Hospital in order to re-establish some kind of health service in County Clare. The people there are now seeking legal advice and have considered resorting to taking legal action about the lack of a health service in the county. They wonder what their legal rights are under the Health Acts and their present position as a result of mismanagement by the Government.
Ba mhaith liom chead a fháil chun an t-am atá fágtha agam a roinnt leis an Teachta O'Donoghue.
An bhfuil sé sin aontaithe? Aontaithe.
Since the foundation of the Progressive Democrats just four years ago, the party have constantly advocated equality of access to essential health care for everybody in this country irrespective of means. In the intervening four years, we have put forward many proposals to alleviate and/or resolve the outstanding problems in the health services. I am very proud of the practical role the Progressive Democrats have played in ensuring, for instance, that extra resources were made available in the agreed Programme for Government last July to tackle some of the foremost problems in this area.
It is also obvious, and indeed it is conceded by spokespersons for the various parties in this House, that simply throwing more money at our health services provides no panacea or cure-all. The key focus of health policy in this country now must be to ensure greater efficiency in using the resources devoted to health care, and ensuring that the various health care procedures are carried out in the most cost efficient and caring manner possible.
One clear implication of this has to be the greater development of community-based facilities, focused on the general practitioner. This in turn can greatly reduce the burden currently falling on the more costly acute hospitals and other institution-based services. To the extent that extra financial resources have been necessary to tackle some of the most pressing and immediate problems, I am very pleased that the Progressive Democrats, as partners in the present Government, have provided significant additional resources to the health budget in the latter half of last year and again this year.
It is important, therefore, to bear some fundamental facts in mind in this debate. To that end I wish to first recall to the House the particular measures agreed and undertaken as part of the Programme for Government in July last year.
An extra £15 million was provided to tackle the unacceptable waiting lists, particularly in the areas of hip replacement operations and child deafness procedures and also to provide accident and emergency services on a 24-hour basis in all the major Dublin hospitals from 1 September last.
The Government are also committed to ensuring that the management of the health services is improved and, to that end, are prepared to review the entire system by which the services are managed and delivered. It is the consistent view of the Progressive Democrats that the present health board structure is cumbersome, uneven and does not ensure the most efficient use of the extensive financial resources devoted to health care.
The Programme for Government also agreed that it was necessary to improve the management information systems within the health service so that they could be reviewed and updated on an ongoing basis. A practical example of what we have in mind is the problem of waiting lists. I and my party believe that if there was a continuous review of the waiting lists, a lot of the backlog could be more efficiently dealt with, and a lot of human suffering and anxiety accordingly allayed. The Programme for Government also calls for the publication of a national drugs formulary by the Department of Health and urges the greater prescription of generic drugs so that greater savings can be effected in this area.
All of these measures, of course, are set down in the Programme for Government to ensure compliance with the basic principle of equality of access to health services for our people, irrespective of means.
I and the Progressive Democrats have also been concerned that the specific hardship needs of particular groups should also be dealt with, whether by tackling outstanding waiting lists in certain areas or by dealing with the particular needs of special groups. The most obvious case in point here, which was immediately addressed in the context of the formation of the present Government, was the decision last July to provide £1 million for the Haemophiliacs Society.
Specific targeting of resources on the particular needs of other sectors has also been carried on in last week's budget by the provision of £5 million to develop services for the elderly; by providing an additional £3 million to improve the dental services and there by deal with the extraordinary long waiting lists for children's orthodontic services; through the allocation of £2 million extra to provide additional places for the mentally handicapped and the provision of a special carer's allowance of £45 a week for people who look after the sick and elderly at home. The provision of this additional sum of £13 million last week was on top of an increased allocation of £120 million provided on the non-capital expenditure side for health in the Estimates for this year compared with last year. By any yardstick this amounts to a massive deployment of funding for health care in this country. It is also worth bearing in mind that spending on health now represents over one-fifth of all Government spending. What this underlines, as I have signalled earlier, is that the mere deployment of money is not the answer to the problems in our health services. The key issues to be addressed in this debate, and which have to be tackled by Government, and I am satisfied that the present Government are beginning to tackle them, is to ensure the optimum deployment of these financial resources; the most efficient management systems possible in our services; the proper and equitable treatment of all staff working in the health area; and the creation of a proper balance — which clearly does not exist at present — between community-based services and institutional services. I would like to address these various issues in turn and to highlight the kind of practical proposals the Progressive Democrats are advancing in Government with a view to having the problems resolved.
The hospital waiting lists for treatments like hip replacement, heart by-pass operations, optical care and other procedures, need to be totally reviewed and constantly updated. This is essential in the interest of the dignity and peace of mind of the people concerned. What I have in mind is that different categories of waiting list be drawn up, which naturally gives priority to those in need of immediate treatment, and which also sets out subsequent categories of people less in need of urgent attention. In consultation with the hospital authorities and the medical and nursing staffs, the urgent cases must be immediately dealt with, while the people further down the waiting lists are written to, and given a clear indication of the time that is likely to elapse before their own admission date.
This should be done by all hospitals, and such a procedure requres constant revision and updating. It would greatly reduce the anxiety, worry and hardship faced by many families who at present are left in a no-mans-land, worried about their particular ailment, yet not knowing when precisely they are likely to secure a hospital bed and the appropriate treatment. This highlights a major priority of the Progressive Democrats. It is vital that in all sectors of the health system the needs of the patient and his or her family are uppermost. That, too, is why I warmly welcome the Minister for Health's proposal for a proper hospital appointments system.
It is incredible that all over the country, whole batches of outpatients should be told to show up at 9 o'clock in the morning, or 2 o'clock in the afternoon where they have to sit for hours and wait their turn for an appointment. Surely in this day and age it is possible for our hospitals to administer a sensible waiting list system in its various clinics which does not have people sitting around for hours. The very fact that we are only getting around now to tackling this relatively simple problem highlights the totally inadequate management systems which have prevailed in our hospitals up to now. Clearly another aspect of this situation which the Minister, his officials and hospital managements will have to grapple with is the role of the consultant in the hospitals if proper appointment procedures are to be put in place.
It is important that all the people engaged in the delivery of the health service — from hospital management to doctors, nurses and consultants — develop a patient-service ethos. I appreciate the pressures on the hospital specialists and consultants. Nevertheless, the present bias in the hospital management system which is geared around suiting consultants, their time and availability, must be turned around to ensure that it is the patient who is given foremost attention.
Another issue that has to be tackled effectively is the increased use of part-time and casual staff in hospitals, particularly in the nursing area. This has led to serious morale problems among the nursing profession. It is wrong that nurses, with many years qualifications, have their career and salary prospects severely limited because they are classified as casual or temporary staff.
Again, I am pleased with the progress which has been promised in this area and the commitment from the Department of Health to increae the level of permanent staffing in the health services on a phased basis to close on 90 per cent of total staffing. There can be no delay in moving in this direction and, in particular, in tackling the imbalance in the employment of nursing staff.
All in all, I and my party welcome the thrust of the reforms outlined, and charted by the Minister for Health in his contribution to this debate last night, but I cannot overlook the fact that the very necessity for the introduction of so many initiatives of itself clearly underlines the weaknesses and the inadequacies in the existing health care delivery system in this country.
I believe, in particular, that the Efficiency Review of Acute Hospitals, to be conducted by Mr. Noel Fox, and the review of the admissions, out-patient and discharge policies in the Dublin hospitals to be carried out under Mr. David Kennedy are very worth-while moves, as is the proposal for an appeals system for medical card applicants. I also note that the Minister will be bringing forward before the summer recess, proposals to change the administrative structure of the health services.
I also believe that all parties in this House must, and will welcome, the increased allocation of resources this year for the development of community based services to do with the care of the elderly, the care of mentally handicapped persons, and the improvement of the dental services. The provision of additional home-care nursing, and home-help support systems is to be greatly welcomed, as of course is the provision of extra residential places for the mentally handicapped.
I hope what we are now seeing emerge is the beginning of the more proper balance between community based and insti-tutional-hospital services. This is not only more cost efficient, but also enables people who are either sick, elderly or handicapped to be catered for in their own homes and in their local communities to the greatest extent possible. That objective is one we must always strive for. Moreover, the administrative and structural reviews of the health system outlined by the Minister for Health must be a first step towards the evolution of a more efficient, value-for-money, and above all, patient-orientated system, from top to bottom.
In that context, too, a more disciplined approach to hospital admissions, particularly through the casualty system, must be put in place, and cases which are not emergency or accidents should be referred back to GPs. This will obviously require that the person making the decision in casualty must be a person of a senior house officer or consultant rank, and there must also be a formal system of liaison with local GPs in such cases.
The present system that has evolved in many cases is nothing more than queue jumping — which is understandable from the point of view of the patient — but it is setting in train a vicious cycle which runs as follows: there are more and more admissions through the accident and emergency systems in our hospitals; that puts greater pressure on beds, which in turn means that elective admissions through GPs become impossible. When the GP cannot get a patient into hospital, the patient is naturally tempted to take the casualty route in.
In this context, too, my party are very concerned about the new system of payment for GPs. We expressed strong opposition to the introduction of the new capitation system a year ago and we still hold the view that some form of fee-pervisit, even if combined with a capitation system, would be a better way to proceed than the present one.
This is not a reflection on the professionalism of the dedication of our GPs, but it is important that there be a proper reward system for domiciliary and out-of-hours visiting, or the inevitable result must be a greater tendency to refer some patients for institutional care in hospitals.
I will sum up by quoting from a recent letter to The Irish Times by a former chairman of the Irish College of General Practitioners, Dr. Michael Boland, in which he stated:
The solution (to the health problems) does not involve extra beds in hospitals, but a return to more rational admission policies, and an improvement of facilities for care at home.
In particular the abuse of the Casualty Department must cease and urgent measures must be introduced to resume traditional referral. The public must come to regard a visit to their GP as more promising (and better value) than going directly to Casualty. Standards of premises and equipment in general practice must also be urgently improved.
The proposals outlined by my Government colleague, the Minister for Health, Deputy O'Hanlon, are a step in the right direction, but more needs to be done. As is generally acknowledged, and indeed as was underlined in the conclusions of the Hederman report on health funding, the solution to the problem is not one of continuing to deploy more financial resources to the health services.
The emphasis from now on must be to ensure the maximum efficiency in the use of the resources already deployed to our health services and the provision for all our people of a caring, sensitive and responsive health service at all levels.
I greatly welcome the opportunity to speak on this motion. During the past few months fantasy has to a large extent been perceived as fact, illusion as reality and nonsense as truth. The health service has been built up during the years — and this is the reality — to be one of the finest in the world. Indeed since the establishment of the health boards in 1971 we have witnessed the building of the most modern hospitals in the world up and down the length and breadth of the country. We have also witnessed the creation of a sophisticated community care programme and have succeeded in changing not just Victorian buildings in which the mentally ill were often cared for but also Victorian attitudes towards the same group of people.
In short we have built up a sophisticated system which can match any in the world but if we are to be absolutely truthful with the people we must now decide as a people what kind of service we want in the future and in doing so we must also decide how much we are prepared to pay. Truly, there is no such thing as a free lunch. Unfortunately, there is not even such a thing as a free medical card or a free bed or any kind of free service. Somebody has to pay and it is best that those who pay the piper call the tune. In this context one way or another every man, woman and child, whether employed or unemployed, disadvantaged or privileged, rich or poor pays in the end.
In recent times the utopian view that you can have a perfect service has been expressed. I recall when I became a member of the Southern Health Board in 1982 that the overtime payments alone in Our Lady's psychiatric hospital in Cork city amounted to in excess of £1 million. I also recall that at the same time the overtime payments in St. Finan's Hospital in Killarney were virtually negligible. When ultimately the overtime ended not a bed was closed, not a ward was shut and the service continued as before. If anything old buildings such as Our Lady's Hospital had been closed down and the patients transferred to better care.
It would be foolhardy to say and more foolhardy to believe that waiting lists grew up overnight. Whether we like it or not, there have been waiting lists in the Irish health service for more years than we care to remember. There have been waiting lists for orthodontic treatment for years. The same may be said for speech therapy, orthopaedic and ENT services. Waiting lists have been part and parcel of the health system for generations. It is not true to say, therefore, that this Minister or this Government created the waiting lists. When I went into the health board in 1982 for the first time there was a very long waiting list for orthodontic treatment, a child would grow into an adult and still not get treatment, a child could wait then for speech therapy for months on end, and a child could wait for ENT surgery in a Cork hospital for years. This Minister introduced an ENT service for the very first time in Tralee General Hospital in my county. He also for the first time improved speech therapy in County Kerry.
In regard to the mentally handicapped, with whom I have the greatest personal sympathy and empathy, let no Member of this House tell the Irish people that the adult mentally handicapped were ever properly treated by any Government at any time. It simply is not true. There was never a coherent policy for the adult mentally handicapped, and this Minister in justice, in so far as he could within the resources available to him, tried to improve their situation in whatever way he could. Much more needs to be done about the mentally handicapped but let nobody come in here with a bleeding heart stating that those people were in any way adversely affected by health cutbacks. There never was a coherent policy for them, or if a coherent policy was ever introduced I challenge any Member of this House to say where it is. This Minister for Health contacted the health boards and sought a policy in relation to the mentally handicapped and boards, such as the Southern Health Board, are examining those proposals at present.
Much has been made over what happened in the last few months by many people who had an opportunity of remedying the situation over the years. In Tralee General Hospital and in many sections of the Southern Health Board region there was an increase in activity at the Christmas period of 40 per cent. That was an emergency if ever there was one. The service was put to what can only be described as the ultimate test and the question is whether it responded to that test. The answer is irrefutably "yes". I have listened to experts in health speak about what can only be described as the emergency situation. I heard an eminent nurse of 30 years' standing, saying in public: "I have worked in the health service for 30 years of my life. In the period of those 30 years I can safely say this: we have always had overcrowding at one stage or another; we have always had emergencies at one stage or another; we have always had our difficulties at one stage or another, but throughout those difficulties, we always survived. We survived then and we will survive now".
It would be grossly unfair to let the perception go out to elderly people that there would be no bed in hospital for them if they became ill. The truth is different. I do not believe any health board would say that any sick man or woman would be turned away at the door. I accept that there are waiting lists — we have always had waiting lists — but let us not frighten the elderly with talk about them not getting a bed if they were seriously ill tomorrow morning.
There has been a call for the centralisation of health boards, to remove the power from the local to the centre. We have centralised enough over the years. In fact, we have centralised so much that my view is we are over-centralised. Regional health boards make an enormous contribution and they have made that over several years, and the members of those boards are more often than not best equipped to articulate the problems and views which exist in a local health board area. For example, Comhairle na nOspidéal are a centralised body but I do not believe Comhairle na nOspidéal would be as informed or advised as health boards would be. It is strange to hear people who would call for the centralisation of the health service condemn the centralisation of the agricultural service, for example.
There is a need to improve management procedures in many hospitals and this need has been recognised by the Minister. Only on Monday at a Southern Health Board meeting in Tralee it was stated that a manager would be appointed to the regional hospital in Cork. That could be extended to many of the larger hospitals, sometimes with budgets of almost £30 million, the equivalent of what a local authority's budget, on average, might be.
I would like to take the opportunity of paying a very special tribute to those involved in community care. In this regard, none has been more important or active than community service groups throughout the length and breadth of the country. They have provided on the ground tremendous comfort and aid to the elderly, whether in relation to special housing aid schemes for the elderly, meals on wheels or other charitable works. I pay tribute, too, to other organisations such as the Rehabilitation Institute who have over the years done a tremendous amount for people with disability, mental or physical.
The motion of no confidence in the Minister for Health tabled by the Opposition parties is clearly a diversionary tactic by those who have no clear view of what direction health policies should take in future. Listening to the debate last night I could not but be struck by the poor standard of contribution by some, not all. It demonstrated to me that this no confidence motion is concerned primarily with deflecting attention from the Opposition parties since they have little concrete to say about how our health service should be delivered. It is highly constructive to contrast what the Opposition parties have been saying with what the Minister for Health has been doing. There is an immense difference between the futile and often misleading statements of Fine Gael, Labour and The Workers' Party representatives and the Minister's solid, efficient actions. While the Opposition have been talking, and fantasising the Minister has been getting on with the job and doing it very well despite the constraints that we all face. Even a brief examination of the progress made in improving services since the Minister came to office in 1987 illustrates what has been achieved. There is no doubt that development in the major service areas has been significant. In 1990 alone, the allocation to health boards has been increased by £65 million or almost 9 per cent while the moneys allocated to voluntary hospitals have been increased to £36 million, or over 14 per cent. The increased allocation continues the improvement of the services commenced in autumn of last year, when additional resources of £15 million were made available. In the 1990 budget Deputies will recall that the Government allocated an additional £10 million to the services for the elderly, mentally handicapped and health board dental provisions. In addition there is a new carer's allowance which is a recognition of the invaluable contribution of family members who look after their elderly relatives. Within the additional £10 million, £2 million has been provided in the current year for the further development of services for the mentally handicapped. As I have said before, the Minister is to be commended for this. To assist matters further, co-ordinating committees of the voluntary and statutory agencies have been established in each health board area. The committees will formulate five year plans to meet development needs.
It is clear therefore, that in spite of the limited resources available, the Minister has demonstrated his ability to channel funds into improving services; more importantly, he has also ensured that the money is spent in the most cost effective way by putting in place appropriate mechanisms for identifying service needs and by pinpointing the best approach to meet these needs.
There is no Utopia in the health service or indeed in any other services but in so far as the service can be improved we must do so within the resources available to the Minister. To that end far from putting down a motion of no confidence in this Minister, I would have hoped the Opposition would have recognised his tremendous contribution to Irish life which will be recognised in the years to come.
I seldom have the luxury of sharing time with anybody in this House; indeed the opposite is often the case and I have tried to get time from the other parties. The Labour Party and The Workers' Party have been generous to me on those occasions when I sought time from them. Tonight I have the rare luxury of being able to share my time with a few of my backbench colleagues. With your permission, a Cheann Comhairle, I intend to share my time with Deputies Garland, Foxe and Sherlock. I intend to share my time equally with the Deputies if that is in order.
Is that agreed? Agreed.
This is a relatively short debate on a very important issue. The debate is long overdue and I am very pleased to have the opportunity of making my contribution to it.
There is a crisis in the health services. I do not use that word lightly. The word "crisis" is often bandied about in our society, but there is a crisis in the health service and we should say so. There is no point in denying it. There has been a great deal of criticism of the flaws, shortcomings and defects of our present health system. There is no point in my listing a long catalogue of the flaws and shortcomings in the service over the past three years. I come from a constituency which has suffered the effects of the cutbacks. As people know, I come from Limerick where Barrington's Hospital was closed down two years ago, and the matter was debated in this House at that time.
I am a realist at all times. We live in a world of change. We live in a country that has a great many problems. It would be foolish to expect that health expenditure would remain immune from Government action. It is understandable that society has to use equipment and services in a co-ordinated and centralised way to ensure as far as possible that efficiency and value for money is obtained. Everybody who lives in the real world knows that.
While cold, hard economic decisions will invariably clash with humanitarian considerations, no civilised society should ever lose its sense of anger when faced with preventable suffering. We have plenty of preventable suffering and anguish in our society.
I did not come into this House to make a personal attack on the Minister or the Minister of State, that would be very foolish of me and I do not believe in that. I do not believe in tagging the Minister with names such as "Dr. Death" or the other names that he is being called because that is a cop-out for serious thinking. I have never used this House to attack any Member in a personal way and I would not do so.
I would be lacking in my public duty if I did not say that health services are very inadequate. I also know that a great deal of unnecessary suffering and distress is being caused to people, mainly poor people, by these shortcomings. Every TD in the country knows that people are suffering because of the cutbacks. Unfortunately, the Minister has taken a stand and has decided to brazen it out and hope that the crisis will go away. There is no virtue in denying that there are shortcomings in the service. Unfortunately as in so many areas of society, money can buy immunity from worry and secondclass treatment. Money cannot keep one alive but it can certainly do the next best thing, keep you alive for as long as possible.
When one thinks of health, one thinks of doctors who take the Hippocratic oath and nurses who dedicate their lives in a selfless way to people. We may think of people like Florence Nightingale, Elizabeth Fry and people like that, but when some people think of health and hospitals, they think of money and profit. There is plenty of money to be made despite the Minister's cutbacks. There is plenty of money being made, but it is being made by the wrong people — people involved with international drug or pharmaceutical companies, the professional people who cream off the VHI and the health boards. When the Minister attempted to prune the service, he started at the bottom with the casual workers, the nurses and the ordinary working people instead of at the top where the money is being made. We must certainly have reform but we should be thorough and start at the top where the money is being made. That did not happen, as we all know, but very few people will say that in this House. The casualties are the poor, people who are queuing up in waiting rooms in hospitals, those on long waiting lists for operations and treatments. Indeed many people have died while waiting for treatment. You will not find wealthy people on waiting lists or you will not find them waiting at midnight for casualty treatment at the Regional Hospital in Limerick, but you might find a few of them in the Blackrock Clinic or places like that. It is wrong that money, power and influence should be a factor of health care, but that is what is happening with the development of a two-tier system along American lines.
I know something about the health service in Limerick. I should know because there is pressure on me every day to make telephone calls to hospital administrators, admissions officers, matrons, asking them to admit people, so I know the score. I know that the waiting lists are growing. I did not come here tonight to rehash the debate on the closure of Barrington's Hospital, which would be a fruitless exercise, but I can say for certain that if Barrington's Hospital had remained open there would be fewer on the waiting lists for the regional hospital, St. John's Hospital or Croome Hospital. That is a modest statement. I can guarantee that the queues would be far shorter if Barrington's Hospital had remained open. Limerick people have suffered, indeed Clare people have suffered, and they are paying the price for the closure of Barrington's Hospital since then.
I have tried to be as low key and unemotional as possible. Indeed many of the Fianna Fáil Deputies with whom I have spoken in private would agree with much of what I have said. Most of them have taken the medicine fairly well on the ground but one or two, one certainly has been running with the hare and chasing with the hounds. He condemns the cutbacks, the Minister and the Department in his own constituency but comes into this House, votes for all the cutbacks and will troop in here tonight behind the Minister to vote on the motion of no confidence. I see no virtue at all in that. We could all do that; we could all have our loaf and eat it; we could all run with the hare and chase with the hounds.
I suggest that some Members should put their house in order in that respect. One of the Minister's loudest critics in my area is a member of his own party. Hardly a week goes past without the papers publishing his attacks on these cutbacks. Indeed the same Deputy speaks much more than do the Minister for Industry and Commerce, Deputy Noonan, Deputy Clohessy and myself on this issue. Every week the three newspapers are filled with his attacks on these cutbacks. I see no virtue in that at all, it is a useless exercise and certainly does not help matters.
I see little point in the Minister stone-walling. Indeed it is fair to say that the Minister would have made a fine stonewall batsman had he ever taken up the game of cricket. The time has come to end that stone-walling. The time has come to face reality. The time has come for the relief of suffering and hardship in our society, for the expenditure of as much money as possible on reducing hospital waiting lists, giving people access to the operations and treatment to which they are entitled. The time has come to relieve the fear and anxiety, especially of the elderly, many of whom come to departmental offices clutching VHI documents and booklets terrorised that they will not receive hospital treatment. That psychological pressure on elderly people is totally wrong.
In summary the time has come to end this crisis, the time has come for the expenditure of as much money as possible, be that lottery or lotto money, on essential items. We cannot stand by in this House and see money spent on nonessential items while so many people continue to suffer. Money must be spent on essentials.
I thought Fianna Fáil had learned a lesson in the course of the last General Election. They had a close shave then and will have a close shave this evening. They cannot continue these close shaves or continue to play with people's lives. I hope the Minister will learn a lesson from this debate. Action always speaks louder than words. I listened to what the Minister said last evening — I read his remarks carefully — but that is not sufficient unless there is a follow-through in the reduction of waiting lists and ensuring that our people have a decent health service.
I am unimpressed with the Minister's latest panic response to the health service shambles by appointing Mr. Noel Fox, a well known accountant, who specialises in receiverships and liquidations. Perhaps he will recommend the closure of the hospitals and all of the Department of Health on the grounds that they are loss-making. This is the type of ad hockery we can do without.
Whilst I can accept some of the statements of the Fine Gael spokesman, Deputy Yates, particularly in the area of community care, I would remind the House that the Fine Gael Party were totally supportive of the 1987 Fianna Fáil Government's running down of the health services. As usual, Deputy Howlin, on behalf of the Labour Party and Deputy De Rossa on behalf of The Workers' Party, simply bleat about how much more money is needed in the health services without — as is their wont — saying where the money will come from to prop up this system which is wasteful and unworkable.
The Deputy should read the scripts.
The problem is not one of finance but of structure and commitment. The Green Party, Comhaontas Glas, believe that the health service is adequately funded but grossly mismanaged. Last year over £1.2 billion was spent on health. Every year this figure rises but there has been no corresponding improvement effected in the health status of our population.
The Green Party have the solution to the problems obtaining in the health service tody, those being (1) the financial crisis of the health service, (2) the failure of the present system to deal with the prevailing disease patterns in society and (3) inequities in health. The primary goal of the Green Party health policy is the preservation of health, not the cure of sickness. It would be our aim to radically restructure the health service in order to establish decentralised, community-based, democratically accountable health services which allow for local variations and minimised dependence on expensive, high technology hospital-based medicine, developing the promoton of health services instead of the present repair services; in other words, a complete reversal of present trends.
Why do the Department of Health continue to target their resources into top-heavy, high technology, costly, chaotic hospitals? Is there not a need for community hospitals which would provide care for the elderly, the dying, for those with minor ailments who need the presence of friends, families and nursing care instead of high-powered casualty hospitals? We believe the reason for the current policy is the involvement of vested interests — the pharmaceutical companies, the medical establishment and the vote-catching tactics of politicians, such as Deputy Foxe in Roscommon and the latest Fahey deal in Waterford.
Perhaps the House will allow me retrace our steps somewhat. In 1978 Ireland, as a member of the World Health Organisation, was signatory to the ALMA and ATA Declaration, which stated that primary health care was the key to attaining health for all by the year 2000. The declaration called on all Governments to formulate national strategies, policies and plans of action to launch and sustain primary health care as part of a comprehensive health service. Successive Governments have paid lip service to this declaration. In order to shift from institution to community-based services the former Minister for Health Deputy Barry Desmond, made a start, as Minister for Health, by tackling vested interests and overseeing the publication of two very important documents, namely, Promoting Health through Public Policy and Health: the Wider Dimensions. These documents were consultative and should have formed the basis of a radical restructuring of our services. Unfortunately these reviews merely seem to have served as a substitute for rather than a prelude to action.
In its primary and secondary forms the public health care system is declining in quality. People are responding by turning, where possible, to the private sector. In fact the State is subsidising this shift to private medicine by providing tax relief to VHI subscribers or income tax relief on hospital bills, allowing consultants free use of public facilities. This is not leading toward health for all but rather toward health for those who can pay for it. As a matter of urgency the Green Party demand that tax relief be withdrawn from all but the cost of the basic VHI plan, that is Plan A, or the equivalent income tax relief.
When will the Minister come up with a master plan? How much longer must we move from crisis to crisis? The Minister cannot remain forever with his fingers stuck in the hole in the dam endeavouring to hold back the flood gates.
One provision of the budget the Green Party would applaud is the increase in the carers' allowance. We see this as a step in the right direction. However, it is a drop in the ocean only. We need real commitment to primary health care. There is no national plan or strategy, but rather consultative documents, personal reviews and reports only. Structures for the promotion of health have been instituted at the top of the health pyramid but not at the bottom.
Finally, and most importantly, resources vital to the development of primary health care have been committed. Until this commitment is honoured the Green Party have no choice but to support the vote of no confidence in the Minister for Health. It is with some reluctance I support this motion. Of course, a mere change in the person of the Minister for Health will not fundamentally change the direction in which the health service is travelling. Nevertheless, as an expression of my dissatisfaction with Government policy in this area, I support this motion.
If anybody remained in any doubt about the unsuitability of Dr. O'Hanlon to hold the important office of Minister for Health the matter must have been put beyond doubt by his extraordinary speech in this House last evening. I am a member of the Southern Health Board which, in the year 1989, had a deficit of £500,000. In 1990 that health board chief executive informed the board that it had been agreed with Department of Health officials that the requirement of the Southern Health Board for 1990 was £146 million. The Department told the health board: you will get £143 million; you can make do with it because that is all you will receive. That would mean an increase of approximately £6.6 million over last year, £6 million of which would be expended on wages. Indeed that makes no provision for an increase in the cost of living in excess of 4 per cent. In the Southern Health Board area there has been a reduction of 1,000 staff in the last three years, from 1987 to 1990, and there has been a reduction of 599 beds in that area.
How could anyone say that the finance being provided is adequate when that is happening? The Minister said that an appeals system will be set up for people who are disallowed their application for full eligibility. That appeals system exists already. Let the Minister tell the House that tax and PRSI is deductible when assessing a person's eligibility. I have seen people being turned away from health boards. Mothers of small children cannot afford to go to the chemist with a prescription from their doctor and that is a scandal to say the least.
Much play has been made of the prescribed relative's allowance which is being increased to £45. Is it a great honour to this Department to give £45 a week to people who have dedicated their lives to looking after their relatives? I would ask the Minister why the drugs subsidy scheme which he promised last year has not been implemented. People, especially asthmatic sufferers, are spending up to £100 a month, and sometimes in excess of that, on medicines.
It appears that the only section of the Health Act that will be complied with by the Minister for Health in 1990 is section 30. Health board officials are required to live within their budget and if they do not do so section 30 will be applied against them. The reduction in expenditure in the health board area which I represent will result in a reduction in general hospital services. We had to go to the High Court in 1989 to save the general hospital in the Mallow area. There will be a reduction in community care also because the number of public health nurses is well below the national average and no effort is being made to redress this problem. All the services within the Southern Health Board area will be affected.
The Minister has failed totally to come up with a programme of immediate steps necessary to deal with the near collapse of hospital services in many parts of the country, or the range of imaginative and innovative long-term measures necessary to give the country the sort of health service our people need. What we got instead was the announcement of the allocation of an extra few million pounds — a sum totally inadequate to the scale of the problem facing the health service — and the appointment of yet more consultants, experts and committees.
I would have thought that the one thing the health service was not short of was reports and recommendations. What it is short of is money and resources. Over the years successive Governments have appointed a whole series of consultants, experts, committees and working groups. Many of them have produced excellent reports — indeed there must be a library full of reports in the Department of Health — but virtually none of them has been implemented. Without the will to act, more reports will be useless.
The Minister clearly believes that attack is the best form of defence and instead of dealing with the issues the main thrust of his speech last night was an attack on the Opposition parties in this House for continuing to raise the health cuts as a political question. The Minister accused the Opposition parties of exploiting the problem and causing fear among the old, the sick and the handicapped. There is genuine fear among these groups but the fear has not been caused by the Opposition parties. The fear is caused by what the Minister has done to the health service. The fear is caused by the knowledge that if they are ill, there may not be a bed for them. The fear is that if they need an operation they may have to spend many painful months on a waiting list. The fear among the parents of the mentally handicapped is that if they die there will be no-one to look after their dependants. There is no need for the Opposition parties to stir up fear and concern among those who are dependent on the public health services. The fear is genuine. The fear is real. Only someone who is out of touch, as the Minister for Health is, could deny that it is there.
I think the Minister for Health has some nerve to accuse the Opposition parties of exploiting the problem. The Minister's party is, after all, the one which based its 1987 election campaign around the slogan "Health cuts hurt the old, the sick and the handicapped". The slogan was right. Health cuts do hurt the old, the sick and the handicapped. They hurt them in 1987 and they are hurting them even more severely now due to the cuts imposed by this Minister. What makes people in this country so cynical about politics is that they see parties adopting certain positions in opposition and then doing the direct opposite when they get into government. The Fianna Fáil performance before and after the 1987 election is the most outrageous example of this in the history of the State.
Back in 1984, when the health cuts introduced by the Fine Gael-Labour Coalition were still at a relatively minor level, the Fianna Fáil Leader, Deputy Haughey, gave an interview to The Irish Press. In the course of that interview he said: “The health services have been reduced to dangerously inadequate levels, and I think that if it hasn't happened already, people will die because of the unavailability of particular services in certain areas”. The Taoiseach says little about the health services these days — understandably enough considering the roasting he got on the matter during the last general election campaign. Perhaps at some stage soon he might take some time off from his role as President of Europe to let the country know how many people he believes have died because of the far more severe round of cuts introduced by his Government.
What really shocked me about the Minister's speech last night was his statement that health care must be run as a business. Is the Minister really serious? Is he really suggesting that the health service, the quality of which affects the interests of hundreds of thousands of people and which can in fact determine whether people will live or die can be run in the same way that Ben Dunne runs his supermarket chain or Larry Goodman runs his meat business. In business the amount of money at your disposal determines the speed and quality of the service you get. This is, of course, increasingly the case in the health service also, but it is the first time we have heard a Minister for Health prepared to admit it.
If Ben Dunne has a supermarket which is not making money, he will simply close it down. Is the Minister seriously suggesting that the same approach can be adopted in relation to hospitals or health centres? I believe the Minister's statement reflects an underlying hostility in Fianna Fáil and the Progressive Democrats to the concept of a comprehensive public health service. The real objective of the health cuts has been to create in this country a US style health service where the amount of money in your pocket determines the quality of the health care you receive: a service where only the poorest of the poor qualify for a limited public service and where everyone else must take out private medical insurance or pay themselves.
Families have to go to credit unions or banks to borrow money to enable their relatives to have operations. That happened just today in my own constituency in the case of a person who has full eligibility and should be treated under the public health system. This must not be allowed to continue. We are totally opposed to this approach. We believe that any civilised society has an obligation to provide the best possible standard of health service for its people on the basis of need rather than wealth. We are in favour of a more efficient health service and the more effective use of scarce public resources but we are opposed to cuts which diminish the standard of health care for those who need it. We opposed the health cuts of the Fine Gael-Labour Government, we opposed the health cuts of the last Fianna Fáil Government and we will oppose the health cuts of this Fianna Fáil-Progressive Democrats Government.
At the outset, I would like to thank you, a Cheann Comhairle, for giving me time to speak and I would also like to pay tribute to my colleague, Deputy Jim Kemmy, for sharing his time with me. I have no political allegiance to any party, but seven months ago the people in my constituency in Roscommon elected me almost solely on the health issues. It was not a decision they took lightly. After all, to topple an experienced political figure was not an easy task. But when people saw what was happening in the health services they realised that unless they had one of their own to work for them their chances of getting fair play, even in our own health board area, was almost nil.
Over the last five or six weeks it has been the in-thing to criticise over-crowding and under-staffing in hospitals. That is not new in Roscommon hospital. Since the health cuts were first introduced three years ago there has been continual over-crowding and a shortage of nurses in our hospital. There have been seven beds in four bed wards and sometimes six beds in a four bed ward and so on. That, along with under-staffing, has left the health services in Roscommon in a dire state. The fate of Roscommon hospital was never highlighted by many of our politicians or our health board representatives but the moment it came to light that there was over-crowding in the Regional Hospital in Galway and a scarcity of nurses, the boys jumped onto the bandwagon immediately. Maybe the TV cameras were an incentive. Even Western Health Board representatives from my own county failed to highlight the disadvantages faced by Roscommon hospital for one reason or another. However, we in Roscommon are not now surprised at the furore that is being kicked up throughout the country due to the shortage of hospital beds.
It may be unfair to blame the Minister for Health alone for the shortages and the under-staffing because after all he is a member of the Government which, I am sure, took a collective decision to do what he has taken responsibility for. The Minister strikes me as an honest man, a believing man and indeed he must be a believing man if he can say with apparent honesty that there is no over-crowding in certain hospitals and in particular in Roscommon hospital. I gather than the Minister genuinely believes that, so I would advise him to seek new advisers and to get rid of the guys who are continually feeding him untruths, to say the least. I will not use a stronger term.
He hears what he wants to hear.
I accept that the Minister believes what he says when he comes on television with an angelic face and says that there is no over-crowding in Roscommon hospital, but I would advise him to seek his advice elsewhere the next time.
We did not jump on the bandwagon at Christmas to talk about the over-crowding due to the flu epidemic. We have not been suffering a flu epidemic in Roscommon for the past three years and during every month of 1989 there was over-crowding in Roscommon hospital. We have 25 surgical beds, 27 medical beds and eight beds for coronary care, a total of 60 beds, although the Minister thought that total was 70 beds. It is quite common to have 45 patients for the 27 beds. Obviously, somebody must suffer and the people who suffer most are the patients and then the working staff, the doctors and nurses in the hospitals. It is grossly unfair to put the onus for discharging patients prematurely on any doctor or matron. In the not-too-distant future the day will come when some doctor will be had by the "short and curlies" for discharging a patient prematurely. I wonder who will face the reality then? Who will foot the bill — the doctor who discharged the patient, the health board or the Minister for Finance? It is unfair to put such an onus on one person when there is a simple answer.
In Roscommon hospital it is hard to explain to patients that they cannot be admitted because of bed shortages when they can look around and see a ward with 30 or 40 beds completely locked up. The Minister spoke about loving care and preventive medicine. Preventive medicine is a good line to take but one will not get far with preventive medicine if patients are turned away from hospital because of bed shortages, or if one puts the onus on the doctors to examine patients to see which two or three of them might be less deserving of a bed so that they can discharge them to allow in others. The sooner we get away from that type of thing the better.
One would wonder if our health services are being administered by the proper authorities in the proper manner. One would question the structure of the health boards and of the health board areas. The Minister spoke about review bodies. The first review body should review the health boards and the health board areas because, as I see it, there are many mini-Hitlers in the health boards. The Minister talks about loving care but those people never heard of it. Maybe they have as much loving care for the patients as Herr Adolf had for the Jews.
We have been told that the sense of panic has been heightened amongst patients by people highlighting the over-crowding. Highlighting that problem will not cause as much panic amongst people as would a refusal of admission to hospital or the knowledge that nurses are unavailable to tend to the needs of patients because they are so over-worked. More panic is caused if a person who has been involved in a car accident is brought into casualty and is left there for a few hours because of the shortage of nurses to take care of the problems. If we are talking about heightening panic that is the way to do it. The way to solve that problem would be to employ a few more nurses and open up some of the locked wards.
I hesitate to interrupt the Deputy but I merely inform him that he has some three minutes now remaining to him.
We have been told that we have a dwindling population and that there is not the same necessity for as many hospital beds as before, especially for elderly people. It is true, unfortunately, that our population is dwindling but despite that we have an increasing ageing population — the parents of people who have hit the boat trail and emigrated. Instead of decreasing the number of beds for elderly people we should be increasing them. The Minister should take full responsibility for preventive medicine and put it into proper perspective.
The Minister was tardy in recognising the shortcomings in the health services, especially in Roscommon, the area about which I know most. I am delighted, however, that he is now facing reality and that when we discuss the health services in perhaps six months' time the situation will be much different in Roscommon. It will not then be at the bottom of the pile, the forgotten county of the health service, as it has been for the past three years.
With the permission of the House, I will give five minutes of my time to Deputy Flood.
Is that agreed? Agreed.
There can be few public debates which have engendered so much bad feeling, bad blood and gross misrepresentation as this debate. We all accept that there are problems in the health services — certainly I do and I would never suggest to the contrary — and we all equally accept that there is no such thing as a perfect public service because the day we claim a service is perfect is the day we accept that there can be no change.
There is no such thing as a service that cannot be improved by thoughtful analysis and timely action. There can be no doubt, however, that the public debate was called for by Fine Gael and some of the key vested interests — a number of the minority parties spoke here tonight about vested interests and I will be focusing on them — in medicine, most notably the Hospital Consultants' Association. The debate is not aimed at improving the health service, it has been destructive, ill focused, untruthful, bullying and, at the end of the day, sterile. Their aim, collectively, is base. On the one hand the aim has been politically destructive and on the other it has been to defend the honey pot which has been used to line private pockets from public funds. Neither Fine Gael nor the consultants' association have had much regard for the common good in their sometimes indistinguishable antics over the last few months. That party and the association share another distressingly common feature which is new to public debate, a total and absolute disregard for the truth.
Dear God.
I will listen to Deputy Carey's speech with interest.
I will tell the truth.
Deputy Carey must contain himself.
They have put about the view that our health service is a Third World service. That is a lie and all Deputies in the House should know that that is the case. The lie undermines the work done by the tens of thousands of men and women who contribute to the service. It also undermines the contributions of the taxpayers to the service. Between them they have shaken public confidence to the core in our public health institutions. Our public health institutions are not perfect, they are extremely large and costly. In the current year the non-capital costs, without taking into account the recent budget changes, will amount to £1,397 million, 21.3 per cent of total Government expenditure.
In the current year the increase will be of the order of 9.6 per cent or just double the rate of inflation. I am not saying that that is enough, if we had more money we should — and could — put more money into the services. However, it is a significant amount of public funds. Yet these figures have been dismissed as insufficient. Deputy De Rossa, gracing us with one of his occasional visits from Europe, not only suggested that the figures were insufficient but 50 per cent lower than they should be.
Current health expenditure costs the average PAYE taxpayer about £1,500 per annum. Would the average taxpayer agree to put a further £750 into that service? Somehow, I doubt it. I have some sympathy with Deputy De Rossa as in recent times he has become a little removed from the realities of life here. He is beginning to sound like his party colleagues on Bray Urban District Council who, for the last two years have been calling for this and that service but, when it came to voting for the services, were missing.
The truth is bitter.
The Workers' Party can be forgiven because they can always say they have not been in Government and cannot influence decisions here. However, at local government level they cannot make that play. Last year the health spokesman for The Workers' Party in Bray went to Fassaroe and Wolfe Tone Square in Bray and promised the people they would get support for certain community services but, when it came to putting £1 on charges to support the services, he was nowhere to be seen; he reneged on his promise and turned his back on the people. The same applies to The Workers' Party in the House because, when it comes to supporting any budget, they will always be in the "Nil" lobby. That applies no matter what Government are in office.
Public confidence in the health service has been severely dented in this debate and truth has been the first and final victim. At a very early stage in this debate the main Opposition party, the consultants and other vested interests decided that exaggerations, misrepresentations and common lies would set the tome of the debate. I will give a couple of examples and I am pleased that Deputy Yates is here. On a recent "Today Tonight" Deputy Yates said: "a consultant physician for diabetes in Beaumont Hospital has 56 of his 57 beds filled with accident and emergency patients and is unable to admit patients with diabetes". The following day the consultant, Mr. Devlin, wrote to the CEO of Beaumont Hospital — and Deputy Yates — to say that the allegations were totally untrue. He went on to categorically refute the claims made by Deputy Yates. He categorised the allegations as instilling a lack of confidence in the hospital and a lack of concern for patients. Beaumont Hospital took the unusual step of issuing a press statement categorically refuting the statement of the Fine Gael spokesman.
I admitted I made a mistake.
I will deal with that in a moment. Faced with the truth, did Deputy Yates blush or apologise? No. He simply dismissed the fact and suggested that it was a slip of the tongue. He said that he referred to Beaumont Hospital when he meant the Mater.
The Mater have the problem.
This proves what we all suspected about Deputy Yates. Not only has the gentleman a brass neck and a contemptuous disregard for the truth or accuracy, he does not even know his Beaumont from his Mater. I could be rude and say that he does not know other things too. The issue of truths and misrepresentations is not confined to Deputy Yates. Politicians of all hues, including local government level — some from my own party, to their eternal discredit — have also been engaged in this. For example, in Clare County Council on 8 January a full debate was televised by RTE which dealt with the unfortunate case of a man who died on 5 January. We were told that he had been refused admission to Ennis Hospital on Christmas Day because there were no beds available. There is an old saying that the truth does not have its boots on when the lie is three quarters way around the world. If anything ever proved this saying this case is it.
On 9 January we had a full report on the issue from the Mid-Western Health Board. It seems — this is an interesting point — that the decision was a clinical one and had nothing to do with—
(Interruptions.)
I challenge the Deputies opposite to read the report.
I reminded the House last night — and it should not be necessary to remind adults too often — of the need for a civilised debate. This has been the case so far and it will continue. People who interrupt will get one further warning from me and after that I will ask them to remove themselves to a position where we can continue a civilised debate. I will not repeat that. Deputy Roche will make his contribution without interruption.
I should like to thank the Chair. My apologies if I contributed to the heat to any extent. The fact is that if the Deputy opposite took the trouble to read the press statement of the Mid-Western Health Board of 9 January he would see that the last sentence he uttered was a total untruth. That case did not have anything to do with the availability or non-availability of beds. The final paragraph of that press release indicates that there were beds available that week and that there were admissions where clinical judgments suggested that admissions were in order.
That proves once again that Deputy Yates has scant regard for the facts and only a passing acquaintanceship with the truth. Unfortunately, Deputy Yates and local councillors were not the only people to jump on that bandwagon. Our national public broadcasting system, RTE, was very quick to relay all of what they described as the sordid details of that matter. So too was the local press. The distressing point about this is that there was a disregard on all sides for what must inevitably be the consequences on families and people who were seeking medical care.
One does not always expect accuracy from RTE and local newspapers can occasionally go over the top. Deputy Yates is, of course, always over the top. However, one does not expect that a certain standard relating to truth will be observed by professional bodies such as the organisation which represents hospital consultants. I should like to deal with some of the statements they circulated in recent times. Increasingly in recent times the hospital consultants' organisation have operated in their public performance in a manner more like a new and vigorous political party than a caring and professional organisation. When the association's performance and the antics of some of the consultants are examined one is forced to ask who they are caring for.
Controversies between vested and well heeled medical interests and Ministers for Health are nothing new in Ireland. We all recall that former Deputy Noel Browne had a tempestuous relationship with medical interests. That is part of the political history of the State. In more recent times, former Deputy Barry Desmond had difficulty opening Beaumont Hospital not least because of problems he had with the consultants. What concerns me about the operations of the consultants in recent times is the disturbing amount of evidence which suggests that the association, and some key members, are not just prepared to misrepresent the facts but are prepared to manipulate them in a way that will further exacerbate a problem in a circus which is cash hungry and against cash limits.
I am sure I am not the only TD who has worried public patients calling to his office with a totally distorted view of reality presented to that public patient, or the parents of a child, by a hospital consultant. I would be willing to make public outside the House details of two cases, one concerning a tonsillotomy and a consultant and the other concerning a patient with more dire consequences in another hospital. I will deal with those matters at health board level.
Certainly, some of the stories going the rounds at present regarding the antics of consultants demand investigation. There is, for example, the suggestion that two consultants in one of the major accident and emergency hospitals in this city packed clinics artificially with public patients when they learned that the Minister might visit that hospital. I will be asking the Eastern Health Board to investigate that. If it is true it is a scandal. The two men in question were caught on the hop because on the day in question the Minister visited two other hospitals.
There is also the consultants' collective response to the recent flu epidemic. To say the least it was remarkable because of its disingenuous nature, particularly in Dublin. The six accident and emergency hospitals in Dublin coped well with that dramatic event, a flu epidemic of unusual proportions which resulted in a 40 per cent increase in hospital intake through accident and emergency departments over two weeks. The work of the staff of those hospitals was dismissed by the consultants and their associations. Why have they such contempt for their fellow health workers? Who are they serving? Who are they defending?
One of the extraordinary things about the flu epidemic is that if one examines the studies carried out by the Eastern Health Board on daily admissions — the health board monitor admissions — one will find that during that period there was a surprisingly high level of what are called misadmissions or inappropriate admissions, to use the health board's phrases. Indeed, throughout that period there was never a day when inappropriate admissions went below 10 per cent. As the consultants are in the driving seat for admissions that raises a number of questions, particularly given the volume of admissions over the period of the flu epidemic. Do the statistics denote a lack of competence amongst the highest paid group of workers in the public service? It should be remembered that some of them are topping the £250,000 per year mark. Do the statistics suggest that some consultants were packing the wards? We will have to wait for the conclusion of the analysis by the Eastern Health Board to get answers to those questions. I wait that analysis with interest.
There are other aspects of the consultant's operations which warrant attention. There are close on 1,100 consultants in the country and their total take from the health service last year was almost £100 million. There is something extraordinarily perverse about 1,100 people sharing £100 million in one year. There are many honourable consultants who do not lace their pockets. I am aware of one consultant, a professor, who will not accept any fees from private patients but reverts these back to the teaching hospital or the institution where he is available. He is an exception. I do not doubt that consultants work hard but I doubt that they work as hard at their public sector services as they do in their private practice. There was a ray of familiarity in the cases highlighted in one of the British "quality" newspapers recently. That newspaper highlighted abuses in the British NHS by consultants. Any Deputy who is honest will recognise that those allegations had a disturbing ring of truth. The suggestion was made that there should be an audit of consultants over there. That is long overdue in Ireland.
I am aware that the Gleeson Committee are looking into the pay and conditions of consultants and I do not wish to anticipate recommendations that will be brought by that group. One thing I would like to see would be a new consultants' contract being offered. I would like that contract to set out in specific, objective and measurable criteria the amount of service consultants will be expected to produce for the large pay they get. Under such a contract we could judge efficiency. We would know when the consultants are due in the hospitals and the number of hours they are expected to work there.
I listened to what Deputy Yates said last night. While I disagree radically with the way he has behaved in recent times I would not brush off all he said. For example, I was interested in what he had to say about the use of generic drugs because the Minister told us that he intends going that route. It was interesting too that he seemed to be unaware that the Minister in the last Government his party supported was the person who was responsible for the cosy deal with the drug companies. I listened to what Deputy Yates said about institutional changes in the health services. I would not agree with him in regard to that. I listened in vain for the Deputy to say anything about consultants. Would that have anything to do with the person who now heads their organisation?
I did refer to the consultants; the Deputy missed it.
The sponsors of the motion said that they could do better than the Minister. We have no objective criteria against which to judge the attitude of the minority parties but we do in the case of the two major Opposition parties, the Labour Party and the Fine Gael Party. In all truth they cannot say that they would do better because in the past they most definitely did not. This point has been taken up by some of the minority Opposition parties and I will not pursue it but if one looks at their past performance one will see that they do not have the cure-all available.
There were no hospital closures in Louth when we were in Government. We were opening them, not closing them.
We should have the water in County Louth tested because evidently the Deputy's memory is failing him. The most historical day in the Irish health services was when former Deputy Desmond closed eight hospitals in one day.
He opened two in County Louth but Fianna Fáil are closing two.
He did not open any in County Wicklow. The Fine Gael cure-all for this problem is to produce another State-sponsored body. This is an institutional matter and something on which I would like to spend the next three or four minutes before passing over to Deputy Flood. That party has a touching faith in State-sponsored bodies. At present Deputy O'Keeffe is promoting a State-sponsored body to replace the Land Registry, admittedly it could not do a whole lot worse. The idea has surfaced from time to time. Every time we have a problem in any public sector institution in this country Fine Gael suggests a State-sponsored body. What does this mean? It needs teasing out because the facts are that the Deputy opposite — Deputy Yates — has never spelt out how a non-commercial State-sponsored body would improve the public health services.
Let us look at what a non-commercial State-sponsored body would do. The fundamental reason we have established non-commercial State-sponsored bodies is to free areas of administration from ministerial responsibility. Thus we free them from answerability to Dáil Éireann. If Deputy Yates does not know this, there are people in his party who know it, and I would refer him to the book which was written some 20 years ago on the subject by Deputy Garret FitzGerald. The idea is that the State-sponsored body frees the day-to-day operating managers from "political interference and allows them to get on with the task". There are other advantages organisationally and in terms of personnel. However, the central issue is freedom from ministerial responsibility and freedom from answerability to Dáil Éireann.
Does any Deputy believe that if total democratic answerability is removed from the State-sponsored bodies in day-to-day matters, that would improve our health services? I do not think so. Would any Deputy, for example, Deputy Bell — be willing to accept a situation where he could not ask a question about a matter that concerns him in a hospital or in a health centre in his constituency? No, he would not accept it. I would not accept it in my constituency and neither would Deputy Yates in Wexford.
This is an ill-thought-through proposal and one which would have disastrous bureaucratising influences on health services. It is easy for people to come forward with meaningless suggestions such as this. I do not want to go over all the failures of past Ministers for Health because that is fundamentally arid. I do not suggest that the present Minister for Health has all the answers immediately. Of course he does not, he is human. Some of the suggestions he has made will work and others will not but, at least, he is making an honest effort. The attitude of this whole debate was well summed up in a recent edition of the Irish Medical News dated Monday 15 January in an article by David Nowlan in which he said:
Only the Minister, his Department and the health board executives, it seemed, were actually trying to analyse and understand the situation. While the shouting went on around them they were trying ... I thought that they held their nerve well and they did considerably more for the patients than most of the roaring opponents.
That is the case. Which Deputy in the Opposition had the generosity, a few minutes ago — I think it was Deputy Foxe — to say that he believed that the Minister for Health, Deputy O'Hanlon, was a good man. I believe he is a good man. I believe he is an extremely good Minister. I believe that if we searched the whole 166 of us and if we were honest with ourselves we would not get from amongst our membership a better Minister. He is a Minister who has a difficult and arduous task. There is no doubt in my mind that there are problems now in the health services and there are other problems to be solved, but I have every confidence in the Minister for Health, Deputy O'Hanlon, that if the problems are solved they will be solved by him. One thing is absolutely certain; they will never be solved by the spokesperson on health from the leading Opposition party, who clearly has shown in all his antics over the last few weeks not just a disregard for truthfulness, not just a disregard for facts but a total and an absolute incompetence to deal with health issues. I now concede my remaining time to Deputy Flood.
The remaining time is approximately six minutes. I remind Deputies on the Government side of the House that encouragement to their own can be regarded as interruptions and I ask Deputy Browne not to persist.
In the short time available to me I want to stress some of the positive developments that have taken place in the health service over the last number of years. None of us would deny that when the Minister for Health, Deputy O'Hanlon, took over in 1987 there was a problem relating essentially to funding. It must be said that he did inherit a very substantial bill of £55 million from the health boards over the previous two years. Much of the blame for this overrun has been put on the health boards. I should like to point out that under the 1970 Act the Minister is specifically empowered to deal with such a situation and, quite frankly, any Minister would have to take serious account of the fact that health boards decide on an ad hoc basis to overrun their particular allocations. I do not think that should have been allowed to happen then, and I do not think it should be allowed to happen now. The Minister for Health has the responsibility for ensuring that it does not happen.
Over the past two years in particular, once the Minster was able to come to grips with what had been, in certain areas at least, duplication and over-expenditure, he is now entering into a phase, certainly over the past nine months, of developing the health service as he outlined to us in his excellent contribution to the debate last night. We cannot ignore the fact that the Department of Health is a very substantial spending Department where almost 22 per cent of Government expenditure goes; nor can we ignore the fact that there is an increase of £120 million allowed for in 1990, an increase of almost 10 per cent. To be fair to contributors from the Opposition many of them have rightly said that the problems in the health service cannot be solved simply by throwing money at the service. That is a correct approach.
I respect the right of individual contributors here to put forward their various contributions in a largely constructive way. I do not think the time of this House should be wasted in entering into argument and detailed differences across the floor of this House in an attempt to score political points. That is not helpful in the present situation in the health services. For that reason I welcome wholeheartedly the contribution of the Minister for Health last night. He indicated that he would have to look at the operation of the acute hospitals, that he would introduce a number of initiatives in the immediate future, thus building on what has happened over the past year.
I believe this is the correct way forward to deal with the reorganisation and strengthening of the health services. I should say that any suggestion coming from any quarter that the health service can be improved by simply throwing additional sums of money willy nilly at the service is not helpful to the development and strengthening of our health service.
Waiting lists, which are a positive example of the Minister's work over the past year particularly in terms of joint replacements, have come in for a considerable amount of criticism. Many people have forgotten that the Minister, on his own initiative, did take steps to improve facilities at Cappagh Hospital whereby additional theatres were brought into operation in an effort to reduce the waiting lists, so that at the end of 1989 the list stood at 2,316, and 63 per cent of those on the list were waiting for less than one year. That was a positive development on the part of the Minister. The additional expenditure in the dental services is going in the right direction. His demand that the health services look at their efficiency is correct. The bringing in of outside expertise, possibly for the first time, since the health boards were set up, is a positive approach. With all these initiatives being taken over the next three or four years we will see a dramatic improvement in the operation of the health boards.
Finally, I am anxious to see details of the capital programme for the next five years because even now some of the hospitals are archaic; they are badly designed, lacking facilities for visitors, lacking theatre facilities. It is time that these were looked at in the context of the capital programme which the Minister is to announce.
I believe we are going in the right direction. We need to look at the health service in a calm and rational way. There is little point in people trotting out individual cases and holding them up as examples of how our health service is run. Because of the numbers going through the health service there will always be individual complaints, but they are not representative of the operation of the health service as a whole. This debate has contributed something to calming the situation as far as the health service is concerned. In the years ahead we will see the trojan efforts of the Minister for Health bear fruit and there will be a service available to all who need it.
I understand now that the Whips have come to a sensible arrangement whereby Deputy Lee will have seven minutes, Deputy Creed will follow with five minutes, and the remaining 18 minutes will go to the Labour Party to be used in whatever fashion they wish. Is that agreed?
Agreed.
Over the last three years there has been a sinister development under the Minister's unsteady hand of a two-tiered health service for the first time in the history of the State, one for the rich and wealthy where health services are available freely on demand and one for the unfortunate and under-privileged people who, by virtue of their social and economic circumstances, have been relegated to the status of second class citizens. The service, in some instances, is comparable to a Third World health service run by a third rate Government.
The Minister portrays a simplistic scenario in answer to every conceivable problem. He portrays a frightening lack of comprehension of the gravity of the situation. I have no particular pleasure in, day after day, week after week, month after month highlighting the gross injustices that exist in the Fianna Fáil health service. I take no pleasure in castigating a fellow general practitioner, in calling into question the veracity of each and every one of his statements. Both of us were educated in the same medical school; both of us were trained in the same hospital; both of us chose the same speciality, family medicine. Both of us have chosen a career in politics; thankfully we have different political beliefs.
I believe that all people in this country should be treated equally and fairly, especially in the area of medicare. All people should, as a birthright, have access to a caring and considerate health service, regardless of their financial status. I believe, as do the majority of people that the Fianna Fáil health service under the care of the Minister has deteriorated rapidly. What the Minister has achieved in his short reign as Minister for Health is morally and socially unjust and against all the principles of a caring, Christian society.
The Minister's introductory speech last night is a hyped-up PR document, if ever I saw one. It is easy to discern what was written by the Department of Health. It is easier again to discern what was written by the Minister's dirty tricks department and still easier to discern what was written by the Bunny Carr organisation. It is still easier to see what was written by the Minister's advisers.
The Minister stated what brought him into politics. He talked about the physical and psychological fears caused by sickness. He talked about his concern for patients' fear over the lack of vital treatment. He says that his patients taught him that fear of sickness makes one less able to cope. He says that his patients taught him that old people are a valuable and precious resource and that a decent society cares for its old people. That just does not wear. The Minister said that he learned to admire the courage of people in the face of pain. He says, once again, that he learned to admire their courage in the face of death.
I have some illustrations of what is going on in the real world, the world outside this House, the world outside the Department of Health, what is happening in the acute hospital system, the paediatric and maternity system, the geriatric, the psychiatric and the dental health systems.
The Minister's speech was a litany of pious hypocrisy and sanctimonious sham, the likes of which I have never heard in my life. One would think to listen to this hyped-up PR document that there is no two to three years waiting list for ENT operations. One would think that we have an excellent school health service when the reverse is the truth — the service is grossly understaffed and underutilised. Surely prevention and early detection of illness, as the Minister knows as a general practitioner, should be the aim of a caring and efficient service. The Minister and his advisers, however, obviously do not think so. One would think that routine post-natal services had not been cancelled. One would think that there is now no two to three year waiting list for cataract and hip operations. One would think that last December there was not a cancellation of all elective admissions to the Mater Hospital on the north side of this city. — and I will now state the obvious because I feel that for Fianna Fáil it has to be stated — with the exception of those listed for cardiac surgery, cataract surgery and oncology treatment.
Unfortunate sick people in a poor state of health who for many months have undergone major psychological stress, who are concerned and worried about their health, now find that because of mismanagement by the Government they will not be admitted to hospital, have psyched themselves up to go into hospital in the first place. One would think we have an excellent physiotherapy service on the north side of Dublin; the reality, as every GP on the north side of the city knows, seemingly with the exception of the Minister and his secret advisers, is that it is not available to GPs. One would think, to listen to the Minister, that we had an excellent and efficient and caring geriatric service and that there is no shortage of beds. Daily in my work I see the anguish, the pain, the suffering inflicted not only on the unfortunate patients but also on their immediate families who are ill-equipped and ill-advised and unable to cope with the situation. One would think that we have an excellent chiropody service. I have seen, in the last year, the development of a rare disease in medicine. It evolved under Fianna Fáil and it is called "Fianna Fáil toenail". The Department have reduced the chiropody services available to the elderly to three times a year. Many of the elderly and partially blind, obese, suffering with arthritis. They need to have their feet treated at least once a month but because of what the Minister. has done they now have to pay for these treatments at a minimum cost of £10 per treatment. Surely that is not the hallmark of a caring Government.
This morning I left this House and went out to visit a patient of mine in a convalescent hospital not three miles from here, quite near my home. There were 12 beds in that ward where normally there would be five. I had to pull beds out of my way to examine patients. I had an elderly patient last week whose sister was taken to hospital. He has severe Parkinson's disease and severe arthritis and is very unsteady on his feet. Could the geriatric services take him? No. He had to stay at home for seven days. Baggot Street said they had no beds; Linden said they had no beds and St. Mary's said they had no beds. Fortunately, I got that patient into hospital yesterday. That is the kind of service we have. Fianna Fáil said before the last election that health cuts hurt the old, the sick and the handicapped.
Finally, four close friends of my family were very seriously injured in a car accident. One ambulance was despatched from the regional hospital in Galway, eight miles away. The ambulancemen who came to the scene of the accident were excellent but one of the victims was left bleeding in the back of a car for two hours because an ambulance could not be provided. The patient was taken into the Regional Hospital in Galway——
I must advise the Deputy that he has already taken up one minute of his colleague's time and there are only four minutes left for him.
Three days after that patient was taken into Galway Regional Hospital her mother had to wash her. If that is the kind of health service being provided by this Government I certainly intend voting for this motion tonight.
I am glad of this opportunity to express my opinion on the current crisis in the health service. If one was to believe the utterances from the benches across the way, one would believe that there was some political benefit to be gained from whipping up an imaginary crisis in the health service. The Minister and the Government would do well to consider where the criticisms of their policies are coming from. These criticisms are not emanating from the benches of the Opposition only; they are also emanating from people working in the front line services of the health service, hospital staff, patients and members of the public.
It appears the arithmetic will ensure that the Minister for Health will survive this no confidence motion tonight. However, I believe the public have lost confidence in the Minister for Health, which is far more serious. I believe also that Members on the Government benches, who are not allowed to give full vent to their frustration at the level of service being provided by the Minister, have also lost confidence in him. I appeal to the Minister to listen to what is being said by Fianna Fáil representatives on county councils and health boards. As late as last Monday at a meeting of the Southern Health Board, the views of the Fianna Fáil members were quite apparent.
The Minister would like us to believe that the current difficulties in the health service are due solely to the flu epidemic but the reality is that this crisis has bean building up under his stewardship for the past three years. Since the Minister will survive this vote of no confidence, one can only hope that something positive will emerge from this debate and that the genuine concerns being expressed by Members on all sides will be taken on board by the Minister in an attempt to resolve these problems.
I want to deal specifically with the problems of the health service as they manifest themselves in the Southern Health Board area with which I am most familiar. There are now 1,000 fewer staff and 500 fewer beds in the Southern Health Board area than there were in 1987. Anybody who argues that the quality or quantity of the service being provided in these circumstances can remain as it was in 1987 is not in touch with reality.
As my colleague, Deputy Lee, said the slogans used by Fianna Fáil in the 1987 general election stated that "Health cuts hurt the old, the sick and the handicapped vote Fianna Fáil; there is a better way". We are still looking for this better way but there are no signs that the Minister for Health, Deputy O'Hanlon, has got an iota of how to provide a better way for the health services. As they say, as you sow, so shall you reap. During the 1987 election campaign the public were led to expect a better service, but the reality fell far short of that, and the Minister reaped his reward in the 1989 general election. During that election campaign the Taoiseach said he was not aware of the extent of the problems in the health service, and it appears that to date he is still not aware of the extent of those problems.
I want to briefly outline the difficulties in the health service in the Southern Health Board area. I have a document in front of me which was submitted by the Southern Health Board to the Department of Health outlining their requirements for 1990 in order to maintain their level of service at 1989 levels. The shortfall in the allocation vis-à-vis the requirement is £3.35 million. I believe this highlights the extent to which the Minister is not aware or in charge of what is happening in his Department. The Southern Health Board have an obligation to pay the 26th pay round but there is a shortfall of £200,000 in their allocation. The Southern Health Board are in possession of all the facts on the numbers employed in their organisation, yet the Minister has refused to accept that reality. This is indicative of the Minister's lack of knowledge of the requirements and problems facing not alone the Southern Health Board but every health board.
Despite the Minister's contentions, the Southern Health Board are facing their third year of cutbacks under his stewardship. The ironic thing about this is that in the letter outlining the health board's allocation the Minister asked them to build up the services as they affect the elderly and the handicapped and to improve the AIDS programme. If adequate funds were forthcoming the Southern Health Board would not be found wanting in that regard.
The problems of the Southern Health Board are also being faced by the nation as a whole. The problem with our health service is that it is hospital orientated. There is little reward for good health and little hope for the sick. When the cutbacks in nursing staff and beds are coupled with the reductions in community care we get a very dangerous combination. This Government have got the cart before the horse. If they want to cut hospital services they have to put the resources into the community. That is where they have failed.
The Minister may say that the embargo on recruitment has been lifted, but there is only one district health nurse for 7,000 members of the population in the Southern Health Board area whereas the recommended average is one district health nurse per 2,500 people. The embargo may have been lifted but the resources being made available to the Southern Health Board are not adequate to even consider recruiting other staff. Numerous other key personnel posts need to be filled to remedy some of the worst cutbacks in the Southern Health Board area over the past number of years, but little hope has been emanating from the Minister or the Department in this respect.
As I indicated earlier, the Labour Party have 18 minutes.
I appreciate your efforts, a Leas-Cheann Comhairle, to facilitate us particularly since the Labour Party played such a major role in having this debate structured properly. Our spokesman on health, Deputy Howlin, tried to depersonalise the debate away from the Minister because we all respect the Minister as a person. However, we cannot ignore the fact that the Government have collective responsibility for the administration of all Departments, including the Department of Health. Irrespective of the constraints which may be placed on the Department of Health by Government borrowing, budgeting or whatever, no priority is being given to the health services. In fact, there has been a continuing drop in health funding in real terms as a percentage of GNP every year since the Government took office.
When most of the members of the Government were in Opposition, they were involved in a nationwide campaign of vilification of the then Labour Party Minister for Health, Mr. Barry Desmond. Fianna Fáil Members led campaigns of assault, both physical and verbal, on Mr. Barry Desmond, when he visited my constituency of south Tipperary to open a new psychiatric unit in St. Luke's Hospital. There are television reports on this incident. At that time, he referred, in principle, to the report on the psychiatric services, Planning for the Future, which had as its aim the closure of outdated psychiatric beds and advocated care and treatment for patients in the community. On the day he visited my constituency, Mr. Barry Desmond publicly stated that neither he nor the then Government had any plans for the closure of acute or sub-acute hospitals in that region, or in any part of the country. He was striving, at that time when there were Fialla Fáil dominated health boards, to bring some order into spending. In spite of that campaign of vilification, he never lost a hospital bed, a nurse's post or a patient. Immediately on assuming office Fianna Fáil, who still had a majority on the health boards, set about their dirty tricks campaign with the closure of hospitals in their book-keeping exercise. They closed five hospitals in the south east region; they closed acute beds in St. Joseph's and Our Lady's in Cashel and a sub-acute hospital in Tipperary town. When he was later blamed for allowing health boards dominated by Fianna Fáil to overspend one CO publicly stated on RTE — and I have a transcript of his statement — that they expected the economy to improve. Under the Fianna Fáil Government all the health boards were whipped into voting to close these hospitals and to cut back on dental care, ophthalmic care, transport for medical card holders and other services.
When the sub-acute hospital in Tippeary town was closed, the community, led by the then co-adjutor Bishop of Cashel and Emily, Dr. Clifford, went to the High Court. Before we arrived at the High Court, the Minister for Health signed an order agreeing to the closure of the hospital but only a few days ago he listed the hospital as still being open. Of course it is still open but only as a day care centre being run by voluntary associations who provide an excellent service. In the recent past we needed a hospital urgently. Just for the record, that health centre was going to be provided anyway. The health board purchased a site from the urban council but it is now a white elephant as they are not going to construct anything on it. They reopened this hospital as a day care centre to be run by the voluntary associations.
The closure of hospitals, such as St. Vincent's Hospital, has led to a critical shortage of beds in acute hospitals not only in south Tipperary but throughout the country. This has resulted in pressure being brought to bear for early discharges which is not without risk. Elderly patients in particular are being discharged back into the community without any community care. Geriatric beds are at a premium with the result that these elderly people now have to wait for people to die in geriatric hospitals, assessment units or in welfare homes before they can have any hope of getting a hospital bed.
Let me now refer to the ambulance service. I have in front of me a letter from a person, which I can give to the Minister, who recently broke his leg. It was considered to be an emergency case and he was admitted to hospital where his leg was put in plaster of Paris. This person who is a medical card holder and who came to hospital by ambulance was then told to find his own way home. In another case the relatives of a seriously ill person who looked for an acute hospital bed for him in Clonmel were told he could not have a hospital bed and that an ambulance could not be sent to collect him but that if they were willing to take a taxi they could try to have him admitted to the psychiatric hospital. Unfortunately, when they arrived there they were told to go to St. Luke's Hospital and from there to St. John's Hospital but again there was no room for the patient. They then went back to the acute hospital where they were reminded that they had been told there was no bed for him but that hospital kindly rang the psychiatric hospital where he was later admitted and put to bed. The doctor at the hospital wanted a letter from the GP before admitting the patient but the relatives did not have any such letter. They then went back to the doctor and returned to the hospital with the letter only to find that the patient had been discharged. He had been taken by ambulance back home. After much deliberation he was taken back to the acute hospital where he was finally admitted. He died the following morning. No wonder my colleague, Seán Lyons in Clonmel, is looking for an investigation into the circumstances surrounding that tragedy where a man was in and out of five hospitals, four of which were psychiatric even though he was not a psychiatric patient.
Similar examples can be given by other Members of this House. Deputy Taylor has statistics on the dental service which show that there is a waiting list of 11,000 adolescents in the Eastern Health Board region. There is a crisis, yet the Minister tries to tell us otherwise. I have before me a number of newspaper headlines. For example, the headline in a recent edition of The Sunday Tribune reads “Operations hit by Anaesthetists Crisis” and the headline in the Irish Independent of 1 February “Bed Shortage Forces 50 Per Cent Cut in Heart Operations”. Neither of those headlines were drawn up by the Labour Party. Then there was the headline in The Cork Examiner of 4 February to a report on a Southern Health Board meeting which read “Dying Patients Sent Home”. The report stated that Councillor Jackie Healy Rae of Kerry said, in claiming that some patients were being hunted out of hospitals before they were fit to be discharged, that people were scared. Jackie Healy Rae is a Fianna Fáil councillor, a former chairman of the health board and an advocate of the Minister.
That is probably why they were scared.
That is the truth. It does not amount to vilification. They are the facts as presented by Fianna Fáil members. There is no way the Minister will be able to whitewash over this service.
Where is the Minister?
Last night I listened to a litany of promises. The Minister promised that there will be a further investigation, that a further review committee will be set up. This will have serious consequences for every CEO and every programme manager as they will find they have another review group looking over their shoulder to see whether they are overspending, even if they do occasionally make excuses for the Government. I am saying there is a crisis and that the sooner the Minister puts into effect some of the recommendations in the reports which have been published, the sooner we can stop calling on him to resign and start telling the old, the sick and the handicapped not to worry about Fiann Fáil posters. We may then believe that something will be done to resolve this crisis. We are not the ones who started the scare. We have tried to act responsibly. For the past three years we have been consistent and are now calling for action. Regardless of the way the vote goes the Minister will still have to address the problem.
I rise to support the motion before the House because in my long years in public life, almost 30 years, I have never before experienced the volume of complaints I have received in recent months about the inadequacy of the health service. It is a sad experience to have to take up the telephone to listen to the pleas of family members concerning some member of their family who is in urgent need of hospitalisation. It is even sadder to have to listen to the person concerned, the victim, who in many instances is in severe pain, appealing to their public representative to try to have them admitted to hospital to obtain whatever medical attention they require.
I have received many complaints from people who are waiting for overdue hip operations. Often these people are in indescribable pain and agony and unable to move. The same is true in respect of other categories of illness. Where the service has fallen down badly is in the provision of a hospital service for the elderly who need hospital treatment. Those who do gain admission invariably find they are being treated in a corridor. They might as well be out on a public street. When I recently visited our own county hospital in Kilkenny, St. Luke's Hospital, I found that the corridors, particularly in the female wing, were packed tight with beds. Many of the patients found themselves in hospital for the first time in their 60, 70 or 80 years of life. The first time anyone goes to hospital is a traumatic experience but to find oneself out in a corridor receiving medical attention with a steady stream of visitors to other patients passing nearby is anything but dignified. This problem has got much worse in recent times. As my colleague, Deputy Ferris, has said, it has become a major issue. It became a major issue during the 1987 general election campaign and it is an issue on which one could safely say Fianna Fáil got into Government. During the last general election campaign the Taoiseach admitted that he was not aware of the problems in the health service. We want to make quite sure now that he is fully aware of the present problems. I make a special appeal for the additional hospital beds for the elderly who need them.
This Government's policy, and that of the previous Fianna Fáil Government, directly caused the closure of seven district hospitals in the south-east region, and they made absolutely no provision for care in the community. It is no wonder that now there is this tremendous problem which is causing so much hardship. I appeal to the Minister, if he survives this vote this evening, to arrange, as quickly as possible for at least some of those hospitals to be reopened. Above all, he should be sure that no further such hospitals, be they in the south-east or anywhere else, close. I understand St. Mary's Geriatric Hospital in Drogheda is under threat. The Minister should intervene personally there to see that it does not close. This is the least that could be done for people who have given their whole lives to the service of this country in one way or another. At the end of the day, they should not be told there is no place for them and, in other words, the quicker they get out of the way the better.
I want to place a few comments on record. Government speakers here tonight have tried to say the cause of this problem was overspending by the previous Minister.
I advise the Deputy he has three minutes now remaining of the time available to him.
I refer the House to the Minister's own motion which he moved in this House on 27 May 1986, as reported in the Official Report column 189, volume 367. Deputy O'Hanlon's motion stated:
That Dáil Éireann warns the Government that the lives and the health of members of the public are now at risk in many areas because of the dismantling of the health services and calls for the immediate restoration of adequate funding to health boards and hospitals as a matter of extreme urgency.
The Minister, a few short years ago, was alarming the people, warning that their lives were in danger. If they were in danger four years ago, they are in very grave danger now. Similarly, another Government supporter, Deputy O'Connell, stated, as reported at column 215 of the same volume, and in the same debate, and I quote:
I never cease to smile when I hear Ministers get up to speak. This Minister is perpetually in cloud cuckooland. He has the audacity to come in here tonight and tell us that the health services are normal and that he has provided adequate finance for them.
If that was a reference to the previous Minister — which it was — it can be multiplied many times over with the present Minister. These are just a few collective quotes. The present Minister when he was spokesman in Opposition never ceased at Question Time to ask the then Minister, Deputy Desmond, to provide extra funding for this, extra funding for that, you name it. He had a parliamentary question down on any matter he could think of.
On 28 May 1986 the present Minister said, and I quote from column 500 of the same volume: "I cannot understand how any Minister can come in and tell us we have a good service when the most vulnerable in the State are suffering."
He said that four years ago. Matters have become infinitely worse since then. The same man, now Minister, said on 11 February 1986, and I quote from column 363, in reference to the then proposed closure of the district hospital in Roscrea:
How much thought went into the needs and care of patients when the decision was made to axe the district hospital in Roscrea? If we are committed to the transfer of resources from hospital care to community care, as all parties say they are, surely it is an integral part of community care to keep a small district hospital in a town like Roscrea ...
Of course, the Minister, barely two years after that, proceeded to close district hospitals all over the place.
I have not attacked the present Minister personally but a feature of those debates, as my colleague, Deputy Ferris, said, was personal abuse. Deputy Nolan said and I quite from the Official Report of 12 February 1986, column 2522, volume 363:
I am glad to have this opportunity of registering my protest at the action of the Minister for Health ... I do not think I would be out of order in accusing the Minister of being mad but I shall not do so because that would result in your not allowing me to be here at 8.30 to register my protest by way of my vote. However, I must question the sanity of some of the Deputies on the other side.
The Deputy will now bring his speech to a close. His time is exhausted.
I regret I have not more time but I will close with an appeal to the Minister, or whoever will be Minister if tonight's motion succeeds, to ensure that the elderly are taken care of in a fit and proper way.
For the last few weeks — it seems like months — we have had to listen to the Opposition health spokesmen using every media opportunity they could manufacture to demand this debate on the health services. Having heard their contributions I am left wondering what all the fuss is about.
(Interruptions.)
We have had to listen to a rag-bag of half-truths which would do a seanachaí credit but which have no place in an intelligent debate on the future of our health services.
(Interruptions.)
It is quite clear that the reason for this is that neither Deputy Howlin nor, indeed, Deputy Yates, have any in-depth understanding of the complexity of the health services, nor have they any understanding of the direction in which those services should be going.
(Interruptions.)
Let us hear the Minister of State without interruption.
It is clear to me that Labour and Fine Gael policy is still as barren as it was when they were last in Government. They let the services drift into financial chaos then and they have no constructive policies to follow now beyond throwing out a few well-worn cliches, a point that has not been lost on the journalists reporting their contributions. The contribution from the Opposition benches has been a contribution of the shroud waving which my much maligned ministerial colleague, Deputy O'Hanlon, refered to in his speech. He has set out clearly, in a strategic plan, the direction in which he sees the health services going in 1990 and beyond. I challenge the Opposition to do the same and stop making outlandish generalisations about the services.
The allegation was made here last night that beds in Cavan hospital were "chained up". A quick telephone call to the North-Eastern Health Board would have put Deputy Boylan right. The board opened 48 medical and 48 surgical beds when they transferred services to the new hospital at Lisdarn in Cavan. Twelve beds were left unopened at the time because they were not required. Those additional beds were then available to meet the increased demand which resulted from the 'flu epidemic, even though listening to Deputy Boylan last night you would think the people of Cavan and Monaghan were spared the 'flu epidemic. I know Deputy O'Hanlon is an excellent Minister for Health but it would be far too much to expect him to quarantine the people of Cavan and Monaghan from the 'flu epidemic. The North-Eastern Health Board have refuted any suggestion that people were forced to lock wards or chain beds. This sort of unfounded allegations cause nothing but harm and distress to the staff and patients in these excellent hospitals and I think Deputy Boylan should withdraw them forthwith.
The same Deputy raised the position of a 91-year old woman in Cavan General Hospital who was admitted on 19 January with a suspected peptic ulcer. She had a third check-up and was given medication and has now recovered. She suggested to the management of Cavan hospital that they contact her nephew who should be asked to take her home. An arrangement was made with the nephew, a time was agreed, the nephew failed to turn up and, lo and behold, an hour later who should be on the telephone suggesting that she should be left in the general hospital but the bold Deputy Boylan? It is time he got his facts right and that he came into this House, told the facts and withdrew any allegations about the outstanding staff in that hospital.
Health expenditure has grown consistently over the past three decades. Expenditure has grown to over 65 times its 1960 level over a period of 30 years. When we deflate these figures to allow for inflation we can see that spending on our health services has increased in real terms by a factor of over five-and-a-half times during this period.
Health care accounts for about one-fifth of Exchequer spending and it was, therefore, inevitable that the health sector had to carry its share of the burden. In particular, I would like to pay tribute to the staff in the various hospitals and to take this opportunity to thank all the staff in the health services who coped so admirably with the recent 'flu epidemic, thanks to their dedication and commitment. An eminent consultant physician has felt it necessary to write to the Minister for Health because, to qoute him: "of the superabundance of hysteria being generated" about hospital beds at the moment. He acknowledged that a viral epidemic, as confirmed to the Minister by Professor Irene Hillary of the Virus Reference Laboratory, was the cause of the unusual demands on hospital beds in December and that this demand was not the result of a breakdown of the health services. The Minister has been saying this time and again but the Opposition prefer to ignore medical facts, as we have seen so often in the past, and particularly in this debate. The emphasis for the past three years has been on streamlining services, seeking out inefficiencies, increasing productivity and protecting key services.
With the success of the Government's overall economic strategy, resources are now becoming available to address priority needs and the last six months have seen significant moves in that direction. There have been three significant boosts to health funding since last summer. Firstly, the 1989 Supplementary Estimate allocated an additional £15 million to deal with specific priority areas in the acute hospital services. The Minister for Health himself gave a prior commitment on this on 24 June, and this was subsequently sanctioned by the present Government on 18 July 1989. Second, the health provision in the 1990 Estimates showed an increase of £120 million, or almost 10 per cent in non-capital expenditure on the health services for 1990 as compared to the original 1989 provision. Finally, last week's budget allocated a further £13 million, including £5 million for services for the elderly, £3 million for the dental services, £2 million for the mental handicap services and over £3 million for substantial increases in the various health allowances from next July.
The measures which have been announced show clearly the Government's determination that whatever additional resources can be made available must go to the priority areas of greatest need — in particular to the strengthening of community-based support services.
The Opposition parties have used figures which attempt to prove that there has been a real reduction in the funding available to the health services since the present Minister took office in 1987. However, the reality is that since 1986, and including the recent budget measures, there has been an increase of around £200 million in gross non-capital expenditure on the health services.
After inflation.
These increases have been spread widely across different programmes, covering community care and the general hospital services. It is untrue to suggest that there has been any decrease in real terms — the total level of expenditure has at least kept pace with inflation.
To listen to Deputy De Rossa's claim that all OECD countries are spending an average of 8 per cent of their GNP on health, one would imagine that Ireland is way out of line. In fact, one would assume that Deputy De Rossa with all his European travel behind him would be an expert on international comparisons.
The Civil Service are becoming more imaginative when writing a speech.
Analysis of public health care indicates that compared to other European Community countries, Ireland had the second highest expenditure as a percentage of GDP in 1987, only exceeded by Luxembourg.
That is not true.
Those are the facts, Deputy. His European friends should tell him that.
The Minister is telling an untruth. He has misrepresented the statistics.
Order, it should not be alleged that the Minister issued an untruth. That is not in order——
The Minister accused me of telling four untruths in five minutes.
He has misrepresented the statistics.
They should not forget the distress and concern caused by these exaggerated claims, both to individual patients and their families and friends.
The Minister could have being fooling us.
These figures demonstrate beyond all possible doubt that the Government have been fully committed to ensuring that the public health system in this country continues to be one that can stand comparison with any other health service in the world. The determination to get the public finances right and put them on a permanently sound footing has not blinded the Government to the absolute need to provide an improving health service for its people.
The Minister could have fooled us.
As proof of the Government's recognition, Deputy, and I will come to you later, of the need to protect services it should be noted that the proportion of total net Exchequer spending taken up by the health sector has risen from 19 per cent in 1986 to 21.3 per cent. in 1990.
Of what?
This shows that the Government have, while making such major progress in stabilising overall Government spending and reducing borrowing, gone out of their way to maintain decent hospital and community care standards.
The Minister is closing down hospitals.
The consumer price index is often used as a proxy in determining the real level of health expenditure. While this index can be used as a guideline it is of limited value in making year-on-year comparisons.
The index does not reflect the true growth in health service costs as, for example, it is significantly affected by movements in interest rates. These movements have a lesser effect on the health services as interest payments represent a relatively small proportion of total expenditure. Similarly the movement in energy costs have a much greater impact on the consumer price index than on total health expenditure.
There has also been much ill-informed comment on the percentages of gross national product and gross domestic product devoted to the health services. At a time when there is vigorous growth in GNP as a result of favourable economic trends, it does not follow that maintaining percentages of GNP expenditure, on health services is necessary to preserve services at existing levels. This is borne out by the fact that although it is generally accepted that significant additional resources have been made available to the health services in 1990 as compared to 1989, health expenditure is still likely to show a slight decline when expresed as a percentage of GNP.
The Minister is contradicting himself again.
In the United States, for example, a far higher percentage of gross domestic product is spent than in Ireland. Using this criterion it could be inferred that health services in the United States are therefore more comprehensive than our own. We know, however, that this is not all the case in reality. Indeed, the Commission on Health Funding considered these points in their deliberations over a two-year period and concluded that the level of expenditure which this country devotes on health care cannot be determined by reference to a fixed proportion of gross domestic product or by reference to international comparison. It is not true, as is so often claimed, that during the period of the Fine Gael-Labour Coalition health expenditure was maintained as a percentage of GNP. The Minister for Health at that time, the then Deputy Barry Desmond, admitted——
It is happy for you to say that.
——in his speech on the budget debate in 1985 that health spending had been reduced from 8 per cent of GNP in 1982 to 7.6 per cent of GNP in 1985. Furthermore, health as a percentage of gross current expenditure as set out in the budget tables was reduced from 14½ per cent in 1982 to exactly 12 per cent in 1986. Today, in 1990, health has a marginally higher share of current expenditure at 12.7 per cent.
The Government are building no houses.
The last Labour Minister for Health, in a speech to the Irish Nurses' Organisation on 11 November 1983 admitted:
There is a definite limit to the number of acute hospital beds which we can afford to provide and maintain at an acceptable level.
We hear no comments from the Deputy.
Only this time last year the Leader of the main Opposition party, Deputy Dukes, stated in the Mansion House on 27 February:
We do not need to spend more than £1.3 billion to provide an adequate health service.
That was then.
This year the Government are providing more than £1.4 billion.
What about inflation?
During the general election campaign the Fine Gael Party sought increased resources of £30 million for the health service in 1990 and in 1991 from the lottery. The Labour Party sought an extra £70 million.
To save lives.
Compared with the original 1989 Estimate on which their proposals were based, the Government are in fact providing in 1990 and extra £122 million——
That is for pay.
——which even, allowing for an inflation element in the figures, more than meets the case that was made by all parties opposite during the election campaign and on which they now base their spurious arguments.
Deputies
Hear, hear.
(Interruptions.)
The Minister would make a great contortionist.
Deputy Howlin please desist from interrupting. I understand that the Deputy has already spoken and he has spoken again this evening. In the meantime he should restrain himself.
I am sorry, a Cheann Comhairle.
I would like to acknowledge the role played by the nursing profession as a core component of the Irish health services at all times. The professionalism and selfless dedication of nurses in the provision of care, sometimes, under trying conditions, is deeply appreciated and the capacity of the profession to influence the general thrust of health service delivery has been recognised.
The high regard in which Irish nurses are held world-wide bears testimony to the quality both of Irish nursing and nurse training in Ireland. The fact that the skills of Irish nurses have become extremely marketable abroad provides us with continuing evidence of this fact.
But they are working world-wide.
There is another aspect, however, to this high profile. In the course of 1989, much media attention was focussed on the supposed outflow of specialist nursing skills from this country and the impact which this outflow would have on the domestic health service.
They have emigrated.
Upon investigation it was found that hard information which would substantiate or disprove these claims was simply not available. In the absence of such information, much of the comment must be treated as highly speculative and unhelpful, both in terms of the image of the public health system and in terms of the morale of the many highly trained and dedicated nurses, who continue to work in Ireland.
This lack of information has prompted a decision to create an accurate database of available nursing skills. An Bord Altranais are therefore to undertake a national skills audit and census of practising nurses.
This audit, when completed, will, for the first time, provide an accurate picture of the extent and variety of skills and qualifications which are currently available amongst practising health services personnel and identify these skills which are in short supply.
What about those abroad?
Health service management will then be in a position to take appropriate steps to remedy the situation. Health service management at both local and national level will be afforded an invaluable aid in the organising of staff in a manner which will give the best value from available resources.
Although the audit and census will be of tremendous assistance in the effective utilisation of existing resources, the questions of providing for future needs has wider implications for training and education for the nursing profession. This question is now being addressed by An Bord Altranais who undertook, towards the end of 1989, to carry out a review of all aspects of nursing education and training with a view to putting in place a structure which will equip nurses with the appropriate skills to address the needs of a modern demanding health service.
The impact of both of these initiatives of future planning of nursing services and needs cannot be under-estimated. The availability of a comprehensive, accurate, database in tandem with a modern education system for the nursing profession will certainly facilitate the rational future development of this core component of our health service.
In the meantime, the Department of Health are constantly monitoring, in a structured way, the personnel needs of the services, both as regards numbers of staff and skills required. This is evidenced by the fact that some 50 per cent of the over 1,000 additional permanent appointments approved in 1984 were in the nursing area. This approval is also reflected in the similar representation of nursing posts among the almost 4,000 replacement posts approved in 1989. The selection of the replacement posts from competing boards was specifically designed to target front-line needs and specialist nursing skills. We are further confident that, with the Minister's action plan in position, a further re-allocation of priority nursing resources should be possible.
I would like also to make reference to many uninformed and, often mischievous, views which have been expressed regarding administration of the health services. Some simple points warrant attention——
The Minister should tell Jackie Healy Rae.
Deputy Ferris should tell the Deputies on either side of him. The administrative staff figures include some 400 community welfare officers and other specialist personnel, as well as medical records staff and many others providing direct services to patients; administration accounts for less than 3 per cent of total non-capital expenditure; central administration in the eight health boards accounts for less than 3 per cent of all personnel; the service management tier within health boards accounts for no more than 40 posts, or less than 0.2 per cent of local health staff.
Various commentators have chosen to characterise this reasonable level of administration as being almost exclusively composed of unnecessary and inefficient office staff. In point of fact this represents a gross distortion of the actual position and an unwarranted attack on many dedicated staff. It surprises me that many Deputies who are closely associated with the trade union movement should, even by their silence, give tacit support to this view.
The reality is that these staff are engaged in tasks which directly relate to patient care in its most basic sense. They are the people responsible for the organisation and management of medical, surgical and diagnostic appointments; the maintenance of medical records; the provision of secretarial services to consultants and senior management; the payment of staff and suppliers; the issuing of medical and hospital services cards and the general management of an enterprise costing nearly £1.5 billion and employing circa 60,000 people.
It is ironic that some colleagues of these workers should be among those who criticise their number and commitment. It is unpardonable that many of these same people place the greatest demands on health services administration.
However, my colleagues and I will not be deflected from our course of strengthening the management ethos in the health services as was clearly indicated in the contribution of the Minister for Health last evening.
They are getting outsiders in.
These measures and others in formulation, will build on the skills we have so that we can improve efficiency and effectiveness while practising good industrial relations which are an integral part of an organisation as labour-intensive as are the health services.
Why is the Minister engaging a liquidator?
It was asserted in the House last night that there are lengthy waiting times for orthodontic treatment.
(Interruptions.)
This is utter nonsense. In my area on 1 January 1990 there were 3,522 children on the waiting list for orthodontic treatment in the Western Health Board. The board are currently organising treatment for children to reduce these waiting times. All children are assessed in accordance with the guidelines issued by the Department. Priority in the provision of treatment is given to children with the most serious conditions. I am happy to say that all children with the most severe conditions are under treatment at present and do not, in general, have to wait for treatment.
(Interruptions.)
The Western Health Board have been able to undertake the treatment of an additional number of children thanks to the allocation they received from the Government in December last.
What about the Mid-Western Health Board area?
It will receive a further special allocation from the funds recently provided in the budget. The mid-west has an outstanding consultant orthodontist. These moneys supplement those already provided by the health board.
The Western Health Board will be advertising the post of consultant orthodontist in the near future following the review of the conditions attached to the post. The direct employment of a consultant is considered to be the most cost-effective way of providing this expensive treatment.
The Minister and I are confident that the additional resources provided last year and in the recent budget will help all the health boards to relieve the situation. We are also hopeful that the posts of consultant orthodontists, which are outstanding, when filled, will offer a long-term solution to the problem of providing this expensive treatment for children with severe orthodontic problems.
Where is the Minister?
Figures on hospital activity over the last 30 years show a striking increase in the annual number of in-patient admissions. Between 1960 and 1988 the numbers almost doubled from 250,000 in-patient admissions to over 490,000. Even when the parallel increase in population is taken into account the admission rates per 1,000 head of population have witnessed steep increases during the past three decades. A measure of the efficiency of the health services in coping with such unprecedented activity levels can be gleaned from the great strides made in reducing lengths of stay in hospital. These have been more than halved in the past 25 years, from a figure of over 16 days in 1965 to eight days in 1988. In 1988 approximately 1.2 million out-patients and approximately 500,000 in-patients were seen in our hospitals.
Deputy Howlin misrepresents the real situation. In early January he stated: "At least 20 hospitals have closed since March 1987". The reality is both less sensational and more complicated.
The figure is now 22.
The Minister gave me a figure of 19 by way of parliamentary reply.
Shame on the Minister.
If we look a little more closely at the hospitals which the Deputy simply says have been closed we can see that in fact the real story is very different.
The Deputy says that Jervis Street and St. Laurence's hospitals in Dublin have closed. This can only be called deliberate misrepresentation. In fact, the services of both hospitals have been transferred to a fully modern hospital at Beaumont which provides hospital care to equal any in Europe. Is the Deputy arguing that we should close Beaumont and that all the patients there be transferred back to old and now totally unsuitable accommodation on the old sites, if that were possible? I hope the Deputy is not seriously suggesting this.
Did the Minister, or did he not, take 4,000 beds out of the system?
(Interruptions.)
Please, Deputy Howlin.
Let us now look at some of the hospitals in the Deputy's own health board area. He might at least be expected to know something about them. He stated that the South-Eastern Health Board closed five hospitals in their area. In fact these hospitals have changed their role in the health services and are now providing different but equally important services in the health sector.
They are not hospitals any longer.
To simply say that they were closed is not correct. Again I hope that the Deputy is not arguing that we should have a health service which consists only of acute hospitals. Is that what the Deputy wants?
No.
A full range of health services are required. It is of no benefit to have an over-supply of hospital beds if there are no public health nurses, no home helps and no social workers. From what Deputy Howlin has said it would seem that this is, in fact, what he would prefer.
(Interruptions.)
Is the Deputy not aware that the policy of all countries, agreed and approved by the World Health Organisation, is that greater emphasis should be put on the development of community care? This Government are committed to that policy and their commitment is not going to be weakened by opportunistic sniping by the Opposition, based on unprincipled appeals to sectional interests and pressure groups.
The former district hospital in New Ross is being used as a voluntary community hospital with the same number of beds as before.
Not true, one has to have £100 tickets. I had to buy one myself.
The former auxiliary district hospital in Kilkenny is now a psychiatric day centre. The former Bagenalstown and Brownswood-Enniscorthy district hospitals have been leased by the South-Eastern Health Board and are being run as a voluntary welfare home and a nursing home, respectively.
As private nursing homes. One has to pay to get in.
Similarly, the former Lismore district hospital is now a nursing home. In both Kilkenny and Lismore there are similar numbers of beds in the homes now as there were when these institutions were district hospitals.
But they are private hospitals.
The former St. Vincent's district hospital in Tipperary town is now being used by the South-Eastern Health Board as a psychiatric and geriatric day centre. Is Deputy Howlin or Deputy Ferris prepared to deny the patients attending these centres these necessary community services?
They are not hospitals any longer.
Some of the hospitals to which Deputy Howlin refers as having been closed in Dublin and Cork were small hospitals which contributed to the fragmentation of the hospital services in those areas. Care of the highest standard cannot be provided in small hospitals. So, the service in Dr. Steeven's Hospital was transferred to St. James's and the Adelaide Hospitals. The service provided by Monkstown Hospital is now also provided by St. James's. In Cork the services previously provided by the North Infirmary Hospital are now provided by the Mercy Hospital.
The Minister should tell that to the people of north Cork.
The buildings which previously housed the Cork Eye, Ear and Throat Hospital have been acquired by the Southern Health Board. The ENT service there has been transferred to the South Infirmary-Victoria and the ophthalmology to Cork Regional Hospital. As far as Erinville Hospital, Cork is concerned, while the gynaecology service is now provided elsewhere, the hospital remains fully open.
The maternity hospital is no longer available.
In relation to St. Mary's Geriatric Hospital, Drogheda, this hospital has not been closed as Deputy Bell said earlier. The North-Eastern Health Board took a decision to transfer the service there to the Cottage Hospital, Drogheda, due to the inferior standard of accommodation there.
On a point of order——
There is a time limit to this debate, Deputy, please.
Approximately £170,000 in total will be spent on the Cottage Hospital to ensure that the accommodation is of the highest standard.
A Cheann Comhairle, on a point of order——
Deputy Bell, please resume your seat. The Chair is most reluctant to accept——
The figures the Minister quoted are grossly inaccurate.
Deputy Bell, please desist, I am on my feet.
The information the Minister gave is grossly inaccurate.
There is a time limit on these speeches. Accordingly, points of order or interventions of any kind are disorderly.
The information the Minister gave is inaccurate.
The Minister of State has only five minutes to conclude.
There is no question of any decrease in the level of service in this case. Indeed, the standard of accommodation for the patients concerned will improve significantly.
(Interruptions.)
Please, Deputies, the Minister of State has just five minutes to conclude. Would Deputies please allow him to do so in quietude?
The current position is that, while 21 patients have already been transferred to the Cottage Hospital, a further 47 will remain in St. Mary's until the renovation works at the Cottage Hospital have been completed. The service at St. John of God's maternity unit in Cahercalla was transfered to Limerick Maternity Hospital as a result of the falling birth rate——
(Interruptions.)
I will not permit any Member of this House to be shouted down.
The information in the Minister's document is inaccurate.
Deputy Bell, resume your seat please or leave the House. This is a democratic assembly.
——in that area and to ensure that maternity services remain at a safe standard. Comhairle na Ospidéal recommended that for maternity units to remain open, there should be a birth rate of at least 1,500 to 2,000 per annum Cahercalla's rate was only 700. I am sure mothers in the area are happier now, confident that the care they and their babies receive is as safe and effective as possible.
If they get there in time.
Deputy Taylor-Quinn, if you interrupt once more I will insist on you leaving the House.
This level of care can only be provided in a larger unit. Again, I hope Deputy Howlin is not arguing that all of these mothers return to having their babies in a small and unsatisfactory unit.
It is no matter of sneering or jeering either.
Another role for the buildings on the Cahercalla campus within the health services is currently being considered by the Mid-Western Health Board. In that area the board decided that Kilrush and Thurles district hospitals should not be retained in that role. There is now a voluntary nursing home in Kilrush and the building in Thurles is being used by the health board as a health centre.
At £100 a week.
The Deputy wants to be put out, I take it.
I would remind the House that a total of £250,000 in national lottery funding was provided to help many of the former hospitals change their role. Lismore, New Ross, Bagenalstown and Tipperary all received £40,000 each while Kilrush received £90,000. The provision of these funds shows the commitment of this Government to respond flexibly and appropriately to the demands on the health services. Some of the hospitals to which Deputy Howlin referred had so few beds open that the need to provide a service of the highest standard and at the best value for money demanded that their services be transferred to regional hospitals.
Building on what has been achieved in the health services to date, we can go forward and deal with the real issues and the real problems. Of course, there are many aspects of the health services which need development but no country in the world is in a position to meet them all. What is important, however, is that we have laid the foundation on which steady progress can be built. This will be done not by spending money we do not have but by carefully and efficiently using our resources and reorganising our activities to tackle problems carefully and rationally.
The Minister last night announced details of what I consider to be an exciting and thoughtful action programme for the health services in 1990 and beyond. The first tangible evidence of the impact that this action programme will have was contained in last weeks Budget Statement with a very considerable additional resource for the elderly, for the mentally handicapped services and for the dental services. I have a particular responsibility for dental care and I am very much aware of the problems which exist in that area.
As I said earlier, these budget announcements were merely the first instalment of the Minister's action programme. The other elements include: A detailed evaluation of the scope for greater efficiency in the health services, beginning with the major acute hospitals headed up by Mr. Noel Fox who has played such a major role in the recovery of the VHI's financial position; Mr. David Kennedy, whose reputation and track record speak for themselves, will head up a new initiative to streamline the hospital services in Dublin which, because of their unique role, need special organisational arrangements for maximum effectiveness.
The content of the action programme, no less than the calm and measured way in which he has dealt with the problems arising over the past three years, mark the knowledge, insight and compassion of Dr. Rory O'Hanlon, our Minister for Health. In my appointment as Minister of State at the Department of Health, I have had the opportunity to gain a deeper appreciation of his approach to health services, his passionate concern for the quality of care for the patient and his real anger at the denigration of our health services and their dedicated professionals by the thoughtless and malicious scare mongering of Opposition spokesmen. Unfortunately such scare tactics find an uncritical reflection in media comment which not only does a disservice to the quality and commitment of our health service professionals, but does real harm to patients, striking fear and alarm into the elderly in particular. Worse still, these alarmists succeed in portraying the problems of meeting rising expectations for health care which exist right around the western world as if they were something unique to Ireland.
The Minister of State might now bring his speech to a close.
Shortly. The Minister would have grounds for even deeper anger at the cynical exploitation of the sick and the disabled by the Opposition who, on the one hand, call for more services and more expenditure and on the other say that by waving a magic wand we could do all that needs to be done without spending an extra penny. The public have seen through this double-think and double-talk. They recognise that the Minister is in command of the situation, that he is not going to be bullied by vested interest groups or taken in by political con merchants. With his long political experience and his intimate knowledge of the health service and the needs of patients, he is in an ideal position to chart our course for the development of health care in the future. His record of achievement in facing up to the unpleasant but inevitable task of bringing services into line with the resources available and the major initiatives which he has announced in the action programme can only serve to inspire confidence in his continued stewardship of the health services.
On a point of order, could the Chair bring the Minister to a conclusion as there is a number of speakers waiting?
I was rudely interrupted by members of the Deputy's party.
The Chair is doing his duty in this matter, Deputy Bruton.
I have no doubt that the public are thoroughly disgusted by the political antics of the last couple of weeks in relation to the health services and do not want health care used as a political football. Deputy Howlin has not been alone in this scaremongering.
I must call another speaker.
He has received equal support from his constituency colleague and competing Fine Gael health spokesman, Deputy Yates. He in turn is being pushed forward by Deputy Dukes who is trying to catch up with Deputy Spring in the stakes for the title "Leader of the Opposition". Of course Fine Gael have made a conscious decision to target health matters during 1990 as a constant vulnerable issue in the run up to the local elections.
(Interruptions.)
They have even communicated this to their local authority members throughout the country. How irresponsible of them.
The Minister must now conclude.
In deference to your wishes, a Cheann Comhairle, I appeal to the Deputies opposite to withdraw this unwarranted and irresponsible motion.
I wish to share my time with Deputies John Connor, Jimmy Deenihan, Michael Finucane, Ted Nealon and Pádraic McCormack.
Is that satisfactory? Agreed.
He will say more in five minutes than the Minister of State said in half an hour.
The real blight in my constituency has been the total undermining of the county hospital in Ennis since this Minister came to office. I thought he was a progressive man but last night in his speech he indulged in snide remarks and talked, about scaremongering. The hospital in Ennis was brought into disrepute both last year and this year, not by the Fine Gael Deputies or the Labour spokesperson, but by the Fianna Fáil councillors who were ably led by Deputy de Valera. For as long as the Minister remains in office the people of County Clare do not know whether Ennis General Hospital will remain open. Since he came to power the number of beds in that hospital will remain open. Since he came to power the number of beds in that hospital has been reduced from 127 to 70.
That is not true.
After a lot of toing and froing, by agreement with the health board, the number was increased to 78, including six surgical beds. In August 1988, at the highest of summer, the number of beds occupied was 85. The statistics on the records of the administration of that hospital show clearly that a wrong decision has been made in the allocation of beds to Ennis General Hospital.
There is no way I can accept the Minister shaking his head. In 1989 the overspend in Ennis General Hospital was of the order of £250,000. In future the health board will have to operate with a cutback of £800,000 and the prospect is that there will be further closures. The Minister should tell the truth. He is backing a Government who decided to make major cuts in the hospital area. They saw a soft political target and they realised that most of the people who got sick were those who would not vote. They thought that by the time the election was called the people would have forgotten about it. The real cynicism is over there.
The Minister for Finance came in here the other day and said that the Government have rectified the economy and that every financial problem has been solved. The Minister for Health and his Minister of State must give a guarantee to the 90,000 people living in Clare that there will be continuity of service at the county hospital. Deputy Foxe complained about there being only 60 beds in Roscommon Hospital to cater for 70,000 people in County Roscommon.
There is competition for skilled staff, particularly general surgeons. The Irish Medical News the other day contained an advertisement for a general hospital in Newfoundland, hardly the most progressive part of the world. The hospital concerned had 100 beds, the number the Government promised us in the last general election, when, ironically, Fianna Fáil put forward a hospital candidate. People should note the cynicism and hypocrisy of Fianna Fáil in County Clare where they once had 66 per cent of the vote. Do they not realise what they are doing to their own party down there?
(Interruptions.)
The Minister should listen to the medical staff who will tell the departmental officials what is happening. I presume they read these recruitment advertisements which show the competition for skilled professionals. In this 100 bed hospital there are 11 specialists, two surgeons, two gynaecologists, two radiologists, two interns, one pathologist, two anaesthetists, seven GPs and a 24 hour emergency department fully staffed by full-time casually officers.
And you want that in Ennis?
We want that in Ennis. It was promised by Fianna Fáil. Fianna Fáil closed Barrington's but no one will let them get away with further downgrading Ennis.
(Interruptions.)
Because of the time constraint I will confine my remarks to the hospital care situation in Roscommon. It is not necessarily parochial to speak about Roscommon Hospital as that hospital reflects the chaos, mayhem and sheer disorder in the health services.
In political terms Roscommon spoke loudest on the health issue in the last general election. Notwithstanding that, the Minister has failed to respond to the situation in Roscommon in the same way as he has not responded anywhere else. Worse still, the Minister in response to questions in this House and from the media made misleading and inaccurate statements about this hospital, its over-crowding, its bed complement and its dangerously inadequate staff levels. I will give the Minister the facts and when he again wishes to comment publicly about the situation in this hospital we hope that accuracy will be the hallmark of what he says even if afterwards he intends to do nothing to improve the situation.
There are 60 beds in Roscommon Hospital, not 70 as the Minister has repeatedly said. The Minister promised ten single day beds when the number of beds in this hospital was decimated from 137 to 60 in 1987, but they were never provided because of the savagery of the cuts. The medical wing in this hospital has 27 beds with an additional eight coronary care beds. On any average day in recent months on the medical side, excluding coronary care, there have been 40 and sometimes more beds crammed into the space allocated for medical care. During the day three nurses try to cope with the huge work overload. By all accepted standards, three nurses are inadequate to look after 27 patients let alone 40 or 44 patients. Between 6 p.m. and 8 a.m. there are no orderlies or domestic help to assist on the wards, so that the already overworked nurses have to do domestic and non-nursing duties.
The acute surgical side has 25 acute surgical beds and this complement caters for paediatric surgery, intensive care and the ordinary waiting and recovering patients including men, women and children. On Monday last, a typical day, the surgical wing had 32 patients. There are only two nurses to look after the intensive care unit which could be catering for up to ten patients. At night the intensive care is staffed by one nurse more or less on loan from general surgery.
In the paediatric surgery unit there is only one nurse to look after up to six small children, some of them infants. The Minister knows, or ought to know, that paediatric care needs greater nursing attention than other areas of acute care, yet that has not been recognised in the staffing allocations. Last Sunday night four people were admitted to surgery after a serious car accident so that the operating theatre was busy all night with these patients who were then moved to an overcrowded and understaffed ward.
The Minister may, without batting an eyelid, say in this House and on television that there is no problem in Roscommon, just as he says there is no problem in Galway, Ennis or anywhere else, but this is a very dangerous problem in which the system is being pushed to the limit so that patients who would in normal circumstances be admitted to hospital are turned away because of a lack of beds. Patients are being sent home from hospital, often to live alone, far sooner than they should be and the doctors, consultants and nurses are caught up in a nightmare trying to cope, always haunted by the fear that patients will die because they cannot stretch their mental and physical properties to meet the awful situation they are placed in.
In 1989 the budget for acute hospital services in Roscommon Hospital was £4.3 million. In 1990 this budget is down to £4.1 million. This £4.3 million gave us the hospital care services which I have described, but only God knows what description I will have to give one year on with the budget reduced by £200,000.
All this is a far cry from the situation described by Deputy Foxe in revelations he made to local newspapers in Roscommon and Galway last week. Deputy Foxe recounts that he was taken to the Taoiseach's house at Kinsealy by Deputy Leyden one Sunday last June where he found Mr. Haughey, pacing the floor in desperation trying to devise some ways and means to secure enough support to be re-elected as Taoiseach.
Order, order.
(Interruptions.)
Deputy Connor, Members of this House must be referred to by their title. The Deputy referred to Mr. Haughey.
I stand corrected. The Taoiseach asked Deputy Foxe what he needed to secure his support and Deputy Foxe very modestly requested the very minimum to pull the health services back from the brink. Deputy Foxe revealed that he requested 20 additional beds in the hospital, with the necessary back up staff, the appointment of an anaesthetist when the present one retires, that psycho-geriatric accommodation would be maintained at Castlerea——
(Interruptions.)
——that a high support psychiatric hostel would be kept in Castlerea and that Castlerea would be the administrative centre for psychiatric services in the Roscommon area. No one could quibble with the items requested by Deputy Foxe, even though one would have to quibble with the behind the scenes dealing, which is a particular wont of the present Taoiseach.
(Interruptions.)
The Taoiseach had no difficulty accepting the need to put in place the reasonable requests of Deputy Foxe. He told him so on the following Wednesday. We were informed that the Minister for Health was told to implement the Taoiseach's promise. However, other events took place, the marriage of the irreconcilables between the Progressive Democrats and Fianna Fáil, born in something of a comic opera not unlike the Marriage of Fiagro which placed new imperatives on Mr. Haughey——
The Taoiseach.
The promises to Roscommon Hospital were cynically and dismissively welshed upon. One could only have felt revulsion listening to the Minister last night talking about his heavy burden, his concerns for a better health service for all and his profound and unique understanding of sickness, patients' fear of sickness and the need for support for them. He said that this concern was born out of his years in general and hospital practice. What does one say when one compares his bleeding heart declarations with the situation in one hospital, which I described tonight, a typical case?
There has been a lot of weeping for the welfare of patients by the Minister and his leader who, since their political survival became imperative, are willing to promise, to scheme and to use understaffed hospitals and well meaning and inexperienced people as pawns in their cynical little game to survive. The motion asks the Minister to go, he has been found guilty by what has transpired in this House last night and tonight. He has lost his battle in Cabinet and the confidence of the public. He has also lost the confidence of the health service as not one doctor or nurse believes in him any more. As Cromwell said to parliament, we ask the Minister, in God's name, to go.
A Deputy
Deputy Connor might be asked to go.
In the short time available to me I should like to refer specifically to the present level of the public health service in County Kerry. Since 1987 we have lost 60 acute beds and as a result Tralee General Hospital cannot adequately cope with the demands of the public, despite the Trojan efforts of the staff. Last night a sick man was put into the geriatric unit because there was not an acute bed available. As a result he left during the night and went home. This is no way to treat a sick man.
There are no five day beds in Tralee General Hospital although the Minister promised 15 five day beds when he visited the hospital last November. The promise has not been acted on and I appeal to the Minister to ensure that these beds will be made available as soon as possible. At the moment, although hips are available for elective patients in the hospital, there are no beds available. This is a scandal.
Because of the pressure on beds sick people are forced to leave the hospital prematurely. I met an individual last Friday night who was forced to leave the hospital, still bleeding, following an operation. The token ENT service to which Deputy O'Donoghue referred, is totally inadequate and will not make the slightest impression on the waiting list. The present financial allocation will run out in six months and more people are being added to the waiting list for treatment.
Young people are no longer accepted in Cork for an ENT operation. There is no adult ENT service in County Kerry and I am personally aware of several adults who have been on the waiting list for years and who have no prospects of having this operation.
There is also a major orthopaedic problem in County Kerry. I do not have to remind the Minister that the problem will not be solved with the present facilities. The Minister of State referred to orthodontic services but there are over 1,300 young people in Kerry waiting for orthodontic treatment, and over 400 of them have been classified as severe. Even though an orthodontist was appointed last November he can only treat — at most — 28 people each month, which is not sufficient.
The waiting period for surgical out-patients in Tralee Hospital is one year, the longest in the Southern Health Board area although more patients are being seen in the surgical out-patients unit than in any other hospital in Munster.
Services for the mentally handicapped and community care for them are not up to standard in County Kerry. I appeal to the Minister, on behalf of the people of Kerry and the Minister region, to do something about that problem. He cannot hide behind a wealth of statistics and continue to ignore the plight of the suffering.
Fianna Fáil said that we manufactured this debate on the health services. Have they been living in Disneyland for the past few months or have they deserted their clinics? They must have heard the views of their constituents in relation to problems in health care.
I want to talk about a sector of the population who do not have people rushing to their defence or organisations to represent them, the elderly. I want to refer to my own town of Newcastle West because the geriatric unit there is symptomatic of other areas around the country. Over the last few years the number of beds has been reduced from over 220 beds to 160 beds. That is a shortfall of 60 beds; it is officially recognised that people are living longer but that the number of dependants upon whom they can rely is diminishing.
There are queues of people trying to get into geriatric units. Their families are suffering a severe financial burden trying to cater for them in private nursing homes where the differential between their old age pension and the cost of the home is often £70 to £80 per week. People are telling us they cannot afford this and asking us to try to get patients into a geriatric unit. How can we get them in when all the beds are filled and there are waiting lists?
I could say a lot more but other colleagues want to get in. Newcastle West epitomises what is happening in other geriatric units around the country.
I wish to pay tribute to the North-Western Health Board, the best in the country. Without them, there would have been an unmitigated disaster in the area — with them it is a disaster. There is a two and a half years' wait to have one's eyes examined and to get a pair of glasses. People have been confined to their homes for that length of time — it would not have been tolerated in Ceausescu's Romania.
The orthopaedic situation is worse as there is a waiting list of four years for treatment. People are being told not to worry, to try to get around and that they will be in great shape for their funeral. The Government are trying to give the impression that the health cuts are over but in the north-west we have been asked to cut £766,000 in real terms after cuts of £9.3 million in the previous year. We received £3 million for the dental service and there are 70,000 eligible people in the area. We are now asking for action, not an action committee, so that we have sufficient funds to take our health service out of crisis and to bring it up to a level suitable for the last decade of the century.
I have a full file of cases which have been referred to me but I will not dwell on them tonight. I know that there is overcrowding as I have spoken to nurses and doctors in University Hospital, Galway.
The Minister, Deputy O'Hanlon, blamed the overcrowding at Christmas on the `flu epidemic. Having spoken to many people in the hospital I can assure him that very few patients had the `flu coming in to hospital but many had it going home because they were left in corridors. I witnessed relatives of a patient putting their coats around the end of of a bed to keep the draught off him.
The Minister of State, Deputy Treacy, knows the solution. Merlin Park is a first class hospital in a wonderful setting. However, its 230 beds are closed. Unit 9 is closed with 20 beds, Unit 8 is closed with 40 beds, Unit 1 is closed with 50 beds and Unit 10 is closed with 122 beds. This all happened under the present Administration. The Minister should order the opening of Unit 1 immediately and the rest later. This would alleviate the pressure on space in University Hospital. If Merlin Park was opened the patients could be discharged from hospital to convalesce for a week or two in Merlin Park. They would then be fit to go home and it would stop the vicious circle where people are being rushed out of University Hospital because somebody else wants the bed. They are not fit to go home and have to be readmitted in a few days. I will produce evidence to the Minister, and his Minister of State, of such cases. I entered this debate for a specific reason and I do not apologise to any Member for doing so. I represent Galway city on the borough council and I am aware that the Minister has denied us any representation on the Western Health Board.
So did the last Minister.
That is not correct. We were only made a full borough in 1986.
I must close in on the Deputy on the matter of time because he does not have any left.
We should have representation on the Western Health Board. I appeal to the Minister to open the closed wards in Merlin Park and the closed wards in other hospitals. If he does so, he will put the minds of many people at ease. When we return to normal the Minister will find that there will be less tension in the community and fewer patients in need of hospitalisation. The Minister should act now and open the closed wards. There are many nurses willing to work on those wards.
Listening to the debate I frequently asked myself what the debate was about. Was it about a public health service that was in crisis, something that was denied, or was it about the structure of the sickness industry? A great deal of importance attaches to the Minister's speech last night. In the course of it he made a number of serious points in reply to comments by Deputies. There is no need for me to go through all the points, to refer to the different hospitals, or list the hospitals where acute beds have been lost. The fact is that they were lost but the Minister's speech was redolent with images. He attacked public representatives, the media, the people who gave interviews and suggested that there had been exploitation of the old.
And there was.
I did not interrupt the Minister last night.
The Deputy was not here.
I was here and I can guarantee the Minister that if he establishes a principle of interrupting I will be delighted to follow it for the rest of my life.
Fág é sin agamsa agus ní cheadóidh mise do dhuine ar bith cur isteach ort. An Teacha, gan cur isteach.
It is interesting that the Minister is so sensitive about his speech. He referred to people who exploit any old person, any sick person, any handicapped person whose story can be peddled. He referred to throwing borrowed money at problems. He spoke about fear being generated and attacked the radio media. He said those involved in the radio media would put the emotion on the air before facts were checked out.
I have very little time in this debate but I should like to dispose of one fundamental straight away. There was a real crisis in the health services before Christmas. It was brought to acute proportions due to the 'flu epidemic but it cannot be explained in terms of the 'flu. Let us move on to a second basic fact. The Minister made considerable reference to the report of the Commission on Health Funding under the chairmanship of Dr. Miriam Hederman-O'Brien. He told the House that that report vindicated his thinking. What it vindicated was his confusion and theirs. That report stated that many of the decisions which face policy makers contain a very substantial ethical element. We got a lot of ethics, of course, last night. The report went on to state that health care in modern societies was now seen as a right. The commission did not believe that there was any fundamental disagreement in Irish society on this issue. It is there that the difficulty arises because neither that report, nor the Minister's speech, answered the question, "Does he accept that health is a basic human right?" Is it, as the report suggests, a perceived right that can change tomorrow, the day after, next year or in the next decade? That question was answered by the public who said that it was a basic right. They even converted the Taoiseach to that view in the last election.
They thought they had.
If it is a qualified right on what basis is it to be qualified? The Minister's speech was very interesting in regard to that. He told us that the report vindicates his life and his philosophy in regard to health. A piece of irredentist Fianna Fáilism was thrown in in the following statement:
What I wanted was a health service which was built on the great caring traditions of Ireland — the family traditions, the religious order traditions — and added in the realities of business efficiency and value for taxpayers' money.
There is the nub of the problem. The public want to know whether Oireachtas Éireann reflects their view that health care is a basic unqualified right, that it is not a right that is qualified by the economic theories of the present.
I have some sympathy for the criticism that is piling on an individual Minister because it is little less than hypocritical of those who say that in running our economy we can curtail expenditure and do it in an unplanned way. We heard a lot about planning last night, but when we run the economy as we do now, nothing can be exempted. For example, it is important and instructive to be aware of a number of facts. The public support a general public health service. They have never said that they will not pay tax to support such a service. What they have said again and again is that they object to their taxes being abused. For example, the average person who knows that his or her child can never become a doctor, but has an 87 per cent chance of paying for the education of a doctor, objects when he or she knows that when they are acutely ill they may not necessarily get that service as a right. That enrages them.
I should like to point to an interesting difference, for the information of the Minister and his advisers, between him, the Report of the Commission on Health Funding and the Department's view. The World Health Organisation do not involve themselves in this confusion. They accept health as a basic right. In this Republic, however, that now holds the Presidency of all Europe, it is a qualified right with acute bed disappearing. I am sure that when the Taoiseach, the President of all Europeans, is asked what he achieved in his little country in which there is world interest he will tell them that between 1926 and 1990 we sent 2,226,330 people out of the country; that ours is a country of poverty and that was why the Eastern European countries were revolting, to be just like us. He will tell them that he presided over the end of public health care. I am sure he will refer to the folksy piece that when Fianna Fáil were in office people went to England for their glasses and false teeth. That was the high point of republicanism.
This debate is about a few fundamental issues that flow from the report of the Commission on Health Funding, that flow from the Department of Health and that flow from the conservative parties that have said that in running the economy they will not attack the banks' scandalous fraud and abuse of section 84 to rip £90 million or more per year out of the system and that they will not attack the situation in which we have no wealth tax, a tax that this year would be yielding £20 million. They are wrong and fraudulent when they say that the problems in relation to the funding of the health services can be sorted out by better administration or better management. If they were so concerned about health — all their hearts are bleeding this week — why did they not say above all else there will be basic rights in this country, there will be aspects of education that will not be touched, there will be aspects of health that will not be touched? Instead of that, creeping back into the Minister's speech, again and again, is this question of running the sickness industry. In that speech one can find a number of very interesting phrases.
I was reminded by Professor Titmus, the great theorist of the British health service who died in a public ward just a few years ago, who spoke about the three models of health care, one of which said, let the family and the market place take care of it and when the blood is flowing out under the doors and the patients are stuck in the corridors, we will get concerned. There was another view which said we will have an insurance model of provision related to merit. Then there was the egalitarian view that built the British health service and which served Ireland as well as England. There was a feeling in Ireland for a while that there might be a time when all children, no matter whose children they were, could go to a hospital and expect equal treatment or that all old people could die with dignity. Now here is the new model, derived from the model of American medical ethics, built on the libertarian tradition. That was about freedom of choice. It was never about having the right to have a basic service provided. It is that ethic we find interestingly forming in the Minister's speech.
A phrase is used which is marvellous in its own way. In his speech the Minister criticised Deputy Yates saying that he was technicist and that one did not run a health service like the ESB. The Minister went on to refer to the kind of health service he would like. He said there would be £5 million for the elderly, £2 million for the handicapped, £3 million for the dental services — which will be welcomed — but where are the acute beds? The Minister threw in a derisory remark which is a scandal whether it was penned for him or he wrote it himself. Do you want the beds in the hospital in case people get ill? The fact is that no Minister for Health has a mandate to say to the people your health needs will be treated in terms of the market economy. The Minister went on to say that health must be run as a business. This is the man on whose desk the buck stops. Is it not a good analogy — the fine American imported word. It is similar to Chicago when the ambulance services were privatised and where people would be asked for their health insurance number before they would be scraped off the streets.
As we head for 1992 it is very clear— and the Minister has no protection from that — there will be further competition in private care. What we are deciding tonight is whether there will be a public health service with acute beds restored. I will be asked, and the Labour Party will be asked, how one would pay for this service. We have said that taxpayers never objected paying for it. We have also said other things that it is a scandal to be abolishing wealth taxes, containing corporate taxes, handing fortunes in bank scams out to the banks and so forth.
There is something else I would do; I would borrow if necessary to provide a basic assurance that health was a right in this country. We are now at a veritable crossroads. It is a situation in which, in relation to any of the principles of equality, there is nothing we can show. We can say we did nothing to protect any basic decency. We can say that next we will see privatised education and it will roll on, and when all these Ministers travel abroad and are inundated with meetings, they will be asked sometimes about their Irishness and about their Republic and all they will be able to describe is a betrayed republic.
There were decent people who founded this State and who made it possible for people to sit on these benches. Many of them were egalitarians and the least they hoped, even if they never got a seat on a plane to a ministerial meeting or ever held power, was that the children of this country — when we look at them they are the same — would be treated equally and that all old people would be treated equally. Instead of that the Minister has said we have been whipping up emotion. He said that about the nurses' representative on the Western Health Board in December. When he said it everyone agreed with him but at last Monday's health board meeting, when she again repeated that statement, nobody contradicted her, and even members of the Minister's party decided to visit the hospital yesterday to see the beds in the corridors. There they found people who are suffering from cardiac conditions at a distance from cardiac equipment.
Tá an t-am thart.
I do not need to describe what they found, in University Hospital, Galway. It is all recorded. They make the choice tonight; do they vote in favour of what they saw yesterday in their own local hospital or do they prop up this right wing economic fascism which is curtailing expenditure in this country?
Deputy Dukes, chun deireadh a chur leis an diospóireacht ar son a phairtí.
The Taoiseach has put a great deal of effort into trying to avoid this debate. At best, his effort to avoid it was unstatesmanlike and totally out of keeping with the smooth, suave image which he has being trying to cultivate recently and on which, indeed, £500,000 of taxpayers money is being squandered in Brussels, Strasbourg and Dublin. The attempt to wriggle out of the debate was unstatesmanlike, to say the least——
(Interruptions.)
I said earlier that anybody who interrupts will be asked to leave and he knows the consequences. Deputy Dukes without interruption.
I will go even further and say that that attempt to get out of this debate showed a most appalling and telling lack of political courage on the part of the Taoiseach, his Minister for Health and, indeed, of the whole Government.
It is a matter of record that the Taoiseach himself said, in the course of the general election campaign last June, that he was unaware of the crisis in the health service. He was unaware of the depth of feeling among the Irish people. I wonder if his attempt to wriggle out of this debate shows that he is still unaware of that, or does it show, perhaps, that he is now beginning to understand the problem is but is afraid to be faced with the truth in this House. One or other of those things is true and neither reflects any credit on the Taoiseach and his Government.
On 9 January last, my party proposed that the Dáil be recalled early to discuss the crisis in the health service. There was no response from the Government; I suppose it is not all that surprising. As it happened the Dáil resumed this January, a week later than last year. At the Christmas Adjournment the Taoiseach seemed to have his facts wrong as he thought we were resuming on the same date as we usually do but he dismissed my proposal that we should resume on 23 January. That would have given us ample time to have this debate before the budget and it would have given the Government ample time to do better than the feeble attempt which the Minister made last night to respond. That refusal to give parliamentary time for this debate left me with no option but to use the parliamentary levers that are open to the Opposition in this House to achieve our objective.
The plain fact is that if the Government had had the will to debate the issue rather than try to escape it, there need have been no disruption of Government business here, in Brussels or anywhere else. Any difficulties that the Government have had in that regard have been purely and simply of the Government's own making, due only to the Taoiseach's obduracy. He can spend as much time as he wishes walking around the antechamber to this House with a piece of paper in his hand reorganising the business of the Dáil. The fact of the matter is that if the Taoiseach had had the gumption on the first day this House sat to agree to have this debate none of that need have happened.
In June of 1988 my party proposed fundamental reforms in the way that we run our health services, in the way that we deliver health services to people who need them. Those reforms covered the whole range — the structure of management in our health service, the pattern of hospital services that we need, the back-up that is needed for hospital services, proper hospital management, medical teaching and research, the organisation of community care, health education and funding. The Minister ignored all of those proposals.
In October 1988 we put forward concrete proposals for the better management of the health services. Those proposals and the fundamental reforms that we put forward were designed to make sure that more people could get better health care. The Minister and the Government voted against those perfectly sensible short-term proposals.
In September of last year, the commission on health funding produced its report. That report very largely endorsed the Fine Gael proposals on the structure of the health service, on the reforms that are needed, on the simple, straightforward management techniques that need to be brought in so that we can deliver better health services to more of the people that need them who are now being excluded.
A Cheann Comhairle, would it be disorderly, on a point of order——
It would be disorderly. There is no point of order.
The Deputy is not going to make any more bones here tonight. He has got his chance. The Minister's response to that health funding commission's report was that he was going to ask everybody for their views on the report. What he has not said is that he will be getting views from the very same people who have had a very large input into the work that was done by that commission so that those same people, having been asked to discuss all these issues with the health funding commission are now being asked to discuss the same issues all over again with this Minister. It is simply a way for the Minister and the Government to avoid making up their minds about the kind of reforms we need in our health service.
This debate has achieved a result. The Minister has been forced to make some response. That response, from what we have seen last night, is nothing like enough. Up to last night, there were 21 committees in the Department of Health reporting on various topics to the Minister. There are now 23. I am saying nothing at all against Mr. Fox or Mr. Kennedy. Both are able and dedicated people; but we should not be wasting their time asking them to redo a job that has already been well done by the health funding commission and by all the agencies that that commission talked of.
We need to see real action. The Minister has now begun to admit that there is a crisis; otherwise he would not have laid before this House what he mistakenly calls a wide-ranging strategy. What does that wide-ranging strategy consist of? It is here in the Minister's text. It consists of: a commitment to maintain overall hospital activity; an outline of how to spend £10 million; a major initiative on efficiency in the health service; an initiative — not a major initiative but an initiative — on the Dublin hospital services; a radical new approach to patient care; patient consumer care plans for all agencies; an appeals system; a clear commitment to a five-year capital programme; information systems; two further major announcements to be made shortly; and those two further major announcements will be followed by further announcements. This is the strategy that the Minister is putting before us, a series of outlines, initiatives and announcements, and all the time we still have the same problem to deal with. People are not getting the kind of health service they need and deserve.
There is a commitment to maintain overall hospital activity. What does that mean? Can the Minister still not see that maintaining the current level of activity is not enough? He promises a major initiative on efficiency in the health service. That, if ever there was one, is an admission that the present situation is unacceptable. It is an indictment from the Minister's own mouth of his performance up to now. We are promised an initiative on Dublin hospital services. Why, with all the reports we have had, has it taken this debate to wring that out of the Minister? The Minister promises that information systems will be greatly improved and management development stepped up.
He is surely not trying to say that that kind of thing would need to be done if there were no crisis in the health sector which has been the tune in the last two and a half years. We must have a quality of access to health services. If people wish to pay for private medicine they have every right to do so; but our society can have no self-respect if those on low incomes or dependent on social welfare are denied access to an adequate public health service. It is clearly a big part of our problem that this Government simply do not understand what it is to be a medical card holder with sickness in the family and to have to depend on publicly provided health services.
There has been no proper planning for situations which can be foreseen. We must make sure now, for example, that adequate resources are provided to meet the needs that we know will arise next winter. Next winter, as every winter, there will be an increase in the number of people needing treatment for respiratory ailments. It is a fair bet that there will be a flu epidemic next year. We are not asking the Minister, as he tried to suggest to keep empty wards open and to keep staff idle waiting for an emergency, far from it. What we demand and must have is flexibility at local level, at hospital level to meet these foreseeable needs. Neither these needs nor the other ones that we know about have been adequately addressed by the Minister.
The national cardiac centre has a waiting list of 600 patients. The level of activity there has had to be cut from four operations a week to two. It would take six years at that rate just to get through the patients who are now on the waiting lists there. The 25 beds provided are simply not enough to carry out a higher level of activity than that. There is a clear difference there between public and private medicine even though it is the same surgeons who are carrying out the operations in both cases. There is no equality of access.
The problems of the elderly have been clearly identified in the report for the years ahead, as the Minister quotes so often. We need geriatric assessment units and geriatric departments in acute hospitals. We need to develop community care to a degree that the Minister has not even begun to imagine. For mentally handicapped people we will need, over the next three years, 800 extra residential places and 1,000 extra day care places for needs that we know already exist. We know all the rest of it. Old age pensioners cannot get dentures. Medical card holders cannot get any kind of dental treatment, and orthodontic services are almost non-existent for those who have to rely on public medicine. Those are the needs that we can see; those are the needs that have to be planned for.
In the light of all these needs it is no wonder that the Minister now stands condemned as being a major part of the problem. He is condemned by his own Cabinet colleagues. In May of last year, for example, the present Minister for Industry and Commerce said that Deputy O'Hanlon would go down as the worst Minister for Health in the history of the State. The Minister is condemned by his own backbenchers, by his own party councillors and by his own party activists. I will give one example. Councillor Jackie Healy-Rae has been very loquacious on the subject of late.
(Interruptions.)
Ciúineas.
The Minister blames everybody in sight.
Ciúineas.
The Minister blames everybody in sight. He blames the doctors, nurses and ambulance drivers. The Minister has been so used himself while in Opposition to winding-up outside groups that he cannot now distinguish the difference between windups, which he was an expert at himself when he was in Opposition, and reality. If he had any self-respect he would resign and if the Taoiseach had any regard for the feelings of the sick people in Donnycarney who are suffering he would sack the Minister immediately.
Irrespective of the outcome of tonight's vote we will be watching to see, what developments, if any, take place in our health services. If we do not see progress of the kind the people of this country need to see we will come back into this House and put down another motion of no confidence, only the next time it will be in the Taoiseach himself.
(Interruptions.)
Take your medicine.
It would appear ——
On a point of order ——
Sorry, Deputy Spring, I am now putting the question.
On a point of order ——
There is no point of order ——
Yes, there is.
——but if you want to remind me that it would appear the outside storm has affected some of the people present I would agree.
Would you not give Deputy Jackie Fahey five minutes?
Question put.
The Dáil divided: Tá, 76; Níl, 80.
Tá
- Ahearn, Therese.
- Allen, Bernard.
- Barrett, Seán.
- Bell, Michael.
- Belton, Louis J.
- Boylan, Andrew.
- Bradford, Paul.
- Browne, John (Carlow-Kilkenny).
- Bruton, John.
- Bruton, Richard.
- Byrne, Eric.
- Carey, Donal.
- Connaughton, Paul.
- Connor, John.
- Cotter, Bill.
- Creed, Michael.
- Crowley, Frank.
- 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.
- Flaherty, Mary.
- Flanagan, Charles.
- Garland, Roger.
- Gilmore, Eamon.
- Gregory, Tony.
- Harte, Paddy.
- Higgins, Jim.
- Higgins, Michael D.
- Hogan, Philip.
- Howlin, Brendan.
- Kavanagh, Liam.
- Kemmy, Jim.
- Kenny, Enda.
- Lee, Pat.
- Lowry, Michael.
- McCartan, Pat.
- McCormack, Pádraic.
- McGahon, Brendan.
- McGinley, Dinny.
- Mac Giolla, Tomás.
- McGrath, Paul.
- Mitchell, Gay.
- Mitchell, Jim.
- Moynihan, Michael.
- Nealon, Ted.
- Noonan, Michael.
- (Limerick East).
- O'Keeffe, Jim.
- O'Shea, Brian.
- O'Sullivan, Gerry.
- O'Sullivan, Toddy.
- Owen, Nora.
- Pattison, Séamus.
- Quinn, Ruairí.
- Rabbitte, Pat.
- Reynolds, Gerry.
- Ryan, Seán.
- Shatter, Alan.
- Sheehan, Patrick J.
- Sherlock, Joe.
- Spring, Dick.
- Stagg, Emmet.
- Taylor, Mervyn.
- Taylor-Quinn, Madeleine.
- Timmins, Godfrey.
- Yates, Ivan.
Níl
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, David.
- Aylward, Liam.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Mattie.
- Briscoe, Ben.
- Browne, John (Wexford).
- Burke, Raphael P.
- Calleary, Seán.
- Callely, Ivor.
- Fitzpatrick, Dermot.
- Flood, Chris.
- 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, Michael P.
- Kitt, Tom.
- Lawlor, Liam.
- Lenihan, Brian.
- Leonard, Jimmy.
- Leyden, Terry.
- Lyons, Denis.
- Martin, Micheál.
- McCreevy, Charlie.
- McDaid, Jim.
- McEllistrim, Tom.
- Clohessy, Peadar.
- 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.
- Molloy, Robert.
- Morley, P.J.
- Nolan, M.J.
- Noonan, Michael J.
- (Limerick West).
- O'Connell, John.
- O'Dea, Willie.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Keeffe, Ned.
- O'Leary, John.
- 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.
- Walsh, Joe.
- Wilson, John P.
- Woods, Michael.
- Wyse, Pearse.
Tellers: Tá, Deputies J. Higgins and Howlin; Níl, Deputies V. Brady and Clohessy.
Question declared lost.
On a point of order, may we wish the Minister a happy birthday?