Deputy Ferris is in possession. The Deputy has some 23 minutes left.
Private Members' Business. - Health Services: Motion (Resumed).
The following motion was moved by Deputy R. Bruton on 26 February 1991:
"That Dáil Éireann condemns the Minister for Health for his failure to undertake structural reform or to engage in coherent planning of the health services; and, in particular, for his failure to make adequate financial provision in 1991 to maintain existing services, the result of which will be deteriorating conditions falling most heavily on the handicapped, the elderly and those on public waiting lists for hospitals; and call on the Government (1) to allow health boards run limited overdrafts pending a reassessment of resources needed by them to maintain and develop services in 1991 and (2) to introduce a proper reform plan for the health servics based on numerous studies now available on the need for structural reform."
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"Recognises the substantially increased financial allocation provided for our health services in 1991 and commends the Minister for Health for the initiatives he has taken and is taking to radically reform our health service in the light of the recommendations of various studies now available to him and in particular for the action he has taken to enable the increased level of service to be maintained by our health agencies."
—(Minister for Health.)
Yesterday evening I referred to the cutbacks in the allocation the Minister has granted to health boards and the implications of those cutbacks. The Minister for Health has charged all health boards with providing the same level of service they provided in 1989 and the current budget provisions will not allow them to maintain that level of service. Indeed, they will result in health boards being forced to cut services back severely, thus causing suffering and further waiting lists for our people. Our health services are in a vulnerable, weak condition and health boards have been forced to decide what services they will cut back, what beds will be closed and what staff will be let go, temporary or otherwise, to live within the allocations made by the Minister for Health.
It is ridiculous for the Minister to attempt to tell us bed numbers will be maintained at the same level as last year or 1989. How can that be? Who is to provide the nursing, the medical care and the round the clock service that is necessary? I am sure the Minister is aware that health boards last week, and the week before, made decisions which will reduce beds in acute hospitals and will force the closure of those beds during holiday periods. This will reduce the necessity for boards to replace staff on holidays. These acute hospitals are surviving with skeleton staffs. How many skeletons will we as Members of the Oireachtas be responsible for at the end of a period, as it will be almost impossible to quantify the needs during holiday periods particularly in acute hospitals on our national primary routes which have to be available around the clock to deal with tragic accident cases?
Our health services are existing from day to day and not providing the essential service required. The Labour Party are, therefore, calling on the Government to introduce a Supplementary Estimate. The Government have had no problem about introducing Supplementary Estimates. We had a whole string of them before Christmas for the Taoiseach's Office, the purchase of Carysfort and for the health services. The Government are not slow in introducing Supplementary Estimates for political reasons or whatever else. We are suggesting they do the same now and allocate £15 million to provide services for the people we represent. To do so would be a great deal more honest than what has been going on all around the country recently.
Last week Fianna Fáail Deputies, Senators, councillors and the Leader of the other House went to the health boards and told them, in the words of the former Tánaiste, that there was no problem, money was on the way. At the same time the Department of Health are letting it be known, without contradiction, that there might be savings of up to £8 million arising from the establishment of the national drugs formulary and those savings might be applied to easing the crisis facing health boards. In other words, health boards are being told, "live horse and you will get grass". Angry citizens and people in need of health services are being fobbed off with the story that more money is on the way. Every Member knows that there is no way savings which might arise at the end of the year can deal with the crisis. A Supplementary Estimate must be introduced immediately. The Department of Health confirmed again this week that they have no intention of introducing a Supplementary Estimate. In short, the public are being told lies and there will be no improvement in the situation.
That is not true.
What is not true? We know there will no additional money unless a Supplementary Estimate is introduced. Last night when the Minister spoke on the provision for drugs even the words he used were peculiar. He said, "if the existing allocations do not meet the requirements". We would like to know about this because there are hidden costs over which health boards have no control. Health boards are unable to control the cost of drug refunds, the GMS or the price being charged by the Department for hospital stays outside their region. However, the Minister expects them to be responsible.
The only comfort in all this is that it will probably lead to another drubbing of the Fianna Fáil Party in the local elections. I would much prefer if the health services were not made an election issue, but the Minister in his period on those benches ensured that health services and cutbacks were used as political sticks to beat people with. I hope the Taoiseach will not claim in the course of the June elections that nobody told him about this crisis. The Taoiseach is being told here and now that there is a crisis because of health policy.
We view our amendment as a temporary stop gap and not as a lasting solution to this increasing problem. Since Deputy O'Hanlon became Minister for Health the health services have gone into a state of crisis particularly as a result of policy decisions by the Government to reduce the financial allocations to health year after year. When the Minister's predecessor left the Department of Health spending in that area was at 7 per cent of GNP, but it reduced to 6.60 per cent in 1987, to 6.30 per cent in 1988 and to 5.80 per cent at the end of 1990.
The crisis in the health service is reflected in statistics submitted by the Department in response to questions in this House. Some 4,000 health board workers and health workers generally have gone out of employment since the Minister took office. In the last year the Minister brought some back because they could not be done without but there is a net deficit of 4,000 health workers since the Minister took office. The Minister introduced charges for essential services which had already been included in the PRSI contributions which were increased before Christmas. Two thousand acute beds, 300 geriatric beds and 700 psychiatric beds have gone out of the system. Some health boards are now forced to cut back by millions of pounds in psychiatric services——
There are no patients for the psychiatric beds. They do not need them.
——when we were just about to make some progress. The Minister says he does not have any patients for the beds but that is because they are all out in the community and there is no money to look after them. Up to 24 hospitals have been closed and there are further threats to closed some hospitals even for short periods. These hospitals should be in the system all the time.
Statistics alone are only a cold impression of the suffering caused by health cuts. Suffering has also been increased for people who suffer from spina bifida, hydrocephalitis, mental handicap, psychiatric illness, asthma, AIDS and a host of other ailments. To their suffering must be added the hardship and indignity caused to the elderly and the infirm. These groups are to a considerable extent defenceless and voiceless. It took the 1989 general election to bring home to this Government the reality of the suffering and to remind them of who caused the suffering. It might be as well to consider that in the context of the local elections this year. The politicians who caused this suffering are those who proposed the health estimates over the last four years and those who did not oppose the cutbacks. For four years the Labour Party have sought to bring home the depth of the crisis. It was not until the Dáil was dissolved and candidates began to knock on doors that they began to realise there was something wrong with the health services.
However, it is not necessary to listen to the Labour Party on this subject. One need go on further than the document "Let's Look Again" by the Joint Health Commission of the Catholic Church which unequivocally described health care as a human right so basic that there is an explicit obligation on the community to discriminate positively in favour of the poor. Instead, policy has discriminated against the poor, making it increasingly difficult for people on low incomes to secure any access, let alone equality of access to the health services. The extra £15 million that we are demanding for the health services will not reverse that trend. At best it will help to stave off some of the worst consequences of the cutbacks for a short period. We will never have equality of access to the health services unless we devote a proper level of resources to the health services. The Government had access to a whole range of reports on health funding. They had the Kennedy report and the Fox report and still nothing has been done except to fiddle at the edges of the system. A final decision cannot be made on how much we spend on our health services until we decide whether health care is a basic human right. If it is we must make the necessary provision to give effect to that principle.
It is not possible for me to deal with every aspect of the health services that needs attention. However, the area of mental handicap is creating increased anxiety as this area is in acute crisis. The most worrying feature is that there is little or no planning for the future. Lip service has been paid by the Minister and the Government to the concept of planning but the agencies are too busy dealing with the crisis in current services and worrying about next year's financial allocation to look ahead and plan. The human hardship involved in mental handicap will get a good deal worse unless we start planning in the knowledge that resources will become available. It is imperative that the Government commit themselves for a period of years to improving the funding available for mental handicap. I am not talking about pocket money. The extra revenue made available in this area in the past two years has been in the region of £2 million and it will be £3 million extra this year. This represents about 2p in every 10p in that area. This is a scandal by any standards. In our amendment we are calling for another £4 million this year to come to grips with this problem. As I said this morning, I sympathise with mothers of children with a mental handicap who were forced to occupy the Minister's offices today to bring the Minister's attention to their problem.
The Labour Party have constantly demonstrated to the Minister for Health the heavy burden placed on families with mentally handicapped members because of the lack of resources and residential facilities. A nation that prides itself on Christian values is just paying lip service to the aspiration to cherish our children equally. It is disgraceful that there is not a Government commitment to providing resources which would express the Government's concern.
I am extremely concerned about all the voluntary groups in this area — the mental handicap associations, the Hospice Movement, the physically disabled movement, the Wheelchair Association, the AIDS groups and the Conquer Cancer Society who are very active in these areas, who are forced to organise charity functions in order to arrange operations for children who cannot afford to wait two or three years for an operation, for people who are in danger of not getting the operation unless they can afford to pay for it. In constituencies throughout the country Labour Deputies are involved in collecting money to assist people to get operations to which they should be entitled under the health service.
The Minister is now going to open up all beds in public hospitals to public patients only, which means that health boards will be forced to redesignate public beds as private ones——
Not necessarily.
——to ensure that they have a continuing income from VHI. That is the only way that public hospitals will be able to come to grips with the loss that will be incurred through private patients using public beds. We will wait until July but we have warned the Minister that there is a possibility that it will create problems. If the Minister increases the number of private beds in public hospitals, then he will reduce the number of public beds and he will create additional waiting lists. That is one of the inevitabilities.
To remove this subject matter from the public political arena on the Floor of this House, it might be opportune to take account of the Labour Party's suggestion to establish an all-party Dáil committee which could have discussion and dialogue with the officials of the Department of Health who make decisions about the distribution of funds to health boards. People operating in the health area do not know what norm is used to decide how much any particular health board get to carry out their functions. The Minister admitted at his recent meeting with the chairman of the South-Eastern Health Board that their application and their accounts were correct. Their deficit is correct at £1.8 million, based on last year's level of service. How can the health boards get their share of the proportion of money available for any particular category of bed? I would like an opportunity to discuss this with whatever section deals with it, away from the glare of the publicity. Let us have responsibility about this. One of the Fine Gael speakers agreed to this process last night. I would hope that the Government in responding would agree to this concept of an all-party Committee of the House.
I am offering the Minister a promise that if he brings in a Supplementary Estimate, the Labour Party will guarantee him a very substantial majority in this House. We would be respected for doing so, the Minister would be respected for doing so, and he would be supported on many sides of this House. The Minister must not hide any longer behind platitudes and clichés written by civil servants in his office. The Minister has the competence and the professional training to make decisions based on medical ethics alone, apart from the restriction that may be on him. We are asking the Minister to recognise the real problem. Whether there are elections or not, the problem is there. The Minister will be doing the country, his party and the Government a real service if he does that and he will have our support.
Perhaps you will allow me to share my time with Deputy Quill.
Is that satisfactory? Agreed.
Listening to Deputy Ferris one would be forgiven if one thought one was back in the middle eighties when major health board overruns were the order of the day and when Government borrowing was well over £2,000 million per annum. We are not back in those times and this Government are not going to return to those times on either of those two issues. We must get those issues out of the way; they are not a solution. The Minister could come in here any day if he had a free hand to borrow willy nilly and throw millions of pounds at the health boards, but that is not a solution. It is not an option for us. Deputy Ferris will have to face up to that fact. In fairness to the Deputy, he has disagreed with the Fine Gael proposal on overruns, so clearly he has learned his lesson from the last days of the Barry Desmond administration. We should be thankful for that, but he has gone on to look at the prospects of what I consider to be basically selling family silver. That is not an answer either for current expenditure. You do not sell capital assets to fund current expenditure. It would be very unwise because that runs out.
We have to face the problem that is present in the health service, not only in this country but throughout the world. That is the responsibility of this Government and that is the responsibility and the challenge which has been taken up by the Minister for Health since he took over in 1987. The Fine Gael motion accuses the Minister of many failures. It asserts that he has failed to undertake structural reform and that he does not have a coherent plan for health services. It further asserts that he has failed to make adequate financial provision to maintain services in 1991, with the result that conditions will deteriorate for a number of categories of patients. It then calls on him to solve the problem by increasing overdrafts and by introducing a reform plan for the health services.
In his address to the House yesterday evening, the Minister dealt definitively with the unfounded assertions and the soft options contained in the Fine Gael motion. I want to remind the House of the principal points made by the Minister and deal with a number of issues which have been raised during the course of this debate.
It has been a dreary experience listening to the same tired assertions and accusations being made by the Opposition. Not one of their speakers has touched on any of the really fundamental issues in the health services, issues which should be the concern of every Member of this House, irrespective of the party to which he or she belongs. Not one single constructive suggestion has been made which would assist the Minister or the Government in coping with one of the most difficult issues which faces Governments all over the world at this time.
I will start then by reminding the House of the undertakings which the Minister gave yesterday evening in dealing with the claim that services will deteriorate during 1991. Since last year, the number of acute hospital beds has been set at 12,000. This level of bed availability will be maintained during 1991, apart from seasonal closures which are a normal part of the health service.
This is a point which was not picked up by any of the contributors from the Opposition last night. The Minister and the Government have given a specific commitment that the 12,000 acute beds which were available last year will be available this year. That means no closures.
Does that mean that as many people will get admission to hospital as last year?
It means there will be 12,000 beds available, as last year.
There will be beds available but there will not be patients in them.
The Minister of State should be allowed to make a speech without interruption. There is a time limit in this debate and interruptions are particularly unwelcome, if not disorderly.
The Government will help health boards and agencies to maintain this level of provision by supporting an enhanced value for money programme, and by assisting in meeting any costs which occur on demand-led schemes beyond that provided in the initial Estimates.
The Government are rightly insisting that there will be prudent management of the significant resources which have been made available to health agencies. It is not going to accept that there is a need for any additional funding until it is clear that everything possible is being done to make the best use of the resources available to agencies, individually and collectively. It is certainly not going to come to a conclusion about this at this time of the year.
The Government will honour fully all the commitments which they have given, including those given by the Minister in the House yesterday evening, in relation to the maintenance of services. We will maintain the services at a level not less than that which was approved for 1990.
The Minister's approach to waiting lists is clear, straightforward and simple. As he stated at the conclusion of his address yesterday evening, his strategy is to work at getting the maximum return from every pound invested and seek efficiencies where they can be found. Then and only then should the question of additional funding be considered to finance needs and not demands.
There has been reference during the debate to waiting lists and claims made about their seriousness, whether for inpatient or outpatient services. A very selective presentation of the recommendations made by the Kennedy Group was made by today's Irish Independent. The headline boldly proclaims “Waiting Lists Due to Lack of Beds”. That is not, in fact, what the report states. I would like to take this opportunity to put the record straight in this House.
The report makes a number of very important recommendations regarding in-patient waiting lists and outpatients services. It does not accept that it is merely a question of throwing more resources in an undirected manner at either or both of these problems. In fact, it makes detailed recommendations on a lengthy number of steps which should be taken by each hospital before it is in a position to demonstrate that it cannot provide an adequate service with the resource already available to it.
In relation to waiting lists, the report recommends that waiting lists are validated. Each hospital should maintain comprehensive, standardised information concerning the numbers and types of patients awaiting admission. Validation to establish reliable waiting list data should be adopted as a firm policy in each hospital and such policies should ensure that appropriate management and clinical action is taken on foot of such reviews.
Hospitals should immediately carry out a bulk postal review of patients who have been on a waiting list for more than an agreed period of time. On completion of this comprehensive review and validation of current waiting lists, formalised regular arrangements should be made by each hospital for the ongoing review and validation of lists.
Might I say that this approach is not standard practice in all hospitals and until it is, data relating to waiting lists should be treated with great caution.
The report further recommends better scheduling of activity to reduce waiting times, analyses by hospitals to establish whether their activity levels, having regard to case mix, are broadly comparable with the productivity levels of similar services in other locations, a systematic review of the scope for increasing levels of day surgery for appropriate conditions, development of appropriate information technology and better information to general practitioners with regard to the average waiting times for admission.
In addition to these obvious and sensible steps, the report further points out that activity levels and throughput can be improved by changing the manner in which patients are treated. The report comments:
It is only when the scope for redeploying beds, theatre time and other resources within a hospital have been shown to be impossible, having regard to target waiting times, and when the scope for increasing day case activity has been maximised, that a valid case for resources can be made on the basis of waiting problems. In short, we do not consider that waiting times, even when validated, or themselves constitute a basis for requests for additional resources by the hospitals.
The report makes a number of similar recommendations with regard to the organisation of the out-patient services. It highlights the need for better adjournment systems for out-patient clinics, for a policy for dealing with non-attenders, and for reducing the level of unnecessary return attendances. It makes recommendations on better patient information and it highlights the need to match staff to the particular demands of providing a high quality out-patient service.
Again, the report refers to the need for the computerisation of pathology and radiology departments and the introduction of good transmission and retrievals systems between the various departments which are involved in the treatment of out-patients. It emphasises the need for a review of out-patient waiting lists and highlights the scope which exists for the development of out-patient care.
These recommendations do not come from a group representative of any single discipline. The group which assisted Mr. David Kennedy was representative of the management of the hospitals, their consultant staffs, the general practitioners.
The message from the report is very clear and very much in line with the approach which the Minister indicated to the House in grappling with demands for additional resources. There is plenty of scope for putting our house in better order and we have an obligation to do this before we assume that there is an unanswerable case for devoting additional resources which may, in any event, end up being spent in ways which are neither efficient nor effective.
Deputy Bruton fulminated last night about the supposed horrors of the accident and emergency services in the Dublin area. Let me put the record straight. Since 4 September 1989, all major hospitals have been open 24 hours per day, seven days a week. Prior to September 1989, a rota system operated whereby two hospitals were on call.
The 24 hour accident and emergency service costs an additional £6 million per annum. Approximately 162 additional staff have been assigned to the six hospitals to facilitate the expanded service. Ten additional observation beds have been provided at St. Vincent's, 14 at St. James's and 16 beds are coming on stream in the Mater Hospital. In addition, a new accident and emergency department has been opened in St. James's Hospital, while St. Vincent's Hospital have extended their accident and emergency department by 15,000 sq. ft.
Over the past few weeks, there has been additional pressure on accident and emergency departments which may be attributable to the recent severe weather conditions. This is in line with the normal pattern of demand at this time of the year. By the very nature of its work, it is not possible to say in advance what the workload of an accident and emergency department will be on any particular day. From time to time, particular pressures will arise which tend to level off and decline over a period. This is the experience of all accident and emergency departments in all major urban centres.
The fact is that all appropriate medical attention is provided to patients in the accident and emergency departments. Although delays have been experienced recently in arranging admissions to the wards, all patients requiring hospitalisation were admitted.
The overall accident and emergency service is being monitored closely by the Steering Committee on Accident and Emergency Services under the chairmanship of the Eastern Health Board, which is keeping my Department informed of the position on a daily basis. Protection arrangements have been put in place whereby each hospital makes contact with ambulance control and advises of the bed situation, at 9-10 a.m. and 4-5 p.m. each day in order to ensure that delays are kept to a minimum. The six accident and emergency hospitals are currently implementing the recommendations contained in the Kennedy report in order to shorten waiting times in accident and emergency departments and to improve management. I would like to point out that this is an example of the benefits to be achieved from reports and confirms that certain aspects of various reports are being implemented.
There is a consensus that we should continue to spend the extra money that becomes available in the community rather than in our hospital services. If we continue to spend all the extra money on the hospital services, we will choke the system because the logic of spending the money in hospitals and not developing our community services is that more and more people will find themselves in hospital beds when they might be more appropriately treated elsewhere.
At present there are elderly people in our acute hospitals who have completed their acute medical treatment and are waiting to be placed in a home for the elderly or in their own community with support services. There are also physically disabled people who are permanently in acute beds in hospitals. We want to spend the extra money coming on stream in the community so that we will build up our community services and provide places in the community for those who need them. The ideal is to be treated in the area most appropriate to ones need.
Apart altogether from health economics, that is what we want in humane terms. People do not want to go into hospital unless it is absolutely necessary. The Programme for Economic and Social Progress spells out very clearly the direction in which we should be going. I believe there is a consensus to go in that direction, despite the fact that Opposition Deputies are saying that we should put more and more money into the acute hospital service.
In allocating capital and current funding to each service, we will be implementing the key recommendations of the working groups which examined that area in detail. Deputy Bruton made a big point out of the lack of service targets for community services in the Programme for Economic and Social Progress. He blithely ignored the fact that there are already in existence detailed policy statements and targets for most of the services covered by the commitments in the programme. For example, the priorities identifed by the working party on health and welfare services for the elderly, The Years Ahead, are closely reflected in the provisions of the programme. We will be allocating resources to develop home nursing and other support services. We will also extend respite facilities to relieve families caring for dependent elderly in their own home, and we have committed ourselves to ensuring an adequate number of extended care beds in those health boards experiencing significant increases in their elderly population.
The Government's commitment to implmenting the key recommendations of The Years Ahead is illustrated by the speed with which we enacted the Health (Nuring Homes) Act, 1990. The funding commitments under the Programme for Economic and Social Progress will ensure that both the report and the new Act are fully implemented as rapidly as possible.
There is no money for them this year.
The Green Paper on services for the disabled proved very valuable in identifying service priorities. The report of the review group on mental handicap services has been accepted by the Government and will influence significantly the determination of priorities, as well as giving a big boost to service co-ordination. Priorities for people with physical disabilities will include the provision of additional paramedical services, day centres and home support services. We will also arrange for the provision of respite care facilities and new training workshops, as well as improving existing facilities.
In the area of mental handicap, the programme undertakes to allocate resources to community and residential services. As recommended by the review group on mental handicap services, our emphasis will be on identifying an appropriate mix between communitybased and residential facilities, so that all mentally handicapped persons will enjoy care in the most appropriate setting.
I would emphasise that developments will take place in a structured, co-ordinated way, based on the priorities already identified by the working group. The Department will continue to work closely with health boards and voluntary agencies providing services for the handicapped to ensure that the entitlements of the mentally handicapped under existing legislation and service arrangements are made available in a consistent, caring and efficient manner.
Central to the development of our psychiatric services has been the study group report, Planning For The Future. The Programme for Economic and Social Progress provides continued impetus for implementing the priorities it identified. We will make funds available for the continued development of specialist assessment and rehabilitation units associated with acute general hospitals. In addition, we have undertaken to fund the provision of additional places in day centres, workshops and support hostels, together with developing further our child and adolescent psychiatric services.
The Minister has been determined for some time to update and strengthen the law in relation to the care of children, particularly those who are at risk or who have been mistreated or abused in any way. This House approved the Child Care Bill before Christmas and I hope that the Seanad will do so in the near future.
The programme commits funding for implementation of the Bill on a phased basis. We will be providing resources for extra residential facilities and home support services. We will also increase the number of social workers, psychologists and medical staff over the period of the programme.
We made considerable progress last year in developing orthodontic and adult dental services from the extra funding in the 1990 budget. This process will be continued through the Programme for Economic and Social Progress. We will be allocating resources for the recruitment of additional staff and the development of existing personnel, as well as for re-equipping existing health board dental facilities and the commissioning of new facilities. We will also be engaging in a major programme to develop health centres over the next seven years.
In summary, therefore, the Government will be developing community based services in a co-ordinated and planned way. Our policy will be based on priorities identified by the expert working groups in each area, and will be implemented through a careful allocation of additional capital and current funding over the period of the programme.
Deputy Bruton referred to the differences in the financial 1991 allocations for the health boards and voluntary hospitals. It will be recalled that the Government committed last year an additional £25 million to the general hospital system. This was provided to maintain the level of services in the acute hospital system. The voluntary hospital sector has a substantial proportion of acute beds yet has a total funding base which is about one-third that of the health boards. Any significant increase in the funding of the hospital sector generally will, therefore, have a greater impact in percentage terms on the voluntary hospitals.
Deputy Allen castigated the health boards and their members, and accused the Minister of indecision because he has not accepted the recommendation of the Commission on Funding to abolish the boards and set up one body to manage the health services. The Government have set out their position very clearly in the Programme for Economic and Social Progress.
There will be a practical rather than an ideological approach to organisational structures; any changes in structures will take account of the needs of patients and of the strengths and traditions of individual organisations within an overall framework for delivery of services. It must also reflect the interests of the patient, the people who deliver the services and the taxpayer. Based on these principles, the Government will announce proposals for the improvement of the administration and management of the services during 1991.
I want to thank the Minister for giving me this time. In the time at my disposal I will concentrate on making two key points.
In my budget speech two weeks ago I warned the Government that health could very well be the Achille's heel of this Government and might very well be made the Achille's heel of this Government. That is something we cannot afford to ignore.
It is a fact that patients, their families, taxpayers and consumers find it extraordinarily difficult to understand how it is that there can still be problems in the health services at a time when so much increased Government resources are being ploughed into the service. Last night the Minister, Deputy O'Hanlon, quite rightly pointed out to this House that more than £1.5 billion was being made available for the health services this year, that is 22 per cent of non-capital Government spending. This is the highest amount ever spent on the health services since the foundation of the State. Despite all that, we still have problems within the services.
The view of the Progressive Democrats is that part of the problem lies with a health service that in its administration and management is overtly complex, and that rests very much in the hands of the health boards that are bogged down with excessive bureaucracy.
In the Programme for Government negotiated in July 1989 one of the commitments was that the new Government would review "the entire system of management of the health services nationally, including the health boards, to ensure an adequate efficient health service providing the best possible patient care". I was relieved, therefore, to hear the Minister Deputy O'Hanlon outline last night the detailed value for money measures which are now being instituted in health boards and are being supervised by his Department. I also look forward to a major restructuring of hospital services particularly in the Dublin area following the specialist Fox and Kennedy reports.
I also welcome the emphasis which the Minister placed on value for money reviews on matters like energy costs, the cost of hospital supplies and pay generally. The publication too of the National Drugs Formulary last week by the Minister should also lead to a major reduction in the cost of drugs and to greater prescribing of generic drugs.
What is needed right across the board at this time in the health service is a greater degree of transparency, more basic information and management systems which are independent of sectoral medical interests. Very basic every day issues need to be tackled. I was glad to hear the Minister of State mention some of these issues. My belief is that proper regulation of hospital outpatients' appointments ought to be put in place so that patients do not have to hang around for hour after hour waiting for treatment as happens so frequently at present.
Another matter is that hospital waiting lists for various medical procedures should be overhauled. We should have detailed and regularly published waiting lists including the numbers of persons on that waiting list and the categories under which these people are waiting for treatment. These should be regularly updated so that patients and their families would know exactly — or relatively exactly — where they stand on the list and how soon they can hope to have the treatment which they so urgently need. Those two matters, if addressed urgently, would make a vast improvement in the degree of patient care as it hits patients or impending patients at the cutting edge.
I am very taken aback with the prescription that is written for ailments in the health service by the Fine Gael Party. There are problems——
At least we have a prescription.
It is a very costly prescription and that is the point I am trying to make. What this country now needs are not politicians who highlight our problems but politicians who will find solutions to our problems. The solution to the problems in the health service does not lie in allowing the health boards to go into an overdraft situation for the remainder of the year. For that reason I could not give my support to the motion before the House but I look forward to a substantial improvement in the health services in the year immediately ahead. I take heart and courage from what the Minister said in his speech last night. I am also encouraged by what is said in relation to health in the Programme for Economic and Social Progress where a commitment is given to a radical overhaul and development of our health service in the year ahead. If that happens we will see a badly needed and long awaited improvement in the year which we are about to enter.
An Teachta Sherlock. Caithfidh an Teachta críochnú roimh 8.15 p.m.
Cén fáth? Cheap mé go raibh leath uair a chloig agam.
De réir ordú an Tí, caithfidh mé glaoch ar an Teachta Creed.
I would like to advise that I will be sharing some time with Deputy Gilmore and Deputy McCartan.
Is that agreed? Agreed.
Just over a year ago, on 6 and 7 February 1990, the Dáil discussed a motion of no confidence in the Minister for Health because of the serious crisis then facing the health services. Twelve months later, it is clear that the problems of the health service are as serious as ever and in many respects have worsened. The Workers' Party have little confidence in the Minister as was the case last year. If the Minister for Health and his Minister of State were to stand before the bar of justice they would stand indicted and condemned because both have come into this House and tried to defend the indefensible. They have stated that it is scaremongering by politicians. In the little time available to me I hope to refute that argument by the Minister. I will give an example of the Southern Health Board where the chief executive officer and his executive were asked last autumn to submit their requirements for 1991. This was done using the adjusted 1990 allocation as the base for determining the 1991 requirement. If the chief executive officer and his team are employed by the Southern Health Board and the Department they must be regarded as competent to do a job. The figure they arrived at was £151,432,000. That was the increased allocation they required under general hospital services, community care and psychiatric services programmes. Who was better qualified to know the requirements? The result is that an allocation was made leaving a shortfall in excess of £4 million.
They got £149 million, subtract that from £151 million.
There is a shortfall in the health boards in excess of £104 million. In the Western Health Board there is a shortfall of £3.25 million, the South Eastern Health Board have a shortfall of £1.80 million and the Southern Health Board have a shortfall of £4 million while there is a shortfall too, in the Northern Health Board. The Minister's argument is completely refuted.
The Minister talks about the availability of 12,000 beds. Can he tell us what ratio is now being applied? The ratio used to be three beds per 1,000 of the population, if that were the case he would require in excess of 12,000 beds. The health board cannot maintain the same level of service — I am sorry Deputy Quill has left — because there are such things as wage increases, a 39 hour week and inflation but have all those been taken into consideration? In case the Minister thinks I was talking off the top of my head I will quote, as I am entitled, from the minutes of the meeting of the Southern Health Board on 7 January 1991 as follows:
The Board considered letter dated 18th December, 1990, from the Department of Health regarding the Board's allocation for non-capital health expenditure 1991 and report thereon dated 20th December, 1990. The Chief Executive Officer provided a further detailed verbal report explaining the background to the estimated requirements of £153.1 million and contrasted this with the allocation of £149.026 million. He stated that it would not be possible to maintain the service at 1990 levels. He explained the tight controls which would operate in regard to cash flow which would result in the Board being confronted at an early stage with the problem of pegging back the level of services.
That is irrefutable evidence that what the Minister is saying is wrong. They are the people who have the responsibility for the health services and not Mr. Kenny. What does Mr. Kenny know about the health services? What information or involvement has Mr. Kenny, Mr. Kennedy or Mr. Fox on the health services? They are different people with different qualifications. It was said last night — and I said it previously — that the health service is now a supermarket operation, cost effective, value for money etc.
Having heard of the provision for mentally handicapped people I feel obliged to say that I have a letter which was submitted to the Southern Health Board, signed by social workers representing various groups within the Southern Health Board — the Irish Wheelchair Association, the Cork Spastic Clinic, the Multiple Sclerosis Society, the Cork Regional Hospital social workers and the Mercy Hospital — in which they said:
We have become increasingly aware of the discrepancy between the demand for and the availability of services to meet the growing number of young chronic sick and disabled people. There are two groups about whom we are concerned. One group consists of about 110 people living at home potentially at serious risk.
Those people cannot be provided for by a health board with a shortfall of over £4 million.
The other aspect I would refer to is the home help service provided for the parents of mentally retarded children. In my own area, and right across the east Cork section of that area, a number of mothers are getting home help service from one or two social workers. In mid-1990 the board were advised that the service would have to be cut. The allocation from the health board to the Wheelchair Association was reduced. Consequently the social worker service is to all intents and purposes not available to mothers caring for mentally handicapped babies. The Minister stands indicted and condemned on those issues. The sooner he faces up to that fact the better for all and sundry.
Has the Minister not received the INO submissions and has he not seen their public pronouncements? Has he not received a request from the Southern Health Board, first, to meet the parliamentary party members who are members of that board and, secondly, as was decided at their last meeting a broad based delegation who would represent the board? Why has the Minister not received those delegations to enable——
I met the chairman and chief executive officer of the board on numerous occasions.
That is different to meeting with the representatives of the board. I believe the Minister is telling the chairman and chief executive officers of the boards what is happening but he is not meeting any delegations.
I want to put it on the record that most people believe that 39 per cent of the population of this State have full eligibility to free health services. That was the case up to about the mid-eighties but this figure was reduced to 33.55 per cent by 1989 and to 32.63 per cent by 1991.
The figure is 37 per cent.
The national average is 34.99 per cent. If the Minister is getting his statistics from a different source I would be glad to stand corrected on this issue. This is a vast reduction in the number of people who are eligible to a free health service. People are being turned away from hospitals every other day. People who are marginally over the limits have had their applications for medical cards turned down.
I want to refer to the position in regard to the mentally handicapped and long-stay patients. Great emphasis was placed in the programme for the care of the elderly on the appointment of additional public health nurses. The number of public health nurses in the area I represent is far below the national average. Increasing the number of health nurses by one or two in a very large district will not rectify the problems. No provision had been made for beds for long-stay geriatric patients even though this recommendation was made by the Commission on Health Funding. This recommendation should be taken on board by the Minister straight away.
In the late seventies an application made by St. Patrick's Hospital in Fermoy for more beds was sent back to the board to be modified just because the official in the Department thought the cost was a bit high. The matter has rested there since then. Consequently there is a chronic problem in this hospital in regard to the provision of beds for long-stay patients. The use of beds as respite beds is no solution to that problem. In 1989 the Southern Health Board made the provision of an additional 20 beds for Mallow General Hospital a priority but to this day no move has been made by the Department in this regard. Little children who are hospitalised are being accommodated in the same wards as adults. This situation cannot be tolerated and I ask the Minister to do something about it.
Last year the ‘flu epidemic was blamed for the chaos in our hospitals. This year there is no epidemic yet the health boards and patients are facing a crisis every bit as serious as that of a year ago. Health boards simply cannot maintain services on the basis of the funds provided to them by the Government. The inevitable outcome of this will be longer waiting lists, more beds in corridors, the early discharge of patients, longer closure of beds and wards during holiday periods, a worsening of the plight of the physically and mentally handicapped and even less money for child care services and facilities for the elderly.
The Minister sits in the comfort of his office in the Custom House repeating parrot like that "there is no crisis", totally ignoring the reality being experienced every day in the health service by doctors, nurses and administrators who have to cope with the chaos resulting from his disastrous policies and especially from his refusal to acknowledge the need for increased funding.
Let us look at the reality of the situation. As I have previously stated, at the end of January the members of my health board were informed by board officials, following a meeting with the Department, that they were proposing a reduction in the level of activity to that operating at the end of 1989. This is in clear conflict with the commitment given to the Dáil by the Minister before Christmas that all health boards‘ services would be maintained at their 1990 level.
I will honour that commitment, just as I have honoured every commitment over the last four years.
It could hurt.
It does not look like the Minister can do that unless he increases the allocation to the health board.
Other proposals involved the longer holiday and seasonal closure of beds, an increased range of surgical and medical procedures to be undertaken on a day basis, the elimination of what were described as "unnecessary tests" and the temporary deferment of the filling of some vacancies. Under the proposals there would be no additional money for the physically handicapped or for child care services. The Minister of State referred to the position in regard to child care services. What additional finances have the health boards got to implement the proposals in this regard——
There is a provision of £1 million in the budget for this.
Under the Health (Nursing Homes) Act, 1989, subventions are now due to be paid to private nursing homes. Do the health boards have the money to pay this subvention? I do not believe they have.
There is money in the budget this year for the elderly.
But there is none for the health boards.
The same problems are being experienced by hospitals all over the country. The Irish Times of 19 February carried a report signed by the Chairman of the Mater Hospital's Medical Council which gave a graphic account of the problems facing that hospital. He stated:
In recent weeks, the number of patients awaiting admission and remaining overnight in the accident and emergency department has increased. This in turn has given rise to inadequate supervision of patients that are left unattended on trollies in various cubicles whilst the nurses and medical staff attend to other patients.
Arising from this, staff numbers in the department are unable to monitor patients appropriately. It is not unusual to find two patients per cubicle, either being assessed for admission or awaiting admission. This practice is humiliating for the patient, the patient's relatives and is an extreme embarrassment for all the staff concerned.
It is not a public representative who is creating that scaremongering.
The Workers' Party have never suggested that additional spending on its own would create a better health service. Combined with the restructuring of the health services additional funding can give the Irish people the quality and range of service they need. The proportion of gross national product spent on public health has been steadily declining. Unless there is a commitment to bring the level of spending back up to what it was in a planned and phased way the problem will remain. In 1983 public health spending accounted for 7.61 per cent of GNP. This figure was gradually brought down to 7.1 per cent in 1986, 6.6 per cent in 1987, 6.24 per cent in 1988 and less than 6 per cent in 1989.
The Workers' Party, noting that the percentage of gross national product allocated to public health services has declined significantly since the mid-eighties and that many of the problems now being experienced in our hospitals are a direct result of years of under funding and believing that adequate health services cannot be provided on the cheap, call on the Government to move towards a target figure for health expenditure of the OECD average in terms of percentage of GNP. They further call on the Government to make an immediate cash allocation available to those health boards who are facing a shortfall and to introduce a proper reform plan for the health services based on numerous studies now available on the need for structural reform.
Deputy Gilmore has approximately six minutes.
Are you aware that I am sharing my time with Deputy McCartan?
I mentioned that at the outset.
You are sharing six minutes with Deputy McCartan.
Listening to the Minister's very detached speech a short time ago one would be forgiven for thinking there were no patients in this city, for example, who are waiting up to two years for heart operations, that there are not 10,000 people waiting for orthodontic treatment and that there are no parents trying to tackle the problems of handicapped children. It is very easy to make a detached speech when you are not on the suffering side of the health crisis we are now facing. About a week ago in this House I raised the case of a three and a half year old child whose parents were told he would have to wait a year for a tonsils operation in St. Michael's Hospital in Dún Laoghaire. A couple of years ago he would not have had to wait that long——
He would.
He would not, and I will give the reason. At that time Monkstown Hospital was open but it has been closed since by this Government, the children's ward in St. Michael's Hospital was closed down by this Government, and as a result there are now over 100 children waiting for a tonsils operation in that hospital. In the same period, the maternity unit in St. Columcill's Hospital, Loughlinstown, was closed down, leaving no maternity hospital from Wexford town to Holles Street. In his reply to me a week ago the Minister of State referred to a review of hospital services in south-east Dublin. That reference worried me because I fear that even the limited hospital services that at present exist in the Dún Laoghaire area will be further diminished. I would like the Minister to give an assurance that that will not happen because, should it happen, it will not be tolerated.
I would like to refer briefly to the Labour Party amendment. One proposal in that amendment surprised me — the reference to cancelling the purchase of Carysfort College. While I share the reservations of the Labour Party about the circumstances surrounding the purchase of the college, the cost of it and so on, the position would be much worse if it is not purchased since it would revert back to private ownership and would probably end up in private use. I am a little surprised to find that proposal included in an amendment dealing with the health services.
I would like to thank Deputy Sherlock for affording me a few moments to add a further point of reality to this debate. In the face of the many criticisms levelled at the Minister and his Department by Deputy Sherlock in respect of inadequate services, the Minister retorted across the floor that he has honoured the many commitments he made over the past four years. That may be his view, but I want to instance two cases in my constituency that have come to my attention in the last week which suggest that commitments do not seem to be enough and that a lot more needs to be done. The first instance concerns a young boy of six years of age from Darndale who called to the Mater ear and throat clinic in August of last year needing an urgent tonsillitis operation; he was told he would have to wait for six to eight weeks.
What age is he?
Six years of age.
He went to the Mater?
That is correct.
Why did he not go to Temple Street?
I am sorry, but I have a very short time available to me. The Minister can comment all he likes later and I hope he will resolve the matter. This boy is still awaiting a tonsillitis operation. He is missing days from school. He is suffering from severe throat and other ailments and is now facing impairment of his hearing. All this has been witnessed and attested to directly by me.
The second instance concerns a boy of similar age from the Howth area who called to Temple Street Hospital on 11 May last year when he was advised he would be put on a list of approximately 80 children in need of operative treatment to their ears. This unfortunate child has extremely protruding ears and, no doubt the Minister can appreciate, while it is not life threatening, nonetheless, makes the boy's existence in the community and the school which he attends somewhat difficult at times.
Earlier this month the parents of this boy checked with the hospital to find out the position and were told his name had been removed from the list. When I made inquiries of the hospital I was advised that there are now between 250 and 300 patients of similar age on the waiting list for this type of treatment. The consultant who wrote to me gave the following explanation:
It is a common misconception that waiting lists are like bus queues. As I am sure you are aware, more urgent problems skip the queue so that, in effect, less urgent problems do not move in the queue at all and may even start moving backwards.
That is the level to which our medical services in this city have been reduced. There are queues which are moving backwards.
Sorry, Deputy McCartan, the order of the House requires me to ask you to conclude. I must call Deputy Creed now.
In conclusion, I say to the Minister that something needs to be done urgently. If we cannot protect the health of our children——
Sorry, Deputy McCartan, I have called Deputy Creed.
——we are failing entirely in our duties in this House.
I would like to share my time with Deputy Fennell and Deputy Bruton.
Is that agreed? Agreed.
The debate to date and the contributions from the Minister and the Minister of State have been along usual lines in debates such as this. We have come to expect that form of verbiage from the Department. It is quite obvious the Minister and Minister of State are out of touch with what is happening in the administration of the health services. We had a nice piece of political posturing from the Minister's colleague, Deputy Quill. She was quite right in assuming that health services would be the Achilles' heel of this Government. She is aware, of course, as is any good politician, that there are local elections impending. The Minister should take note that less political posturing and more resources for the health services might be rewarding in the local elections.
Any debate on the health services must focus on the patients' requirements and the capacity of the Minister to meet these requirements. Because of the Minister's appalling disregard for patients and because the question of access to health services is one the Minister would prefer to ignore, the patient has been removed from centre stage in this debate and replaced by lies, damn lies and statistics. I want tonight to restore the patient to centre stage, to bring home to the Minister the fear and anxiety, the pain and suffering and the sense of hopelessness and rejection felt by the suffering patients.
Perhaps the Deputy could indicate that his comment to "lies" was a quotation rather than an accusation.
You assume correctly, it is but a cliché. We have an overanalysed, overadministered and underfunded health service. The Commission on Health Funding, Kennedy, Fox and all the other reporters, confirmed what we all know, that the health services are in crisis. Waiting lists for hip operations, cataract operations and ear, nose and throat surgery are——
Reducing.
——unacceptably long. The needs of the mentally handicapped are ignored and community care, dental treatment and other essential services are practically non-existent. Yet the Government, apparently with the blind support of all the Government backbenchers, have the audacity to table an amendment commending the Minister for providing additional resources, for taking radical and reforming action and for maintaining the level of services. The Fianna Fáil and progressive Democrats Parties are burying their heads in the sand because the Government have failed the patient dismally in their handling of the health services.
The Minister has bled the health services dry while failing to eliminate waste in administration. Do we need eight health boards? Why does the Minister not do something about reforming administration and reallocating the saved money to treatment of additional patients and providing more beds and nurses in the health services? The Minister is neither radical nor reforming. He is like Nero, the old Roman Emperor, fiddling and dithering while the health services wither before our eyes.
Clichés again.
The Minister is inactive, uncaring and indifferent to the plight of the patients. He is blatantly untruthful in the amendment and to the patients who are affected by that amendment. The Minister will not maintain the level of services in 1991. The Cork Regional Hospital——
The Deputy told us the same thing last year.
——will have 1,000 fewer admissions in 1991 than in 1990 and that is not maintaining the level of services. The Minister, of course, is not alone in his remove from reality. If any of his backbench colleagues had the interests of the patient at heart, they would take him by the hand into the real world. However, they too have thrown in the towel and shamefully succumbed to the ethos that nothing can be done for the suffering patients. Fine Gael do not accept that. We believe that access to medical care should be determined by need and not by the size of one's bank balance. There should be one waiting list for public and private patients. Resources must be concentrated on front line services in relieving pain and suffering, not squandered through inaction in administration and greed.
We do not want consultants hogging health debates; we want more beds, more nurses and more patients catered for and taken off unacceptably long waiting lists. Above all we firmly believe that the Minister, after four years, does not show any signs of understanding the fundamental issues. He shows scant regard for the patient and the public deserve better.
The Deputy's party believed in borrowing.
I should like to thank my colleague for allowing me time to contribute. In supporting this motion I will briefly deal with two points and I am sure it will not be a surprise to the Minister that one of them concerns the mentally handicapped, a group of people in whom I am particularly interested and whose problems will not be solved by a stay in hospital or by pills.
Today's events, where parents of handicapped people forcibly occupied the offices of the Department of Health with their children indicate a very serious problem and a degree of frustration seldom seen in any campaign. This group of ordinary people — ordinary parents — who came together only one and a half years ago to highlight the needs for residential accommodation for the handicapped took this action because they felt no one was listening. No one condones any group breaking the law and when it is a group involving severely handicapped young people, many of whom are in wheelchairs, it has to be remarkable. The people involved in today's protest have a just cause and they want a meaningful, practical response, not £1 million or £2 million as a stopgap. They have held public meetings, visited TDs' clinics and gone on the streets with their children. Does the Minister understand how painful this is for parents in that position?
The Minister for Health is a caring man who is familiar with the stress which a handicapped person creates in a family. However, this group was tired of sympathy and their need is to transfer caring — however good — into practical action. The Minister must allocate the necessary £9 million investment in residential accommodation to cater for the waiting list about which he has been told again and again in the Dublin area. If necessary, this allocation should be made out of national lottery funds. It is precisely this type of use that people who buy tickets and subscribe to the lottery want to see their proceeds going.
Deputy Quill said that the health area is the Achilles' heel of the Government, and handicapped people are the Minister's Achilles' heel. I appeal to Fianna Fáil not to hide in a bunker and hope that the handicap issue will go away as that party did in relation to the haemophiliac group some time ago. It is now an issue of public concern among people not personally involved and it is the test of the Government's real commitment to health spending rather than the aspirational one incorporated in the Programme for Economic and Social Progress.
I should like to speak very briefly about yesterday's court case on the sale of condoms. The Dublin District Court decision yesterday on the sale of condoms was regrettable. It places an onus on this House to change our family planning Acts to ensure that contraceptives can be more freely available. We are truly living in a Victorian age when our laws penalise people for being responsible in their sexual habits. Fianna Fáil have great difficulty in this area and seem to have a pathological dread of the word "condom". It seems to send a tremour through them.
It was legislation which the Deputy's party introduced which was dealt with in court yesterday.
Fianna Fáil share the notion that family planning is a women's problem but it is not. They said so in the Programme for Economic and Social Progress. They put family planning under “Women's Health Services” and said that operation of family planning services would be kept under review in association with the relevant organisations. Family planning and contraceptives are not women's issues, they are issues for everybody. If condoms and other forms of non-medical contraceptives were readily available and promoted by the Department of Health, there would be fewer women on the pill, which is not good for them.
Condoms, as far as I know, are the only means of male contraception and we must do something in this House to make them more freely available. I hope that changes in family planning laws will be made in a mature and enlightened way for many reasons, including AIDS, the increase in people diagnosed as HIV positive and the broader reason that people need contraceptives to prevent pregnancy. I am not over-confident, however. I recall the disgraceful opportunism of Fianna Fáil when, in 1985, the Coalition Government effected necessary — but minimal — reform. We made changes but I regret that we did not go far enough. The onus is now on the parties opposite to take the matter further.
The situation tonight is very depressing. The Minister said last night that he must distinguish between demands and needs and fund the latter. Does the Minister regard people staying overnight on trollies in humiliating circumstances in the Mater Hospital as a need or a demand? Is it a need or a demand that hundreds of mentally handicapped children are going without any service and that their parents do not have any respite care? Is it acceptable that people have to wait up to two years for cardiac surgery? Is that a need or a demand? Any reasonable person listening to the Minister recognises that he is out of touch with what is happening. He could be forgiven if he was not getting advice but the Minister's response to the advice from the health professionals is summarised in his conclusion that health agencies are always looking for additional funding. He has refused to even address any of the detailed reports from each health board as to the defects they have to face this year.
The South-Eastern Health Board will have to cut hospital admissions by 8,000. That is the reality, it is in their report and the Minister should read it. The Minister fraudulently announced that he will maintain approved levels of service in 1991 but everyone in the House knows that that means there will be fewer hospital admissions this year. That means, in consequence, longer waiting lists and there is no getting away from it. It is misleading to come in here and talk about a 7 per cent increase in the approved allocation. Every health board can say that last year, with Government sanction, they spent much more than their approved levels because there was a crisis. Now the Minister is squeezing that back from the system. It is ironic that the Minister, who allowed his Taoiseach to face an election in 1989 ignorant of the crisis in the health services, should ask his councillors to go into the same electoral arena ignorant of the true crisis in the services. Perhaps what we heard from the Minister of State, Deputy Flood, is the signal that the Minister is keeping back a little money and will look at additional needs closer to the local elections. What sort of management is that to offer to our services? We have professionals in the services seeking to plan on a long term basis.
We have known for years that we need multi-year planning but the Minister has refused to do so. We have known for years that we do not have a proper structure for community care but the Minister has not acted on it. We have known for years that we do not have adequate management systems in our hospitals but the Minister has not acted on that. He now expects applause from the House for saying he read the Fox report and will take some of those suggestions up.
I implemented it.
Those issues were identified five years ago by his own Department in a worthwhile document on the wider dimensions of the health provision. He has done nothing about that document, he is providing more consultants to again look at the problems which were identified then and he sits on his hands. The Minister is immune to what is happening to many people who will have to deal with early discharges which will be the necessary consequences of his action. That is the reality of what we will face this year.
The Minister talked about the publication of the Programme for Economic and Social Progress. However, responding to that, the general secretary of the INO said that the reduction of moneys in this year's health services could only be seen as a direct contradiction of the spirit and intent of that programme. That is the reaction from the professionals in the service which councillors will face during the year.
There are very few specifics in the programme but one is that the Minister will take the 1,500 mentally handicapped people who are inappropriately placed in psychiatric hospitals out of those hospitals. Within a week of that programme the Minister announced he was reneging on that, he was not going to do that. That was a direct quote from the Minister reported in the papers and not denied by him. We have fraudulent presentation here tonight. The Minister is going back on commitments given to the social partners and he will pay the price for that.
Amendment put.
The Dáil divided: Tá, 73; Níl, 67.
Tá
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, David.
- Aylward, Liam.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Mattie.
- Brennan, Séamus.
- Briscoe, Ben.
- Browne, John (Wexford).
- Burke, Raphael P.
- Callely, Ivor.
- Harney, Mary.
- 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.
- Molloy, Robert.
- Morley, P.J.
- Nolan, M. J.
- Noonan, Michael J. (Limerick West).
- Clohessy, Peadar.
- Connolly, Ger.
- Coughlan, Mary Theresa.
- Cullimore, Séamus.
- Davern, Noel.
- Dempsey, Noel.
- Dennehy, John.
- de Valera, Síle.
- Ellis, John.
- Fitzgerald, Liam Joseph.
- Fitzpatrick, Dermot.
- Flood, Chris.
- Flynn, Pádraig.
- Geoghegan-Quinn, Máire.
- O'Connell, John.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Keeffe, Ned.
- O'Kennedy, Michael.
- O'Leary, John.
- O'Malley, Desmond J.
- 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.
Níl
- Ahearn, Therese.
- Barnes, Monica.
- Barrett, Seán.
- Bell, Michael.
- Belton, Louis J.
- Boylan, Andrew.
- Bradford, Paul.
- Browne, John (Carlow-Kilkenny).
- Bruton, Richard.
- Byrne, Eric.
- Connaughton, Paul.
- Connor, John.
- Cosgrave, Michael Joe.
- 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.
- Flaherty, Mary.
- Flanagan, Charles.
- Gilmore, Eamon.
- Gregory, Tony.
- Harte, Paddy.
- Higgins, Jim.
- Hogan, Philip.
- Howlin, Brendan.
- Kavanagh, Liam.
- Kemmy, Jim.
- Kenny, Enda.
- Lee, Pat.
- McCartan, Pat.
- McCormack, Pádraic.
- McGinley, Dinny.
- Mac Giolla, Tomás.
- Mitchell, Gay.
- Mitchell, Jim.
- Moynihan, Michael.
- Nealon, Ted.
- Noonan, Michael. (Limerick East).
- 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.
- Timmins, Godfrey.
- Yates, Ivan.
Tellers: Tá, Deputies V. Brady and Clohessy; Níl, Deputies Flanagan and Ferris.
Amendment declared carried.
Question put: "That the motion as amended be agreed to."
The Dáil divided: Tá, 73; Níl, 67.
Tá
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, David.
- Aylward, Liam.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Mattie.
- Brennan, Séamus.
- Briscoe, Ben.
- Browne, John (Wexford).
- Burke, Raphael P.
- Callely, Ivor.
- Clohessy, Peadar.
- Connolly, Ger.
- Coughlan, Mary Theresa.
- Cullimore, Séamus.
- Davern, Noel.
- Dempsey, Noel.
- Dennehy, John.
- de Valera, Síle.
- Ellis, John.
- Fitzgerald, Liam Joseph.
- Fitzpatrick, Dermot.
- Flood, Chris.
- Flynn, Pádraig.
- Geoghegan-Quinn, Máire.
- Harney, Mary.
- 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.
- Molloy, Robert.
- Morley, P.J.
- Nolan, M.J.
- Noonan, Michael J. (Limerick West).
- O'Connell, John.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Keeffe, Ned.
- O'Kennedy, Michael.
- O'Leary, John.
- O'Malley, Desmond J.
- O'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.
Níl
- Ahearn, Therese.
- Barnes, Monica.
- Barrett, Seán.
- Bell, Michael.
- Belton, Louis J.
- Boylan, Andrew.
- Bradford, Paul.
- Browne, John (Carlow-Kilkenny).
- Bruton, Richard.
- Byrne, Eric.
- Connaughton, Paul.
- Connor, John.
- Cosgrave, Michael Joe.
- Cotter, Bill.
- Creed, Michael.
- Crowley, Frank.
- D'Arcy, Michael.
- Deasy, Austin.
- Deenihan, Jimmy.
- De Rossa, Proinsias.
- Lee, Pat.
- McCartan, Pat.
- McCormack, Pádraic.
- McGahon, Brendan.
- McGinley, Dinny.
- Mitchell, Gay.
- Mitchell, Jim.
- Moynihan, Michael.
- Nealon, Ted.
- Noonan, Michael. (Limerick East).
- O'Shea, Brian.
- O'Sullivan, Gerry.
- O'Sullivan, Toddy.
- Doyle, Joe.
- Dukes, Alan.
- Durkan, Bernard.
- Enright, Thomas W.
- Farrelly, John V.
- Fennell, Nuala.
- Ferris, Michael.
- Finucane, Michael.
- FitzGerald, Garret.
- Flaherty, Mary.
- Flanagan, Charles.
- Gilmore, Eamon.
- Gregory, Tony.
- Harte, Paddy.
- Higgins, Jim.
- Hogan, Philip.
- Howlin, Brendan.
- Kavanagh, Liam.
- Kemmy, Jim.
- Kenny, Enda.
- 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.
- Timmins, Godfrey.
- Yates, Ivan.
Tellers: Tá, Deputies V. Brady and Clohessy; Níl, Deputies Flanagan and Ferris.
Question declared carried.