The House will now hear two minute statements on matters appropriate to the Minister for the Environment and the Minister for Health. I propose to call on the Deputies I have selected in the following order: Deputy Bernard Durkan and Deputy Austin Deasy in respect of matters to the Minister for the Environment and Deputy Nora Owen, Deputy Mervyn Taylor and Deputy Richard Bruton in respect of matters appertaining to the Minister for Health. Each Deputy is entitled to two minutes in respect of each matter and each statement will be followed immediately by a two minute reply by the appropriate Minister or Minister of State.
Adjournment Debate. - Environment and Health Matters.
In the course of the budget speech in January 1991 it was announced that a plan for social housing would be later put forward by the Minister for the Environment. Subsequent to that the Government Information Service issued a statement entitled Flynn's Plan for Social Housing which set out the apparatus within which it was proposed to provide 1,500 housing units nationwide through a social housing plan, part of which incorporated what has become known as a share ownership scheme. This scheme has operated very effectively in several other European countries and in the UK and Northern Ireland.
Following repeated questions and promptings to the Taoiseach and the Minister for the Environment before the summer recess, the Minister for the Environment gave an undertaking that a pilot scheme would be put into operation which would enable applicants throughout the country to apply for loans under this scheme, that the local authority would be empowered to process and approve those loans and that everything necessary would be done to ensure that that would happen. Since then nothing has happened. Numerous local authorities have had applications on hands for months and, except in very limited circumstances, have not been able to give approval. In Kildare County Council out of 50 applications we have managed to approve only eight and none has been paid so far. Again despite numerous promptings, questions and pleadings to the Minister from several local authorities, including Kildare County Council, nothing has happened.
We were promised earlier in the summer that following the recess the legislation would be put in place which would allow the scheme to be put into operation immediately. My grievance at this stage is that too much of the year has now elapsed for any worthwhile impact to be made under the social housing programme. Flynn's plan for Social Housing is not a plan any longer. It has failed miserably. It has misled local authorities, estate agents and those involved in selling houses. It has misled local authorities to the extent that nothing will happen in the current year. It is a total farce.
The plan for social housing made it clear that some of the new schemes would require legislation but it promised that, where possible, they would be implemented on an interim basis. The shared ownership system has attracted a high level of interest. Local authorities are free to operate the system on this basis and there is provision for dealing with 1,000 houses under the pilot programme. Several hundred applications have been received by local authorities——
——none approved.
——and approvals have issued in some cases. I am fully satisfied that the interim arrangements provide an effective basis on which to allow shared ownership transactions under the pilot programme to proceed in advance of the legislation. Again, I urge local authorities to avail of them.
The Housing Bill is being prepared urgently and will be published very soon.
When?
In the current session.
Direct the local authorities to approve the applications and pay them.
We will now hear a two minute statement from Deputy Deasy.
Waterford Regional Airport has been developed over the past ten years at considerable cost to the taxpayer and has also been heavily subsidised by contributions from the local business community. The total investment runs into several million pounds. The development has, however, been quite unbalanced because the road leading from the airport to the city is little more than a cart track and, despite repeated requests no moneys have been forthcoming from the Government to ensure that a reasonably good road is provided.
People's first impressions of any town or city are often formed by the surroundings they first view. Travelling along what is little more than a boreen with a corkscrew profile does not enhance the impression of any visiting dignitary or tourist.
The distance involved is merely three kilometers of very inferior roads, of which two kilometers are located in the county council area and one is in the city area. A year ago Waterford County Council and Waterford Corporation made a joint submission which was examined by an inspector from the Department of the Environment who carried out a CPO inquiry. No findings have been issued as a result of that inquiry and no progress can be made with the upgrading of that road until the findings of the inquiry are published. I ask the Minister here tonight to see to it that the findings of the inquiry are made public and that moneys are made available to the city and county to ensure that a proper roadway is constructed between the airport and the city.
As the road in question from Waterford city to the airport is not a national road responsibility for its maintenance and improvement rests with Waterford Corporation and Waterford County Council. The cost of any works on non-national roads falls to be financed from the local authority's own resources, supplemented by the discretionaary grants provided annually by my Department. These discretionary grants give local authorities a greater say in the works they wish to carry out.
The county council's discretionary grant has risen from £607,000 in 1986 to £1,733,000 in 1991. The corporation's block grant has increased from £149,000 in 1986 to £193,000 in 1991.
One would hardly buy a house for that.
The determination of priorities in the expenditure of these grants is a matter for the relevant local authorities.
Having regard to the level of funds available to me for special grants and the competing demands of other projects throughout the country, I regret to say that I am not in a position to provide a special grant in the case raised by Deputy Deasy. However, I must point out very clearly that this is a matter for the corporation and the county council because they have discretionary powers.
What discretionary grants will they get from the Department?
That being so, they will no doubt use their intelligence——
Intelligence is not much good if you have no money.
Compulsory purchase orders for the necessary land are being processed in my Department. As the Minister's role in determining the orders is of a semi-judicial nature it would not be proper for me to make any further comment on the scheme at this time.
When will the findings of the inquiry be published?
I hope shortly.
We will now hear a two minute statement from Deputy Owen.
I urge the Minister for Health to make a statement as soon as possible on the drug, Halcion, which in recent weeks has given rise to great concern among the medical profession. Halcion, which contains benzodiazepine, is a hypnotic compound which can be administered for short term and intermittent use to patients with recurring insomnia and poor sleeping patterns. It is available in Ireland on prescription. The UK have withdrawn the drug already and will have a full hearing on its use in December. In Germany, although it is still available in pharmacies, the licence to manufacture has been suspended pending investigation.
Many worrying side effects such as hallucinations, personality changes and depression are being reported and doubts have been cast on the authenticity of clinical trials of this drug by the firm Upjohn in a recent "Panorama" programme.
The National Drugs Advisory Board are currently examining recent documentation on the product and hope to have a result on their deliberations by 7 November 1991.
I believe the Minister should recommend to hospitals and GPs to use extreme caution before prescribing this drug as there are many other suitable similar products available on the market until such time as all current investigations are completed and the drug has been declared safe for use.
I am aware of the concerns being expressed recently with regard to the drug Halcion and I have been in close contact with the National Drugs Advisory Board which maintain on-going monitoring of the drug and, indeed, of all benzodiazepine drugs of this class which are available on the Irish market. The board, in fact, reviewed this drug in the week preceding the announcement of its suspension in the United Kingdom on 2 October. It did not conclude that the product should be withdrawn.
This drug has been available in Ireland since 1979. It is a prescription only medicine and its use is, therefore, subject to medical supervision. It is recommended for short term use only.
Arising from the decision of the United Kingdom licensing authorities, the Committee for Proprietary Medicinal Products of the European Communities, which include representatives from the National Drugs Advisory Board, met to consider the position on 16 October. A position statement was issued which indicated, inter alia, that upon preliminary consideration of the available data, evidence of new risks at recommended doses did not seem to be available. However, given the large volume of information produced to the committee, it was decided that a full review of all the available data and information from pharmacovigilance should be undertaken. The committee will formulate their opinion in December 1991, taking into account this full review.
At this point I should say that the drug has not been withdrawn by the Food and Drugs Administration in the United States, as may have been suggested by Deputy Owen.
No.
On the contrary, the Food and Drugs Administration in the US are carrying out a similar review to that being undertaken by the European Communities CPMP. Pending the receipt of the opinion of the CPMP and subject to any advice in the meantime from the National Drugs Advisory Board, I do not propose to take any action modifying the current authorisation of this product.
However, I would re-emphasise that this drug is intended for short term use only. In accordance with the most recent advice of the Committee for Proprietary Medicinal Products, it should not be used for more than two to three weeks and treatment thereafter requires a complete re-evaluation of the therapy. Patients in any doubt should consult their medical practitioners.
We will now hear a two minute statement from Deputy Mervyn Taylor.
Much ado has been made by the Fianna Fáil-Progressive Democrats Coalition with regard to their new agreement for Government. However, the decision to postpone the construction of the new hospital in Tallaght is a disgrace considering the urgent need for an actute facility for the people of that area. Not one mention was made of the construction of the Tallaght Hospital in that agreement.
The site development was initiated in the mid-eighties to provide essential hospital services for the 150,000 Dublin citizens in Tallaght and surrounding districts. In the 1991 health capital programme there was no provision for the Tallaght Hospital. However, since 1982, when the project was originally approved, £8.7 million has been spent on the development of the hospital. The board responsible for the project has met on 104 occasions.
Despite that, it is now clear that the Government may have no intention of proceeding with the project, which leaves the people of Dublin South West and the west side of Dublin city and county entirely without basic health care facilities. Cork, an area of comparable population, has many hospitals, but Tallaght has an £8 million hole in the ground.
The ultimate irony is that Dublin South West has been given a junior Minister and a "Minister for Clean Air," both of whom have failed absolutely to secure any priority for the project. In fact, it seems as if the more political perks are applied to Dublin South West the fewer essential basic facilities are available for the people who live there.
Everyone in Tallaght — but especially the women of the community — have suffered in the light of the Fianna Fáil-Progressive Democrats Government decision not to proceed with the Tallaght Hospital now.
In our society it is the women who are the carers of the elderly and the handicapped; it is women who look after their children when they are ill. The women of Tallaght are burdened by the lack of an acute hospital service. In order to receive hospital treatment they are forced to take two bus journeys into the city. Why should women in the nineties be expected to put up with such an atrocious situation? Why should they be expected to travel ten miles in order to receive what is a basic human right?
Fianna Fáil and the Progressive Democrats who boast of their progressive input into the Cabinet, must learn that the women of Tallaght are not prepared to accept that form of discrimination.
At the end of the day, it is a matter of priorities in the Department of Health, and it must be shown that the priority now is to build a hospital for the people of Tallaght and Dublin South West.
I am pleased that the Deputy has on this occasion afforded me an opportunity once again to explain the position in relation to the construction of the new hospital at Tallaght.
The Deputy will be aware that the Tallaght Hospital project will cost an estimated £118 million and will be the biggest health project ever undertaken here. I have previously informed the House that the construction period involved is about four years, following which a further period of 18 months would be required for commissioning.
In relation to the commencement of work on this project, as has been stated before, the position is that the capital allocation available to my Department for 1991 does not allow for the commencement of the Tallaght project in 1991. However, as I have indicated on several occasions, together with the Minister for Health, Dr. O'Hanlon, I will be considering the development of the Tallaght Hospital project in the context of the capital resources available to my Department in 1992 and subsequent years.
I should like to remind Deputy Taylor that he did have an opportunity when in Government for four-and-a-half years to make considerable progress on this project he speaks so highly of tonight.
And we did.
I regret to tell Deputy Taylor that he made no such progress except to carry out what I and the people of Tallaght consider to have been a public relations exercise on the site of the hospital by clearing away some earth.
That is not true and the Minister knows it. He should stick to the facts.
I further remind Deputy Taylor that most of the expenditure of £8 million to which he referred was incurred under Fianna Fáil administrations.
The Minister's party have been in power for four-and-a-half years.
The Fine Gael-Labour Coalition Government had an opportunity to provide the hospital but failed to do so and now members who belonged to that Government are running around saying it could be provided overnight. The people of Tallaght will judge that statement.
Deputy Richard Bruton will now make his two minute statement.
Thank you very much, a Cheann Comhairle, for giving me the opportunity to speak tonight.
I am very disturbed at the agreement of the Association of Irish Hospital Consultants at the weekend on a new recommended fee structure. It seeks to set a minimum fee and indicates a range above that. Even the minimum fee will be 40 per cent above the 1990-91 fees charged. The top rate will be a massive 100 per cent above those fees.
When one considers the top 30 surgical procedures it is recognised that the proposed minimum fee is 80 per cent higher than the VHI schedule. If the proposed fees are charged, in a typical case, a VHI member would have to pay out of his or her pocket half the cost of his or her consultant's fees.
In addition, the schedule proposes an extra 50 per cent loading on top of those fees if surgery is done outside of office hours. The Minister of State is aware that in the majority of cases private treatment is carried out outside of office hours, because of consultants' commitments to their public patients, who occupy the majority of consultants' working days.
I do not believe for one minute that they are reasonable charges. They are being proposed against a background in which consultants' fees have increased by more than 35 per cent since 1987, which is more than double the increase granted to other people under national pay agreements under which the Government have recently agreed to a revised schedule of public recompense to consultants for their public patients. That contract now yields an income of up to £60,000 to consultants.
It must be pointed out, and I hope the Minister of State takes note, that this attempt to fix a recommended set of fees flies in the face of section 4 of the Competition Act, recently passed in the House, which bans an attempt to directly or indirectly fix prices. The schedule of fees interferes with competition. I can see no purpose in such an agreed schedule other than an attempt to interfere with competition which is banned by the Competition Act.
The consultants argue that their fees are a private matter between them and their patients. That is not so. First, the Minister for Health must intervene to protect patients, because they are desperate in their need for care and, hence, are in no position to argue about fees. Secondly, it must be remembered that the taxpayer permits tax relief on these charges, so that effectively it will be the taxpayer who will pick up half of the proposed increases.
I urge the Minister to take urgent action in concert with the Minister for Industry and Commerce and, if necessary, the Revenue Commissioners to protect patients. In conclusion, I have to say that the Minister of State, and the Minister, are not guiltless in this matter because they have created the intense pressure on public care that has left patients desperate and willing to pay virtually anything.
I have listened with interest to Deputy Bruton's comments on this issue. While the new scale of fees for medical consultants has been put forward by the Irish Hospital Consultants Association as a guideline, it does nonetheless mark a new worrying departure from previous practice in this regard. The primary concern of the Minister for Health is the possible effect on public health and the anxiety which such a significant increase will cause individual patients.
As the Deputy will be aware, one of the good and admirable aspects of our health services is the existing balance between public and private health care, something which has evolved over the years. The Minister and I are anxious to preserve this mix in the interests of patients and believe there would be considerable support for this view from the medical profession.
The availability of effective and affordable private health insurance cover to the maximum numbers in the population is crucial to the maintenance of this balance. The Voluntary Health Insurance Board, on which the great majority of the privately insured depend for their cover, can hardly be expected to meet in full whatever rates of charges medical consultants decide to impose. One of the greatest threats to VHI membership and the source of most complaints about the VHI over the years has been the inability of the board to provide benefits to meet the full costs of consultants' fees. However, recently the VHI have successfully concluded full cover agreements with a number of specialities.
Fees of the order now proposed by the Irish Hospital Consultants Association would result in a very wide disparity between the maximum benefits recoupable by the VHI and the level of fees charged by medical consultants. This could well prompt many individuals to question the value of VHI membership.
As indicated in the Programme for Economic and Social Progress, the Government recognise the crucial role played by voluntary health insurance and is sensitive to the need to ensure that this important role and contribution to the health care system is not diminished in any way. It is misleading, therefore, to suggest that the advent of competition in the private health insurance field will dispense with the need for close co-operation between the insurers and the medical profession.
In conclusion, I should like to inform Deputy Bruton that my colleague, the Minister for Health, is discussing this matter with his colleagues in Government. It would be inappropriate for me to make any further comment at this stage, but I am sure the Minister, who is concerned about this matter, will return to it again publicly.
The Dáil adjourned at 9.20 p.m. until 10.30 a.m. on Thursday, 24 October 1991.