Deputy Ferris is in possession, he has 27 minutes left.
Private Members' Business. - Health Charges: Motion (Resumed).
The following motion was moved by Deputy Flanagan on Tuesday, 30 March 1993:
That Dáil Éireann, mindful of the hardship that will accrue as a result of the recent significant increase in health charges in respect of hospital accommodation and outpatients services and having regard to the likely consequent increase in Voluntary Health Insurance premia, hereby annuls the Health (In-Patient Charges) (Amendment) Regulations, 1993, and the Health (Out-Patient Charges) (Amendment) Regulations, 1993, as such regulations represent an unwarranted and unacceptable attack on families, particularly those in the moderate income sector of the community.
Debate resumed on amendment No. 1:
To delete all words after "That" and substitute the following:—
"in view of Government policy, not merely to maintain health services at their existing level, but also to ensure that the substantial developments provided for in this year's Budget, for example, to reduce waiting time for admission to hospital and to provide additional services and facilities for persons with mental and physical handicap, are implemented, Dáil Éireann approves the Health (In-Patient Charges) (Amendment) Regulations, 1993 and the Health (Out-Patient Charges) (Amendment) Regulations, 1993 (S.I. Nos. 50 of 1993 and 51 of 1993 respectively)."
—(Minister for Health).
I would like to share my time with my colleagues, Deputies Callely and Brian Fitzgerald.
Is that satisfactory? Agreed.
The Fine Gael motion to annual the regulations on revised charges for hospital services conveniently forgets one simple fact of life and that is the growing costs of health services in every country. A motion on charges cannot be debated without some recognition by the Opposition of that reality which now faces all Governments of whatever persuasion. This year the health services here will consume an additional £183 million, increase over last year's figure. This £183 million represents no less than a 12 per cent rise over 1992.
Given that background it surely cannot be expected of any Government that it can year after year make considerable levels of funding available to health services without looking at some degree of cost-sharing. No Government can take that approach. If it did, it would simply create serious problems for itself in managing its borrowing and spending requirements. We are continually having lectures from those right wing people across the floor about the need for discipline in the public finances but, when it comes to support for decisions which underpin discipline, the backing for such measures disappears.
A departmental press release.
Let us consider the context within which those decisions were taken. It was widely known that the Estimates for the public services this year would be difficult and would give no easy options. The demands on Government had never been greater and simply could not be met without unacceptable increases in taxation or borrowing. The figure for the health services to finally emerge after detailed discussions at Government is £1.7 billion, an increase, of 12 per cent over last year. However, in arriving at that figure, hard decisions had to be taken and were taken. The Minister did not like to take those decisions but he has a statutory right to take decisions for the provision of health care. The revised charges was one of those decisions.
I thought it was a good decision.
The decision to revise the charges effectively targeted about £7 million extra income for hospitals this year. That is a considerable amount of money. This must be compared with the increase of £183 million provided in the Health Votes. Based on these figures additional funding by the Exchequer is greatly in excess of any income coming to hospitals from the charges and underlines this Government's determination to do what is necessary to provide a high quality service to the community.
When the decisions were taken to revise the charges there was no underhand attempt to disguise this as was suggested in the House last night by Fine Gael. A parliamentary question was tabled by Deputy Richard Bruton for 23 February and the Minister did not want to mislead the House so he gave the correct reply which was then considered to be sleight of hand by the Minister.
The priority of the Government in deciding on the Estimate for health was to ensure that services are maintained this year at current levels and important developments are implemented. To achieve that aim, it will be necessary for health agencies to achieve efficiencies in their programmes. Where savings can be identified they must be implemented so that the maximum return is obtained from every pound spent. There are already comprehensive value for money programmes in existence throughout the health services. There is a detailed programme on the use of generic drugs by general practitioners. Clonmel Chemicals in my constituency has launched a new programme as an incentive to doctors to prescribe generic drugs. I am delighted that the Minister in his budget is giving an incentive to doctors to respond to the needs of the State in this area.
Those programmes are continually seeking ways and means of getting better results whether it be on non-pay, hospitals procedures, purchasing and so on. Nothing is being overlooked which might bring benefit to the services and free up resources for deployment to critical areas. It is not the case that the revised charges are being introduced in an environment where potential efficiencies are being ignored or overlooked. The reality is that the health agencies have responded to the challenge of seeking more value for money and will continue to do so this year and in the future.
The revised charges are necessary, not only to maintain services but also to implement the important initiatives provided for in this year's budget. They have not been introduced to deny access to services and this Government would not countenance any decision that would have such an effect. Fine Gael has attacked the Government for doing nothing on waiting lists and neglecting other critical areas including services for the elderly and dental treatment. I am very surprised that they believe what they say and have chosen to ignore the £20 million programme for reducing waiting times which will be implemented this year and which was provided for in this year's budget. Already, guidelines have been sent to health boards.
Fine Gael have also mentioned other areas where resources are needed and I must point out that the Minister for Health has resolved to proceed with the implementation of the Nursing Homes Act on 1 May of this year and to provide £4 million for that purpose. This was provided because people who hold medical cards are denied access to public health care either in geriatric hospitals or welfare homes. These people are sitting in private nursing homes. There is now a commitment to the tune of £4 million by the Minister in order to assist people to pay the additional charges over and above social welfare income.
Dental services will also be provided with additional funds, for those with special needs such as children and the handicapped. I attended a meeting for handicapped people in Limerick last weekend, I am involved with the handicap persons' association in my constituency and with all those who represent handicapped people. We have identified a need for £25 million for services for the handicapped. This year we have made the first instalment with a payment of £8 million for adult respite care accommodation for the handicapped. I prepared a Private Members Bill on this issue when we were in Opposition. We have not forgotten the handicapped despite the fact that people in RTE will start programmes by saying "so, Dick Spring has let you down" in case people might forget to say it. Of course they do not suggest that Fine Gael let people down in the past. Did Fine Gael ever vote for the handicapped in relation to charges? Did Fine Gael ever abstain? Of course, they abstained when it came to the Tallaght strategy and other such programmes.
(Carlow-Kilkenny): You are doing a somersault.
Now that Fine Gael are in Opposition they find it easy to ignore the demands of Deputy Michael Noonan and others to live within the Maastricht guidelines.
(Interruptions.)
You cannot have it every way.
Tell us about Tallaght hospital?
Deputies will be aware that there is a provision whereby the chief executive officers of health boards can waive charges if hardship is being created. It is also a fact, and Fine Gael know it, that for £1 a month people can insure themselves against these charges. One can also claim against income tax or medical and dental charges. If people are well off, like people in Fine Gael, to have VHI cover, that will cover the costs. The Minister will not agree to any increase in VHI premiums unless such increase is justified.
(Carlow-Kilkenny): I bet the Deputy has VHI cover himself.
Let us be honest with ourselves. There is much flexibility in the system. I have no doubt whatsoever that Fine Gael people on health boards will ensure that there will be flexibility in the implementation of these charges, which is a matter for the discretion of the health board and its executive officers. Having been a member of a health board in the past, I am aware one can have negotiations in areas of difficulty. In his contribution last night the Minister referred to the importance of VHI and said it provides inexpensive cover against hospital charges. It cost about £1 a month for an adult and if family cover is required it can be even cheaper.
Fine Gael have alleged that the charges will have consequences for the VHI premia. Such an assumption is wholly premature as the Minister has asked his Department and the VHI Board to consider what steps should be taken to prepare itself for the Single European Market in health insurance areas. If the VHI is not able to compete in that area I am sure health insurance people in Europe would be prepared to give proper cover to people for an insurance premia rather than have the VHI continue to scream while they are making millions of pounds of profits. When the Minister for Health talks about making the VHI pay for private health care, which ought to be available to people, then the VHI have the responsibility to fund that section. I know many ordinary people in Ireland who cannot afford VHI cover and are glad to get a public health bed. They are glad to know that for £1 per month they can cover themselves for any costs involved in the hospitals and any additional hospital cost can be reclaimed by means of a tax refund. People on medical cards are exempt from the charge.
The Minister is trying to deliver an essential service. He has shown an understanding of the health brief, an understanding which he built up during his years as Opposition spokesperson on health. This was despite the fact that the "Tallaght strategy" was in operation. That suited Deputy Dukes and the Minister and his colleagues at that time. But the public never forgave them for it because at that time they failed to act as an Opposition. Now they are opposing everything and I suppose we should commend them for that. For the first time ever Fine Gael can afford to oppose in the knowledge that none of their votes can do anything to help the constituents who voted for them, unlike the Labour Party who managed to get into a position of influence——
We did not mislead the public.
——where over the next three and a half or four years we can make sure that this Government will care for the people for whom nobody else cares. Certainly, those who advocate the abolition of PRSI have no regard whatsoever for those people.
Read the page in favour of Thatcherism.
I am pleased to have the opportunity to speak tonight on the motion before the House regarding——
(Carlow-Kilkenny): The Deputy does not mean it.
——the regulations on revised hospital charges. The reason for the introduction of the hospital charges was because people were abusing the system. Rather than use the facilities of the general practitioner they used the hospital facility free of charge. It was introduced to create the correct balance and to free up out-patients and emergency and accident departments. I am concerned at the proposal on charges. As a member of the Eastern Health Board it has been brought to my attention by the chief executive officer. When presenting his budget he pointed out that the charge accruing in the Eastern Health Board area would be £446,000. This was seen as an income source. Initially, most people supported the introduction of the charge because of the abuse. A person who would go to their general practitioner and pay whatever the charge may have been, £10 or £15, could have gone to the hospital free of charge, received the same attention and returned to the hospital for dressings and further attention free of charge. Against that background the charge was introduced to prevent that blatant abuse. Initially progress was made in reducing the long delays in accident and emergency and out-patient departments. But the scenario has changed. Previously, general practitioners encouraged visits; under the new capitation system general practitioners may be accused of not encouraging recurring visits from a patient.
I have listened with interest to some of the Fine Gael statements in relation to the proposed new charges. It is important to highlight the fact that there are a number of conditions and clauses that prevent hardship. Can the Minister clarify whether the proposed charges are meant to prevent the long delays and the abuse of accident and emergency and out-patient services, or are they now seen as a source of income? We all recognise that £6 is not too much to ask for every visit. But if that £6 is to be increased at each annual budget, at what figure will the charge stop? I appreciate those concerns. A number of people contacted me who were paying £10——
It was £10, but it has been reduced to £6.
The Minister has just said it was £10 and that it has been reduced to £6. He is correct; it was £10 for one visit only.
(Carlow-Kilkenny): The Deputy is bad at maths.
He is doing them a favour.
The charge was £10 and it has now been reduced to £6 for every visit. Can the Minister clarify whether the charge will remain at £6 for the foreseeable future, or will it be increased to £10 at the next budget for every visit and afterwards to £15 because it may be seen as a source of income?
I would say the Deputy is right.
In the Eastern Health Board alone it is seen as an income source of £446,000 to be collected in this way in 1993. I do not know what discussions or negotiations have taken place between the Minister and any other authority in relation to revising the charges. Can the Minister say whether the increase to £20 per day in private and semi-private accommodation in hospitals will have any effect on VHI?
Swingeing.
I do not share all Deputy Flanagan's concerns, but I do share his concern in regard to waiting lists. We in this House would be foolhardy if we did not give our support to the Minister for Health in recognising the urgent need to address the totally unacceptable waiting lists in some specialty areas, such as orthopaedic surgery, hip replacements operations, cataract and ear, nose and throat treatment and cardiac and plastic surgery. The £20 million allocation by the Government should assist in the delivery of such services and thus reduce the waiting lists to an acceptable period of time. I would like the Minister to explain how he intends to utilise this £20 million in addressing those waiting lists, because throwing money at hospital services in this fashion will not meet the essence of what the Minister wants to do and I am sure he is aware of this. What are his proposals in this regard?
I congratulate the Minister on the additional allocation of £8 million for the mentally handicapped services, an area about which both the Minister and I are very concerned. This £8 million will cover a broad spectrum of necessary services, including residential and extra day places, respite services, additional home support, improved sevices for the behaviourally disturbed and an extension of early intervention and child development services.
I do not understand the motive behind this motion, particularly as it was put down by Fine Gael, a party who brought down a Government because of health cuts in 1987 and forced the Labour Party out of Government.
(Carlow-Kilkenny): We had the backbone.
Subsequently, Fine Gael supported another Government on the clear understanding that it would introduce the cuts it wanted. Fine Gael has now brought a motion before this House condemning a Minister who has done something to reverse the cuts that have been taking place over the past number of years.
(Carlow-Kilkenny): The Deputy did not see what they opposed.
Deputy Fitzgerald should be allowed utilise his five minutes without interruption.
He is inciting a response.
He should state the facts.
Deputy Flanagan will have an opportunity to speak later.
This Minister did not propose a charge per item on prescriptions for people with medical cards which would have caused a great deal of hardship for the less well off.
It was the former Deputy Desmond who proposed that.
It was proposed under Deputy Allen's name in 1987.
(Interruptions.)
If Deputy Fitzgerald would direct his remarks through the Chair we might avoid the interruptions.
Where did the Deputies get the evidence they referred to in relation to the hardship that is being inflicted because of the changes the Minister has introduced? Approximately 40 per cent of the population have medical cards and many other groups, to which the Minister referred, will also be exempt from those charges. Approximately 30 per cent of the population have some form of insurance policy which will exempt them from such charges. There is a positive bias in favour of the patient in the charges the Minister proposes. The outpatient's charge has been decreased from £10 to £6. He has put a cap of £60 per annum on the cost of outpatient services to a family and a maximum cost of £42 will apply to individuals in that regard.
However, the real problems exist in regard to private beds. We are all aware that there is an obligation on the Minister to ensure that a number of private and semi-private beds are available in our public hospitals. Should we not improve our public hospital facilities to facilitate those who go to hospitals such as the Blackrock Clinic or the Mater Private? Should we not charge a reasonable sum of money to people who wish to avail of private and semi-private beds? It is a disgrace that people should complain about the £120 per bed charge in public hospitals when one considers the £250 per day charged in private hospitals. Such complaints should be directed at the private hospitals, which obviously are being subsidised in some form by the VHI.
The Minister has introduced a number of positive changes in the area of health. He has increased the budget by 12 per cent, which is no mean feat when one considers the inflation rate of 3 per cent. He has also done something very important for the people who have been on waiting lists for surgery for a number of years by allocating £20 million to those services. In particular I welcome the special allocation to the services for the handicapped. Those services require much more resources, but this is a start. I am sure that when this Government leaves office in four and a half years time people will say that the health services have never received such a great injection of capital.
It is important to set in context these increases in health charges. When hospital charges were introduced in 1987 Deputy Howlin opposed them saying "They are a crude and vicious instrument whose only effect will be to undermine the standard of health care". I have no doubt that his views then were genuine, but I am disappointed that he fails to follow through on those views and instead has lost his nerve. The development of medical technology and the increasing complexity of health care have put strains on costs and necessitate a certain rationing of services. Nevertheless, the health of the patient must always be central to the service and these increases negate that principle. Providing for people's needs on an equitable basis does not necessarily mean costs going out of control and a comparative study of health costs between Great Britain and the United States shows this to be the case. In Great Britain health care is free and provided on the basis of need, yet less than 8 per cent of GDP is spent on health care, while in the United States, where the free market dominates health care, people are treated on the basis of their ability to pay and costs have soared out of control to the point that over 13 per cent of GDP is spent on health care. That does not say much for the efficiencies of the market.
The problem in our health services is not inefficiency but inequity and, in his first move as Minister for Health in increasing the burden of hospital charges, the Minister has simply made things worse. Our general hospital services have many good features. Their workforce is highly trained, dedicated and the quality of care for those who gain access to it is excellent. However, access to those hospital services is extremely inequitable and reflects the class stratification of our society.
There are medical cardholders for whom access is free, but who find it difficult to get many services. There are those who are fortunate enough to have VHI cover and so obtain reasonable access to services for themselves and their families. There are those in special VHI schemes which give them direct access to top class services in luxury hospitals such as the Blackrock Clinic, which is subsidised at the highest marginal rate of tax by the general taxpayer.
Finally, there are the people who make up the group who are over the limit for a medical card and who are generally in work or dependent on people in work — PAYE taxpayers who are obliged to pay for their GP services and prescribed drugs. These people will now be obliged to pay more in hospital charges. They account for 30-35 per cent of the population. This is the group who, through PAYE, are subsidising those who can avail of care in luxury hospitals. These are the workers and their families who the Minister is hitting by these increased charges. Any attempt to disguise this fact by the Minister is pure blabber.
Why is the Minister insisting that these people should now pay for out-patient services, X-rays, laboratory tests, physiotherapy and other services? Is it simply to raise finance? If it is, I suggest that he should consider the tax relief given on VHI premia for luxury hospitals. This is a separate matter, but there is a big question mark over the matter of subsidising super-luxury hospitals. I do not believe that finance is the reason for these increases. Rather, the agenda is to discourage the use of hospital services by this group, the one-third of our population who, in large measure through their taxes, finance those very services.
The Minister is quite rightly not putting a financial obstacle in the way of medical card patients, the least well-off section of our community. However, the VHI system which caters for approximately 30-35 per cent of our population is an incentive to over-use hospital services. This over-use of our hospitals is likely to increase with the liberalisation of medical insurance schemes under the Single Market. There is a discriminatory set of charges or taxes on people with low or middle incomes who fall outside the guidelines for a medical card and who cannot afford the VHI. With regard to Plan P, I have no doubt that people who take up the Minister's offer to pay into the VHI will quickly find those premia soaring. I believe these increases are being introduced to encourage people to join the VHI. As I said, they will find out very quickly that they are unable to pay their premia.
I wish to refer to some of the underlying assumptions about our health services. One assumption is that the general hospital services are over-used and inefficient. Is this true? A recent study carried out by the OECD which compared the health services in seven OECD countries in Western Europe found that while Ireland was somewhere in the middle range of the number of acute general hospital beds per 100,000 of population, it also had, on average, the shortest stay in hospital beds — it is seven days here in comparison to 12 days in Germany, a country which is often held up to us as a paragon of industrial and administrative efficiency. Are people in Irish hospitals less ill than their German counterparts or could it be the Irish acute general hospitals are more efficient and effective in the use of their resources? I suspect it is the latter. I also suspect that the Government and Minister do not recognise just how efficient our system is.
There is a chart in this week's edition of The Economist which compares the proportion of GDP spent on health in 24 OECD countries in 1961 and 1991. There were only three countries where the amount declined — Turkey, Germany and Ireland. In all other countries the percentage of GDP spent on health care had increased. The decline in Turkey and Germany was marginal, but in Ireland it declined from 9.5 per cent to under 7 per cent during that period. This is a massive decline in real terms. The cutbacks of the last ten years have done their job. However, in doing so they have created massive inequities, one of which we are debating this evening; the other inequity is the appalling waiting lists.
Our health services could be better and more equitable, and at the same time provide jobs for more of our highly trained young people. Paradoxically, if the Minister wishes to make the hospital services more efficient and equitable he should start with community and GP services. The key to an even more efficient hospital service is the provision of access to GP services and investment in the other necessary community-based services which allow people where possible, to have their medical conditions investigated, managed and treated at home. There have been good developments in this direction in recent years, such as the spread of the daffodil nurse scheme for the terminally ill. I should say I was rather shocked when my local daffodil nurse told me she is 100 per cent dependent on voluntary subscriptions from people.
There is also the pilot scheme of district care units for the elderly in some areas of the Eastern Health Board. The scheme operated in my area is extremely effective. In addition the initiatives were also taken by the enlightened North-Western Health Board. In order for this scheme to be developed further, there must be a national scheme of registration of people with GPs and free access for all to GP services. If the Minister had introduced these hospital charges together with free access to GP services it would have made some financial sense. If he had chosen to introduce a free GP service and let people pay for their drugs for the time being, it would have made some kind of sense and facilitated the rational development of the hospital service. However, he has not done this.
When the choice of doctor GMS scheme was set up during the early seventies to replace a very old, dilapidated and inequitable dispensary system the then Minister, Erskine Childers, in a very far-seeing and enlightened move insisted that the new contract for GPs would contain a clause which provided that a doctor could not distinguish between medical card patients and private patients in the provision of service. By and large, that system has served us well. It is now time for hospital consultants employed in public hospitals to be given a similar contract which will oblige them to treat all patients equally under the same conditions and from the same waiting list. They should not be able to distinguish or separate the treatment of private and public patients in public hospitals.
One of the problems in this area is that much of the managements of public patients in hospitals is carried out by non-consultant hospital doctors and there is a certain distance between the patient and the consultant. The recent report issued by the joint study group called for more consultant posts and a pro rata reduction in the number of non-consultant hospital doctor posts. This would help ensure that there was more hands-on management of patients by consultants in hospitals. It would also provide a career structure for non-consultant hospital doctors. The Minister has to tackle this issue. It is a scandal that the taxpayer is paying for the expensive education of highly trained young doctors only to see them emigrate to well-off societies like the US which benefit from their skills. In the meantime approximately 35 per cent of the non-consultant hospital doctors which provide a service in our hospitals come from non-EC countries. A career structure must be set up for young doctors if our society is to benefit from the investment made by taxpayers in their education and training.
The Minister should instruct Comhairle na nOspidéal to undertake to make as many hospital consultant posts as is practicable — obviously there are practical problems in this respect — job-sharing posts. The NHS in England has already made a move in this direction. Job-sharing appears to lead to a better and more wide-ranging service. Over half of our young medical graduates are women, and while job-sharing may not be exclusively used by women it would realise a return from the investment in their education and make it more cost-effective.
To summarise, consultants must be given a new contract which will ensure that they treat all patients equally, there must be more consultant posts with a pro rata reduction in non-consultant hospital doctor posts and job-sharing should be introduced in order to lead to the more efficient use of expensive technology. Many people find it hard to understand why expensive technology in which we have invested is not used on a 24-hour basis. If doctors worked eight hour shifts, as happens in manufacturing industry, there would be a much greater return on this horrendously expensive technology.
There are approximately 60,000 people employed in the health services. More Irish people could be given jobs in the highly rewarding area of service while at the same time providing greater efficiency. This could be done by way of investment in people rather than in institutions. I accept, in saying that, that there are limits in spending in health, although people generally want to see money spent on health care and they see it as an important investment by the State. I challenge the Minister's statement yesterday that 7 per cent of GDP is the ideal. The Irish percentage is low among industrial countries and we do have special needs. We have a higher dependent population at both ends of the spectrum where more health services are consumed, children and old people.
We have a lower number of elderly people.
I understand we have a large dependent population and I know we will very soon have a fairly elderly population. I am not speaking about today or tomorrow, I prefer to speak in a larger framework than some Deputies perhaps do. I ask the Minister to take on board what I am saying. I do not expect miracles overnight, but I expect solid, overall planning for the short term as well as the long term.
The question of the investment and the percentage that should be spent on health care averages around 8 per cent and that would be a reasonable figure. The average is the least we should be looking for. There are inherent inequities in the system and, rather than tackling those inequities and inefficiencies the Minister is making them worse by increasing the hospital charges. The fact that somehow the chief executive officer of the health board is there to listen to the case of someone who cannot afford health or hospital charges is not the point. That is degrading and is adding a whole new layer onto the clientelism which, as somebody who is looking forward, I feel we should be actually reducing. People have a right to expect certain services. They should not have to plead, they should not have to beg for concessions via, inevitably, their local Deputy or Senator. That is not the way people should view the hospital services. They should view them as services that have been paid for by us as taxpayers for the community at large, and particularly for those who most need them.
The last point I wish to make is in relation to the whole area of health care. There is not sufficient concentration on the efficacy of those vast amounts of money we are spending. Who are those who are most sick in our society? Why are they sick? What areas are we looking at when we look at health spending? Are we looking to see if we can reduce the impact of serious deprivation of unernploymnt, of children suffering from poor diet, of people suffering from the complex social conditions that lead to ill health, and serious ill health, in our community? We need to focus the resources we have and make it a fairer system.
I am disappointed with the approach of the Minister so far. It seems to amount to more of the same. There will always be some pressure group demanding money and there will always be some Minister who will cave in and hand over some money. It is welcome, but it means that we are not looking at our health services in total. We are not focusing on or prioritising those people who most need health care services or making them efficient by ensuring that those who want to have coordinated furnishings in their hospital bedroom and to have menus and choices from three dishes, pay for it. I have no problem with private hospitals — let people pay for private hospital care if that is what they want, but let not one penny of public money or tax subsidy go towards that particular luxury. That is an inefficiency in the health care service and it needs to be taken out so that our scarce resources are spent on those who need care most.
When Deputy Howlin was appointed Minister for Health I expected he would be a reforming Minister because he had such good and enlightened ideas when in Opposition. To say that I am disappointed is an under-statement. The first act of the Deputy as a Minister was to impose further hospital charges on a public who are already overtaxed and who are now expected to pay more and more for reduced services. The promises made prior to the election have been shamefully reneged on.
Not so.
What we have seen is the greatest U-turn, the greatest confidence trick on the Irish electorate since the 1977 Manifesto. It is a shame that a Labour Party has imposed further burdens on an already oppressed public who have to pay more for less service.
It seems to be par for the course now that when a Minister gets inside a mercedes the atmosphere of that car changes his perspective on the services he is supposed to administer. Is it the insignia on the mercedes that changes his perspective?
People are paying more and more for a reduced service. Deputy Flanagan went through a list of people who were waiting for gynaecological services, surgery and so on. The list is as long as my arm. Behind those statistics is a saga of human suffering. One example is a man in Cork in his late seventies who has been told he will have to wait two years for an initial appointment with a consultant, and that person's general practitioner told me that that man was in danger of having his leg amputated because of neglect by the health services. But for a special pleading by the doctor, and me, that man would not have been seen. As the Democratic Left spokesman said, this continues the dependency on politicians for the delivery of services. I know that Fianna Fáil are dab hands at it but I am amazed that the Minister would continue that dependency factor.
The Deputy is not too bad at it.
We have a two-tier system here and nothing the Minister has done so far has sought to change that. The quality of service offered to people is in direct ratio to the size of their bank account. If one is a medical card holder or is dependent on the public health services one must wait at least two years. It may be up to four years before one can get an appointment at an orthopaedic out-patient clinic. People of 70 and 80 years of age are being told they must wait two years before they will be seen at an out-patient clinic in my health board region. Many of those people will be dead before they get an appointment. Maybe that is a way of reducing the waiting lists. If that is the best the Minister can do, God help us in the years ahead.
I am providing £20 million.
What will that do? I put it to the Minister that in six months' time the services will still be in crisis. What is needed is real reform and the Minister should have got involved in reform rather than in the imposition of charges and the cutting of services.
I have restored funding.
We have a two-tier system and the Minister had better start working on that. The patients' charter is worth very little unless the key elements are added — the right of immediate access to an out-patient clinic, the right of immediate access to treatment and immediate access to a bed when it is required. To give another example, two weeks go in Cork a constituent of mine was choking to death from emphysema and his family was told that there was no bed available because the Cork Regional Hospital closed a ward during the week in which St. Patrick's Day fell. People get sick irrespective of the occasion and public suffering is the direct result of the cost-cutting service of closing wards during holidy periods.
I have a short time available to me this evening, but I should have said earlier that I shall be giving Deputy Cullen two minutes of my time.
Much has been spoken tonight about private Bills and the need for public hospitals to generate revenue. The concept of designating private beds is fine in theory, with the proviso that there is an increase in the overall number of beds in a hospital. What has happened, however, is that the designation of private beds brought about a reduction in the number of beds available to public patients. The Minister should not shake his head at that comment, it is true.
I shall shake my head if I want to.
I could provide figures from the Southern Health Board area that demonstrate the truth of what I have said.
It is expected that £4 million will be lost to the VHI this year and the projection for next year is a loss of £8 million. I ask the Minister to come to grips with the absolute scandal of overly high professional fees. People go into hospital at a time of great stress, expecting to have adequate health insurance cover for the treatment received and then, when on the road to recovery, are inundated with bills from different consultants. It seems that consultants' fees increase by the month, if not by the week. Does the Minister consider that the time has come for the Department of Health and the Department of Enterprise and Employment to get together to examine and control professionals' fees? People are being taken for a ride, with professionals' fees escalating almost every week. If that matter is not examined, the VHI will suffer more and more. There has been a suggestion that the door should be opened to competition. I am all in favour of competition, but it should be competition on a level playingfield. It would be wrong to allow foreign companies to cream off the most lucrative parts of the market, leaving the most vulnerable parts to the VHI.
The Minister has said that health boards will show compassion to their patients. It is my experience that the health boards are not great in the compassion stakes. Health boards throughout the country now employ solicitors and debt collection agencies, bodies that terrorise the people at a vulnerable time when they are recovering from an illness. Former patients receive letters demanding payment of hefty bills and when the bills are not paid the debt collection agencies go into action. People are frightened by that practice. I ask for a real sign of compassion for the patient.
I am disappointed that the Minister's first action after taking office was to impose charges.
That is not true.
The Minister has made no attempt to bring about the reform so badly needed. Until such time as the inefficiencies, the abuses and the overly bureaucratic nature of the service are tackled, it is possible that more and more money will be poured in without the service becoming more efficient.
Deputy Ferris spoke very critically about my party for its stand on this matter. Some of the greatest political somersaults witnessed in my 12 years in the House have occurred in the past two months. Everything that was said by Labour Party spokesmen when in Opposition has been the subject of a U-turn. It seems that one's perspective changes once one gets into the back of a Mercedes, one's viewpoint is different and the promises and pledges given when in Opposition are not put into effect.
I thank Deputy Allen for giving me some time to speak on this motion. Because my time is so limited I shall not waste valuable minutes by bringing to the attention of the Minister, Deputy Howlin, the various comments he made when speaking as an Opposition Deputy in the past five, six or seven years. I have two or three points that I should like to raise, however.
I seriously question the role of the health boards, something upon which the Minister has commented. I do not believe that value is being obtained from the health service. The administrative and other costs associated with the organisation and operation of the health boards are very unsatisfactory. I ask the Minister to examine one way of beginning to reduce the role of the health boards, for it is impossible to remove them overnight. In the development of the regional hospitals and the major hospitals strategically placed throughout this country, a leaf should be taken from the book of the Department of Education, which oversaw the transition of regional colleges from the control of vocational education committees to the Department. It is my belief that the regional hospitals should deal directly with the Department. Regional hospitals should be directly accountable for what they do, how they spend their money and develop their services. That would be preferable to the practice by which regional hospitals are locked into the overall health board structure, which is outmoded and cumbersome. Vast savings could be made not only in terms of cash but also in terms of efficiency, if the health boards were removed. I am absolutely convinced that a better and more direct relationship with the Department would be one way of moving forward.
Is the Minister considering legislation to allow the VHI to own, operate and run private hospitals? This is a measure the VHI has sought for a long time. Hospitals owned and operated by the VHI would be run much more efficiently. The changes and cost controls implemented by the VHI in past years are evidence of that board's efficiency. The VHI should at least be allowed the opportunity to examine the possibility of running hospitals itself. That ability is allowed to BUPA and other agencies in other parts of the world and the VHI should be allowed to do the same.
I cannot understand why the health service provided by our hospitals is as bad as it apparently is. For instance, in the new regional hospital in my area the wards are closed and nothing happens. In the new hospital, people are still in beds in the corridors during the weekends. In the past two weeks I had to take my child to that hospital and I realised the seriousness of what is happening. Millions of pounds have been spent, yet the new facilities provided are locked up. Are we telling people that they can get sick only during the week, not in the weekends? It is ridiculous to pretend that people do not need specific, serious and urgent medical care during the weekends. Surely there is something seriously wrong in the system when such vast sums of money are provided for capital expenditure but there is no provision of resources to utilise the capital assets.
I ask the Minister to respond to the three points I have raised.
I wish to share my time with Deputy Eoin Ryan.
Is that agreed to? Agreed.
At column 373 of volume 372 of the Official Report of 28 April 1987 is a speech made by Deputy Allen on a motion in his name. If I understand the English language correctly, Deputy Allen tabled a motion in favour of the application of prescription charges to medical card holders. I am sure that Deputy Allen will excuse me if I treat the special plea he makes on behalf of medical card holders with a certain amount of reserve.
The Minister should go back to the script. Let us hear what the Government has to say.
I shall make my own speech, and the Deputy can make his speech.
Let us hear the speech, then.
We on this side are miniature Dessie O'Malleys.
The Minister is the only miniature.
What about Earnonn de Valera?
I want to avail of this opportunity to correct some of the statements made on the other side of the House. I must remind the House that the amendment to the motion tabled by the Minister for Health seeks approval by the Dáil of the regulations on revised hospital charges in order to allow services to be maintained at their existing level and improved in certain key areas. It would be useful for the House to be reminded of the important developments that will be introduced this year in the overall health services.
Deputy Flanagan spoke at length last evening about waiting lists in the health services. I share his concern that waiting lists be reduced. I am delighted that the Government has allocated £20 million for a major action programme in 1993 aimed at reducing waiting times in public hospitals, specifically in the areas of orthopaedic surgery, including hip replacements, ophthalmology — cataracts — ear, nose and throat surgery, cardiac surgery, vascular and plastic surgery. I am confident that the provision of these additional resources will help the Government to meet its objective of reducing waiting lists in excess of 12 months in all of these specialties and to set a maximum waiting period of six months for children awaiting treatment for ear, nose, throat or eye conditions.
The Minister for Health is to be congratulated on securing this additional funding which will help to address one of the Government's main priorities in 1993. The provision of this additional money represents a significant start in dealing with some of the problems facing our public hospital services. The Minister is adopting a planned approach to ensure that these additional resources are used to reward those hospitals performing efficiently and not those inefficient ones.
I might remind Deputy Flanagan of some of the other significant service developments being funded this year. For example, special additional funding of £8 million has been provided to improve services for people with disabilities. I am aware, as is Deputy Noonan of Limerick East, that we have particular problems in the mid-west. Nevertheless, Deputy Flanagan might take note of some of the additional services which will be put in place for persons with a mental handicap and their families, within these resources. They are as follows: 70 extra residential places; 200 extra day places; an extension of respite services to support families; additional home support services for 800 to 900 families; improved services for those who are behaviourally disturbed; further transfers of persons with a mental handicap from psychiatric hospitals to more appropriate placements within the mental handicap services and an extension of early intervention and child development services. The House will agree that these additional services will constitute a major contribution to the development of the potential of each person with a mental handicap to live as full and independent a life as possible.
The Minister is also putting in place additional services this year for persons with a physical or sensory disability including the following: the opening of additional independent living/residential units and appropriate support services; the extension of support services to people with disabilities living at home; respite services for families and relatives caring for persons with disabilities; additional day care places and extra community-based therapists. In addition, capital support has been provided for these initiatives and to lay the ground for further service development.
The Minister has advised the House that he intends to proceed with the implementation of the provisions of the Health (Nursing Homes) Act, 1990, by I May next, on which he is to be commended. I should point out that £4 million have been made available for this purpose in 1993. The Programme for a Partnership Government places much emphasis on the vulnerable in our society. The dependent elderly are among the most vulnerable. I am pleased their needs are being addressed and I welcome the Minister's commitment to implement the provisions of the nursing homes Act as a matter of priority. I had a number of inquiries about it today.
The matter of dental care has also been addressed. I am pleased to note that the Government is providing a sum of £2 million in 1993 towards the implementation of the provisions contained in the Programme for Government. I welcome particularly the Minister's proposal to extend eligibility to school children up to age 14 years with effect from 1 December 1993 and to extend such eligibility up to 16 years over the course of the programme.
Deputy Flanagan voiced his opposition to hospital charges, conveniently ignoring a number of facts. I should point out that medical card holders and their dependants are exempt from payment of public hospital charges.
We are aware of that.
That exemption will encompass 36 per cent of our population. I might add that neither will they have to pay prescription charges. Children up to six weeks are exempt and children referred to hospitals for services arising from examinations at child health clinics or in the course of school health examinations are also exempt.
They always were.
Persons receiving medical services in respect of certain infectious diseases are exempt, as are persons in receipt of long term institutional care.
That is not as a result of the Minister's largesse.
In addition, the chief executive officers of the relevant health boards have power to waive charges in cases where they consider that payment would result in undue hardship for the individual concerned. I welcome the Minister's initiative in requesting the chief executive officers to be mindful of these hardship provisions, particularly in cases where a number of members of the same family may be subject to the charges within the same 12-month period. I can assure the House that the Minister and his Department will be closely monitoring the implications of the charges to ensure that the hardship provisions are satisfactorily implemented.
In view of the need to fund the new developments and maintain services, and given the safeguards against hardship to which I and others have referred, I ask the House to approve the regulations on the revised charges.
I welcome the Government commitment to maintain and improve our health services. I welcome also the increased expenditure of 12 per cent which should reduce waiting lists somewhat while improving the services.
I note that Deputy Flanagan referred yesterday to the dark days of Fianna Fáil, contending that the Minister had not moved from those dark days. I might remind Deputy Flanagan that over £500 million were spent during those dark days. If he contends they were dark days I might ask him how much money he wants any Government to expend.
I criticised the manner in which it was spent, not the amount.
There were many increases effected in services over the lifetime of two successive Governments, that is when the Fianna Fáil Party were in Government alone and in Coalition with the Progressive Democrats. A huge amount of extra money was expended on our health services, effecting massive reductions in some waiting lists and a huge increase in the numbers of operations carried out. For example, in Cappagh Hospital alone there was a 40 per cent increase in the number of hip replacement operations.
I contend that politicians on all sides of the House are guilty on this issue. We have tended to kick this issue around, taking advantage of people when sick. We spend 20 per cent of our overall budget on the health services and if we are not reaping the service we want, we should endeavour to improve it.
If the new Minister improved that service rather than just throwing money at it he and his Minister of State would go down in history as having been very successful. Yesterday the Minister said he had worked extremely hard at the Cabinet table to obtain as much money as possible and, that while he and his colleagues had not received all they wanted, they were reasonably happy. I have no doubt that former Ministers, such as Deputies O'Hanlon, O'Rourke and Dr. O'Connell would say the same. That is part and parcel of their task which will be realised by the new Minister as he progresses.
These extra charges will yield approximately £7 million, a very small amount of money when one looks at the total budget of £1.7 billion. We should endeavour to eliminate inefficiencies in the health services and I agree with the points made by Deputy Cullen. I have grave doubts about the necessity for so many health boards, particularly when one thinks that the area in and around Birmingham, with approximately the same population as our nation as a whole, has one health board.
Whenever cutbacks are effected they affect nursing staff and lead toward closures, they are never implemented anywhere else or, if so, we do not hear about them. Ward closures tend to be an emotional issue. By no stretch of the imagination are nurses paid well. They do a fantastic job but are not well paid. There is insufficient recognition of their work and contribution. All of us politicians are guilty in this respect. It is time we ceased kicking this issue around like a political football and really endeavoured to improve the badly needed services.
Deputy Allen spoke about the reduction in waiting lists. In his speech the Minister mentioned in particular that he has set aside £20 million to reduce the waiting lists for orthopaedic surgery, hip replacements, ear, nose and throat surgery, cardiac surgery, vascular surgery and plastic surgery. In addition, this money will be used to improve services for the mentally handicapped. An extra 700 residential places and an extra 200 day places will be provided; respite care services will be extended to support families; additional home support services will be provided for between 800 and 900; family services for those who are behaviourly disturbed will be improved; more persons with a mental handicap will be transferred from psychiatric hospitals to more appropriate placements within the mental handicap service; early intervention and child development services will be extended and services for those with sensory or physical handicaps will be improved. Furthermore, services for the elderly are to be improved through, as has already been mentioned, the implementation of the Nursing Homes Act, while a sum of £2 million is to be provided for the dental services.
Each of these services has been raised by various politicians, including myself, who have argued that they need to be improved. The Minister for Arts, Culture and the Gaeltacht, Deputy Higgins, has announced that we will have a new Film Board, and we all welcome this. On the Order of Business this morning the question was asked: where is the money? Not only is the Minister, Deputy Howlin, saying that services will be improved but that the money will be provided. This should be welcomed.
Does this mean that there will be no money for the Film Board?
Many of us have complained that money should be made available for these services and that is what he is doing.
Where is the Minister getting it from?
The Minister has outlined in detail the categories who will be exempt from paying these charges and I welcome these exemptions. In regard to the hardship provision, I agree with Deputy McManus that the Minister should make it clear who will be included. I have no doubt that people will knock on my door and on the door of every single Member of this House and the Seanad and of local councillors to argue that they should be included. It is important therefore that it is spelled out clearly who will be included.
I also welcome the Minister's statement that his Department intends to have discussions with the VHI on its future and on how it intends to respond to competition in the Single Market. I hope its position will not be undermined by the influx of foreign companies which will offer the same services. As a member of the VHI, I may complain about the fees charged, but these compare very favourably with the fees charged in many other countries, in particular the United States, where medical charges are enormous. I do not like to see increases as I will have to pay them myself, but in many ways the VHI has provided a good service and I hope the Minister will ensure that it will continue to provide this service and that any increases will be kept to the minimum in the future.
With your permission, a Leas-Cheann Comhairle, I wish to share my time with Deputies Nealon and Flanagan.
Is that agreed? Agreed.
I welcome this opportunity to address the House on this Fine Gael motion and compliment Deputy Flanagan for bringing it before the House. The Minister chose to introduce these increased health charges on the day the budget was introduced in this House. I wonder if this date was chosen at random by the Department of Health, or was it a well thought out strategy to lessen the impact of the announcement of these increased charges to the general public. The reaction that has been generated by the public to these charges is not hidden and they are very aware of them when they visit outpatient Departments or become inpatients in our hospitals.
I acknowledge that the Minister, Deputy Howlin, is only a short time in his new Ministry and that is will take him some time to accomplish all of what he wishes to do. However, in the short time he has been in the Department it is incredible that he should do a U-turn in relation to health charges. I refer the House to the debate that took place during Private Members' Business on 28 April 1987 when the Minister, Deputy Howlin, then in Opposition, brought forward a motion to annul the health charges which were introduced by the then Minister, Deputy O'Hanlon.
What did Fine Gael do on that night? The answer is that they abstained.
In the course of a very fine speech delivered by the Minister——
The Minister described them as immoral.
Fine Gael abstained.
——he said and I quote from column 352, volume 372, of the Official Report:
Taken all together, I would classify these charges as immoral and no amount of exemptions or exceptions will make them moral. They are a crude and vicious instrument whose only effect will be to undermine the standard of health care.
The Deputy's party put them into effect that very night.
That was the statement the Minister made in 1987. While I appreciate that six years have passed, it does not seem logical that charges which were immoral on that occasion should be increased by him and suddenly become moral. Is it that the action the Minister then condemned as being immoral has changed, or is it that the position of the person deciding on the morality of the case has changed?
Has Fine Gael changed?
He has a chauffeur now and a Mercedes — Meres and perks.
It was the Deputy's amendment.
I note that in his speech last night the Minister said——
The Deputy in possession to continue without interruption.
The Minister is heckling us. Tell him to be quiet.
I note that in his speech last night the Minister said:
‘I firmly believe that patients will want to get the treatment they need in the environment that is most appropriate for them and that the £6 charge at out-patients departments will not change patients' attitudes one way or another.
Let me again refer the Minister back to the debate that took place on 28 April 1987 because on that occasion he said:
There will be even worse effects. It is all too easy to envisage situations where necessary treatments will be foregone because of the fear of these charges, where children will simply not get the X-rays, where old people will try to nurse themselves at home rather than face the humiliation of going to a hospital with an empty purse.
The Minister should hang his head in shame.
(Interruptions.)
The Minister continued:
I have already met people who are in terror of the prospect of facing an illness and simply not having the means to cover the charge proposed by the Minister. I know and every Member of this House knows that hospitals will not turn people away because they have no money with them. I have total confidence in the ethics and standards of our medical profession, but I know that people have their pride even when they have little else and that there are many situations where they would simply be unwilling to expose themselves to the fear of humiliation which these charges would visit upon them.
The Minister for humiliation.
I ask the Minister how he can reconcile the statements he made in 1987 with his present statements. How is it that people who would have been afraid of charges then and who would have gone without treatment because of their pride are now suddenly going to be able to avail of the services without any fear of humiliation?
Is the about turn which the Minister appears to have made not leading towards cynicism and the sceptical attitude with which the public view us as politicians? Is it not pronouncements such as those the Minister made when in Opposition and his ability to do the opposite when in Government that is the cause of such disillusionment, especially among our young people?
As Fine Gael are doing tonight.
(Interruptions.)
Is there not a case to be made that the Minister's actions will bring about a credibility deficit in relation to politicians in general? Last night the Minister stated that he is and always has been opposed to hospital charges. I ask him tonight therefore is it not his responsibility to make such important decisions in his Department or was he in his statement last night distancing himself from a decision made by the Government of which he is a member?
The Deputy should complete the sentence.
Because I have been a regular attender in Leinster House in one capacity or another since 1954 I am not one to get carried away by political promises, whatever the source or party, but I have to admit that I had some hopes for the Labour Party in Government in the health sector mainly because of the person it nominated as Minister. In Opposition Deputy Howlin was a man who knew his brief very well and gave the impression that he cared about the health service. Because he was a negotiator in the partnership negotiations I felt he would have provided the finance to make improvements.
There has been a 12 per cent increase, £183 million.
The last thing I expected from the new Labour Minister for Health was that he would hike up hospital charges but, sadly, I was wrong.
That is how he will get the money.
His very first action of any significance in my area, the North-Western Health Board area, and in the rest of the country was to increase hospital outpatient charges from £10 to £42 and inpatient charges from £15 to £20 — this from the man we have been just told described the outpatient charge of £5 introduced by one of his predecessors as immoral and who then went on to call for the resignation of that Minister. If Deputy Howlin, as he then was, said that a £5 hike was immoral and a resigning matter for the then Minister, I wonder how he would describe his own mini-budget if he were still in Opposition? I take it "immoral" would be much too mild a word.
Resignation.
The Deputy abstained that night.
That was only the beginning of the Minister's assault on the health services in the North Western Health Board area. At their meeting last week the board members were told there would be cutbacks of almost £700,000 in pay and £500,000 in non-pay, in addition to extra charges imposed by the Minister amounting to £700,000. How will that improve the health services in my area? How will that reduce the waiting lists where people have to wait two, three or four years for hip operations? Would the Minister confirm to the House that it will mean, for example, the loss in job equivalent of 20 nurses in Sligo General Hospital alone? This is what the Minister is doing in the health board area which by common consent has been extremely well administered and is the best in the country.
Silence from the Minister.
The Minister is stunned.
The most extraordinary aspect of this saga is the relative silence from one of my colleagues and a colleague of the Minister, Deputy Bree. He is a man well known locally for his opposition to health charges through the years, indeed to any charge whatsoever. I therefore anticipated he would have reacted with fire and fury to these outrageous and unexpected charges and cutbacks.
Will Deputy Bree vote tonight?
That is the point I want to make: will he vote tonight? I will be asking the Minister that in a moment and I will tell the Minister what he will be voting for if he does vote. I thought that being in office would not have changed a man so quickly, but unfortunately, I was disappointed. All we have heard from him so far is a passing comment that he had asked the Tánaiste and the Minister for Health to ensure that the outpatient charges are phased out in the next budget if not earlier. There was no question of him seeking an immediate withdrawal, no suggestion that the charges were immoral — as the Minister said on an earlier occasion — and of course no demand that the Minister should resign. The Deputy has no need now to wait until the next budget. Thanks to my colleague, Deputy Flanagan, he will now be afforded the opportunity to have these charges scrapped by voting against them in about ten minutes' time.
I will even convince the Progressive Democrats of that tonight.
I am, of course, extending the same invitation to my Fianna Fáil constituency colleagues, Deputies Brennan and Ellis. I want to put on record that if they vote against Deputy Flanagan's motion they are voting for an increase in hospital outpatient charges from £10 to a total of £42, an increase in inpatient charges from £15 to £20 and further cutbacks in the North Western Health Board area which, as shown in the example I have given, will mean in effect the loss of 20 nursing jobs in Sligo General Hospital.
I wish to acknowledge the contributions over the past three hours of Deputies representing all sides in this House. In particular, I appreciate the interests of my many Fine Gael colleagues who spoke with depth of feeling and authority on the consequences of the ministerial charges.
Listening to the Minister last night one could only wonder if anyone at all will be adversely affected by these charges. The Government line is that these charges are of little consequence and a matter of minor concern. We hear tonight from the Minister of State, Deputy O'Dea, that a mechanism has been set in place that will allow the chief executive officer of the health board become the final board of appeal. We heard the Minister when in Opposition talk about the bureaucratic nature of the health services and the need to reduce the level of bureaucracy in the health services. The Minister is now introducing a new layer of bureaucracy. On the one hand he is increasing the charges by ministerial regulation and on the other he is saying that while the charges are being imposed, the chief executive officer has the power to waive them. Is that not bureaucracy? If it is not I would like to know what it is.
I wish to tell the Minister that those in society who will be burdened most with the increased charges are those families most heavily taxed over a wide range of schemes. Families in modest and middle income brackets, mainly PAYE taxpayers, have been asked to foot the bill yet again. The people who are paying PRSI at too high a rate, those who are paying income tax at too high a rate, those who must under Labour and Fianna Fáil pay an extra 1 per cent income levy, a tax on falling ill and now a tax on death since the most recent budget — those are the people charged yet again with the responsibility of meeting higher charges imposed by the Labour Minister for Health.
This Government has specifically targeted workers in the modest income sector in a most callous and indiscriminate manner by hiking up the hospital charges that were so vehemently opposed by the Minister when in Opposition. The Minister not only has eaten all his words but has displayed last night a very high standard in the art of the somersault. I regret that the Minister was unable to provide the House last night with details of the action programme on waiting lists with which even Fianna Fáil Deputies are now familiar.
As well as the suffering endured by the tens of thousands of people awaiting treatment, the cost of waiting lists must not be ignored in the overall context of health funding. A GP in my constituency recently carried out a survey on those on waiting lists. According to that survey, it is fair to assume that a 70 year old person waiting four years for a hip replacement operation will consume drugs to the value of £2,500. Assuming that a person on the waiting list will consume drugs to that value, that figure when multiplied by 7,000, which represents the number on waiting lists, reveals the hidden cost of leaving people on waiting lists——
That is right.
——notwithstanding the pain and suffering endured by the person whose health over the four year period will deteriorate and will require further treatment that will cost extra money.
An undeniable effect of those charges, in spite of the Minister's comments, will be a significant increase in VHI costs forcing many families to opt out of health insurance cover. Since medical card cover is no longer an option families face Russian roulette in regard to their health. The Minister has denied that the VHI is seeking an increase or that he will allow it increase its charges as reported in a Sunday newspaper. I put it to the Minister that the increase in VHI insurance premiums will be at least 6 per cent and that increase will be a direct consequence of the charges he imposed on 23 February.
That is right.
When the Minister was in Opposition he was most vociferous in his attack on the handling of the health charges by Fianna Fáil Ministers. I am not going to recount any of his comments but he will recall many of the highly charged debates here——
The Minister is already squirming about them.
——when accusations were flung at Fianna Fáil Ministers; one particular allegation was that of Dr. Death. The Minister is the first non-general practitioner to hold the health portfolio for six and a half years with the exception of a previous Minister, Deputy O'Rourke, who held the post for a short time. I hope the Minister will never be accused of being Dr. Death but I hope he will never stand accused of being Dr. Dolittle. From his performance to date I believe it is not Dr. Death or Dr. Dolittle that will be most applicable, but Dr. Jekyll and Mr. Hyde given his attitude and volte-face since 1992. Those backbenchers in the Fianna Fáil Party and in the Labour Party under the chairmanship of Deputy Toddy O'Sullivan who criticised the health charges in the public arena——
Will Deputy O'Sullivan be voting with us tonight?
Maybe the Deputy is not holding the chair of that committee.
Will Deputy Bhamjee be voting with us tonight?
Both Labour and Fianna Fáil Deputies have publicly, at health board levels——
(Interruptions.)
Deputy Flanagan without interruption.
Will Deputy O'Sullivan be voting with us tonight?
Will the Deputies be voting tonight for a change?
I know Deputy O'Sullivan will represent the true interests of his party.
Will Deputy Kemmy be here tonight?
I invite Deputy O'Sullivan and his colleague, Deputy Bhamjee——
I am not intimidated by the numbers in the Deputy's party.
(Interruptions.)
——who is familiar with the consequences of the health charges——
A spoonful of sugar tonight will help the medicine go down.
Get it straight, Deputy.
I invite Deputy Toddy O'Sullivan and his colleague, Deputy Bhamjee, who is familiar with the consequences of the health charges, to take a stand on behalf of the hundreds and thousands of families on moderate incomes——
Honest words.
(Interruptions.)
I invite them to take stand on behalf of those who have been singled out and abandoned and offended by the Taoiseach and the Tánaiste.
Spending of the order of 6.9 per cent of gross national product.
As it is now 8.30 p.m. I must put the question on amendment No. 1 in the name of the Minister.
Amendment put.
The Dáil divided: Tá, 71; Níl, 43.
Tá
- Ahern, Bertie.
- Ahern, Dermot.
- Ahern, Michael.
- Ahern, Noel.
- Aylward, Liam.
- Bell, Michael.
- Bhamjee, Moosajee.
- Bhreathnach, Niamh.
- Bree, Declan.
- Brennan, Matt.
- Brennan, Séamus.
- Briscoe, Ben.
- Broughan, Tommy.
- Callely, Ivor.
- Coughlan, Mary.
- Davern, Noel.
- Dempsey, Noel.
- de Valera, Síle.
- Doherty, Seán.
- Ellis, John.
- Ferris, Michael.
- Fitzgerald, Brian.
- Fitzgerald, Eithne.
- Fitzgerald, Liam.
- Flood, Chris.
- Foley, Denis.
- Gallagher, Pat.
- Haughey, Seán.
- Higgins, Michael D.
- Howlin, Brendan.
- Hughes, Séamus.
- Jacob, Joe.
- Kavanagh, Liam.
- Kenneally, Brendan.
- Kenny, Seán.
- Killeen, Tony.
- Kirk, Séamus.
- Lawlor, Liam.
- Lenihan, Brian.
- Leonard, Jimmy.
- McDaid, James.
- McDowell, Derek.
- Moffat, Tom.
- Morley, P.J.
- Moynihan, Donal.
- Mulvihill, John.
- Noonan, Michael (Limerick West).
- Ó Cuiv, Éamon.
- O'Dea, Willie.
- O'Hanlon, Rory.
- O'Keeffe, Batt.
- O'Keeffe, Ned.
- O'Leary, John.
- O'Sullivan, Gerry.
- O'Sullivan, Toddy.
- Quinn, Ruairí.
- Reynolds, Albert.
- Ryan, Eoin.
- Ryan, John.
- Shortall, Róisín.
- Smith, Brendan.
- Smith, Michael.
- Stagg, Emmet.
- Taylor, Mervyn.
- Treacy, Noel.
- Upton, Pat.
- Wallace, Dan.
- Wallace, Mary.
- Walsh, Eamon.
- Walsh, Joe.
- Woods, Michael.
Níl
- Ahearn, Theresa.
- Allen, Bernard.
- Bradford, Paul.
- Browne, John (Carlow-Kilkenny).
- Bruton, John.
- Currie, Austin.
- Deenihan, Jimmy.
- De Rossa, Proinsias.
- Doyle, Avril.
- Dukes, Alan M.
- Finucane, Michael.
- Flanagan, Charles.
- Foxe, Tom.
- Gilmore, Eamon.
- Gregory, Tony.
- Harney, Mary.
- Harte, Paddy.
- Higgins, Jim.
- Kenny, Enda.
- Keogh, Helen.
- McCormack, Pádraic.
- Clohessy, Peadar.
- Connaughton, Paul.
- Connor, John.
- Crawford, Seymour.
- Cullen, Martin.
- McDowell, Michael.
- McGahon, Brendan.
- McGinley, Dinny.
- McGrath, Paul.
- McManus, Liz.
- Molloy, Robert.
- Nealon, Ted.
- Noonan, Michael (Limerick East).
- O'Donnell, Liz.
- O'Keeffe, Jim.
- O'Malley, Desmond J.
- Owen, Nora.
- Quill, Máirín.
- Rabbitte, Pat.
- Sheehan, P.J.
- Timmins, Godfrey.
- Yates, Ivan.
Tellers: Tá, Deputies Dempsey and Ferns; Níl, Deputies E. Kenny and Browne(Carlow-Kilkenny).
Amendment declared carried.
Question, "That the motion, as amended, be agreed to", put and declared carried.