I move:
That Dáil Éireann, having regard to the widespread demand for health care and personal social services, the fact that in many areas this demand is not being met and the certainty that demand will increase in the future, as also will the costs associated with providing those services, noting, in particular, the urgent need—
—to provide more hospital beds and to attack hospital waiting lists,
—to make further and more effective provision in the areas of care for children, the elderly and persons with mental disability, and
—to develop a comprehensive system of care in the community,
bearing in mind that Irish per capita spending is among the lowest in the European Union, and believing that the present period of economic expansion should return a dividend to the people by way of a major and sustained increase in funds committed to the public health system, calls on the Government—
(1) to declare a target figure for public health expenditure, as a percentage of gross domestic product, and
(2) to commit itself to a programme of spending increases until that figure is achieved and to the maintenance of spending at that level.
The purpose of this motion is threefold. We want to highlight the major inadequacies in our health services, prioritise the areas which are in need of substantial funding and establish a resource framework to develop our health care services over the next decade in order to bring them up to an acceptable level which is, in some way, commensurate with our growing economic wealth.
Our motion is informed by one principle; economic growth is not an end in itself but must lead on to improved living standards and a better quality of life for our citizens. If it is to be a source of social solidarity and inclusion, its effects must be evident in all sectors of society. It must be used to address the deficiencies of the past, of which there are many, and it must evolve to tackle the reasonable, growing demands which progress creates. That has clearly not yet happened. In spite of the existence of social partnership, the feeling remains that the main beneficiaries of recent economic progress have been the well off.
Ireland remains a very divided society. The decisions taken in the area of taxation in this Government's first budget clearly exacerbated tensions in this area. The division in Irish society is nowhere more apparent than within our health system. In recent years, much effort has been put into the development of our economy. Thankfully, this has resulted in unprecedented economic growth. We now need to put the same kind of concerted effort into developing our society so that it can accommodate the needs of all our citizens. That means putting community at the top of the political agenda and spending money where it is needed most. What is the point, one might ask, of having an extra few pounds in one's pocket if one is going to be turned away from a casualty department because of a shortage of beds? What is the point if an elderly parent cannot get into a nursing home? What is the point if child care services remain over-stretched leaving many children at risk? How can we feel good about our booming economy when elderly parents must struggle with a mentally handicapped son or daughter because there are insufficient places for them in care? How can we feel good about our society when vital home help workers are being paid less that £2 per hour?
The motion sets out some of the challenges which face our public health system and with which Members will be familiar. We have debated these on many pervious occasions. They include the provision of services for the elderly, the young — particularly children at risk — those in need of acute services and those with particular disabilities.
The Department of Health and Children has published two significant documents in recent times. The first strategy document, "Shaping a Healthier Future", appeared in 1994. More recently, the Department published its own strategy statement for 1998 to 2001. Both documents are a welcome contribution to the debate on this issue but until funding is addressed these documents remain largely aspirational.
The existence of long hospital waiting lists is a major source of public concern. The latest available figures reveal that more than 32,000 people are currently on hospital waiting lists. While this figure represents a fall from the 1993 high of 40,000, it also represents a significant increase of more than 6,000 from the 26,000 mark achieved by the previous Government. Up to 25 per cent of operations are being cancelled in some hospitals because of the shortage of hospital beds. Almost 1,000 adults have been waiting more than 12 months for cardiac surgery and a similar number await plastic surgery. The vast majority of children on hospital waiting lists have been on the lists for more than 12 months. In Ireland, it remains true that if one needs an operation and can afford to pay for it, it is available but if one is dependent on public care, one faces long waiting lists.
Although this Government set out its intention to tackle these lists, it has clearly failed to do so. The Minister established a review group to examine hospital waiting lists and it is due to report by the end of June. I welcomed the Minister's initiative but did so on the condition that resources would be put in place to tackle the immediate crisis. Unfortunately, no such move has been made and we now face the prospect of a further crisis in our hospitals next winter.
I guarantee that one of the group's main findings will be that a large number of acute hospital beds are being blocked. In the Eastern Health Board area alone it is accepted that there are approximately 300 patients in acute hospital beds who should not be there. This figure comprises elderly people who are unable to gain access to nursing homes, chronically sick people in need of long-term care and many other patients in need of rehabilitation who simply have nowhere else to go. For these beds to be freed up for those awaiting operations, funding must be provided to accommodate those who are currently inappropriately placed.
Much of the progress in the hospital waiting list initiative over the past five years has been based on a quicker turnover of patients. Since 1980, there has been a reduction of 3,500 in the number of hospital beds. This is an area of growing concern to the public who are increasingly uneasy with the hospital as a conveyor belt syndrome. While the reduction in the length of time spent in hospital has been welcomed by many working in the area of hospital economics, the public tends to take a different view which is that the conveyor belt approach is not necessarily in patients' best interests.
Equally immediate is the crisis in child care. A plethora of commitments currently await implementation; these include the establishment of a child care authority, an ombudsman for children, a social services inspectorate and an increased number of foster places for children who are currently awaiting placement. The renaming of the Department of Health as the Department of Health and Children helped to create the impression that this was an area the Government would take seriously. However, as in many other areas, this proved to be yet another exercise in window dressing.
Recently, the Irish Government was severely criticised by the United Nations Committee on the Rights of the Child for its failure to address adequately the needs of children. The UN report expressed serious concern about inadequacies in our child care services. These services are crisis driven at all levels. The lack of availability of suitable places for children often leads to them being housed in hospitals because there is nowhere else for them to go. Large numbers of other children are left in situations where they are seriously at risk.
We should be deeply ashamed that this situation is allowed to persist. Piecemeal attempts to tackle the problem have failed. What is needed is an overall assessment of the scale of the problem, a strategic plan to tackle it over a defined period and a Government commitment to fund that plan. The Minister of State, Deputy Fahey, indicated that the financial requirements in this area alone are in excess of £100 million. I believe this is an accurate assessment.
One of the reasons Ireland has been able to maintain a reasonable standard of care, despite its low per capita spending, has been the relative youth of its population. An OECD report last year indicated that while the health of our younger people is as good as that of younger people in other OECD countries, the health of our elderly compares unfavourably. The health disadvantage in Ireland is primarily based in this sector. There have been welcome improvements in recent years but the challenges ahead are immense.
Over the next decade, our population will age considerably. Projected estimates indicate there will be an additional 100,000 people over the age of 65 years by 2010. There is already massive pressure on existing services, such as nursing homes. The current rates of subvention from the health boards for nursing home care are hopelessly inadequate to meet the expenses involved. Many families are put under severe pressure because of this and there is an urgent need to update the rates. Equally, health board nursing homes cannot cope with the growing demands on them.
There is huge under-provision of day care services for the elderly. The existing situation puts enormous strain on older people and on their families, both financially and emotionally. These problems are likely to increase substantially and will require additional investment by the State. The Minister of State, Deputy Moffatt, is aware of this. He has met a number of groups who are working to improve the lot of older people. In the Dublin area where there is a major concentration of this age group, there are no day care services. People are marooned in their homes, isolated and lonely, and we have not put in place the type of services these people require and deserve.
The situation in many other areas of health service is equally appalling. Ireland is enjoying the most prosperous period in its history, yet over 3,000 people with mental handicap are being denied services. There is an urgent need for day services for 1,200 people who currently have no such service. A further 1,300 people who urgently require residential services do not have them and an additional 1,200 people are currently inappropriately placed in various large old institutions throughout the country. The fact that these placements are allowed to continue is a disgrace. The conditions in some of those old institutions are shameful but there appears to be no political will to do anything about it.
Let us look at the need with regard to mental handicap. Over the past few years there have been small incremental improvements in this area. Little by little, the allocation to mental handicap services has grown and that has been welcomed by parents and agencies working in the area. However, much of the pressure for services was staved off while the database was being compiled by the health boards. I told a public meeting on this issue last year that as soon as the database was completed, the exact need would be known and, because we would know how many people were in dire need of services, there would be no running away from it.
I could not believe that this Government would run away from the stark figure of over 3,000 people in urgent need of services. In the last budget, a capital allocation of a mere £7 million was made for mental handicap services. This allocation was made at a time when it was known that £63 million was needed to deal with the problem. The allocation of £7 million was the smallest capital allocation made to mental handicap services in the last five years.
If we continue to proceed through small incremental improvements, we will alienate many people. Large numbers of people are currently being denied their basic human rights because the State has denied them the resources to live a life of dignity. Since 1980, expenditure on health as a percentage of our GDP has fallen considerably. This fall has been influenced by a number of factors. The difficult economic situation in the 1980s necessitated a considerable reappraisal of existing services and although the figure climbed somewhat during the early to mid 1990s, the recent spectacular economic growth has not been matched by a commensurate increase in health spending.
The Labour Party believes it is time to take a fresh look at this situation. Many of our services are hopelessly inadequate. They reflect to a great extent where we have come from as a society rather than where we are now. Ireland continues to record lower health status indicators than other European countries. The main focus of attention is on acute services but if one looks at what is happening at community level, and there is general agreement that we must concentrate our services there, one can see that only lip service is being paid to the many people who work in community care services.
All Members are aware of the huge shortages in community care services. There are waiting lists of between 18 months and two years for occupational therapy services. There are inadequate chiropody services. Day care services are hopelessly inadequate.
Much lip service is paid to the vital role of home help workers in our community services.
The move from institutional to community care in recent years has necessitated the involvement of large numbers of people providing home help. However, we do not appear to be prepared to put our money where our mouths are in this regard. It is shameful that large numbers of people who provide vital support services in terms of home help are being paid derisory amounts. Over the years the State has saved significant amounts of money by moving people out of big institutions and into the community. Yet all we can do is praise the good work of those who volunteer to become home helps. We should be ashamed of the derisory rates of pay allocated to those people.
The Labour Party believes that in order to address inadequacies in our health services considerable progress will have to be made in the years ahead. To facilitate a proper and phased improvement in these services it is important for Government to set clear targets. Such an approach to tackling a problem is not unprecedented. Clear targets were put in place for increasing aid to developing countries and to a large extent those targets have been met. What is required is the political will to tackle a pressing problem.
The motion cites increases in health spending as a percentage of GDP. The Labour Party is not wedded in absolute terms to this measure. It was chosen because it is the internationally accepted measurement. The principle underpinning the motion is that as society becomes more affluent additional resources need to be committed to the health system. Standing still is simply not acceptable. Improvements are urgently needed over a wide range of services.
In its last budget the Government reduced capital gains taxation by 50 per cent. The cost to the Exchequer of this move is estimated to be more than £40 million. No doubt that cost has been added to by the inclusion in the second Finance Bill this year of provisions for land rezoning for residential development. Those measures have brought no social benefit whatsoever. Those two measures taken together would have been sufficient to pay for the needs of all our mentally handicapped people. These are the choices a Government must make. They are the options that are open to it at budget time, but the choices made in the last budget were seriously flawed and bad for society.
The motion before the House is intended as a constructive contribution towards general debate on this important issue. It does not lambaste the Government for its failures, although failures in the health area have been considerable. Rather it sets out a platform on which to build the progressive health care system for our people as we approach the end of this century. For that reason it is worthy of serious consideration and, I hope, support. I call on the Government to accept it.
I wish to share the remainder of my time with Deputy Wall.
