Dáil Éireann debate -
Wednesday, 27 May 1998

Vol. 491 No. 4

Private Members' Business. - Health Care and Personal Social Services: Motion (Resumed).

The following motion was moved by Deputy Shortall on Tuesday, 26 May 1998:

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 Irishper 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.

Debate resumed on amendment No. 1.

To delete all words after "That" and substitute the following:

"Dáil Éireann,

Affirms and supports the many initiatives already taken by the Minister for Health and Children in relation to the provision of improved health and personal social services and in particular,

— The significant overall increase in health expenditure provided in 1998 together with the enhanced multi-annual capital programme put in place up to the year 2000; and

— The increased funding provided for the development of acute hospitals, tackling hospital waiting lists, services for the elderly, child care, mental handicap and other community services;

Further notes with approval the range of commitments contained in the Government's Action Programme for the Millennium and the determination to implement these developments within the life of the Government."

—(Minister of State at the Department of Health and Children, Deputy Moffat).

Mr. Deenihan

There are more than 500,000 patients within the remit of the Southern Health Board which has specialist responsibilities for up to one million people. Many of its services are inadequately funded and not keeping pace with the needs of the sick. What is most noticeable is that the staff-patient ratio is markedly lower than in any other health board. In the community, the district nurse-speech therapist-social worker-patient ratio is also lower than that in all comparable health boards. Our hospitals have the same deficiencies.

It has been recognised by officials of the Department of Health and Children that the staff nurse-patient ratio in Cork University Hospital is much lower than in Dublin. The rate of new consultant appointments in the Southern Health Board is 5 per cent compared to a rate of 14 per cent to 25 per cent throughout the rest of the country. Junior hospital doctors in Cork and Kerry work one night in four whereas their counterparts in Dublin work one night in every eight or ten.

There is an urgent need for capital and revenue investment in Cork University Hospital. A submission regarding its requirements was made to the Department recently but I understand there has been no response to date. On the capital side, several major items of equipment are obsolete. The normal life of a CT scanner is eight years or one million scans. The CT scanner in use in the hospital has been operated night and day for ten years and 1.5 million scans have been taken. It has broken down on six occasions in the last four months necessitating the referral of patients to the Mercy Hospital, causing major inconvenience to very ill patients and leading to delays in reaching a diagnosis and greater expense to the health board. There is a six months out-patient waiting list. It would cost £400,000 to replace the scanner.

There is a need for an ophthalmology microscope which costs in the region of £150,000. There is also a need for cardiac-telemetry equipment which costs in the region of £400,000. Overall, some £2 million is needed immediately for capital investment to satisfy current patient requirements in Cork University Hospital alone.

In Tralee General Hospital, with which I am familiar, there is a requirement for extra nurses for the coronary care unit, especially from 5.30 p.m. to 9 a.m., particularly in the step-down ward. There is also a need for up-to-date equipment, especially dinamaps for taking blood pressure and "hi-lo" beds. Some of the equipment in use in the hospital is 14 years old. The equipment transferred from the old hospital is antiquated.

The Southern Health Board has great difficulty in replacing retiring consultants. Two senior consultants have announced their imminent departure. The board has applied to the Department for replacements but, to date, these have not been approved.

Cork University Hospital is, undoubtedly, the flagship hospital in the Southern Health Board and provides more specialist services than any other hospital in the State. However, without the financial support of the Department a further decline in services is inevitable.

A constituent of mine who was recently diagnosed as having leukaemia could not be admitted to Cork University Hospital for treatment because there was no bed available. This is unacceptable. The person concerned had to travel to St. James's Hospital in Dublin resulting in considerable stress and hardship for his family.

The Southern Health Board has a statutory obligation to provide an acceptable service, comparable to that provided throughout the rest of the country. To do this, it requires adequate funding which has not been forthcoming. I understand the Minister has been requested to meet a deputation. I hope he will agree to do so within the next few weeks.

Mr. Neville

I support the motion and congratulate the Labour Party on bringing it forward. I wish to refer to a disorder which, although the Minister has met delegations and is aware of the associated problems, the Department does not fully accept merits treatment — attention deficit disorder. It affects the learning ability and behaviour of up to 10 per cent of all children. There is much confusion among parents and children about the nature of the disorder and the treatment required. It often remains undiagnosed. Children may be labelled anti-social, hyperactive or unintelligent while parents are incorrectly criticised for their poor parenting.

For many children, growing up is tough. For some, the going is even more difficult because the symptoms of attention deficit disorder are not apparent to the casual observer. At school, they have trouble learning, disrupt classes and frustrate their teachers. At home, they create many difficulties for their parents and siblings. Often inattentive, overactive and impulsive, they can also be clumsy and aggressive.

Despite the high percentage of children suffering from the disorder, it is largely ignored by some sections of the community, especially the educational and medical professions. To them, these are not handicapped children but children who are not being taught appropriately or disciplined. The Department should promote greater public awareness of the disorder — particularly among teachers and the medical profession generally — to help parents of ADD sufferers to identify the disorder in their children as early as possible. Left untreated, it can have serious consequences for the sufferer, his or her family and the community at large.

Psychologists have listed the symptoms as follows: short attention span, insatiability, inability to sit still for a reasonable period, easily distracted, often interrupts others, acts without thinking of the consequences, often loses things, moves from one uncompleted task to another, often talks excessively and has difficulty in waiting their turn in games and so on.

There is a large genetic ingredient. The condition affects three times more boys than girls. Some 5 per cent of the population is affected. There is a higher incidence among children who have been adopted. The disorder is believed to originate from an abnormality in the frontal lobe of the brain resulting in poor communication between the parts of the brain controlling impulses to act. The effect is poor self-control and abnormal impulsive behaviour.

I would like to pay tribute to the mid-western branch of the association based in Limerick with which I have been working and which is working closely with the Mid-Western Health Board. I congratulate the Mid-Western Health Board on its work in this area. We are not happy with the progress being made, but are due to get a report in this regard at our next health board meeting. I hope the Department considers this work a pilot project and that we can develop the views that stem from it.

The mid-western branch of ADD, the adult family support group, is encountering growing problems with children in schools because there is an appalling ignorance of this disorder among school teachers and general practitioners. That group stated many of these children will be dismissed from school because their disorder can make them unmanageable for teachers who have no training or knowledge to deal sympathetically and with patience towards them. They also stated that if these children are left without schooling they will inevitably turn to drugs and anti-social behaviour which will later help to inflate the prison population, all because there are no adequate means to diagnose and treat this problem at local level. The group further stated that since it came into existence it has received many telephone calls on this.

Minister for Health and Children (Mr. Cowen)

I wish to share my time with Deputies Cooper-Flynn and Roche.

An Leas-Cheann Comhairle

That is agreed.

Mr. Cowen

I am pleased to address the House on this important subject and to take the opportunity to update Deputies on the delivery by the Government on its commitments in the health area. Unfortunately, I was called away at short notice yesterday evening and I would like to thank my colleague, the Minister of State at the Department of Health and Children, Deputy Moffatt, for moving the Government's amendment to the motion in my absence.

It is almost inevitable that when there is debate about the health services the concentration is on deficiencies in the service. However, we should not dismiss our current level of achievement. A high number of people benefit every year from the availability of quality health and personal social services. Shortages and deficiencies exist in most health services, many of which absorb much greater amounts of money than our own.

The OECD recently gave a positive assessment of our health services relative to those in other countries. Its conclusion was "The Irish health system.. has resulted in a good provision of health care at a relatively low cost to the taxpayer." Therefore, there is much to be proud of in the core service provided. I do not wish to deny that problems exist in specific areas. However, the Government will not walk away from addressing those issues. It has set out clearly in An Action Programme for the Millennium its resolve to address, in a targeted fashion, the improvement of key aspects of our health and personal social services. Very significant increases in both capital and non-capital funding were provided in 1998. These increases have allowed me to make significant progress in implementing the Government programme.

Further funding will be required over the life of the Government to achieve all we have set out. I welcome the general support during this debate for an increase in the resources devoted to our health services. As a Government we are determined to carefully manage the economy and our success in this area should allow us to plan for increased resources being made available to health. Continued economic success is the key to improving our social services since this will supply the base on which progress can be sustained over the medium term.

This Government began to address the deficiencies which exist in our services almost immediately upon taking office. Given that these deficiencies existed during the time of the last Government, it is ironic that those same parties are now scrambling to convey their commitment to the health services. This Government was faced with a number of very urgent service needs in the health area and we responded by providing a very significant injection of funds in the latter half of 1997.

In the acute hospital sector I made funding available for high cost drug treatments many of which, although very expensive, are of a life saving nature. The sum of £3 million was made available for such drugs and a further sum of £2 million went towards the treatment of young haemophiliacs.

Progress was also made in the child care area, in particular, the problem of homeless children and children with emotional and behavioural difficulties. A total of £4.5 million was provided on an ongoing basis to cover the additional costs incurred by health boards in caring for these children and to introduce targeted measures intended to alleviate this problem. Funding of £6.9 million was provided to health boards to allow them to meet the increasing demand for subventions toward the cost of care of older people in private nursing homes. A package of once off funding was also provided to meet pressing needs in relation to the disabled and the elderly at the end of 1997. The sum of £4.8 million was provided for the purchase of equipment, aids and appliances by voluntary organisations working with people with physical and sensory disabilities and with older people. A further sum of £4.5 million was made available in relation to services for people with physical and sensory disability. That funding went towards the elimination of historical funding deficits in voluntary organisations which had built up over the previous years.

On taking office I was very concerned at the serious under investment in our capital programme which has occurred in the past. An extra £23 million in capital funding was provided in 1997. Among the issues this allowed to be addressed was the replacement of urgently required hospital equipment, the purchase of which had been postponed in previous years under the previous Administration, and tackling the serious backlog in fire prevention and maintenance works which had also built up.

The year 1998 has been the first full year in which the Government was able to address the necessary improvement in our health services. The net non-capital provision for health in 1998 shows a 10 per cent increase over and above the 1997 outturn. Further progress has also been made on the capital programme wherein we have achieved a 12 per cent increase over the 1997 outturn. I do not have sufficient time to set out all the progress that this has allowed during 1998. However, I wish to refer to some of the areas raised in the Opposition motion to assure the House the Government is already committed to addressing these issues. It is regrettable the Government is confronted by so many urgent problems due to the fact that the parties now on the Opposition benches failed to address these areas when they were in Government during a period of unprecedented economic buoyancy.

Regarding acute hospitals, additional non-capital funding of approximately £30 million has been provided in 1998 in respect of acute hospital services, not including the new Tallaght Hospital. This funding will meet the additional costs of developments initiated in recent years and allow for further developments in relation to the ambulance services, the cancer strategy, the opening of new units which are ready to be commissioned, development of accident and emergency services and increased funding for the waiting list initiative.

Some Deputies made a number of claims last night about waiting lists on which I would like to comment. Deputy Shatter noted that waiting lists rose by 6,000 from 26,000 at the end of 1996 to 32,000 at the end of 1997. He blamed the Government for the increase, but conveniently forgot to mention that the great bulk of the increase occurred in the first six months of 1997, when his party and other parties were still in office. His claim that waiting list figures "started to shrink during the lifetime of the previous Government" sounds unconvincing when waiting lists rose by 4,500 during the final six months of his party's participation in Government.

The reason for this increase of 4,500 is quite clear — the last Government cut waiting list funding by £4 million in 1997 from its 1996 figure. When I became Minister I increased this funding to £12 million for 1998 and this represents a 50 per cent increase in the waiting list allocation over that provided for last year by the previous Minister for Health, Deputy Noonan. I also made the funding available to agencies much earlier in the year than my predecessor did. As my colleague, the Minister of State at my Department, Deputy Moffatt, said last night, I also established a review group to advise on how best the waiting list funding could be utilised. In these circumstances Deputy Shatter lacks some credibility when he attempts to criticise the Government for its action on waiting lists.

Deputy Shatter also claims that the Government is seeking to suppress the true nature of hospital waiting lists to ensure that when statistical information becomes available it is outdated. I assure the House that this is simply not true. The information collected by my Department comes, not only from the health boards, but also from a range of voluntary hospitals. Each set of data has to be obtained from some 45 different health board hospitals and voluntary hospitals. The figures must then be collated and rigorously checked. I have emphasised the importance of validating all waiting list figures to ensure they present an accurate picture of the situation. It would be very irresponsible to publish waiting list figures before they have been properly validated. I assure the House that the waiting list figures for the quarter ending 31 March will be released as soon as a validated set is available. There is absolutely no question of delaying their publication in any way. The attention to detail on the production of validated and accurate waiting list information has always been a necessary feature of the waiting list initiative, under each successive Government, since it started in 1993.

On taking up office I was very concerned that there would be imbalances between services in different parts of the country, particularly in relation to hospital services. The Government is very conscious of the need to achieve regional self sufficiency in the specialties where it is possible to do so with high quality facilities. This is in keeping with the principles of the national health strategy. The Government's actions bear out its commitments in this regard. For example, I have proceeded with the implementation of the national cancer strategy which has as one of its main aims the provision of consultant oncology and haematology services in appropriate areas throughout the country. I have also announced that a cardiovascular strategy will be prepared and work on it is already well under way. As a practical indication of the reduction in regional imbalances, I announced plans for the provision of cardiac surgery and radiotherapy in Galway. Similarly, the major capital projects at various stages of development in Galway, Castlebar, Mullingar, Tullamore and Roscommon are testament to the Government's commitment to developing services in a targeted way throughout the country.

A number of Deputies have accused the Government of failing the mental handicap sector. I immediately refute these accusations. The moneys available to this sector in 1998, a sum of £16 million, are equivalent to the investment made in 1997 by the previous Government. However, the 1997 figure was the largest given by that Government during its term. I have matched this figure in my first year.

In addition, for the first time, I have agreed a major capital programme of £30 million for mental handicap services to be invested over the next four years. This is the first time there has been a multi-annual capital programme specifically for mental handicap services. The £5.25 million capital funding provided this year is the beginning of the programme of investment and will allow for the continued implementation of the assessment of needs report. By utilising all the resources available to me the mental handicap services can be assured that the facilities and support services required will be available.

The Minister of State at the Department of Health and Children, Deputy Moffat, last night set out the progress which has been achieved in relation to services for the elderly during the current year as part of a phased programme. Deputies will be aware of the increase in the population of older people, particularly the very elderly. Work has already begun in my Department on planning for the implications of the ageing of the population for our health services. Already bed utilisation problems are arising within our hospital system due to an inability to promptly discharge elderly patients from acute hospitals after appropriate treatment has been given. In dealing with the requirements of an ageing population one of my first areas of attention will be putting proper supports in place so that the elderly can be moved out of hospital to release beds for patients on waiting lists.

As I mentioned earlier, one of the priorities I had on taking up office was to commence the process of increasing the capital budget to a realistic level. It seems the last Government did not appreciate the importance of providing proper capital investment in our services. I am pleased to say I secured an increase of about 35 per cent in capital funding for the period 1998 to 2000 over the outlay for the previous three-year period when Fine Gael, the Labour Party and Democratic Left were in Government. The Exchequer capital allocation alone for 1998 is £147 million while £155 million and £165 million will be provided in the years 1999 and 2000 respectively. I am making every effort to further enhance the capital budget for 2001 and subsequent years in the context of future Estimates campaigns.

I am determined to ensure that the non-hospital sectors will get their fair share of available resources. The continuing care services, which cover areas such as psychiatry, mental and physical handicap, services for the elderly, etc., are in a process of change, the major change being the provision of community-based services as an alternative to institutional care. Evidence of this can be seen in the increase in the number of community residences, day hospitals, community nursing units, daycare centres and other community facilities which are being provided to replace services previously provided in institutional settings.

The motion before the House in the name of the Labour Party suggests that the present period of economic expansion should yield a dividend to the people in terms of increased investment in the public health system. There is some validity in this argument having regard to the substantial need for health services of which we are all aware. We have delivered on that commitment to a far greater extent than did the Labour Party when in Government.

Mr. Stagg

Rubbish.

Mr. Cowen

The Deputy was not present for the speech and so is unaware of what I have said.

Mr. Stagg

I was listening to the Minister.

Mr. Cowen

In that case the Deputy cannot add.

The Government recognises the pressing needs within the health services and the 1998 Vote provision makes a significant start in addressing these. Specifically, the funding provided allows us begin to implement the commitments contained in An Action Programme for the Millennium and to achieve the objectives set out in my Department's strategy statement, Working for Health and Well-Being.

I have a very clear view of what must be done to keep existing services up to the appropriate level of quality and the areas which must receive additional investment in the medium and long-term. The Government's strategy in relation to the health services is clearly thought out and will be backed up by the necessary resources. I therefore ask the House to endorse the Government's strategy as represented by our amendment to the Opposition motion.

Ms Cooper-Flynn

I welcome the opportunity to speak on the Government amendment to the motion put forward by the Labour Party. Everybody in the public domain would like to see much more money being spent on health services, especially at a time when the economy is booming. However, we must also recognise that the resources available are finite and that, despite the fact that we are living in very good economic times, to maintain economic growth we must mind public finances. In particular when looking at spending on health services we must be careful we are getting good value for money.

The Government in its programme is doing exactly what the Labour Party is suggesting, namely, spending more money on health services than was ever the case previously. There has been a 10 per cent increase in non-capital funding in 1998 over the 1997 figures. In addition, £3 billion is being provided in 1998 for non-capital funding of public health services. This represents £8.2 million per day, a very significant amount of money. The capital programme for health services has increased by 12 per cent on the 1997 figures. Furthermore, an additional £7 million has been invested in health services for older people. We must always look out for the elderly who have contributed so much to the economy. Four million pounds of non-capital money has been spent on subventions for older people in private nursing homes. The Government is clearly living up to its commitment to spend more money on health services, something we have never before seen.

The Labour Party motion speaks about increasing the number of hospital beds. In a modern health service we must regard this as a fairly simplistic way of working out whether our health services are adequate. It is far more appropriate and significant to look at the ability of a modern hospital to respond to the demand for daycare treatment which can be less costly than overnight treatment and care. Many more patients can be treated through day care services. We must also examine the proper use of outpatient departments, something that is vital in ensuring hospitals are responding effectively to genuine demand.

There must be a packet of initiatives directed towards lessening pressure on hospital beds, including the setting up of facilities for the elderly and chronically sick, developments to relieve pressure on accident and emergency departments of general hospitals and co-operation between local general practitioners and general hospitals in the continuing care of patients. We must also aim to reduce waiting lists and concentrate effort to ensure the general hospital programme, which consumes 50 per cent of the total health budget, delivers a cost effective service. Focusing on hospital beds, therefore, is a simplistic approach. In terms of standards we compare very favourably to those available internationally.

I compliment the Minister for Health and Children who is doing an excellent job, particularly in the Western Health Board area. He visited the constituency last week and County Mayo and the Western Health Board area will enjoy enhanced services in the years ahead. Some £7 million was provided specifically for the development of services for the elderly in the Western Health Board area. This is over and above general increases for pay, inflation and other increases not directly related to service provision.

This Government has provided £22 million for Phase 2 of Mayo General Hospital which will make the hospital one of the finest in the country. After Tallaght Hospital and St. James's Hospital, this represents one of the highest capital spends on an Irish hospital. I am delighted the hospital in based in Castlebar, County Mayo.

It would be very unfair for anyone to allege that this Government is not looking at the health services in a caring manner. The Minister for Health and Children will be seeking increased funding for the health services in the context of the multi-annual budget exercise covering the years 1999 to 2001. It is important to note that other Departments will also seek funding. However, I am confident that the Minister for Health and Children will be successful in his bid to obtain additional funding in this area. Costs arise in the health services due to pressures such as new technology, demographic factors, legislative obligations and so on. Funding is also required to meet the capital and revenue commitments contained in the programme for Government.

It will not be easy to secure this additional money but, with a committed Minister intent on improving our health services over the next five years, I assure the House this will happen while Fianna Fáil is in Government. I commend the Government amendment to the House and I wish to share my remaining time with my colleague, Deputy Roche.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Mr. Roche

I welcome this debate as it gives us the opportunity to put on record the Government's initiatives in this area. The Minister and the Minister of State pointed out last night that the Government has provided a 10 per cent increase in non-capital funding in the current year. The Minister also updated the House on other initiatives in health services. An additional 12 per cent was allocated to capital spending on health services, well in advance of the rate of inflation.

The total cost of the health services is massive; health services are a particular brand of public service to which the amount of funding allocated will never be sufficient. More than £3 billion in non-capital funding will be spent on public health services in 1998; that is a phenomenal figure by any standards although it is not to suggest that more money should not be spent. The reality is that health services are improving in leaps and bounds, not just because of the Minister's and Government's commitment but also because of commitments made by the previous Government. A real effort has been made in this area; when one considers that almost £8.2 million is being expended per day in this area, one gets some idea of the priority being accorded to it by Government.

In the years ahead, a more targeted approach must be adopted in regard to health services. By their very nature, modern health services are very costly and the more high tech the services, the more costly they will become. The Minister should examine aspects of the health services with a view to improving them and to targeting services which will deliver maximum benefits, not just from the point of view of the taxpayer, but also from the point of view of the community as a whole. Additional funds must be targeted in a way which will identify and address specific problems.

I wish to address the lacuna which currently exists within the GMS. Deputy Shortall and I both served on the Eastern Health Board and are aware of where the gaps in that service exist. In the years ahead, as funds are allocated, the GMS must be targeted both from the point of view of value for money and improving people's lives. The Minister could make an immediate and beneficial impact for the maximum number of people by introducing greater flexibility in regard to medical card eligibility. Notwithstanding the special arrangements and allowances made by chief executive officers, inflexibilities exist within the system in regard to the restrictive nature of eligibility, particularly at the margins. Where means testing and cut off points exist, hardship will inevitably occur.

We are all aware that families in which there is only one PAYE income earner can be dealt with particularly harshly as every penny of income can be means tested. I know the Minister has a personal interest in reviewing medical card eligibility. Low paid public service families, in particular, find themselves marginally outside eligibility levels and some relief must be introduced in that respect. Many such families deny themselves medical services until they reach a crisis and more expensive treatments are required.

I have particular sympathy with old age pensioners who have small occupational pensions. It is time we seriously considered the progressive extension of medical card cover to all old age pensioners. This would result in far greater yields than investment in technology as it would help old age pensioners to stay within their communities and overcome some of the crises they face. The Minister could, for example, agree to extend full GMS medical card cover to all pensioners over a particular age, for example 75 or 80 year olds. The State could then be committed to reducing the age for universal medical card eligibility on a year by year basis until medical cards would automatically become available to people on reaching pension age. There are strong and cogent reasons that would be beneficial. In the longer term, it would certainly help to overcome crises which arise because people deny themselves medical care because of their economic situations.

The Minister could also consider families struck by chronic illness. We are all aware of the 12 major illnesses which confer automatic medical card eligibility. I recently had the harrowing experience of witnessing the partner of a well-to-do constituent being struck down with MS. Over a protracted period, that family suffered a very real economic plight and a medical card was only granted towards the end of the illness. There should be a greater degree of flexibility in cases such as these.

There is a mounting crisis in regard to children suffering from asthma. Asthma is not recognised as a disorder which automatically entitles a child to medical card services, yet we are all aware that this disease can have an extraordinary impact on many families. Such families may deny themselves necessary medical care and the crisis may reach a point where institutional care is required, or where serious illness or even death occurs. We must consider this issue in the longer-term.

I have no doubt that the Government is as committed as any other group in this House to improving medical services. The Minister has adopted a very progressive attitude in this regard and figures show he is prepared to put his money where his mouth is. I do not blame the Opposition for tabling this motion, I would doubtless do likewise in their position. We are all committed to a medical service which the people of the State deserve. The medical services of the State are in sound hands at the moment. I support the Government amendment because I believe in it. I thank Deputy Cooper-Flynn for sharing her time with me and I thank the Minister for his initiatives to date, particularly in regard to the elderly. Ultimately we all hope to reach that status because the alternative is even less appealing. I commend what the Minister has done.

Ms McManus

I wish to share my time with Deputies Stagg, Penrose and Moynihan-Cronin.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Mr. Cowen

The merger is on.

Ms McManus

I welcome the motion and I congratulate Deputy Shortall, who is committed to improvements in the health care sector on her initiative in raising this vital issue.

Nothing defines the conservative nature of this Government better than its rigid refusal to live up to its commitment to deal with the plight of patients waiting for hospital procedures in public hospitals. These procedures are so essential that for some patients they are a matter of life and death. There are cost implications in dealing with waiting lists but if a Government cannot make the required changes now, one cannot envisage a time when a government will ever be able to act.

Some patients are dying as they wait in the queue. Others are undergoing pain and suffering and a reduced quality of life that is simply unacceptable. We do not need to be reminded by the Minister that this is not a new phenomenon which has appeared since this Government took office. However, we live in an extraordinary time when the Minister for Finance can reward the wealthy in the budget, when fortunes are made on every property deal and when prosperity is unprecedented for some.

It is hard to understand that in such a climate an elderly woman can be left disabled for months while she waits for a hip replacement, an old man cannot see properly because he is waiting for a cataract operation and a child fails to perform at school because he or she is waiting for a grommet operation. Over 30,000 patients are on hospital waiting lists at present. We do not know the exact figure. The Minister gave a stout defence of his position with regard to information on hospital waiting lists but one can only go so far in chasing supposed ghosts on the lists. It is time to publish them.

The central point is that if the people on hospital waiting lists had sufficient money, they could get the procedures they are waiting for without undue delay. However, because they are poor they are denied medical attention to the point where some of them might even die. It is deeply offensive that this should be so and that this situation is maintained at a time of plenty.

Fianna Fáil was quick enough to sense the public desire for action and it promised to tackle the waiting lists when in Government. However, now that it is in Government it has taken a U-turn on this promise. The Minister for Health and Children lacked the necessary leadership and determination to make radical changes in order to achieve significant improvements in this area. His defence is robust but the record is plain. The objective is clear to Members who are committed to radical change. It is outlined in the health strategy of 1994 which states that access to health care should be determined by actual need for services rather than the ability to pay or geographic location.

The means to reach that objective are also clear. First, a targeted waiting list initiative should be implemented in all important areas in the same way as the Minister has targeted the cardiac services, an initiative started by his predecessor. Other specialities must be resourced. Orthopaedic procedures such as hip replacement operations, ENT procedures for children and adults and opthalmology and cataract operations must be dealt with also.

Second, the issue of manpower must be addressed. Setting up another forum, as the Minister has, will not deal with the problems that exist in our public hospitals. There are too few consultants, their contracts are too loose and there are too many junior hospital doctors with not enough training to upgrade their status. What is needed is a modern specialist provided service, but what exists is an archaic consultant-led service which is incapable of meeting the central objective of the health strategy. The Tierney report has outlined what needs to be done and people such as Professor Muiris Fitzgerald and others have spelt out in detail the decisions that must be made.

The difficulty lies with the Government and the fact that there does not appear to be a genuine inclination to modernise our public hospital service or to make the decisions necessary to provide the conditions where doctors are appointed to specialist posts at an early enough age; where a high quality fast track specialist training programme provides the extra specialists that are needed; where the training authority is integrated; where female doctors, who now constitute the majority of medical graduates, are not lost to the service; where graduates do not leave the country in such numbers and where patients get the best possible treatment regardless of where they come from and whether they are public or private patients.

There are also problems in accident and emergency units. Not long ago a 93 year old man suffering from a stroke was left on a hospital trolley for 24 hours because he was not given a hospital bed. That indicates the seriousness of the problems. Manpower restructuring would assist in making accident and emergency units more efficient. There is a problem with turnover in manpower. If one goes to an out-patients clinic in the first week in July the profile of doctors, apart from the consultant, is changed and rarely does one encounter a doctor one has met previously. Doctors stay longer in the television series "ER" than in Irish accident and emergency units. The use of expensive equipment must be changed so that it is used more efficiently, if possible on a 24-hour basis. Bed blocking, where hospital beds are occupied inappropriately, must also be addressed.

These problems will not be solved overnight. However, the Minister has a responsibility to provide a well funded strategy — there is no way around the cost implications — to deal with one of the key priorities of this Government's programme, the waiting lists. The Minister referred to geographic imbalance and I welcome the fact that he is tackling that problem. There clearly is a requirement to reconfigure services to ensure that geographic handicap is tackled.

In essence, good management, courageous decisions, vision and foresight are required. When the Minister was appointed he had a reputation for determination and tenacity. Unfortunately, there is general disappointment that in office he has not made the expected significant impact. I accept the problems are not solely his responsibility and that he is dependent on others, particularly with regard to funding.

The Minister for Finance has clearly won the battle with regard to whatever ambitions the Minister for Health and Children had on taking office. Nevertheless, the latter has the responsibility of fighting his corner at Cabinet and he must accept that it is unacceptable, at a time of such prosperity, that so many poor people are condemned to waiting in growing desperation for proper hospital care.

The objective and the means are clear. They have been set out by people who were conscious of the inequities in our hospital service and who are committed — many are professionals within the health service — to providing the best possible care but are prevented from so doing because of a lack of political will to face up to issues such as manpower, bed blocking, the problems in accident and emergency units and geographic imbalance. These are the key elements that must be tackled in dealing with waiting lists, rather than relying on the desperate hope that half the people on the waiting lists are not real or are not really sick. They are sick and they require the Minister's attention.

I hope the Minister will accept the motion proposed by Deputy Shortall. It sets out what must be done if the problem of waiting lists is to be addressed.

Mr. Stagg

I welcome the opportunity to speak in this important debate but I am frightened by the attitude of the Minister to the proposals before the House. He does not appear to be aware of the crisis in the health service. I do not suggest the solution is easy but telling the House that everything is hunky dory is extremely dangerous and will make it difficult for the Minister to tackle the problem effectively.

The motion is designed to address the severe funding problems facing our health service. It is a constructive motion that proposes to establish clear targets for health spending as a proportion of GDP. The indexing of health spending will enable our health service to plan strategically for the needs of the future. At the moment this does not happen and it is a key problem with the operation of health services. A large section of our health service stumbles along from crisis to crisis. This cannot be allowed to continue. We must ensure that the benefits of economic growth are invested in our health service for the benefit of the community as a whole. We must also ensure that the increased funding this motion would direct towards our health budget is invested in a way that produces real benefits for patients and staff.

It is beyond doubt that a review of our funding for health services is urgently needed. For example, the two main general hospitals that serve the people of Kildare are starved of resources. The resulting waiting list crisis and overcrowding problems facing Naas General Hospital and the James Connolly Memorial Hospital in Blanchardstown are intolerable.

Mr. Cowen

Thanks to the Minister for Finance, Deputy McCreevy, a programme is now in place to deal with that matter.

Mr. Stagg

Yesterday a delegation from the Irish Hospital Consultants Association visited Naas General Hospital. They expressed their horror at the conditions they found there. They described the facilities in the hospital as Dickensian and their observations are a damning indictment of the funding system operated by the Department of Health and Children.

In 1996, the then Minister for Health, Deputy Noonan, announced a £20 million investment programme for the hospital, yet the people of Kildare still have to endure the appalling conditions that pertain in one of the main general hospitals that serves the area. The Minister should explain to this House why, given that £20 million had been approved for the hospital since 1996, no significant improvement in services to the public are visible. What action is the Minister taking to tackle the crisis affecting Naas General Hospital? Will he give a response to the comments of the delegation from the Irish Hospital Consultants Association? Will he give a commitment today to the people of my constituency and the people served by my colleague in Kildare South, Deputy Jack Wall, that he will take immediate action to resolve the problems and ensure the necessary funding to eliminate the horrific conditions, which staff and patients in the hospital have to endure, will be eliminated as a matter of urgency?

The problem facing James Connolly Memorial Hospital in Blanchardstown is equally grave. The catchment area for James Connolly Memorial Hospital is one of the fastest growing population areas in the country, taking in most of the large towns in north Kildare and many large population centres in Dublin West. There are thousands of young families in that area and the hospital cannot cope with the demand on its services. Patients have to endure appalling delays, overcrowded wards and an accident and emergency service that quite often cannot cope with the demands placed upon it. By the Minister's admission, it is likely to be the year 2002 before significant improvements in the capacity of the hospital will be seen by the staff and patients. In the intervening period the erratic level of service will continue.

These are just two examples of the pressure on health services affecting the people of Kildare. Deputies from all constituencies can cite similar examples of serious health service deficiencies in their areas. It is clear that our present health budget is insufficient to cope with the demands placed upon it. I appreciate there has been an increase in spending, but it is not sufficient. More funding is needed. I do not accept that the provision of extra beds — it is demonstrably clear they are needed — is bad use of money, as Deputy Flynn seemed to indicate.

The intent of this motion is not just to highlight deficiencies. It also proposes a system of funding that will resolve these major deficiencies by proposing a system of multi-annual budgeting, linked to a measurable figure of economic growth throughout the State. A funding system such as this allows for strategic planning of our health services within a proper budgetary framework. The motion would also enable transparent and measurable targets to be established. This would not only assist in the administration of our health system but it would also introduce a level of democratic accountability that is currently absent from our system. The complex system of health administration mitigates against real transparency and accountability. The layers of administration and red tape in the Department of Health and Children, the various health boards, independent hospitals and State-assisted voluntary organisations prevents many ordinary citizens from understanding the organisation and delivery of our health services and where responsibility lies for policy and administration in each area. By establishing measurable targets, ordinary citizens will be able to judge the performance of individual Ministers in enhancing our health services over a sustained period.

I strongly recommend this motion to the House. It has not been placed before the House in a belligerent or obstructive fashion. My colleague, Deputy Shortall, has been eager to avoid political point-scoring in this debate and I commend her on her approach. Deputy Shortall, in common with all members of the Labour Party, has a passionate political desire to improve the health services available to citizens. The Labour Party believes the State is the only appropriate vehicle to deliver a comprehensive health care system to the citizens. This must be a priority for the State. This motion underscores that principle and provides an open and transparent way for successive administrations to achieve this goal. I urge the House to support the motion.

Mrs. B. Moynihan-Cronin

I welcome the opportunity to contribute to this important debate. Every day of the week I deal with a huge number of complaints from constituents about lengthy delays they experience within the health system. The position is so bad in the Southern Health Board region that last Monday the chairperson and chief executive officer of the health board met Oireachtas Members from Kerry to highlight the chronic difficulties being experienced at present. They also met Members from Cork and requested an urgent meeting with the Minister to outline the problems.

The Southern Health Board seems to be penalised because it is a prudent manager of the funding it receives. It should be complimented for working under such severe pressure. That health board was led to believe that if it managed its budget well, increased funding would be made available to it, but that did not materialise. Morale among the staff is very low. It is unacceptable the Southern Health Board does not receive a fair crack of the whip. The CT scanner in Cork University Hospital was mentioned. It is outrageous that it has broken down on six occasions in the past four months, necessitating very ill patients to be transferred to the Mercy Hospital. That has resulted in delays in reaching diagnoses and extra expense on the health board.

Waiting lists in Tralee Regional Hospital are at an unacceptable level. Approximately 260 women have to wait for up to a year for treatment in the gynaecological section. There are approximately 2,700 people on the waiting list for ENT referrals.

There are up to 400 children awaiting appointment to see a paediatrician. Those children will have to wait a further year before treatment is available to them. In excess of 400 children from County Kerry are awaiting speech therapy and they will have to wait for a further 18 months. By the time those children receive therapy it will be too late. There are more than 600 children in Kerry awaiting orthodontic treatment following assessment.

Another issue which concerns me is the treatment of home helps in the Southern Health Bord area. Because of lack of funding those people receive the lowest rate of pay in the country at £1.70 per hour — that will be increased to £2 in July. In other health boards the rate is £3.50 to £4 per hour. Is the work carried out by home helps in Kerry and Cork worth less than that in other parts of the country? The low rate of pay undermines the valuable work performed by those people and makes it very difficult for families to find people willing to work as home helps. It is a credit to the 2,000 home helps in the Southern Health Board area that, despite the extremely low rate of pay, they provide a very good quality service. Many of those wonderful people go beyond the call of duty and work longer hours than those for which they are paid.

The Minister should immediately proceed with plans to investigate the operation of home help services throughout the country and put in place structures to provide more reasonable pay and conditions in all health board areas. If families cannot get home help, a larger number of people will have to go into long stay care, at greater expense to the Department of Health and Children.

The Kerry Rape Crisis Centre is experiencing great difficulties because of lack of funding. I implore the Minister to make £20,000 available to enable the centre continue its wonderful work. Like all other rape crisis centres, it offers a very professional service and the commitment shown by all its staff is commendable. Its work is of the highest quality. If the health board were to deliver such a service, the current grant available to the Kerry Rape Crisis Centre would cover the cost of employing only two counsellors. Under its current budget, the health board would simply not be able to deliver the range of services offered by the centre.

Unless the centre receives additional funding in the near future, it will have to shed two staff members, open for shorter periods and will not be in a position to accept new referrals. It received ten new referrals in one week last month. Due to the lack of staff at the centre it will not be in a position to carry out some of its vital work. For example, it will not be able to accompany clients to court, a service which makes a major difference to victims. The majority of people who use the service are women and children who do not have a voice. It is incumbent on me as a public representative from Kerry to ensure this much needed service is kept at its current level. I implore the Minister to make that money available to the centre.

If I had more time to speak I would outline many other areas of need, but I am sure the Minister is well aware of the chronic circumstances. I sincerely hope these issues will be addressed as a matter of urgency. I commend the motion to the House.

Mr. Penrose

I welcome the opportunity to speak on my party's motion on health spending. I have always believed a nation can be judged on how it caters for the elderly, the sick and the handicapped. We have an obligation now more than ever to ensure the fruits of our economic boom filter through to all sections of the community.

In doing so, primary services such as health must be improved to a standard which means people do not have to wait and suffer before their needs are tended to. Quality health care services are the key to the development of an economy. Unless we can deliver basic health services to all who require them, we have not reached a satisfactory state of development and all the talk about the Celtic tiger is meaningless guff.

Social partnership lies at the root of our economic success. To achieve this success workers, in particular, have made major sacrifices. In return — most notably in the tax reforms delivered in the December budget — these people have not benefited proportionately. It is time to deliver on the principles of Partnership 2000. If we are to achieve social inclusion and equality in our society, basic vital services like health care must be accessible to everyone and not to the cheque book brigade. There is no doubt we have a twotier health service. In the 1960s my family valued the medical card because it provided access to many places. A medical card no longer guarantees a bed in a hospital for a hip replacement operation, one must go on a waiting list. However, if one can produce £5,000, one will have access to the services within a few weeks. A person from Kilbeggan waiting for a hip replacement operation brought this to my attention last week. How can we stand over that type of service? Even if I were in Government I would suggest that we cannot plough enough money into the health services to ensure equality of access for our people.

The Government must change its policy of spending money where it is least needed and start building the foundations for a truly inclusive society. Our economic growth means nothing to the ill person who is turned away from hospital because of the lack of a bed in a casualty ward or inability to pay for a hip operation. What does it mean to the elderly person who cannot afford home care or secure a place in a nursing home due to a lack of space? What does it mean to the hundreds of people who are waiting for organ transplants or the 1,000 or more waiting for cardiac surgery? Many of these people come from a background like mine where there were no silver spoons. People do not mind waiting, but they should not have to wait for more than 12 months.

The Minister is very familiar with the Midland Health Board area. As a recent patient in Mullingar hospital, I express my gratitude to the staff in casualty, the ward service, the professionals, nurses and attendants for their professionalism and kindness. However, there was an obvious lack of nursing staff in the hospital. A submission in this regard was made to the Midland Health Board by the Irish Nurses' Organisation some months ago, but nothing happened. I accept the Minister provided a sum of £1.5 million, but he knows £3 million was required. All developments have been postponed until September. As some 2,000 patients pass through the accident and emergency service on a monthly basis, more staff must be provided. I ask the Minister to intervene directly with the Midland Health Board to ensure it considers the recent submission received from the hospital.

We made a small change to the medical card system, but it was not enough. Eligibility should be determined on the basis of net income. Illnesses such as asthma and ME should be included on the list of long-term illnesses. I lost an uncle and aunt from asthma, which is a serious illness. Coming from a family with a history of asthma and bronchitis, I get extremely angry when I hear professionals claim asthma is not a long-term illness. Perhaps those professionals should talk to people who have lost loved ones or suffer from asthma.

When will the Minister be in a position to approve the necessary funding for the pathology services plan approved by the Midland Health Board at its April meeting? This service would bring major improvements to all three hospitals in the midlands region, with microbiology being centred in Portlaoise, histopathology with fine needle aspination cytology in Tullamore and haematology in Mullingar. Obviously, the principal function of the haematology unit will be a laboratory to guarantee the use of blood products to the highest level for all patients in the midland area, irrespective of which hospital they attend. The same should apply in respect of the other services. In light of the major laboratory needs in the midlands, I urge the Minister to press ahead as a matter of urgency to develop these units in Tullamore, Mullingar and Portlaoise.

When will the Minister give approval to proceed with phase 2B of Longford-Westmeath general hospital in Mullingar, bearing in mind that it has already been shelled out in conjunction with phase 2A? Phase 2B will increase the number of medical beds in the hospital which are urgently needed because the old nightingale wards are less than satisfactory areas for patient care. Those wards do not afford patients any degree of privacy, particularly where extra beds have to be put in place on a regular basis. Phase 2B will also mean replacement of the current theatre block which, while it has been well maintained over the years, is moving rapidly to obsolescence.

The Minister set up a commission some time ago to examine the implementation of orthodontic services. I would not need much time to outline the problems to him. It is ridiculous that, because a young child has a growth in the mouth that is less than a millimetre outside limits set back in the early 1980s, the child is deprived of a service. People have had to borrow £1,500 or more from the credit unions to have their children treated. I know the Minister has a strong commitment to the health service and I implore him to bring the report forward as quickly as possible. I commend my colleague for tabling this motion. If I became somewhat emotional about the asthma issue it was because of personal circumstances.

Minister of State at the Department of Health and Children (Mr. Fahey)

I thank all of the Deputies who participated in this debate. The discussion has been wide ranging and the number of issues raised clearly shows how central the health services are to the lives of all of our constituents. I share the view put forward by many speakers that, where we are in a position to provide resources for improved public services, there is no more deserving area than our health services.

In line with this thinking, the Government has already provided significant increased funding for the health services. The net non-capital provision for health in 1998 shows a 10 per cent increase over and above the 1997 outturn. The capital allocation which has been agreed on a multi-annual basis shows an increase of about 35 per cent for the period 1998 to 2000 over the outcome for the previous three year period.

In my role as Minister of State with special responsibility for children I would like to summarise briefly the developments which have taken place and are being proposed in this important area. As Deputies will be aware, since 1993 and up to the end of 1997 an additional £43.5 million on an annualised basis has been invested in the development of child care and family support services. In 1998, an additional £8 million has been made available for the child care area together with £5 million for capital purposes. This is a significant level of investment which will allow for the further development of our child care services.

The question of resources is central and my Department is currently negotiating with the Department of Finance on the Estimates for the period 1999-2001 with a view to ensuring that child care provision is properly funded.

One of the difficulties I encountered when I took up my present responsibilities was that the child care policy unit of my Department, which plays a central role in driving policy developments in the health service, was totally under resourced. I dealt with this issue and I have secured the agreement of the Minister for Finance to the creation of an additional 16 posts in this area. This is in addition to the existing 11 posts.

The increase in staff will allow for rapid progress in implementing commitments in the Government programme as well as in other significant areas. One of these is the proposed social services inspectorate. My Department is now in a position to commence recruitment for this inspectorate which will play a central role in monitoring the standard of our child care services.

There are specific commitments relating to children in the programme for Government, An Action Programme for the Millennium and these are being implemented. In particular, the Children Bill, 1996, has been restored to the Order Paper and the Government amendments are currently being finalised.

The Government is committed to bringing forward proposals for the mandatory reporting of child abuse within the lifetime of the present Dáil and, as a preliminary measure, a White Paper is being prepared on this complex issue. Services to address child begging, child homelessness and child prostitution are being improved. The problem is particularly acute in the Eastern Health Board area and this is where resources are being concentrated.

Other issues will also be addressed now that I have the additional staff required. Generally, we must recognise that our child care services have made huge strides since implementation of the Child Care Act, 1991 commenced and, while much remains to be done, we owe it to those involved in the delivery of services to acknowledge the progress and to recognise the achievements. Criticism for the sake of criticism is sterile and unproductive and it benefits nobody. I regret the contributions of some Deputies yesterday fell into that trap.

I will refer to the specifics of the Labour Party motion. It seeks to commit the Government to setting a target figure for public health expenditure as a percentage of gross domestic product. I do not remember Labour having put forward this suggestion when last in Government. I was interested to see if during this debate it would specify what percentage it considers to be appropriate. While I held out little hope, I would have been even more interested to hear its proposals for funding any increase required. In any event, while there is a need for measured increases in the health budget, I consider this proposal to be overly crude.

The relationship between national income and health expenditure is but one of the factors which explain levels of health expenditure in different countries. We should be wary of creating an artificial link which is of little use in planning over the medium term. The health problems we are faced with and the availability of cost-effective responses to these should be the starting point in debates about resource allocation. For example, work has already begun in my Department on the implications for our services of the ageing of the population. The development of clearly thought out strategies for tackling such issues based on the cost-effective provision of services allows us to decide on priorities and allocate resources accordingly.

The Minister for Health and Children, Deputy Cowen, and the Minister of State, Deputy Moffatt, are taking a particular interest in a major move forward in the area of strategies for the elderly.

Mr. U. Burke

I wish to share my time with Deputy Shortall and I thank the Labour Party for allowing me to contribute at this time. I have raised the issue of home helps before in the House. Last February the Minister of State, Deputy Moffatt replied to my question and said he hoped that by now we would have doubled the payment rate per hour for home helps within the Western Health Board's area. That has not happened. The 24p per hour increase is an insult to those who do valuable work. I thought home helps were badly paid in the Western Health Board's area but when I heard Deputy Moynihan's statement I realised that it was not confined to that area.

The Minister's officials should examine the work being done nationwide by home helps. They should see the money that is saved by these people who visit the homes of friends and neighbours in need on a casual basis. Such people are paid for one hour — or two hours if the health boards are being over generous — per day to enable elderly people to live at home. People should realise that the Government, health boards and taxpayers are making massive savings through the work of home helps.

If these people received an allowance of £4 to £5 we would have a far better health care service for the elderly in their own homes. Disabled pensioners are entitled to that.

I also wish to highlight the schools dental service in the Western Health Board area. The Loughrea area was without a schools dental service for two years because of the ill health of the previous holder of that post. After a long struggle, during which temporary appointments were made time and time again, a full time person was eventually appointed. However, that dental surgeon provided one day's service and was gone.

I do not know what must be done to attract people to provide a schools dental service in the Western Health Board area. Some urgent action must be taken to rectify that impossible situation. Children have gone without a school dental service for three years. Who will take the responsibility for the damage that has been done in that period? I plead with the Minister to do something about this situation.

While the Opposition benches highlighted the negative aspects, I acknowledge the improvements, particularly in relation to University College Hospital, Galway. This is a major hospital in the west and it is important that essential specialised services are fully developed there so that people do not have to be transported to Dublin.

Ms Shortall

I thank all Deputies who contributed to this important debate. Last night I moved a motion on our health services on behalf of the Labour Party. The motion identified some of the huge unmet needs across various health areas. It referred to our low level of spending on health compared to other OECD countries and called on the Government to set new targets for spending which would correspond with our new found increased economic wealth. The Minister of State at the Department of Health and Children, Deputy Fahy, made derogatory remarks about the motion and asked why we had suddenly decided to move it now.

The emphasis in the past few years has been on developing our economy and we have had great success in that regard. Having generated such wealth in the country, we now need to consider making serious efforts to develop our society. There is no feel good factor from our booming economy because there are so many gaps in our society. We should look at where we are going as a society and try to have a yardstick to measure the spending required in different areas. For that reason, I suggest that we link our spending in health to the OECD figures and that we measure ourselves against the amount spent in other countries to reach an OECD average.

The Minister of State, Deputy Fahy, also asked how these measures would be funded. Decisions on funding and spending are taken by Government at budget time. Unfortunately, many of the decisions taken in the last budget were bad for our society. Many of the choices made by the Government on how to spend money were bad because they put money back into the pockets of people who did not need it. Money was not spent where it was most needed and the Government avoided making the necessary choices to improve our health services.

The Government has responded with a meaningless and self-congratulatory amendment which completely fails to address the issues raised. The purpose of the motion was not to slate the Government but to raise issues of genuine public concern and to look at what we can do about them. Perhaps the Minister, Deputy Cowen, has difficulty accepting that some people are interested in having mature debate in this House. He seems incapable of addressing issues in an open manner. He is defensive about his own position and trots out various things he has done without looking at the core issue of how to link spending in health to our economic growth so that our health services are not ignored, regardless of what Administration is in power.

This motion seeks to address the problems people face while they are waiting in hospital corridors, in doctors' surgeries and on treatment waiting lists or those faced by people who are isolated in their homes because they are denied access to health services. No Deputy can claim to be unaware of these serious difficulties and the human costs involved. We need a funding framework to ensure these problems are tackled effectively.

Our health system is in dire need of investment. There are 32,000 people on hospital waiting lists, several hundred elderly people are misplaced in acute hospital beds who should have nursing home care, over 3,000 mentally handicapped people are without a place and countless children at risk of abuse or neglect are without any service. The message being sent to the vulnerable and weak is that there is no place for them in our society. No matter how we try to put a gloss on our response by using the language of caring, we have been remiss in the practicalities of caring for our most vulnerable people. The inclusiveness we readily advocate when we talk of bonding communities in Northern Ireland is lost when it comes to looking after the ill, the disabled or the elderly in our community.

The Government has tabled an amendment which means nothing other than the maintenance of the status quo. No one will get to the treatment table any quicker and children at risk will not see a social worker a day earlier. All is fine in the Department of Health and Children as long as “we are beginning to converge towards international averages”. We are coming from the wrong end and we are not getting there fast enough.

At a time of unprecedented wealth, it is indefensible on social and moral grounds that our health services are desperately inadequate. The Minister of State at the Department of Health and Children, Deputy Moffatt, used some familiar excuses yesterday evening. He said that in countries with historically low GNP, health spending was low in tandem. Yet at a time when our GNP has dramatically improved, the OECD has found that the share of GNP devoted to health in this country has gone from one of the highest to one of the lowest at approximately 7 per cent.

In its amendment the Government refers to its commitments in An Action Plan for the Millennium. However, when it comes to establishing the funding framework to meet these commitments, the Government stops short. The most important commitment it can give is a commitment to provide the necessary resources. Money and mouth are easily separated.

The Labour Party is not saying we should fix health spending to GDP just for the sake of it. The purpose of the motion is to impress upon the Government the absolute need to prioritise health as an important aim of Government and to provide it with some form of dedicated means. Lack of dedication is essentially what is wrong with our health service. Our commitment to health spending is conditional each year on the prevailing generosity of the Minister for Health and Children. In other words, there is little relationship between what is allocated and what is needed.

This motion seeks two commitments from the Government. The first is to set a target for itself to spend a set proportion of GDP on health annually and the second is to target spending in those areas of chronic need so that they are brought up to a basic level. The Labour Party has identified five key areas which need Government support and where lack of funding has created enormous hardship. We agree with the Minister that there must be a relationship between spending and the amount of overall funds available in every health care system. Making a link with GDP conforms perfectly to that principle. If the economy is buoyant, as it is at present, that buoyancy should be reflected in improved health investment.

It is essential that as well as auditing our finances we start to audit our needs. The needs in health are great. The mentally handicapped need £63 million for the provision of adequate services. The many people on waiting lists need treatment. The child care service needs to be properly resourced — the Minister has already accepted that £100 million is needed in that area — and various other needs have been listed here during this debate.

The purpose of this motion is to improve the health services. The assumption underlying it is that to do so will require a considerable increase in investment. However, problems exist in ensuring there is a long-term commitment to the health service. One way of ensuring an ongoing commitment is to link health spending to GDP so that our increased wealth, in turn, can bring increased social benefit. I urge the House to support the motion.

Amendment put.

The Dáil divided: Tá, 63; Níl, 55.

Tá

• Ahern, Dermot.
• Ahern, Michael.
• Ahern, Noel.
• Ardagh, Seán.
• Aylward, Liam.
• Blaney, Harry.
• Brady, Johnny.
• Brady, Martin.
• Brennan, Matt. Briscoe, Ben.
• Dennehy, John.
• Doherty, Seán.
• Ellis, John.
• Fahey, Frank.
• Fleming, Seán.
• Flood, Chris.
• Foley, Denis.
• Fox, Mildred.
• Hanafin, Mary.
• Haughey, Seán.
• Healy-Rae, Jackie.
• Jacob, Joe.
• Kelleher, Billy.
• Kenneally, Brendan.
• Killeen, Tony.
• Kirk, Séamus.
• Kitt, Michael.
• Kitt, Tom.
• Lawlor, Liam.
• Lenihan, Brian.
• Lenihan, Conor.
• Browne, John (Wexford).
• Byrne, Hugh.
• Carey, Pat.
• Collins, Michael.
• Cooper-Flynn, Beverley.
• Coughlan, Mary.
• Cowen, Brian.
• Cullen, Martin.
• Davern, Noel. Dempsey, Noel.
• McGuinness, John.
• Moffatt, Thomas.
• Molloy, Robert.
• Moloney, John.
• Moynihan, Donal.
• Moynihan, Michael.
• O'Dea, Willie.
• O'Donnell, Liz.
• O'Flynn, Noel.
• O'Hanlon, Rory.
• O'Keeffe, Batt.
• O'Kennedy, Michael.
• Power, Seán.
• Roche, Dick.
• Ryan, Eoin.
• Smith, Brendan.
• Smith, Michael.
• Treacy, Noel.
• Wade, Eddie.
• Wallace, Dan.
• Wallace, Mary.
• Woods, Michael.

Níl

• Allen, Bernard.
• Barnes, Monica.
• Barrett, Seán.
• Bell, Michael.
• Belton, Louis.
• Boylan, Andrew.
• Bradford, Paul.
• Broughan, Thomas.
• Browne, John (Carlow-Kilkenny).
• Bruton, Richard.
• Burke, Liam.
• Burke, Ulick.
• Carey, Donal.
• Clune, Deirdre.
• Connaughton, Paul.
• Cosgrave, Michael.
• Crawford, Seymour.
• Creed, Michael.
• Currie, Austin.
• De Rossa, Proinsias.
• Deenihan, Jimmy.
• Dukes, Alan.
• Durkan, Bernard.
• Farrelly, John.
• Ferris, Michael.
• Finucane, Michael.
• Fitzgerald, Frances.
• Hayes, Brian.
• Higgins, Jim.
• Higgins, Michael.
• McCormack, Pádraic.
• McDowell, Derek.
• McGinley, Dinny.
• Mitchell, Jim.
• Mitchell, Olivia.
• Moynihan-Cronin, Breeda.
• Naughten, Denis.
• Neville, Dan.
• Noonan, Michael.
• O'Shea, Brian.
• O'Sullivan, Jan.
• Owen, Nora.
• Penrose, William.
• Perry, John.
• Ring, Michael.
• Ryan, Seán.
• Sargent, Trevor.
• Shatter, Alan.
• Sheehan, Patrick.
• Shortall, Róisín.
• Spring, Dick.
• Stagg, Emmet.
• Stanton, David.
• Timmins, Billy.
• Wall, Jack.

Tellers: Tá, Deputies D. Ahern and Power; Níl, Deputies Stagg and Barrett.

Amendment declared carried.

Question, "That the motion, as amended, be agreed to", put and declared carried.