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Dáil Éireann debate -
Wednesday, 14 Oct 1998

Vol. 495 No. 2

Private Members' Business. - Hospital Waiting Lists: Motion (Resumed).

The following motion was moved by Deputy Shatter on Tuesday, 13 October 1998:
That Dáil Éireann deplores the scandalous increase in the hospital waiting lists, which on 30 June 1998 stood at 34,331 an increase of over 13 per cent since this Government took office, and the failure of the Minister for Health and Children to implement the broad range of reforms necessary to end the waiting lists crisis.
Debate resumed on amendment No. 1:
To delete all words after "That" and substitute the following:
"Dáil Éireann
(1) commends the Minister for Health and Children for allocating £12 million in 1998 to deal with waiting lists, which represents a 50 per cent increase in the sum allocated by the previous Government in 1997 as an important initial step towards implementing a comprehensive programme to address the issue, commencing immediately,
(2) notes that the Minister for Health and Children has undertaken the first ever formal analysis of the underlying causes of waiting lists and waiting times which enables a comprehensive overview of the needs of the health care system towards addressing the issue, and
(3) endorses his on-going strategy of dealing with waiting lists and waiting times in a structured, co-ordinated and multi-disciplinary manner, involving all components of the health care system."
—(Minister for Health and Children).

The Labour Party was in possession and it has ten minutes remaining.

I welcome the opportunity to speak on this important motion which sets out the scandalous position which now pertains in relation to hospital waiting lists. This is a subject which impacts in some way upon every citizen of the State. It impacts on the midland region from where I come and I will illustrate the significance and depth of the problem with figures.

It has always been my dearest and long-held wish that the fruits of our economic prosperity would filter through to all sections of the community and not just be the preserve of the few who appear to get wealthier, thus accentuating the gap between those who have and those who have not. It is my strong view that this House has a clear obligation and onus to pursue policy decisions which ensure basic vital services, such as health care, are accessible to everyone regardless of the size of one's bank balance. Such a fundamental and important service as the health service must be improved to a standard that people do not have to wait and suffer before their needs are attended to.

The hallmark of a compassionate, caring society is measured by how we treat the elderly, the sick and the handicapped. In any objective test it is clear that we have failed miserably in this regard. It is clear there is a two tier health service.

The Government must change its policy of spending money where it is least needed and start building the foundations of a truly inclusive society. Economic growth means nothing to the person who is extremely ill, who is turned away from a hospital or is left on a hospital trolley because of shortage of beds in a casualty ward. Nor indeed does it mean anything to the elderly person who cannot afford home care and cannot access a place in a nursing home because of lack of space. What about the hundreds of people who are waiting on a call for a heart or other organ transplant? This economic boom means nothing to them. No matter how much extra money is put in their pocket, unless they are given that vital operation their life chances are left to dwindle away.

People ask where will one get the money for the services. That is always the bottom line — it comes down to money. When the matter of health is involved, money should not be an issue. We should order our affairs in such a way that people who are very well off do not have their capital gains tax bill slashed by 50 per cent, from 40 to 20 per cent, leaving those persons better off. These people can already afford to travel around the world to avail of procedures which might not be available in this country. At the same time we say that we cannot provide enough for health care. What good is satisfying every economic criteria which is dictated to us by outside bodies if we have people who are not cared for properly?

With regard to the waiting lists, we now know the demographic trends in Ireland. The elderly population is increasing. Therefore, we need more funds to ensure that an adequate service is provided. That is an unmistakable fact.

The waiting lists are getting larger. There were 142 people waiting for procedures at Mullingar General Hospital, as outlined in the Minister's answer to a parliamentary question, at the end of June or the beginning of July — that figure had risen from about 81 the previous year. That is a huge increase, even if we are talking about a specialised service.

To look at other areas, ENT procedures for the midland health board area are done in Tullamore. There are 559 children waiting for ENT procedures. Governments have dealt with such issues by handing them over to committees or review groups and waiting to see whether they come up with an inclusive solution which will not cost too much money. There is no need for a committee to tell the Minister what is wrong with the orthodontic service. There are people on invalidity pension, disability benefit and unemployment assistance who have to borrow £1,500 or £2,000 to get a child's teeth looked after because the outcrop is less than 9 millimetres. If it is 8.5 millimetres, it will not be funded by the State. Is it not time we eliminated such a restriction? This is a problem that arises every day of the week and we should find a solution to it. Those parameters for eligibility for orthodontic service have not been changed since the late 1970s or early 1980s.

A review group has been looking at the matter for the best part of 12 months but it still has not reported. The Minister should ask any mother or father what is the solution and he or she will tell him quickly. If he goes to the principal orthodontic or dental surgeon in any of the health board areas, he or she will tell him that the problem is a lack of finance. No matter how good a case the Minister makes, they will tell him that they need more resources.

The waiting lists are actually much longer than they seem. If everybody who needed treatments such as orthodontic treatment were included, the lists would be colossal. We fob people off by creating an artificial cut-off point for eligibility. When a person on social welfare must borrow £1,500 or £2,000 to look after a child's teeth, who are we codding? We hear meaningless guff about the Celtic tiger while half the people who should be eligible for treatment are excluded.

The issue of hip operations, for example, is one which arises time and again at every Deputy's clinic. When Deputy Howlin was Minister for Health and Children, he tackled the root of this problem. It is a matter of providing resources. There are not enough consultants to carry out the operations here, but Deputy Howlin showed what could be done. There is no excuse. People should not have to wait more than six months on a waiting list for an operation. The fact that such people are on medical cards shows the unfairness of the system. Some people have to wait 15 to 18 months for an operation. I know of people on medical cards who have been waiting a long time and it is a disgrace.

All of the health services are being affected by this backlog and patients across the country are suffering as a result. We are developing a two tier medical system, where those who cannot afford private insurance are being forced to wait longer for vital operations such as heart surgery.

There are figures from the Revenue Commissioners to show record tax receipts which have boosted the Exchequer to unprecedented levels. There is palpable anger among the general public that, despite strong Exchequer returns, hospital and health boards are required to streamline their operations in order to save money. For too long interminable waiting lists and inadequate budgets have plagued the health services. The strong economic performance means we have the material resources to invest in the health services and transform health care in Ireland once and for all. We should stop paying lip service to the problem and ensure the necessary resources are allocated.

I want to share my time with Deputies Hanafin, McGuinness, Daly, O'Flynn and Moynihan.

I am delighted to address this important issue. I agree with some of what Deputy Penrose said. When Fianna Fáil and Labour were in Government an initiative was taken which put £20 million into tackling the waiting lists in the first year and £10 million in the second year. There was an improvement and the numbers on the waiting lists fell from approximately 40,000 to approximately 24,000. However, the Fine Gael, Labour and Democratic Left Government took its eye off the ball on this issue. Perhaps it thought it would go away, but that is not what happened because there was a 33 per cent increase in the number of people on the waiting lists.

We should not blame each other on this. It has not been nor will it ever be a simple issue. It will not be solved in the long-term solely by throwing money at it. A Leas-Cheann Comhairle, you did a lot of good work as Minister for Health, which unfortunately was not appreciated at the time, and you created a basis for a great improvement in the health service when money was available.

We must look at this problem in its totality. Everybody wants a good health service. We all want to feel that if our families or friends are sick there will be a health service to deal with problems that arise. It should not be used as a political football. Waiting lists are a problem in practically all countries. The Minister referred to waiting times, which have decreased in cardiac and general surgery and in other areas. We should recognise that positive development.

There are reasons for the increase in the numbers on waiting lists in recent years and it is not simply a question of money because funding has increased since the Government took office. The population has increased by 150,000 and we have an older population with greater needs. The Minister referred to a recent survey which indicates that 3.5 per cent of all acute hospital in-patient beds were occupied by patients who, through no fault of their own, should not be there. If that was addressed 150,000 bed days per year would be freed, which would improve the situation. There are other reasons for the increases, including breakthroughs in medicine and treatment which have increased demand in hospitals.

The Minister's job is to address this issue in the most comprehensive way he can and I believe he is doing so. He is working on the waiting list initiative, which was introduced many years ago and which has proven to be a success. He has also increased the spending of the previous Government and he has established a review group on the waiting lists, comprising people at the coal face and officials from the Department. They have produced good initiatives and I hope and am confident the Minister will implement many of them over the coming period and in the budget.

The review group has made a couple of critical recommendations. In its long-term objectives from 1999 to 2001 it has focused primarily on freeing acute hospital beds. Its recommendations include the development of geriatric day hospitals and rehabilitation facilities on the site of acute hospitals and the development of a planned programme of investment in appropriate facilities for those in need of long-term care. It has also recommended that the provision of stand alone day surgery units on the site of acute hospitals for acute patients should be examined closely. It has proven to be very popular in the US. The review group goes on to say the question of providing additional hospitals and other short-term accommodation for patients who do not otherwise need to stay overnight in an acute bed should be pursued as a means of reducing unnecessary hospital stays.

I am confident the Minister will address this in a comprehensive way which will, I hope, ensure that once it is resolved now and in the coming year it will not re-emerge in a few years. The problem cannot be resolved by throwing money at it. The situation is far more complex, nevertheless, I am confident the Minister and the Minister of State, Deputy Moffatt, will tackle it.

The success of the health service depends on co-operation at local level. In areas like the size of the city of Dublin, where demand for services is great, it is essential we have an integrated hospital system where hospitals can work in conjunction with each other to alleviate pressure and to reduce waiting lists and waiting times.

The area of south east Dublin is particularly well served by excellent hospitals, such as St. Vincent's Hospital, the Blackrock Clinic, Loughlins-town Hospital and St. Michael's Hospital in Dún Laoghaire. Given the co-operation between St. Michael's Hospital and St. Vincent's Hospital I am glad to say St. Michael's Hospital does not have a waiting list problem. This is a proud boast for a hospital which last year catered for 18,500 visits to out-patients, 29,000 in casualty, 24,000 X-rays, carried out 584,000 pathology tests and admitted 5,326 patients.

St. Michael's Hospital operates a 24 hour casualty department 365 days a year and is able to treat 98 per cent of its patients. The hospital is ideally situated, being in the centre of Dún Laoghaire. It is community based and has a long tradition of service, having been founded by the Sisters of Mercy in 1876, and has the ultimate in high standards.

A hospital like St. Michael's, which is an acute general hospital working in co-operation with the larger St. Vincent's Hospital, is the perfect example of an integrated service operating for the benefit of the community. The system which operates between them is an example for the rest of the country. Waiting lists are reduced at St. Vincent's Hospital because it can transfer to St. Michael's Hospital where the day wards and the five day wards are filling a particular need.

At present there are 25 young consultants who serve joint appointments with the two hospitals and this ensures that the best and the brightest are available to both. Given that St. Michael's Hospital is able to provide consultant services in specialist areas and at the same time provide day care and short stay care facilities it complements the work of St. Vincent's Hospital. It is essential, therefore, that this hospital be allowed to develop its services in line with the demands of its catch-ment area and in co-operation with St. Vincent's Hospital. Will the Minister, as part of his overall plan for the hospital services and as part of the waiting list initiative, support St. Michael's Hospital, Dún Laoghaire in its development control plan?

The development of out-patient facilities to include minor surgical and medical procedures in conjunction with the continuing of the day care and five day care facilities will help provide a much needed service and reduce waiting lists elsewhere. The provision of an up-to-date acute geriatric service to include the provision of an assessment facility and of a day hospital for the elderly would be of immense benefit to the local community and release the pressure on acute hospital beds. The remodernisation of the facilities will ensure the long-term future of the hospital offering the most expert services.

The way forward on waiting lists is to take a co-ordinated approach throughout the country between hospitals, all sectors of the health service and the community. In this context, St. Michael's Hospital, Dún Laoghaire provides the perfect model.

I commend the Minister and the Government for the allocation of £12 million in 1998 to deal with waiting lists at a national level. There is no sense in throwing money at this problem unless there is an analysis at national level of the various waiting lists throughout the hospitals to ascertain the origin of the problem and how it should be addressed.

In the South-Eastern Health Board area steps can be taken to ensure a greater and more efficient service to the community. For example, the Kilkenny Hospital programme is now in place and has been approved by the local authority and the health board. In reviewing the waiting lists in Kilkenny, which make up 666 in Kilcreen Hospital and 535 in St. Luke's, any blockages in the system preventing the implementation of the hospital plan by the health board should be removed immediately by the Department.

It would be no harm if the Minister was to take a hands-on approach to every health board. The situation in Kilkenny could be greatly improved if we were given permission to move ahead, develop St. Luke's Hospital and sell St. Canice's Hospital. This would create the necessary finance to develop the services in Kilkenny and the surrounding region.

There should be an investigation into the operation of the orthopaedic hospital in Kilkenny, which is located on a very valuable site on the outskirts of the city and which provides a wonderful service to Kilkenny and the region. It has been allowed to run down over the past 20 years and was not given money to develop or maintain itself. Only recently it was allocated £100,000 for a maintenance programme, which has not been embarked upon. The hospital had adequate time to close down over the summer and undertake the necessary work but that did not happen. Indeed, some of the operations at the hospital have been postponed and the waiting list has grown to 666.

I understand some scheduled operations have not taken place at that hospital. The necessary staff were in place and the theatres were in operation, but the consultants were not available. Why was that the case? That explains why the waiting list has increased to 666. If the operation of that hospital was investigated, it would be found to be highly inefficient. It is a disgrace that successive Governments let it deteriorate to its current state. In adopting a hands on approach, the Minister should examine the services offered in Kilkenny and consider how the plan could be implemented to ensure St. Canice's is sold and the orthopaedic hospital upgraded on a separate site. As the hospital is close to the hospital in Waterford all those requiring this operation are sent to that hospital. A case can be made for the provision of services in the orthopaedic hospital and its expansion to enable it cater not only for Kilkenny but for the greater region. Failure to carry out the proposed maintenance programme for the hospital has impacted adversely on the waiting list and I ask that the Minister investigate this matter.

A number of the beds in St. Luke's Hospital in Kilkenny and in the orthopaedic hospital were closed during the summer months. As St. Luke's Hospital is an efficient operation, during his investigation of the health board area will the Minister examine the reason for the overspend and the closure of those hospital beds? If a hands on approach was adopted and greater efficiency was built into the system, we would not have bed closures during any period of a health board's financial year. I support the Minister and the Department in what they have done to reduce waiting lists. Much more needs to be done, but I understand the necessary work is being undertaken. I call for a review of each health board area.

I am pleased to have an opportunity to contribute to this debate. I compliment the Minister for Health and Children and the Minister of State on the excellent work they have done in this area since they took office. The problem is international, it is not unique to Ireland. It has created headaches for administrations in many developing countries. In some respects it has as much to do with management and organisation as it has to do with money. No one knows that better than the Leas-Cheann Comhairle who dealt with similar problems in a practical way, particularly when we allowed overruns in health board finances which crippled that organisation and nearly brought down the service. That was dealt with effectively by the Leas-Cheann Comhairle in 1987-9. The additional £12 million provided by the Government this year will provide facilities for an additional 15,000 patients. The mid west area was allocated £700,000 of that funding. Waiting lists can often give an inaccurate picture of the factual position.

The Deputy's party has used them.

Members will know from contact with constituents that patients may be called for operations but, for various reasons, the procedures may not be carried out. Recently a constituent of mine who went into Croom Hospital for a hip replacement operation was sent home because he had high blood pressure and he had to go back on the waiting list for two or three months. This caused him great distress. Many people called for surgery have had to be put back on the waiting list because of weight problems and so on.

It is important that a review body is established to examine the issue of waiting lists. It is critical that its recommendations are accepted and that its report should be made available at the first available opportunity. Waiting lists should be properly monitored.

There should be more communication between the various institutions and the patients involved.

The institutions appear to have forgotten that patients have telephones, some have mobile telephones. It would be a simple matter to keep people up to date on their positions on a waiting list and when they are likely to be called for their operations. If that were done, it would avoid much unnecessary confusion about when people are likely to be called for their operations. Recently a constituent of mine wished to postpone an operation. For these reasons, the recommendation that personnel in the various institutions should be assigned to keep people informed of their positions on waiting lists should be implemented and immediate efforts should be taken by institutions and health boards to adopt a co-ordinated approach to dealing with long waiting lists.

Members from the mid west will be aware that there is a long list of people waiting for hip replacement operations in the region. I compliment all those involved in providing that service for patients in Croom Hospital. They do great work and are a credit to the mid west region. The staffing and accommodation problems at that hospital have been dealt with. Deputies from the mid west region will know that new accommodation was provided. The former Minister, Deputy Noonan, must be complimented on the major investment in Limerick Regional Hospital which is critical for the mid west region. We should not make a political issue out of this matter. Many people have serious problems which must be dealt with speedily. The Government is making a major contribution towards alleviating the hardship many people on waiting lists have to endure in the way it is dealing with the matter.

At a time of revolutionary changes in technology, it is critical that personnel in the various institutions keep up to date with those changes. These are changes in practices which would have been impossible to undertake up to now. For that reason I support any effort by the Minister to provide additional finances to keep abreast of changes in technology, which will have a revolutionary impact on the provision of services in the next number of years. We should encourage private investment, as was done in Cork, to support national efforts to provide facilities. I will not go into detail on that because time does not permit me to do so.

I express my appreciation for the work done by the Minister for Health and Children who visited Ennis General Hospital recently. In Ennis and Clare we know the county hospitals are critical in the provision of these services. The provision of adequate resources and finances to county hospitals is of great importance. I welcome the Minister's recent announcement about developments in Ennis. We need about £10 million to bring the general hospital there up to date. This will take some of the pressure off some of the other institutions in the mid-west region. I appreciate the work the Department and the Minister are doing in this area.

I am as anxious as any other Member to see a dramatic cut in waiting lists for hospital treatment. I am sure this aspiration is shared by both Opposition and Government Members. However, some members of the Opposition seem to be suffering from memory loss as regards the existence of waiting lists through the tenure of successive Governments over many years. The last Government did very little to solve the problem and behaved as if it did not exist. When one has no answers it is often convenient to turn a blind eye.

The waiting list initiative which was launched in June 1993 was a positive step in the right direction. It is anticipated this will progressively benefit the people on our lengthy waiting lists. We are all aware it will take more than a short while to do this. One of the factors contributing to the delays is the significant increase in population in the upper age brackets. People live longer which means there is a bigger demand on health services as ageing people need significantly more care. The end result is that waiting lists will inevitably be longer.

I, along with the Government and the Opposition, wish to resolve this issue. I feel compassion for those who must wait and want a humane approach. I hope I do not have to wait until the Opposition do something positive about it. It is easy to come up with brilliant schemes when one does not have to finance them.

I have gone into hospitals in Cork city and have seen overcrowded accident and emergency wards and patients lying on beds in corridors. I have seen the outstanding work being done by doctors and nurses despite staffing and space limitations. They deserve our thanks and praise. I have expressed those views at parliamentary party meetings and they have been echoed by my colleagues. I have heard and read of the Minister's approach to the needs of his Department and I know the emphasis he has put on the need to tackle the waiting lists he inherited. I commend him on his practical and sensible approach.

He has conducted a formal analysis on the causes underlying waiting lists and waiting times. He is intent on reducing the lists and the time spent waiting. He will do this in the context of the needs and demands of the Department of Health and Children. This is not a case for an ill-thought fire brigade approach. Because of the enormous nature of the problem, it must be tackled in a systematic and logical fashion which takes all of its aspects into account. I applaud and support the Minister's approach.

The Minister set up a broadly representative review group which represented all the health disciplines and senior departmental officials. It was given a brief to produce its report in the shortest possible timescale, compatible with accuracy and a practical approach to relieving the waiting list pressures. This was done and the recommendations deserve great merit and show a great knowledge and perception of the problem and the means needed to address waiting lists and waiting times.

Among the proposals were the provision of additional funding aimed specifically at reducing waiting lists in all hospitals, the provision of accommodation needed to cater for the increase in patients being dealt with in line with the review group's recommendations and the examination of the factors which stimulated the demand for health care, treatment and hospital beds.

We cannot ignore the increase of 150,000 in our population since 1990. The capacity of hospitals to provide in-patient treatment has not increased correspondingly. Another factor is the new technology which ensures early diagnosis and highly advanced treatment methods. This means that more people need treatment and more are successfully treated. In many cases they are given a substantial increase in their life span. While I am happy with this and we all like to see people living as long as possible, it is probably one of the factors adding to the burden of waiting lists. We are paying the price of the success and dedication of our medical personnel.

The report stresses the need for enhanced community care facilities to help to avoid inappropriate admissions to hospital. It also puts the spotlight on the need for rehabilitation facilities to enable people to return to the community assured of ongoing care and treatment. These recommendations are based on practicality and commonsense. The review group deserves the highest praise. The Minister should receive the full and ungrudging support of the House. I thank him for coming to Cork several times since he came into office and for the millions of pounds he has given to Cork hospitals. The last Minister of Health did not come to Cork University Hospital once. He gave very little to Cork.

Cork had good news last week.

I share all Members' concerns about waiting lists. However, there is no point in making it a political football and hurling abuse about what happened under previous Governments. The initiative has been taken to review the health service to address the problems and ensure that moneys given to the health service will drastically reduce waiting lists.

Unfortunately, in the past 12 months I have spent a great deal of time visiting patients in hospitals. The standard of care and dedication of staff in the health service is second to none. As public servants, we acknowledge that time and again. However, it is only when one is at the coal face and sees people lying on trolleys at night when there are only 70 beds for 90 patients that one realises the problem.

It is an international problem which we will experience more with the trend toward an ageing population. The health service will need more resources from the Exchequer. We cannot make the problem disappear with one wave of a magic wand. However, a number of sectors must be looked at when it comes to expenditure. Accident and emergency is one of the major areas. We must also look at hospitals apart from the main acute ones.

Last summer I was asked by a constituent to visit a psycho-geriatric hospital which was originally a TB hospital in the 1940s and 1950s. Unfortunately, little money has been spent on maintaining this type of hospital since then. I was appalled at the condition of the hospital I visited. The main acute hospitals are to the forefront as people visit them every day. I was taken aback at the condition of this hospital. The Department and the health boards should look at this. It does not necessitate a major capital investment to ensure that hospitals such as this are reasonably well maintained and decorated for the patients who have been there for more than 40 years, so they can live out the remainder of their lives in reasonable dignity.

I compliment the Minister and thank him for, in July last, visiting Mallow General Hospital, which serves a majority of my constituents.

I wish to share time with Deputies Neville, Ulick Burke, Farrelly, Finucane, Clune, Hayes and Fitzgerald.

Is that agreed? Agreed.

There is a firm commitment in the programme for Government to tackle hospital waiting lists. Until yesterday the public was in the dark as to what the Minister intended to do about the crisis. I, therefore, congratulate Deputy Shatter on initiating this debate. If nothing else, it has flushed out the Minister whose hallmark to date has been secrecy, silence and obfuscation. Under his stewardship major reports on vital health issues paid for by the public have been censored or withheld. He is media shy when hard questions are asked and defensive in the extreme when reasonable questions are asked in the House. It is progress when he is forced to come in here to make a statement about his approach to the problem where the lives of thousands of people and their families are on hold, their health is deteriorating, some to the point of death, and they are living lives in suffering and pain.

There are new and disturbing features to this issue. One consultant in a major Dublin hospital recently had five cancer patients for whom he could not get a bed. This is deeply worrying. Three had pancreatic tumours and two liver cancer, conditions which require immediate treatment. One had been waiting since July for an operation. Twenty years ago they would have been operated on within days.

Another disturbing feature is the number of children awaiting treatment. Our Lady's Hospital for Sick Children in Crumlin has 56 children waiting for over six months for cardiac surgery, 47 waiting for over six months for cardiology and 13 waiting between three and six months. Caring for a seriously sick child is a heavy burden for any parent to bear but to have that anguish extended by months of waiting is grotesque. It is offensive that children and their parents should be made suffer in this way at a time when the economy is performing remarkably well and technological advances are offering new hope to children. It is ironic at a time when medical innovation is offering greater possibilities than ever before it is getting harder for children to secure treatment.

The establishment of the review group was a welcome move, but it is a pity the Minister is refusing to publish its findings. The objectives listed by him do not cover all its recommendations. The over-emphasis on information systems and policy statements has all the feel of a departmental spin rather than a response to immediate needs which a review group would produce. Will the Minister, please, publish the report?

I have sympathy for the Minister on some of the points made. Waiting lists are not unique to Ireland. All sectors of the health services will have to work together if the challenge is to be met. It will not be easy to secure this co-operation. The reaction of consultants to the idea of new specialist posts is a case in point. In its document, Democratic Left argued for a high quality, fast-track specialist training programme to provide extra and younger specialists. Others have also promoted such modernisation, but I am disappointed consultants are resisting the idea. They know better than most about the suffering and anguish patients experience. The health services are staffed in the main by people of great dedication and professionalism. We are fortunate to have them but there are many powerful vested interests. They must be part of the solution rather than the problem.

The Minister's contribution was astonishing, not for what it contained but for what was missing from it. There is an essential principle to which he did not allude, that is, the principle of equality, which is well established at general practitioner level, whereby a doctor is precluded by his or her contract from discriminating in any way between public and private patients. It is disturbing that the Minister did not mention that our system of hospital care is fundamentally discriminatory. All too often the principle of equality is absent from the acute hospital service. Access to treatment is determined generally not by need but by ability to pay. Patients who can afford to attend hospital privately have better and faster access to specialist care and a hospital bed. Those who cannot afford to pay are forced to wait in the ever-lengthening queue and, in manpower terms, receive lesser quality attention. Some, tragically, never make it.

The Minister has presided over a steep increase in the numbers on waiting lists. The statistics have been well ventilated. The Minister, for whom I have regard, referred to previous Governments, but that is a sign of weakness. He is the man in charge and the man responsible. It ill-behoves him that he continues on the arid path of looking backwards instead of dealing with the difficulties.

Choices have to be made. Population and medical advances create new pressures. While they dictate that priorities must be set, it is the Minister who has the authority to determine the future of the acute hospital service. The health strategy states, "Access to health care should be determined by actual need for services rather than the ability to pay or geographic location". That is the challenge. This will cost money but set in the context of our economic growth health spending is modest. In European terms, the health bill is on the low side. Yet, the needs of the population are not being met, not because the resources are not available but because there is a lack of vision and commitment.

We are all familiar with the tragic human face of the statistics — the elderly woman in agony waiting for a hip replacement operation, the man who cannot see because he has cataracts and the child falling behind in school because grommets cannot be fitted. I have been contacted by a young man who has been waiting for almost 12 months for injection treatment in hospital and who continues to work in a local factory even though he is in constant unremitting pain. He is supporting the State by paying his taxes. Yet, at his time of need the State is not supporting him.

These people need action. They need beds to be made available, specialists appointed, nurses encouraged in their profession, a ban on bed closures for budgetary reasons, changes in accident and emergency units, rationalisation of services throughout the country and the changes to which the Minister referred. Most importantly, they need a service which no longer discriminates against them and which has at its basis the principle of equality of access, as promised in the health strategy and demanded of the Minister.

The motion is timely. The dramatic increase in the number on waiting lists to 34,331 in 12 months, an increase of 13 per cent, is unacceptable. A total of 827 adults are awaiting cardiac surgery for in excess of 12 months and 47 children for in excess of six months. Many medical card patients are now seeking treatment privately. I am aware of several people who required immediate surgery and who were advised by their doctors that placement on the waiting list would have a serious impact on the quality of their lives. There is now a trend for people who cannot afford private health care to go into debt in order to pay for it. This causes great stress to such patients and, given the present healthy state of our economy, it is unacceptable. To wait for more than 12 months for medical treatment is cruel and inhuman and should not be tolerated.

In the Regional Hospital in Limerick, referred to by Deputy Daly, 483 people have been waiting more than 12 months for surgery. This figure includes 175 waiting for gynaecology treatment and 197 waiting for cataract operations. In Croom Orthopaedic Hospital, of 324 people waiting for total hip replacements, 75 have been waiting for more than 12 months and of 468 waiting for knee replacements, 342 have been waiting for more than 12 months. Of 298 waiting for all other elective procedures, 236 have been waiting in excess of 12 months. In St. John's Hospital, of the 286 on the waiting list, 179 have been waiting in excess of 12 months. This situation is intolerable and can only be described as a crisis. The health boards must be given the facilities by the Minister to deal with the situation as a matter of urgency. The experience in the mid-west is replicated in other board areas, as we have heard from speakers on all sides of the House. This crisis must be dealt with as a matter of urgency.

The Minister is aware that the construction and equipping of phases one and two of the extension to the Regional Hospital in Limerick has cost £40 million. It is essential that funds be made available to ensure that the building is brought into use for the benefit of the people of the area. I understand that the Minister has allocated £550,000 this year for the partial commissioning of the first phase. To put the first phase into full commission will require £2.3 million next year. This will put the four main theatres into full use and ensure the partial commissioning of the ICU and the out-patients department. Phase one should be fully operational next year at a cost of £2.9 million. It is absolutely necessary that this money be made available next year. The start of phase two will be commissioned early next year. This will include the laboratory, X-ray and accident and emergency departments and other services. The cost of this will be £1.8 million for 1999. The commissioning of the final phase for completion later in 1999 will cost £1 million. The total budget for the complete commissioning of the new regional hospital in Limerick which was built at a cost of £40 million will be £8 million in 1999. The cost for a full year will be £10 million. The expectation in the mid-west is that the intention of the previous Minister to bring proper services to the area through the regional hospital will be carried out.

I thank Deputy Neville for sharing his time with me. I am glad to have the opportunity to highlight the reality on the ground, as outlined by Deputy Shatter last evening. It is a national scandal that three new state of the art operating theatres are idle in University College Hospital in Galway and that this valuable resource is being wasted. The Minister must urgently negotiate with the Western Health Board and allocate sufficient finance to staff and maintain these facilities. In the Western Health Board area we have 3,500 people on waiting lists while many others have gone outside the area to get treatment. There is an onus on the Minister to resolve this crisis.

It is not acceptable that the sale of lands at Merlin Park Hospital should be contemplated to finance capital input for the hospital. The Minister of State at the Department of Health and Children, who was so vocal two years ago in demanding the reduction of waiting lists, is silent today. Those vested interests who were priming him to speak then are silent today. The Minister should urgently investigate that matter.

It is timely that Deputy Shatter tabled this motion. Many people are wondering why, when the Government is projecting a budget surplus of £1 billion, we still have excessive hospital waiting lists. In the Regional Hospital in Limerick, our flagship hospital, 1,300 are on the waiting list.

The most shocking element of that figure is the 500 people waiting for cataract operations. Many of those waiting for such operations are elderly and it is regrettably that such people, having given a lifetime of service to the country, are denied the basic pleasure of reading a newspaper. People who have had cataract operations are full of joy at the restoration of the small dignity of being able to read a newspaper. Within the overall service, we must respond to specific needs. I recently read of an African country where, in response to the growing number of people waiting for cataract operations, emergency remedial action was taken. We must make a similar response on a national basis.

Emergency measures can work. For example, the waiting list was quite excessive over the past few years in Croom Orthopaedic Hospital. Extra operating theatres were put in place, a fifth orthopaedic surgeon was recruited and the waiting list for hip and knee operations has been reduced. This can be done where an appropriate response is made. Road blocks appear to exist within the health service and they must be removed. In the Southern Health Board area there is a queue of people waiting to meet a neuro-surgeon. Unfortunately, a neuro-surgeon in one of our hospitals died last year and the vacancy has not yet been filled. It often takes a long time to fill consultant vacancies. I understand there are approximately 38 throughout the country and if these could be filled the road blocks I referred to could be removed.

Because of the buoyant economy people expect an adequate response to these specific needs which have been highlighted so effectively in the last two evenings.

I welcome the opportunity to speak on the motion. As a member of the North-Eastern Health Board, I can identify with the problems raised. The Minister was very vocal when he was on this side of the House. He spoke about all the problems in health care and nursing and demanded that the then Government provide sufficient funds to cater for the thousands of people on waiting lists. He did not tell us that when he was Minister he would allow the waiting lists grow by 13 per cent at a time when the economy was booming.

Why will the Minister not demand more funds to deal with this enormous problem? If he is five years in office, and if the waiting lists grow at their current rate, there will be a 65 per cent increase in the number of people waiting for beds.

I was in Our Lady's Hospital, Navan last Monday night where friends of mine and other people I know are waiting for heart operations. I am sure the position is the same in every county hospital in Ireland. At a time when so much money is coming into the State coffers, the Minister is doing nothing about this problem.

As a result of this motion, I hope Fianna Fáil reverts to the views it had in Opposition on another occasion when it said that health cuts hurt the poor, the infirm and the unemployed. The Minister should look at the posters his party put up around the country ten years ago. He should consider the welfare of the people waiting for health care and go to the Cabinet table demanding more money to care for those people.

I thank Deputies Shatter, Neville and Bradford for raising this issue. The public perception is that our health services are in a shambles, with more than 34,000 people on the hospital waiting lists. The waiting lists in public hospitals have grown by 13 per cent since this Government came into office. That is an indication that the country is divided between the "haves" and the "have nots"— those who have private health care and others who depend on the State for health services. That situation does not reflect the booming economy we are supposed to be enjoying. It rings hollow to people who paid taxes all their lives and invested in State services only to find that when they required them these services were not available to them.

The elderly would not have joined VHI or taken out any form of private health care. Many of them now find themselves dependent on public hospitals and at the mercy of the health services. Hip replacement operations are needed by many old people yet the waiting list for this type of operation is one of the longest. Many appointments have to be postponed because of seriously ill patients coming into hospital through casualty. Elderly patients are put on the long finger because their cases are not regarded as urgent. This adds to the anxiety experienced by many elderly people who already feel hard done by having paid their taxes in more harsh times than we are currently experiencing. They are now just statistics on a waiting list. The Minister should remember that they are people who suffer unnecessary anxiety as a result of unacceptable delays.

We often hear about doctors having to make three or four telephone calls a day to get their patients admitted to hospital. I am sure many public representatives have spent hours talking to the staff in the admission departments of hospitals. I feel sorry for those people because they are taking the brunt of the public anger about this issue.

Another very vulnerable sector of society is children. The waiting time for ENT care in Cork is more than six months. There are 53 children in the South Infirmary waiting for ENT treatment. Those children probably have to have unnecessary doses of antibiotics. They will also fall behind in their schooling which is not acceptable in their formative years.

There are 47 children waiting to be admitted to Crumlin Hospital for cardiac surgery. The development of these young children will suffer because of this unnecessary waiting. The problem of children not getting the surgery they require must be urgently addressed.

We have heard about the invisible waiting lists for consultant care. I met a constituent this week who has been waiting since last March for an MRI scan. When the scan is eventually carried out he will probably have to wait to be admitted to hospital. That person is not one of the thousands on a waiting list but he is suffering unnecessary pain.

Approximately 60 per cent of the population do not have private health care — VHI or BUPA. The Minister said in media reports that he will press for extra funding for hospitals, which I welcome. With the booming economy the length of public hospital waiting lists is unacceptable.

Mr. Hayes

I want to dwell on two issues of concern. First, I welcome Deputy Shatter's motion and the work he has been doing in this area. The motion does not just condemn but proposes many useful initiatives which he outlined ten days ago. That is the kind of political response that is required.

As the Government prepares its Estimates for the budget in early December, I hope it will focus primarily on health care strategies. I understand the Minister has a difficult job to do in negotiating a package of funding for his Department but there is a realisation now that, for the first time, we can put in place a strong public health care system. The opportunity exists because the funding is available and that opportunity has to be realised in the forthcoming budget. I wish the Minister well in his task.

One of the issues I want to bring to the Minister's attention is the situation in Tallaght Hospital. The Minister visited the hospital some months ago where he saw that excellent facility at first hand. It is a state of the art hospital servicing the new town of Tallaght and all of the south inner city area of Dublin. However, there is now a crisis in funding for Tallaght Hospital. In excess of £20 million is required in the overrun for this year. I ask the Minister to deal sympathetically with the hospital when, inevitably, it comes looking for additional funding in the years ahead. We do not want a situation comparable to that which arose some years ago in Beaumont Hospital, where excellent facilities could not be utilised because funding was not in place.

Finally I ask the Minister to look at the area of eating disorders. I know this a small aspect of the entire budget and that the Minster has increased the number of beds to deal with this illness in St. Vincent's Hospital but it is growing, as many politicians and others will testify.

I am glad to have an opportunity to address the House on the question of waiting lists and waiting times for acute hospital procedures.

I would like to correct some misconceptions. Already the paediatric cardiac waiting list has dropped by 32 per cent from 102 to 69 patients and the adult cardiac surgery list has dropped by 24 per cent, from 1,496 to 1,142 from June this year.

During the debate, a number of important points were made on the measures considered to be necessary to address the question of unduly long waiting lists and waiting times. These related to medical and nursing resources; temporary bed closures; the financial allocations to the acute hospitals and capital investment in health facilities, as well as the organisational and structural issues required to manage waiting lists and waiting times effectively over the longer term.

As regards medical manpower — the need for additional consultants and a new "specialist" grade were specifically mentioned in this context — in May 1998, the Minister for Health and Children established the Forum on Medical Manpower to develop and monitor the implementation of a comprehensive manpower strategy for the acute hospital sector.

The membership of the forum is drawn from all of the relevant regulatory, professional, training, service and policy agencies — the RCSI, the RCPl, the Post-Graduate Medical and Dental Board, Comhairle na n-Ospidéal, the ICGP, the IMO, the IHCA, the health boards, the voluntary hospitals, the Medical Council, as well as the Department of Health and Children.

This medical manpower strategy flows from the national health strategy and is aimed at maximising the quality of care provided and ensuring that every patient who requires access to an acute hospital, regardless of what part of the country they are in, will have equal access to that quality of care. The work of the forum will be ongoing and it will make recommendations to the Minister on the requirements necessary to ensure equity of access to the highest quality of medical care. In broad terms, the forum is currently working on the future structures of the medical workforce in acute hospitals and the future objectives and organisation of post graduate medical training. The forum has been asked to complete its initial work by the end of this year.

The Minister for Health and Children found it necessary to take the initiative in establishing the forum as a basis for developing and implementing an agreed, cohesive medical manpower policy, aimed at striking the correct balance between fully trained medical personnel and those in training, within the context of the current structure and configuration of the acute hospital sector.

The work of the Forum on Medical Manpower is linked to that of the Commission on Nursing, which reported to the Minister recently. The commission made a wide range of recommendations on the regulation of the profession, on professional development, including specialist nursing, on the role of nurses and midwives in service management and on nursing in the community, of the elderly, of the mentally handicapped, midwifery and nursing of sick children.

Clearly, the roles and responsibilities of both nurses and doctors — as well as their working relationships — are changing and it is necessary to assess the new roles of both professions, with a view to putting in place the most appropriate and cost-effective service arrangements, including the introduction of nurse specialists, which are to the benefit of the patient.

Temporary bed closures were referred to by a number of Deputies. Bed closures are an annual occurrence in the acute hospital sector and the closures during 1998 were no more significant than in previous years. This year, an average of 398 beds were closed temporarily and in 1996 and 1997 an average of 383 and 418 beds, respectively, were closed temporarily. The level of temporary bed closures this year was not, therefore, a new phenomenon as has been suggested by Opposition speakers.

Temporary bed closures are required each year to enable hospitals to carry out ward refurbishment and essential maintenance and they also facilitate the taking of annual leave by the staff of the hospital. These closures are also relevant in the context of effective bed management which has formed a normal and integral part of the budget management of individual hospitals for many years. The closures must, however, be set in this context of actual hospital activity rather than simply the number of beds available. As the Minister mentioned in his address to the House last evening, in the period January to June 1998, total discharges for all hospitals have been up almost 4 per cent on the same period in 1997 and within this overall increase of 4 per cent, in-patient activity increased by over 1 per cent and day-case activity by almost 10 per cent.

It is fair to say, therefore, that the record of the Minister for Health and Children and of this Government in actively addressing the needs of persons who require acute hospital services has been in stark contrast to the record of the previous Administration, who failed to tackle any of the issues.

I commend to the House the Government's amendment to the motion.

I will share my time with Deputies Timmins and Shatter. I thank Deputy Shatter for bringing this important motion before us. The level of interest shown by the number of Deputies who spoke illustrates the size and scale of the problem.

I heard my colleague, Deputy Farrelly, mention the old slogan that health cuts hurt the old, the sick and the poor. That slogan was coined by Fianna Fáil in the mid-1980s. The Minister, Deputy Cowen, could take Deputy Farrelly's advice to dust the posters down and reflect upon them. During the general election campaign of 1989 the then Taoiseach, Mr. Haughey, remarked that he had realised there was a health crisis. The members of Fianna Fáil who are canvassing the Cork South-Central constituency now recognise there is a health crisis. We see from the figures presented in reply to Deputy Shatter that there are over 3,000 on waiting lists in the Cork area. While the by-election campaign might be devoid of any great political debate, on many doorsteps we have heard from the people of the constituency that there is a health crisis in the Cork city and county area. If we were to conduct a similar campaign in any constituency we would hear the same cry.

The Government is addressing it.

People find it difficult to reconcile that health crisis and the waiting list problem with the Celtic tiger economy. The problem must be urgently addressed by the Government. People are asking how the Government is responding to the 3,000 people in the Cork area or the 30,000 people nationwide. I am concerned, as the Minister should be, about the impact of this crisis on the elderly. We see the figures for hip replacement and cardiac operations.

The Government is giving more money than ever before — capital funding of £14 million.

The elderly are suffering most and unfortunately in the majority of cases they are suffering in silence. These are the people who built this State and paid their taxes. They are now waiting 12 months for a hip replacement operation and in many cases six months just to see the consultant. The words of the Minister last night will be of scant consolation to those people.

We in this House have a duty to respond humanely to a serious health and social problem. This motion is not about politics, it is about real people, those who have been on waiting lists for 12 or more months. The size of the problem must be met with Government money and initiative. We have not heard much initiative from the Minister of State or the Minister. The year 1999 will be designated year of the elderly. I ask the Minister of State, Deputy Moffatt, who has responsibility for the elderly, to put in place a system which will ensure they do not have to wait 12 to 18 months for basic surgery. If the Government is to do anything meaningful for the year of the elderly it should give a guarantee that they will not have to wait such long periods for surgery.

I compliment the Minister on his generosity in crediting the previous Government with being in office until the end of 1997 which permitted him in his opening speech, under the introduction of a waiting list initiative in Ireland, to claim there was an increase of 33.3 per cent in the numbers on the waiting list during the lifetime of the previous Government. If he had applied the figures correctly, the figure of 33.3 per cent would have been reduced by 25 per cent.

What is that figure?

The Minister claimed that under the previous Government there was an increase of 33.3 per cent on the waiting list.

Did the Minister read the percentage?

It should have been 25 per cent.

What money was allocated by the rainbow Government?

The Minister, by playing with figures in his opening speech when referring to the waiting lists during the tenure of the previous Government, gave incorrect information. He has listened to many contributions during the debate, all of which relate the same tale. During his contribution he outlined his many initiatives to reduce the waiting list, yet it continues to grow. If the trend continues the Irish Hospital Consultants Association has predicted that by the end of the year there will be 40,000 people waiting for treatment.

One of the more vulnerable and weaker groups in society are those waiting to go into hospital and often they are too concerned about their condition to publicise it. As the economy grows there is a danger that our social conscience will diminish and those on the verge of society may be cast aside. It is too easy for us to respond to large and well organised pressure groups and not address those most in need.

By any standard the health budget is a large one, but I have serious reservations that only a small percentage is used on the treatment of patients. During the summer I was disturbed to read in a provincial newspaper that a health board chief executive officer was closing a hospital ward because he had exceeded his budget. Yet on the same day and in the same newspaper an administrative position, which many would deem excessive, was advertised. In this health board area local folklore has it that the health board offices were never officially opened as their exposed luxury would be an embarrassment when contrasted with the facilities at the local hospital.

Many areas of waste need to be addressed. I shall refer briefly to two, one of which is the abuse of prescribed medicine through the medical card system. How often have we visited a house where the press is lined with bottles of antibiotics? In Ireland, we put no value on something we get for nothing. During the past few weeks I encountered an individual who, because of a certain medical condition, is continually prescribed certain tablets. He obtains the smallest amount that can be purchased. However, due to the expiry date he can avail only of one-third and the remaining two-thirds are dumped. Are we slaves to the pharmaceutical industry? Will the Minister look at these two areas to determine whether savings can be made and reallocated to more deserving needs?

Deputy Hayes referred to Tallaght hospital. The charge for car parking facilities has been brought to my attention. Given that the car park fee is excessive in comparison with other hospitals, will the Minister explain whether it is run separately from the Department of Health and Children as a commercial enterprise?

I want to put this debate in the context of the Fianna Fáil election manifesto of June 1997 which stated:

Health; we will tackle hospital waiting lists as a priority. Our aim will be to eliminate waiting lists over 12 months in orthopaedic surgery, especially hip replacements, ophthalmology, ear, nose and throat, cardiac surgery, vascular surgery and plastic surgery. We will set a maximum period of six months for children awaiting ENT or eye treatment. We will ensure that quiet hospital periods, such as the summer months, are used to make inroads into the lists.

The statement was briefer in the programme for Government — I do not know whether this was the Progressive Democrats or the Fianna Fáil influence. Under the heading of social issues, health appears under one sentence, "Key priorities include tackling the crisis in hospital waiting lists."

We have listened to much about what the previous Government did. The reality is that under the previous Government the waiting lists were never at their present level. The waiting lists at the end of June were in the region of 34,500 whereas there are now 36,500 people on the list. Each is an individual, an unwell person, and each has been considered by respected consultants and medical practitioners as requiring inpatient hospital treatment. They require a variety of procedures. Some have life threatening illnesses and some are so debilitated that their quality of life is completely diminished. In the case of adults, some are in receipt of disability benefit and unable to attend at their places of employment. In the case of children some are struggling with tonsils, adenoids and other problems. Some miss days from school and are prescribed antibiotics. In the ophthalmology area, children have difficulty coping in the classroom and experience ongoing health problems.

The reality is that the Minister has completely betrayed his promise of June 1997. Waiting lists at the end of June, the first 12 months of his being in office, had increased by 13 per cent, while in mid-November — or perhaps December because of the inefficiencies in his Department — we will be told that the waiting lists at the end of September 1998 have increased by 18 per cent. In excess of one-third of those people have been on the waiting lists for over one year. Far too many have been waiting for almost two years.

There were to be summer bed closures. In the first nine months of this year 1,992 beds were temporarily closed in a variety of hospitals throughout the length and breadth of the country, more are closing as we speak and will remain closed until 31 December 1998. This is another broken promise. We are informed by the Minister of State that hospital closures are irrelevant, but they are not irrelevant.

I did not say that.

Every Deputy who speaks with a hospital consultant will be told that if the hospital beds were kept open and were not closed for economic reasons it would have a dramatic impact on the waiting lists. As a medical practitioner, the Minister of State is aware of that.

Do not quote me incorrectly.

Do not cover up the reality of what is happening in our medical service. We have heard speeches this evening from the acceptable face of Fianna Fáil, the Members who tread into this House to curry favour with the Minister. Deputy Callelly, who has tabled a variety of questions, did not indicate his dissatisfaction. As late as today Deputy Aylward raised questions about the closure of beds in the regional orthopaedic hospital in Kilcreene, County Kilkenny. He queried the Minister on the reason beds are closing down and got some Civil Service jargon in response. Deputy Aylward is concerned that at that hospital at the end of June there was a waiting list of 666 people more than 400 of whom had been on the waiting list for over 12 months and a great many of whom require a variety of procedures, including hip and knee replacements. Those people have been suffering while the Minister fiddles and requests committees to consider what should be done.

There has been a reference to a working group looking at the waiting lists. The report the Minister received at the end of August and which he has clasped tightly to his chest displays the pathological secrecy and paranoia which haunts the corridors of the Department of Health and Children. Why has that report not been published? We had selected quotes from it in the Minister's speech. Parts of it have leaked through medical journals and into the national press to try to deflect attention from what is happening in the health area. In his speech last night and in the self-congratultatory amendment to this motion he referred to that report but, unfortunately, nowhere did he commit himself to implement a single recommendation in it. The waiting lists are escalating and there is no guarantee from the Minister or the Government that they will reduce, nor that the people who are in pain and whose lives are at risk will be offered the medical treatment and surgery to which they are entitled.

Amendment put.
The Dáil divided: Tá, 65; Níl, 54.

  • Ahern, Michael.
  • Kenneally, Brendan.
  • Ahern, Noel.
  • Killeen, Tony.
  • Ardagh, Seán.
  • Kirk, Séamus.
  • Aylward, Liam.
  • Kitt, Michael.
  • Brady, Johnny.
  • Kitt, Tom.
  • Brady, Martin.
  • Lawlor, Liam.
  • Brennan, Matt.
  • Lenihan, Brian.
  • Brennan, Séamus.
  • Lenihan, Conor.
  • Briscoe, Ben.
  • Martin, Micheál.
  • Browne, John (Wexford).
  • McCreevy, Charlie.
  • Byrne, Hugh.
  • McGennis, Marian.
  • Callely, Ivor.
  • McGuinness, John.
  • Carey, Pat.
  • Moffatt, Thomas.
  • Collins, Michael.
  • Moloney, John.
  • Cooper-Flynn, Beverley.
  • Moynihan, Donal.
  • Coughlan, Mary.
  • Moynihan, Michael.
  • Cowen, Brian.
  • Ó Cuív, Éamon.
  • Cullen, Martin.
  • O'Dea, Willie.
  • Daly, Brendan.
  • O'Donoghue, John.
  • Dempsey, Noel.
  • O'Flynn, Noel.
  • Doherty, Seán.
  • O'Hanlon, Rory.
  • Ellis, John.
  • O'Keeffe, Ned.
  • Fahey, Frank.
  • O'Kennedy, Michael.
  • Fleming, Seán.
  • O'Malley, Desmond.
  • Flood, Chris.
  • Power, Seán.
  • Fox, Mildred.
  • Roche, Dick.
  • Hanafin, Mary.
  • Ryan, Eoin.
  • Haughey, Seán.
  • Wade, Eddie.
  • Healy-Rae, Jackie.
  • Wallace, Dan.
  • Jacob, Joe.
  • Wallace, Mary.
  • Keaveney, Cecilia.
  • Walsh, Joe.
  • Kelleher, Billy.
  • Woods, Michael.
  • Wright, G. V.


  • Barrett, Seán.
  • Howlin, Brendan.
  • Boylan, Andrew.
  • Kenny, Enda.
  • Bradford, Paul.
  • McCormack, Pádraic.
  • Browne, John (Carlow-Kilkenny).
  • McGahon, Brendan.
  • Bruton, Richard.
  • McGinley, Dinny.
  • Burke, Ulick.
  • McGrath, Paul.
  • Carey, Donal.
  • McManus, Liz.
  • Cosgrave, Michael.
  • Mitchell, Jim.
  • Crawford, Seymour.
  • Mitchell, Olivia.
  • Creed, Michael.
  • Moynihan-Cronin, Breeda.
  • Currie, Austin.
  • Naughten, Denis.
  • D'Arcy, Michael.
  • Neville, Dan.
  • De Rossa, Proinsias.
  • Noonan, Michael.
  • Deasy, Austin.
  • O'Shea, Brian.
  • Deenihan, Jimmy.
  • Penrose, William.
  • Durkan, Bernard.
  • Perry, John.
  • Enright, Thomas.
  • Rabbitte, Pat.
  • Farrelly, John.
  • Sargent, Trevor.
  • Finucane, Michael.
  • Shatter, Alan.
  • Fitzgerald, Frances.
  • Sheehan, Patrick.
  • Flanagan, Charles.
  • Shortall, Róisín.
  • Gilmore, Éamon.
  • Spring, Dick.
  • Gormley, John.
  • Stagg, Emmet.
  • Hayes, Brian.
  • Stanton, David.
  • Higgins, Jim.
  • Timmins, Billy.
  • Higgins, Michael.
  • Upton, Pat.
  • Hogan, Philip.
  • Yates, Ivan.
Tellers: Tá, Deputies S. Brennan and Power; Níl, Deputies Barrett and Stagg.
Amendment declared carried.
Motion, as amended, put and declared carried.