Dáil Éireann debate -
Tuesday, 6 Mar 2001

Vol. 532 No. 1

Health Services: Motion (Resumed).

The following motion was moved by Deputy G. Mitchell on Tuesday, 27 February 2001:

That Dáil Éireann condemns the Government's mismanagement of the health services despite the taxpayer contributing unprecedented levels of funding and in particular in its failure to:

provide fair and equitable access to health services;

reform the administration and governance of health services;

make the structural and staffing changes necessary to eliminate hospital waiting lists;

provide for current and future medical, nursing and therapist manpower needs;

provide additional hospital beds;

relieve the chronic overcrowding in hospital accident and emergency departments;

make proper and timely investment in primary care;

provide medical cards for those on modest incomes;

develop and provide positive mental health programmes;

and calls on the Government to immediately address these deficiencies and in particular to ensure:

the appointment of a health ombudsman;

the creation of a covenant of rights and responsibilities for patients and health care providers, overseen by the health ombudsman;

the provision of adequate support services to allow older people to live in dignity and independence in the community; and

the setting up of an independent inspectorate of both private and public nursing homes.

Debate resumed on amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"commends the Government on its commitment to provide a high quality health service directed at those most in need and acknowledges:

the dramatic increases in current funding since 1997 to the health services made by the Government compared to the previous Administration;

the provision under the national development plan of £2 billion in capital funding which will transform the health infrastructure;

the Government's strategic approach to planning for the health system, in particular the launching of significant major strategies, such as the children's strategy, the cardiovascular strategy and the national health promotion strategy;

the Government's strategic and reforming approach in regard to the work now under way in areas like the reform of the medical structure advocated in the report of the Forum on Medical Manpower, the review of bed capacity in the acute hospitals and the pending review of primary health care;

the Government's commitment to the preparation of a new health strategy which will make recommendations on how best to implement a high quality, equitable and accessible health service; and

supports the Government in its approach to modernising the health system through the development and implementation of strategies underpinned by solid investment."

Mr. Howlin:

I have five minutes, which is obviously inadequate to do any form of justice to a debate on our health services. I have some awareness of the difficulties faced by a Minister for Health and Children. It is a difficult ministry. No Minister in Hawkins House, however, has ever had the resources that the current incumbent has had. While the Minister for Health and Children came full of promise, he has been woefully lacking when it comes to delivering. It seems that the Labour Party will once again have to pick up the pieces of a shattered health service left in the hands of a Fianna Fáil-Progressive Democrats Administration.

There is much I could say, but I want to focus on the situation in Wexford General Hospital which is, in many ways, a microcosm of smaller general hospitals throughout the country. I expect that when the Minister is responding to the debate, the points which have general application will be responded to.

The accident and emergency service is stretched in Wexford General Hospital. The Minister has sanctioned four additional consultants for the south east. It is my understanding that all of them are to go to Waterford Regional Hospital. If that is to be the case, there will be no proper supervision for NCHDs in accident and emergency. They will be unwilling to present themselves to work in a hospital like the one in Wexford, and the accident and emergency service will be threatened. The same will happen in obstetrics and gynaecology. The Institute of Obstetricians has demanded that there be at least three consultants before it will recognise training courses. There are only two in Wexford and hospitals like it. The future of gynaecology and maternity services in regional hospitals of the scale of Wexford is under threat. We have a new CAT scan in Wexford General Hospital, provided by the good will of the people of the town and county of Wexford. It is running at anything, but its full capacity because of the lack of resources and personnel. I could deal in some detail with the paediatrics department. It is also under threat because there are not sufficient consultants sanctioned to provide 24-hour, 365-day cover. Training is jeopardised as a result. Anaesthesia and geriatrics face exactly the same difficulty. The most glaring difficulty of all is that planned capital development of Wexford General Hospital has been long-fingered year on year in the past four years. The capacity of the medical department of Wexford General Hospital has been running at something like 130%, squeezing out surgical beds, and planned surgical operations have been deferred because of the pressure of numbers. What we need more than anything else is additional beds. The numbers we have are hopelessly inadequate. Patients wait months on end for outpatient visits because there are insufficient consulting rooms.

What is at stake – I hope the Minister of State will pass this on to his senior colleague – is the future of smaller hospitals like Wexford General Hospital. The Minister must be clear and unambiguous in his reply that he will resource the smaller hospitals in the regions. Otherwise we will be reduced, in a very short time, to a number of very large regional hospitals, an hour, an hour and a half or two hours away from some centres of population. This is wrong, inadequate, and part of the deficiencies for which the Minister is responsible.

Mr. Wall:

I thank Deputy Howlin for sharing his time with me.

I wish to raise the question of overcrowding and waiting lists in hospitals. Is there a plan to co-ordinate all available beds within health board areas, for example, the south western health board in my area or the Eastern Regional Health Authority? What linkages are there between hospital management and health boards? In this era of high-tech, can a plan not be put in place to co-ordinate the workings of all hospitals within the remit of the Department? Would it not be feasible for bed managers of each hospital to collate the spaces available within the system in order that at any one time a general practitioner could, by use of a computer link-up, find out the number of available bed spaces within the system and the hospitals where such vacancies arise?

My general practitioner contacted me in relation to an experience he had recently. He telephoned the casualty department in Tallaght General Hospital, the flagship of the Eastern Regional Health Authority. He was informed that there were 27 patients on trolleys. What is worse is that he was informed that he could send a patient, but only if the ambulance waited outside the door to take the patient home after examination. This can only be described as an absolute and total disaster.

One of the major problems in relation to this matter is that in many cases beds are taken up by geriatric patients who have no place else to go. St. Vincent's Hospital and Naas General Hospital are both packed, and there is no possibility of anything being done about it. We are in the process of spending a major sum of money on developing Naas Hospital, but it will be of no use to the medical system in County Kildare and its hinterland if something is not done about collating the hospital services with nursing homes and the geriatric hospital in Athy to ensure the maximum number of beds are available in Naas to allow for the use of those hospitals' accident and emergency services.

Time and again I am asked by constituents what the health board is doing about the fact that their relatives have had to spend 48 hours on a trolley or a chair in Naas Hospital. When the "Bertie Bowl" seems to be the biggest thing we have, how do we expect the next generation to treat us when they see how we are treating the present generation of senior citizens? What we are doing to senior citizens is an absolute disgrace and totally unacceptable. One has to wonder when a person of 82 years of age is left on a trolley in Naas General Hospital for 72 hours not knowing whether she will get a bed and what will happen to her because she has no one at home to care for her. That is the health system we have and it is an absolute disgrace.

It is time we faced up to the reality that we will be the old people of tomorrow and that if the system is not improved we will have no place to go. If we do not show respect for older people then the younger generation will have no respect for us.

It is an absolute disgrace that geriatric units are being treated in this fashion. No one can stand up in the House tonight and say that they are being treated in a proper and correct manner. The staff in these hospitals who work day and night to give some comfort to pensioners are to be complimented. It is time for the Minister to take action and give hospitals some hope for the future.

Dr. Moffatt:

What about the track record of the Deputy's party?

Mr. Wall:

The Government has the money; we did not have it. What the Government is doing is an absolute disgrace.

Mr. Howlin:

Our record is excellent.

An Leas-Cheann Comhairle:

The Minister should not provoke interruption, particularly as the Deputy has run out of time.

Mr. Callely:

I wish to share my time with Deputies Roche and Dennehy.

Over the years successive Governments and Ministers have failed to adequately respond to the needs of the health service. As a result of such failures, we have serious and challenging tasks. I acknowledge the commitment and determination of the former Minister, Deputy Cowen, the Minister, Deputy Martin, and the Minister of State, Deputy Moffatt, in addressing these tasks. I wish to focus on the eastern region.

The new Eastern Regional Health Authority was established to develop first class services based on assessment of need for the people of the region and to ensure an equitable and co-ordinated delivery of service by the statutory and voluntary agencies working more closely together under the umbrella of the ERHA and, more importantly, being funded by the ERHA on the basis of service providers' capacity to deliver services. The Minister for Health and Children, Deputy Martin, asked the ERHA to provide leadership, interrogate the reasons for apparent chronic problems and not to accept the usual answers.

I was surprised to hear some of the comments made by Deputies, particularly Labour Party Deputies who not too long ago were charged with responsibility for the delivery of service but failed. I accept that there are problems in the service, but we must remember that each year hundreds of thousands of people in the eastern region receive first class treatment in hospitals both as in-patients and out-patients. There are difficulties, but these are experienced by a minority. We are working to put in place initiatives to minimise these difficulties and to tackle them in an ordered and measured fashion.

It is important to put the following points on the record. Last year waiting lists for hospital admissions in the eastern region decreased by an average of 3% per quarter while waiting lists for open heart surgery were reduced by 25%. The Eastern Regional Health Authority has put in place a number of imaginative initiatives to further reduce these waiting lists. We are buying capacity where it exists in public and private hospitals to enable people on waiting lists to have their procedures carried out quickly. We have made arrangements for children in Crumlin Hospital waiting for heart surgery to have their operations carried out abroad, pending the completion of additional theatres in Crumlin Hospital.

The eastern region's population is 1.3 million, 35.7% of the national figure. Population growth in the eastern region accounts for 55.4% of national growth. We have done extraordinarily well given those figures and the fact that people from outside the region regularly avail of services within the region. Unfortunately this distorts the picture, but in light of my comments I think Members will appreciate that we are doing a good job. I pay tribute to my fellow board members on the Eastern Regional Health Authority who have done a tremendous job and showed great commitment over the past number of years. I also thank the chief executive officer, Donal O'Shea, and his management team.

The work carried out by the ERHA includes an assessment of the bed capacity required to treat not only people in the east but also those from other areas who come to Dublin for treatment. It is estimated that at any one time 20% of people in hospitals in Dublin come from outside the region. This causes difficulties.

Mr. Browne

(Carlow-Kilkenny): What should we do with the country lads?

Mr. Roche:

They are much better off than when the Deputy's party was in office.

Mr. Browne

(Carlow-Kilkenny): Is the Deputy saying we should let them die?

Mr. Callely:

The assessment has shown that we need an additional 1,270 beds to cater for our needs. Progress is being made in the Department in this regard.

The review has shown that hospital activity in the eastern region has become more efficient, is accommodating an increased population above national growth and has greater activity, with significant fewer beds in real terms by national and international ratios. Practice has substantially altered with a reduced length of stay and a high proportion of day cases. The development of 1,276 additional beds will allow the authority to examine in a fundamental way how services should be planned and developed over the next decade.

The authority intends to approach this issue in two ways. Plans to provide immediate additional capacity in medical, surgical and dedicated day elective facilities are being finalised. I believe we will have good news in this regard by the end of the year. The authority will also undertake a medium term planning exercise on how to provide the additional places by examining such issues as how major accidents should be dealt with within the eastern region, how hospitals should co-operate in the provision of A&E services, how day surgery and ambulatory care should be organised to provide efficient use of facilities and manpower in a local area and regional context, and whether the hospital configurations planned in the acute hospital development programme in the national development plan up to 2006 will assist the authority in achieving its objectives or if they need to be changed and what human resource implications and opportunities a plan of this scale presents for the authority.

Measures to improve the overall management and delivery of accident and emergency services in the eastern region were given the go ahead at this month's meeting of the Eastern Regional Health Authority. We intend to put these measures in place rapidly. They include additional consultants and A&E managers, the establishment of minor injury units in acute hospitals, improving the physical environments of A&E departments and the treatment of patients with major trauma and critical non-trauma patients in a certain fashion. Specialist treatment units, particularly for conditions such as chest pain, deep vein thrombosis, respiratory illnesses and medical conditions, will be established in each acute hospital. This will help to ensure the smooth functioning of A&E departments.

Funding was made available in December 2000 for a pilot project to evaluate the use of a dis charge lounge in a large acute hospital in the region. Initiatives by the ERHA are already under way to address external delays such as pilot projects to establish how services can most effectively be developed to maintain older people at home and what strategies should be developed to prevent admission or readmission to an acute hospital setting. We are all aware that there gaps in the services. I am pleased that we have rapidly addressed these issues by putting in place managers for services for the elderly and other such features in the community to ensure that we maximise the use of facilities in the community.

Funding of £5 million has already been allocated to contract an additional 495 step-down beds for the winter period to help alleviate pressure on A&E departments. In line with a more co-ordinated approach to the availability of beds for emergency admissions, it is anticipated that a post of project manager based at ambulance headquarters will be established. This will enable a more appropriate allocation of emergency referrals between hospital sites, thus ensuring any one site is not unduly overcrowded. As chairman of the ERHA, I welcome these initiatives which, when fully implemented, will help to improve access to services, waiting times, patient flows and communications between medical staff and patients. I intend to make real progress as chairman and further progress in developing the type of health service which the public deserves, which we all want and of which we can all be proud.

Mr. Browne

(Carlow-Kilkenny): A future Minister.

Mr. Dennehy:

There are nine areas of failure and three calls for action mentioned in the Fine Gael motion. As Deputy Callely said, these issues did not crop up overnight. I cannot deal with all 12 points but I shall refer to one from each list. I was fascinated to see two big hitters from the previous Administration signing this motion, that is, Deputies Noonan and John Bruton. They were the decision-makers, with Deputies Quinn and Howlin, who formulated and implemented health policy. The list included the failure to relieve the chronic overcrowding in hospital accident and emergency departments. Each of those four Deputies were well aware of how bad the position was in the accident and emergency unit in Cork University Hospital—

Mr. Browne

(Carlow-Kilkenny): What about Sean McEntee?

Mr. Dennehy:

—but they did nothing about it. I refer specifically to the position in the Southern Health Board because I am familiar with it. I was chairman when Deputy Noonan was Minister for Health and Children. Those four decision-makers indicated that the accident and emergency unit in Cork University Hospital was designated to cater for 15,000 cases per year but was then and still is dealing with 45,000 cases per year. That is the primary reason for the disgraceful situation of the elderly and other patients being left on trolleys while awaiting treating. My constituency colleague and Minister for Health and Children, Deputy Martin, is dealing with the matter in a proper way with funding and staff support. That needs to be dealt with urgently. There was no response from those four gentlemen to the case made to them for an accident and emergency department. The Deputies who signed this motion will claim money was not as plentiful then. I could buy into that argument but why could even £1 million of the £20 million put into Limerick Regional Hospital not have gone to Cork?

Mr. Browne

(Carlow-Kilkenny): Because Limerick was in need of it.

Mr. Dennehy:

Was it right to put almost the entire capital building programme into one project and to ignore the rest of the country?

Mr. Browne

(Carlow-Kilkenny): What about Cork now?

Mr. Dennehy:

Deputy Noonan may correct me if I am wrong but I believe he never once set foot in Cork Regional Hospital during his tenure as Minister for Health and Children. Contrast that lack of attention to the largest hospital in Cork or Kerry with the attention given to Limerick Regional Hospital. If that was the approach to health issues I shudder to think how Cork would fare if the Deputy had a bigger say in national affairs.

Mr. Browne

(Carlow-Kilkenny): The Deputy should wait and see.

Mr. Dennehy:

Thanks to my constituency colleague and this Government—

Mr. Neville:

The Deputy should hold his breath.

Mr. Dennehy:

—the hospital will get its new accident and emergency unit. Construction will commence in a few months' time and the unit will cater for that larger attendance.

Mr. Browne

(Carlow-Kilkenny): Will the Blood Transfusion Service Board be kept in Cork?

Mr. Dennehy:

Dr. Peter Cusack, the accident and emergency consultant there, is doing an excellent job in poor conditions. It was he as a professional medial person who drew attention to the need for improvements and his report was ignored by the very people who tabled this hypocritical motion. The motion calls for the provision of adequate support services to allow older people to live in dignity and independence in the community. This is an opportune time to discuss this issue because there is a marvellous success story to report. From 1986 onwards there was a moratorium on the provision of day and health centres. These are the most important ingredients in the provision of such care. Since last year, thanks to Government funding, the Southern Health Board has put in place an excellent programme for the elderly entitled Ageing with Confidence for the period 2000-10. The programme contains four modules, keeping older people well, supporting the older person at home, acute care and continuing care. All services for the elderly will be built on these initiatives. The relevant programme manager said: "In light of the national development plan we are in the fortunate position to be able to plan with a fair degree of certainty the development that will take place over the next six years."

Last year's initiatives under that programme included £2.5 million extra for home helps, the employment of 19 additional staff in a range of disciplines and 19 additional CM2s – that post was previously ward sisters in community hospitals. Another £4.936 million was provided to complete or start day care centres in 11 locations. Separate funds were available for the refurbishment of existing community hospitals and a new community nursing unit in Cork city. Another £36.64 million is included for this and the next four years for work on community hospitals and other facilities for the elderly. Revenue funding to provide staff is also included.

Mr. Browne

(Carlow-Kilkenny): Has the Deputy finished with Limerick Regional Hospital?

Mr. Dennehy:

The Fine Gael barrackers will be interested to hear that an additional 33 day care centres will be provided in Cork and Kerry.

Mr. Neville:

Is there one for Limerick and Newcastle West?

Mr. Dennehy:

They are separate from the community nursing unit and nursing care teams being established.

An Leas-Cheann Comhairle:

The Deputy's time is limited.

Mr. Dennehy:

Deputies Burke, Allen and Coveney, who signed this motion and are members of the Southern Health Board, will confirm that what I have said is correct. They are honest Members. Any fair-minded commentator would agree that the Minister has done more than Deputies Noonan and Howlin, the former Ministers for Health and Children, combined to deal with the issue of accident and emergency needs and the provision of facilities to cater for the elderly.

Mr. Browne

(Carlow-Kilkenny): Why not include the Minister, Deputy Cowen, as well?

Mr. Dennehy:

There are a few other things I can add.

An Leas-Cheann Comhairle:

Is Deputy Dennehy sharing time?

Mr. Dennehy:

Yes, with Deputy Roche.

Mr. Dennehy:

On the question of beds, Members will be aware that a new 100 bed rehabilitation unit is being provided in Cork and the new school for physiotherapy and related disciplines is also being planned and provided. Let us contrast that with the immediate record of the so-called rainbow coalition. There is a list of real problems which were created and are being dealt with. I compliment my constituency colleague, the Minister, Deputy Martin, and particularly the Minister with responsibility for the elderly who has done such an excellent job in bringing forward his own programme. I compliment them and wish them well. This motion gave us the opportunity to highlight their good work.

Mr. Roche:

I wish to share time with Deputies Batt O'Keeffe and Marian McGennis.

An Leas-Cheann Comhairle:

Is that agreed? Agreed.

Mr. Roche:

I had thought that because of the foot and mouth disease outbreak the monkey house in the zoo had been locked up, but it is clear two inmates of the august institution have escaped. I am pleased to welcome those two inmates, Deputies Neville and Browne, Carlow-Kilkenny. As the previous speaker said, this must be national brass-neck day. Earlier today Deputy Noonan was concerned about a Cork Deputy when he should have been concerned about his own party. Having listened to the heckling of the past 20 minutes, it is extraordinary. The reality is, and we all know and should be honest with ourselves and our constituents and the wider public, that the health service in terms of expenditure is an endless pit. It does not matter how much money is spent, there will always be a need in the health service for more. It ill behoves Deputies to move the hypocritical motion that has been moved because we all know there are problems and there will always be problems in the health service. Because of the developing nature of the health service, health technology and the challenges in the health service, there will always be resource difficulties.

On the issue of resource difficulties, which Deputy Dennehy dealt with in clear detail, great efforts have been made by this Administration since coming to office. Health expenditure has increased by over 92% of the investment which was made during 1997 by the rainbow Government. There has been a virtual doubling of health spending.

Members opposite can say, with reason, that because of the good economic management of the Government there is more money to spend. Because of good public administration there is more money to spend, but there was not a dearth of funds in 1997. Fine Gael did not do the job.

Capital spending under the NDP will treble. There is a special commitment this year of £44 million to spending on cancer which began in 1997 at a miserly £6 million. The crude statistics do not demonstrate a great deal except that there is a concern on this side of the House to do something positive about the health services. All the chattering abuse hurled at us does not give a fig to reality, which is recognised in the figures that have been published.

The last Labour Party speaker referred to the care of the elderly. It is good to cast our minds back to when Deputies Noonan and Howlin had charge of such care. The total expenditure under the development funding for elderly services was a miserly £3 million in 1997. That is the year the elderly received an increase of £1.80 a week in their pensions.

Mr. Browne

(Carlow-Kilkenny): The Deputy should compare like with like.

Mr. Dennehy:

The Deputy will get his chance.

Mr. Roche:

Last year the total figure was £23.6 million. If Deputy Browne was pleased to support the old age pension increase and to support a Minister that was only prepared to invest £3 million in development services, let him do so. He will have his opportunity.

The Deputy might also wish to address the issue of community care nursing units. In 1997 when a Deputy close to his heart had control over this matter the total spend was £6.5 million. Last year it exceeded £20 million.

Mr. Browne

(Carlow-Kilkenny): The Deputy is not comparing like with like.

Mr. Roche:

The figures are similar in regard to day care. The problem with the health services is that there is not enough funding. It is an issue of quality, not volume.

Mr. Browne

(Carlow-Kilkenny): Agreed.

Mr. Roche:

Capital spending, which has increased by 99%, has not produced a proportionate response. We all know that because when we take off the hats of mockery having left this House and go out into the real world we know there are problems.

Government expenditure in each of the past four years has exceeded the rate of inflation. However, there must be more efficiency in expenditure. I am pleased, therefore, the Minister has introduced the notion of value for money. We must make sure the hospital and health services are delivering because there is no point in any of us deluding ourselves. Investing funds will not produce the results without proper management.

The problem in our health services is management and not resources. There is a confusion of structures within the hospital and other health services. There is a need for whoever is in power to invest time and effort in restructuring acute hospitals and in putting in place proper management structures. The issue will not resolved during one Minister's tenure. It does not matter which party the Minister represents. Without proper management services in place we will not be capable of delivering the services all of us want.

I want the Minister to examine one area which requires courage and not money and that is the Child Care Act. There are problems in this area which I have been highlighting for a number of years. I hope, in addition to the strategy the Minister has laid out for health development, that one of the issues he will find time to address in a busy schedule, is a serious audit of that Act. That will be the next area of scandal which will need to be addressed.

Mr. B. O'Keeffe:

I am intrigued by the motion. I could understand it if it had been tabled by the Green Party or Deputy Joe Higgins because they have not been tested or served their time in Government. It is a little rich coming from Fine Gael. The motion is a manifestation of arrogance. Nobody knew Fine Gael better than Deputy Lowry who said "Fine Gael is living off the exhaust fumes of past glories".

Mr. Browne

(Carlow-Kilkenny): Does the Deputy have a good quote from Ray Burke?

Mr. B. O'Keeffe:

When Fine Gael had an opportunity to blow its trumpet in Government it failed to do so spectacularly in the Department of Health. It is a strange motion coming within weeks of the election of a new Fine Gael leader. It is ironic that the new leader was probably the most dysfunctional Minister for Health in the history of the State. I understand the stress, demise, hopelessness and consequent inertia within the party which made it absolutely inevitable for the party to compound the error.

Mr. Browne

(Carlow-Kilkenny): The Deputy is getting worried about Deputy Noonan.

Mr. B. O'Keeffe:

It is said: "By my past actions will you know me". The lack of direction and compassion and the isolation of Deputy Noonan as Minister for Health does not augur well for the patients of Ireland should he ever to take over the stewardship of the State.

Mr. Browne

(Carlow-Kilkenny): Stand by. The Deputy should fasten his seat belt.

Mr. B. O'Keeffe:

Who will ever forget Deputy Noonan's insensitivity in dealing with the hepatitis C crisis?

Mr. Browne

(Carlow-Kilkenny): Wait until I get out my handkerchief.

Mr. B. O'Keeffe:

Who will ever forget the awful day in the House when Mrs. McCole was insulted by the former Minister for Health? Who will ever forget that he allowed the nurses' dispute to fester? Who will forget that he failed to address the consultants' dispute? All of these issues had to be resolved by Fianna Fáil Ministers in the shape of Deputies Cowen and Martin.

The people of Cork will never forget how the leader of Fine Gael looked after his local patch to the detriment of other areas.

Mr. Browne

(Carlow-Kilkenny): Was the Deputy listening to Deputy Dennehy?

Mr. B. O'Keeffe:

He became the expert in parish pump politics. I remind the Fine Gael party that an extension to the accident and emergency unit was needed at University Hospital Cork. The crisis was worse at the time Deputy Noonan was Minister for Health than it is now. What did he do?

An obstetrics unit was needed at University Hospital Cork. The consultants who are the experts said there was a danger lives would be lost. The opportunity was there for Deputy Noonan to do something but he failed.

Mr. Browne

(Carlow-Kilkenny): Why is the Deputy attacking him? This is a health motion.

Mr. B. O'Keeffe:

An expansion of the radiotherapy and oncology units, major investment in equipment and an extension to the day surgery were needed. Not alone did Deputy Noonan do nothing, he left it to Fianna Fáil to address these needs. It is hypocritical, therefore, of Fine Gael to try to convince anybody that it did its best in the Department of Health when it was in office.

Mr. Browne

(Carlow-Kilkenny): Tell the public.

Mr. B. O'Keeffe:

The present Minister, Deputy Martin, who is my constituency colleague, and Deputy Cowen came to Cork. Deputy Cowen was only in office three weeks when he stood in the University Hospital.

Mr. Browne

(Carlow-Kilkenny): Ní bheidh a leithéid ann arís.

Mr. B. O'Keeffe:

The Deputy should contrast that with Deputy Noonan, who did not set foot in that hospital in two and a half years as Minister.

Mr. Browne

(Carlow-Kilkenny): The Deputy must be very worried about him. He must have something to offer.

Mr. B. O'Keeffe:

Then Fine Gael asks us to take for real his concern for health services.

Ms M. McGennis:

The motion highlights the state of the health services when the rainbow coalition left office. It took a brass neck to table such a motion because Fine Gael left itself open to accusations about the health service when the Government took over. Health spending has increased by 100% since Fine Gael left Government and I do not know how Fine Gael when it replies to the motion will be able to determine that health services have decreased.

Mr. Crawford:

Ask the patients.

Ms M. McGennis:

Did the Deputy ask the patients when he was in Government? It is obvious the Deputy and his party were not listening. I have a particular interest in the care of the elderly, and my constituency has quite a large elderly population. When I was elected I immediately sought support from my party for improvements in services for the elderly. This was from a very low level where the outgoing rainbow Coalition Government had decided to give the elderly increases which were below the level of inflation – an indication of its commitment to the care of the elderly. I am very proud of the performance of the current Minister and his predecessor in the treatment of the elderly and am proud that £71.6 million will be spent directly on services for the elderly in 2001.

The health services will never be in such a position as to allow us say everything has been done. We are catching up from an era of cutbacks and from a lack of commitment in the past to fund the health services. I am glad my party in Government is reversing this trend.

There are still many in our constituencies on waiting lists, but the current waiting list initiative fund of £34 million can be contrasted with the £8 million which the rainbow Government invested, which speaks volumes.

I am proud to be a member of one of the Government parties and of the commitment which Fianna Fáil and the Progressive Democrats have to the health services, in particular the provision of services for the elderly.

Mr. Browne

(Carlow-Kilkenny): The Deputy is very loyal.

Mr. Perry:

I wish to share time with Deputies Crawford, Naughten, Browne, McCormack, Boylan, Belton, Caoimghín Ó Caoláin and Deenihan.

I am concerned that the North Western Health Board retain and upgrade the breast care services at Sligo general hospital. This matter has arisen from a report by a sub-group to the national cancer forum on the development of services for systematic breast disease. In the case of the North Western Health Board area, the report indicated the population only supports one unit but that the geographical considerations dictate that an innovate approach is required to ensure services are available for patients in acceptable settings as far as possible. It also indicates that while there is a facility in Letterkenny and Sligo hospitals, Altnagelvin hospital in Derry can facilitate case load work. I am asking that the upgrading of the service in Sligo be taken on board. Sligo has an insufficient population to justify a unit as the centres are based on a population in excess of 150,000. There is little infrastructure in Sligo general hospital in this area. Considerable resources would be required to establish a breast care unit, and I ask the Minister to allocate funding for this. The only realistic proposal is for health board boundaries to be crossed so the population of Sligo, Leitrim, west Cavan and parts of Mayo can be incorporated. It is estimated that if this were done the population would be adequate to provide a sufficient volume of patients, and would certainly justify Sligo general hospital serving those areas. This approach would need the co-operation and agreement of the chief executive officers and boards of each of the relevant health boards.

It is very disturbing that people from the west have to come to Dublin, which is quite a trauma for families. The Minister must indicate the provision of funding and examine the possibility of funding across health board boundaries, which would benefit the region. Funding should be provided and competition should not prevail. In the interests of patients it is very important that this facility be provided in Sligo.

Sligo is the growth centre of the northwest. The North Western Health Board is doing an extraordinary job with the funding allocated by the State. With proper management this service could be provided in Sligo. I believe Letterkenny general hospital has a breast care centre. Given the cross-Border co-operation in many areas, including health, there should also be co-operation with Altnagelvin hospital in Derry.

Funding is critically important in terms of providing this very necessary service in the northwest. I know a comprehensive survey was carried out by the sub-group, the recommendations of which have gone to Government, as have those of the National Cancer Forum on the development of services for systematic breast disease. It is a big concern for many people.

Mr. Crawford:

The lack of nurses and the closed wards, especially in Dublin hospitals, will be seen as a monument to the way the former Minister for Health and Children, Deputy Cowen, dealt with the nurses' strike. There will be fewer nurses available in the foreseeable future.

Nobody can deny that the health services in general are in chaos. The problem is highlighted in a report recently done on major Dublin hospitals, such as Beaumont, St. Vincent's, St. James's and Tallaght, which shows there is a major crisis in terms of lack of nurses, beds, etc. These hospitals deal with the serious health problems of people from Cavan-Monaghan and are relevant to a very large region. In addition we have the waiting lists and the problems associated with getting somebody into St. Luke's hospital for cancer treatment, which is extremely serious – I have had personal knowledge of that situation with family members in the recent past.

Recently a young mother had to spend four or five hours after having her first child in Holles Street hospital before being put into the seventh bed in a six bed ward. The mother and child were discharged the following day. I raise this because maternity wards in Monaghan general hospital and Dundalk hospital have been closed by the North Eastern Health Board. The Minister failed to ensure this did not happen. The closure is supposed to be temporary. It means 35% more patients will have to be dealt with in Cavan and Drogheda hospitals. Is this the type of treatment that our mothers and future generations deserve? Will they soon be in the same position as the mother I mentioned in Holles Street Hospital?

The situation in Dundalk and Monaghan hospitals must be re-examined. We were promised £10 million for restructuring and upgrading Monaghan general hospital, but nothing has happened with the exception of the replacement of an outside theatre and the refurbishment of the female medical ward. There is a total lack of morale among patients and staff. There is a great urgency to ensure the planning and work is started on Monaghan general hospital. We heard how the Minister is spending millions of pounds in Cork and we know the previous Minister spent money in Laoighis-Offaly. We have heard accusations that the leader of our party, Deputy Michael Noonan, did the same in Limerick when he was Minister. There is a yawning need for a fair service throughout the country. The smaller general hospitals must be maintained and serviced. In north Monaghan young mothers are now expected to travel more than 50 miles to the nearest maternity hospital. Accident and emergency cases cannot be dealt with properly, even though the hospital is along the main Dublin-Derry and Belfast-Galway roads. It is also an area of production in the food and furniture industries where the work is very dangerous. We need a proper accident and emergency service.

Mr. Naughten:

I wish to raise one specific issue, namely the deplorable condition of the county hospital in Roscommon. On two occasions there was a Member of this House representing the hospital, yet during the years matters have gone from bad to worse. The hospital is like something from the Second World War. There are trolleys everywhere: on the aisle, between the beds, in the television room and even in the accident and emergency unit. On an average night there are 15 trolleys in the accident and emergency unit. The wards are completely overcrowded and if a cardiac cart had to be brought to a patient in the wards it would be impossible to get it in because of the overcrowding. Staff in the hospital are working in deplorable conditions. If such conditions applied in a factory, it would be closed on health and safety grounds, yet this issue continues to be ignored and the hospital receives no investment.

Patients are safer going home than staying in Roscommon County Hospital because of the lack of investment. The Government announced three and a half years ago that there would be a new accident and emergency unit for the hospital, but construction has not yet commenced. The Government took the funding away from the new accident and emergency unit and we will only get the investment back under the national development plan.

Conditions in the hospital are so bad that the staff are looking for transfers out of it. We have had debates about staff shortages in Dublin, but while we have capable staff in Roscommon, the lack of investment by the Minister and his Department means that the staff are trying to get out of the hospital. They are of the view that the Government is trying to wind the hospital down by not investing in it. The Minister should come and see the conditions in which the staff are working when he will see the lack of investment for himself. He will see the need for investment and additional beds; if that investment is not made, we will not have staff and we will not have the hospital, though we need an acute hospital in Roscommon.

Mr. Browne

(Carlow-Kilkenny): Tá áthas orm go bhfuil deis agam labhairt ar an ábhar seo. Níl ach trí nóiméad agam. Three minutes is hopeless in this situation, especially when I have to respond to the nonsense I heard from some Fianna Fáil Deputies. Deputy Dennehy is always sent in here to upset me and he managed to convince himself that Deputy Noonan spent a pile of money in Limerick and none in Cork, but then he proceeded to outline all the money being spent in Cork.

The Chair knows that St. Luke's Hospital in Kilkenny and Carlow District Hospital are crying out for money to the extent that the consultants and medical staff are coming to meet the Minister soon to find out if the former can be saved from falling apart and if demoralisation can be halted among staff. Deputy Batt O'Keeffe is completely overwhelmed by the idea that we have an excellent leader and spent most of his speech trying to find fault with Deputy Noonan. He is obviously very upset by our excellent choice.

Examples of funding have been given, but in fairness one must compare like with like. One cannot talk about what was spent eight, ten or 40 years ago when there is a budget surplus now. During the summer I spent four weeks visiting a public hospital ward and four weeks visiting a private ward. I could not understand why the roast beef in the public ward did not look like the roast beef in the private ward. The standard of food in public hospitals should be investigated. I cannot generalise, but this is a case of a Dublin hospital which has public and private wards. There is no defence for its as good food in a hospital is as important in the public ward as it is for those who can afford private care. The standard of hospital food should be investigated.

Despite the beautifully written script read by one Fianna Fáil Deputy giving figures about the falling numbers on waiting lists, there are still problems. One recent case involved a child who had to wait 15 months to have a tooth surgically removed. Another problem relates to elderly people being sent home from hospitals. Recently an 89-year old was sent home from a hospital even though he still needed medical care; he went to his son, who lived in a different part of the county. This is unacceptable. Elderly people need medical care when they need it and sending people home to a house without mod cons is unacceptable. We must make an effort to look after such people. I congratulate our health spokesperson, Deputy Gay Mitchell, on his wonderful policy document, which will deal with the reality of the situation.

Mr. McCormack:

It is a pity the Minister is not present. He should accept that there is a crisis in the health services because if he does not, he cannot cure it. At the end of last year the Minister made great play with the fact that waiting lists nationally had reduced by 5,000, according to him. That was simply distorting the figures, as waiting lists were only reduced because many general practitioners are reluctant to refer patients to hospitals because of the length of waiting lists. Thousands are hoping to be placed on the waiting lists as they are waiting for appointments with consultants.

The lists are being reduced by what hospitals call validating the lists; this involves writing to people to inquire if they are alive or if they have had the procedure in question carried out privately. Lists are being falsely reduced in this way. The manager of University College Hospital Galway informed me that the longest a person has spent on a waiting list is ten years, which is a scandal. Is that the service of which Government Deputies McGennis and O'Keeffe are proud? I would not be proud of it.

A person who was distressed called to my clinic recently because they had received a letter calling a relative for surgery, though the relative was seven years dead. That is a fact. The relative died in 1994 and was only then being called for attention. Nobody could be proud of that situation, not even disappointed Fianna Fáil Ministers of State. It is a good thing we only have a few minutes to speak as we could talk about this for a long time.

There is much red tape involved in appointments. The Minister informed me in January 2000 that he had approved the appointment of a second neurologist at University College Hospital Galway. However, 14 months later the position has not been filled; it is only now being advertised because of the red tape which slows down such appointments. The health board must apply to the Department to fill the post, the Minister must then approve the filling of the post, after its approval by the Department the Minister must seek the approval of Comhairle na nOspidéal. When Comhairle approves the post the matter is referred back to the Western Health Board. That is ridiculous red tape. I ask the Minister to address this problem and cut down on red tape. The second consultant neurologist to be appointed to UCGH will replace a consultant who is due to retire this year. We will, therefore, need two instead of one.

Mr. Boylan:

I agree with the Government backbenchers who say that there was never as much money spent on health, but they fail to realise that the Minister is not delivering the service. To say otherwise is to ignore the facts and a grave disservice to the people they claim to represent. It is also a grave disservice to the Minister, because if he is not aware of the situation on the ground, it is our duty to tell him how we see it in our everyday dealings with concerned families. There are waiting lists for simple and major operations and for people being placed in care. That is unacceptable given there was never as much money as there is now. The economy should be all-inclusive, but people are being left out and they feel hurt about it.

The Minister of State should be particularly interested in the case of Cavan General Hospital. A mammography machine was installed there courtesy of the Friends of Cavan General Hospital, but has not been commissioned to date despite repeated requests, a public meeting in Cavan town and 21,000 signatures to support the machine being commissioned. That is a disgrace given how sensitive and problematic the issue is.

I can give the example of two families in Cavan. One family returned from England with their handicapped daughter. They had been assured by the North Eastern Health Board before they came home that their daughter would be placed in care in the unit in Castleblayney. Eighteen months later that has not happened. That is an affront to those people and an insult to their care for their daughter whom they thought would be better off coming back to Ireland.

The second case relates to a young man of 35 years who is mentally handicapped. He is living with his elderly parents. This is a tragic case and an example of what is happening throughout the country. This young man was placed in open care in an institution not far from his home in Cavan town. He arrived home one day, barefoot and in his pyjamas, having walked a distance of 15 miles. There is no place for him. His parents are elderly and this young man seldom sleeps for more than one hour in the day. The family are distraught. I have tried everything to help them and I have failed.

The Minister says he is delivering a service. He should deliver a service to the two families I mentioned. At least then we would see something being done for somebody. I can give a list of such cases, although these are the most traumatic and sad. There are others in the context of caring for the elderly, an ongoing issue. We are failing to deal with it. We mention institutions and nursing homes but they are not the solution in caring for the elderly. These people want to live their retiring years in their own homes where they feel comfortable and independent.

Mr. Belton:

A recent public meeting in Longford on health issues was attended by 600 people. I am anxious to convey some of the sentiments expressed at that meeting, especially in relation to Longford Westmeath general hospital in Mullingar. Phase 2B of this project has been awaited for a number of years.

Deputy Noonan, when he was Minister for Health, continued the building of this project but then the trail went cold. Nothing happened because all funding went to Tullamore which was given top priority. Where else in the civilised world would one find such a building being left empty for three years? There is nothing in it. A project team was put together in the recent past but now extra services are required and the health board has again put the project on the long finger. These services are needed. That is the reason they are due to be installed in this building. However, what are people supposed to do in the meantime? What have they done for the last three years?

It is hard to watch what is happening in the health services. A constituent came to my clinic recently in great distress. He had come from a hospital where he had been told it would be two years before he would undergo surgery. That is the situation and all the PR and spin doctors in the world, as well as the dark suits, blue shirts and colourful ties, will not change it. That is the service this Government has given and the people will not forget it. I compliment Deputy Noonan on pinpointing the real issue in this country – the lack of health services. People are suffering. As far as they are concerned there is no tiger in the health services. If this Government does not get the health services together, this party and others will when they form the next Government.

Caoimhghín Ó Caoláin:

For the past three months I have been engaged almost full time in a struggle to save the maternity services at Monaghan General Hospital. That campaign reached its height in the month of February and necessitated my absence for a considerable period from this House during that month.

I little suspected when I was elected for Cavan-Monaghan that such a struggle would be necessary. The unprecedented resources in the hands of the Government made it almost unthinkable that there should be a return to the days of closures and cutbacks. However, this year we have seen the closure of maternity services at Monaghan General Hospital, despite widespread opposition from patients, staff and the citizens of the county.

There was a massive public campaign, including a rally organised by the county council. Almost 35,000 people signed a petition to retain the service but the closure still went ahead. The Minister says the responsibility lies with the health board, Comhairle na n-Ospidéal and with the consultant representative bodies. However, the buck must stop somewhere and it stops with the Minister. He has a democratically mandated responsibility for the health services and he must ensure they are both equitable and efficient.

The motion lists this Government's catalogue of failure on a national level. At a county level, I and 35,000 others can testify to the neglect of a key service at our hospital and its callous closure at the behest of unaccountable health service bureaucrats while the Minister washed his hands. I no longer have confidence in the health board system of delivery of health care in the acute services sector. I have no confidence either in the willingness of this Government to provide the root and branch reform of the health services which is required to end the two-tier system that currently exists.

The closure of maternity services at Monaghan and Dundalk is a shameful episode and the people of Counties Monaghan and Louth will not forget it. They also will not give up the fight to restore and upgrade the services which have been so unjustly taken away.

Mr. Deenihan:

I was amazed at the performances of Deputies Batt O'Keeffe and Dennehy and by their personal attacks on Deputy Noonan. I do not know how the Minister could permit that; it was disgusting. Obviously, Deputy Noonan is hurting Fianna Fáil. They are mindful, no doubt, of the respect in which he is held among the medical fraternity. To accuse him of doing a bad job for the nurses at the time of their dispute is ridiculous. Deputy Noonan set up the commission on nursing and, even though there were not many resources available, he secured £60 million from the Exchequer for the improvement of nurses' salaries. Overall, he did a good job at that time.

With regard to the hepatitis issue, apart from one mistake for which he apologised to the House and to the public and which he will forever regret, he did an extremely good job. He established the compensation tribunal and saved those unfortunate people a great deal of money. When Fianna Fáil came into office, it did little more than build on what Deputy Noonan achieved in office. It is a bit rich of Fianna Fáil speakers to attack him on his performance as Minister for Health. He was in office for two and a half years and did excellent work. He handled difficult situations sensitively, including the introduction of legislation which Fianna Fáil would not have dealt with if that party had been in power.

I can imagine why Deputy Dennehy and Deputy Batt O'Keeffe should be so ebullient in the Dáil. One need only look at what they have done in the Southern Health Board. They have desecrated the service in Kerry and run rings around their Fianna Fáil colleagues. There is only one Fine Gael representative from Kerry on the health board while there are five Fianna Fáil representatives. In the strategy for health in the national development plan, less than 3% of the funding was committed to Kerry. The rest goes to Cork. There probably are better facilities in Cork in the last three years but the service in Kerry has been destroyed.

People are left on trolleys in Tralee General Hospital, something that never happened previously. The hospital is under-resourced and under-staffed. There is a five year waiting time for people attending the out-patients surgical theatre. They are awaiting simple procedures, such as gall stones and varicose veins surgery. These conditions can turn cancerous unless they are treated. The consultants can do nothing. A third consultant was appointed but there was no provision for extra space, theatre space and other supports. As a result, that surgeon cannot operate over weekends or even late in the evening. This is a serious situation for a large number of women.

A building plan for Tralee general hospital was submitted to the Minister. I appeal to civil servants to prioritise Tralee as it is obvious the Southern Health Board will not do so. I recently tabled a motion in Kerry County Council requesting the chief executive and his programme managers to attend the council so we could question them on their performances in Kerry. They refused to attend which was an admission that they have not looked after the people of Kerry.

Until recently there was not an epidural service in Tralee so many women had to go to Cork for this service. The breast screening service in Tralee was also threatened. The current service is inadequate but there was a threat to relocate it to Cork.

There is a three-year waiting list for orthodontic treatment in Kerry. The Minister promised to appoint an orthodontic specialist but this has not happened. This is the longest waiting list in any health board area and the waiting time in Kerry is longer than in Cork. I am delighted to have the opportunity to outline the situation in the Southern Health Board where there is total discrimination against Kerry.

Minister of State at the Department of Health and Children (Ms Hanafin):

Opposition Members have accused the Government of throwing money at the health service and getting nothing in return. However, the Government is investing money in the health service and getting results in return. These results are in infrastructure, reducing waiting lists, proper plans on cancer and, in particular, in child care which is my area of responsibility.

The Government has a strategy for how to spend the money and how to deliver the service, which it is doing. Members have referred to the reduction in waiting lists due to the additional allocation of £34 million. There has been progress in breast screening where 120,000 women have been invited to participate in the programme. Women between the ages of 50 and 64 who are most at risk have been given this opportunity to ensure their health risk is identified and that they are helped. Many Members highlighted the fact that the cancer initiative has been expanded with the appointment of 28 consultants meaning that people throughout the country are getting the service they so badly need.

In the past three years, an additional £90 million and more has been invested in child care. This investment means that, for the first time, children are a priority. There is now investment in family support, early intervention and the protection of children so that, we hope, in ten years we will not see the type of troubled children who are coming before the High Court nowadays. These children did not get the service they needed at the end of the 1980s, for which all Governments were responsible. However, at least the investment is being made in this area.

It is not just a case of investment but of investment with a strategy and a plan. The plan is based on the national children's strategy launched last year which ensured that, last year alone, there was additional investment in staff throughout the country. This year up to 600 or 700 child care posts can be created. There is a national children's office to deliver co-ordination between different areas and there are "children first" guidelines which ensure that children are protected, identified if at risk and that people know the proper procedures to follow.

I am not just looking to the past, to criticise what other Governments have done or to hail what this Government has done. I will also outline where we are going. Our investment will be coupled with growth, a plan and a strategy. Plans in my area of responsibility include a White Paper on the mandatory reporting of child abuse which will set out the Govenrment's policy on how to protect children.

I will bring legislation to Government shortly in the area of adoption on the ratification of The Hague convention which will ensure that children coming to Ireland from abroad for inter-country adoption can be protected. I will also bring forward legislation concerning an information and contact register which will give rights to people who have been adopted and who are seeking information. The new health strategy will set out a fair and equitable access to health care and will be backed by funding.

Mr. Timmins:

I wish to share time with Deputy Neville.

An Ceann Comhairle:

Is that agreed? Agreed.

Mr. Timmins:

Funding for the health service has been increased by £2 billion or £3 billion in the past few years but problems persist and may be getting worse. It is difficult to explain these difficulties to constituents.

One of my main complaints about the Minister is that his style of running the Department is based more on image than substance. One example of this approach was the budget announcement of free medical cards for all people over 70. I tabled a parliamentary question last week to see if there had been any discussions with medical practitioners regarding how this measure would be implemented or the impact it might have on the service. However, nothing was organised or had been arranged. This highlights the fact that an announcement is made after which the policy follows.

The orthodontic service in the Eastern Regional Health Authority area is a disgrace and has been going on for several years. I cannot establish who is to blame for this situation but the buck has to stop with the Minister. I have tabled parliamentary questions for four years concerning people who were originally on a waiting list for three or four years when I started and who are still on a waiting list. Children diagnosed as priority cases at the age of six or seven are now 12 or 13 and have not been attended to. The same bland answers are offered for this situation stating that there is an industrial dispute, the matter is sub judice and cannot be dealt with. I have received telephone commitments that more orthodontists are being taken on in Loughlinstown, Naas or wherever but nothing seems to happen. The lists grow longer.

Families are not contacted. There was a controversy regarding this issue just after Christmas following which The Irish Times carried a headline to the effect that tax credits of 25% or 50% and a grant of a few per cent were to be offered to those on orthodontic waiting lists. However, we now discover this is to be a pilot scheme in the Northern Area Health Board area but there is nothing concrete to address the problem.

There was dispute in this area and a judgment was made. However, will the Minister outline what I should tell families, parents and young children? Should they seek private treatment or should they hold on? Ten thousand people in the ERHA region are on the waiting list. It would be some assistance to these people if the Department had the courtesy to contact them by letter outlining the situation and giving a projected date when they would be dealt with. This is the least the families are owed.

Wicklow is an unusual county in that there are four dioceses and no third level institution or general hospital. The county is serviced by hospitals in Loughlinstown, Tallaght and Naas. If an accident occurs, ambulances may bring the victims to Naas only for them to be transferred to Tallaght a short time later. Tallaght might be nearer than Naas to the scene of the accident. I tabled a parliamentary question on this issue but the reply did not refer to Naas hospital and was geared to Tallaght.

If, God forbid, I am involved in an accident going home tonight at Poulaphuca or Hollywood why does the ambulance have to bring me to Naas which does not have the facilities which are available in Tallaght? Who is looking after whom?

The time has come for Wicklow to examine the idea of establishing a general hospital. There is a new hospital in Tallaght and St. Vincent's hospital is on the south side of Dublin. However, the area from Bray to Wexford does not have a general hospital. Wicklow town and Arklow have been identified as areas of major growth over the next few years and it is time to consider building a general hospital in Wicklow. If needs be, Loughlinstown Hospital should be closed down. It is an old sanatorium and, in my view, although it might offend some people, it is a case of throwing good money after bad. It should be closed and sold off for development land. A general hospital could then be built in Newcastle. That would be a productive thing to do and it will happen later anyway. The Minister should take into consideration the idea of building a general hospital. All parties have welcomed the establishment of the Eastern Regional Health Authority but I am beginning to wonder if we have not created a monster.

Mr. Neville:

The Government stands indicted on its delivery of the health services. People's health is very important to them and over the generations we heard the old adage, "Your health is your wealth". The present health service is a disgrace. In 1999 alone we saw an unbelievable figure of 24,590 patients being readmitted to hospital within one week of discharge. What is happening? Under this Government, almost 500 patients are discharged each week only to be back in hospital within one week. This is a disgrace and the Minister must explain what is happening. Why are hospital staff forced to discharge patients before they are ready? What damage is done to their health because of this practice? The Minister for Health and Children must take urgent action to alleviate the suffering caused to these patients. He must intervene to remove the risk to the lives of these patients because they are not physically ready for discharge. Many who are so discharged are elderly people who worked hard in bad times, paid their taxes and created the foundation for our present wealth. It is not acceptable that the Government fails to give them a decent health service in their declining years.

The treatment of mental health has been neglected and under-funded. Mental illness has been the Cinderella of the health service. The attention and resources given to this area are a scandal. Why are provisions in this area not on a par with the general health and hospital services, albeit with its many faults? If there was justice in society the service provided for the mentally ill would be recognised as one of the greatest scandals of our time.

The sub-standard state of long stay institutions is unacceptable. Some institutions are in very bad repair and are symbolic of a different era. All psychiatric institutions which were constructed prior to 1900 should be closed down. Acute psychiatric units should be provided by modern purpose built hospitals for long stay patients. The Government should provide acute psychiatric units in general hospitals for patients in need of acute short stay treatment.

There will always be a small number of long-term disturbed patients and modern special secure facilities must be made available for them. What is happening now is a disgrace. In the new millennium these services should not have younger patients, functional psychotic patients, and patients with intellectual disabilities sharing the same ward. It is an affront to the dignity of each of these groups. As a matter of urgency the Government should introduce segregation for each of these groups.

There is now overwhelming evidence that psychiatric services concentrating on rapid response and community settings are superior to more conventional services. A community early intervention service should be introduced to provide a rapid response service for patients with severe mental illness. The service should see patients in their houses and other appropriate settings, including general practices, the community based day centres or, relatively rarely, in hospital. This should be styled on the hospice services.

In his rambling speech on this motion, the Minister assured the House that he had provided unprecedented levels of funding for health services. If the Minister has that sort of money he should be appearing before a tribunal of inquiry. As the Fine Gael motion states, the taxpayers, through this House, are contributing unprecedented levels of funding for health services. This Minister is not providing a penny. Furthermore, he is not making decisions because he will not take on any hard issues. Though it is a hard act to follow, he will leave the Department of Health and Children as badly led as the Cromien report showed he left the Department of Education and Science.

The public is not yet aware of the Minister's role in what one consultant last week called a mess, because the Minister spent £800,000 of the taxpayers' money on high visibility con job photo opportunities. How many orthodontic procedures could poor children, whose teeth are growing crookedly, have received with that £800,000?

The Minister, with his Cabinet colleagues, is quite happy to appear for soft media opportunities but when difficult questions have to be answered, be they about health or foot and mouth disease, it is very often the Minister of State who is left to face the music. This Minister fails to give leadership because he cannot make a decision.

In the course of his speech on this motion he told us he had created a forum to look into manpower issues, a national joint steering group on working hours of non-consultant hospital doctors, which he will consider, a review of bed capacity, a study of the impact of different measures on reducing waiting lists, a review of the role of general practice, a review of value for money audits within the health system and plans for the future which would provide the foundations for unspecified work.

He said he had entered into lengthy negotiations on reform, again unspecified, and has begun consultations on a new health strategy. Our party's spokesman on Health, Deputy Gay Mitchell, asked the Minister a parliamentary question on the health needs of prisoners. He refused to answer and transferred the question to the Minister for Justice, Equality and Law Reform who replied that, as one might have guessed, he is carrying out a review. All this after four years in office.

There are more varieties of commissions, inquiries, fora, review groups, consultation processes, steering groups, committees and commissions under this Minister for Health and Children than there are varieties of Heinz food products. There have been more than 57 varieties of such costly dogs' dinners which are excuses for inaction. The Minister and his Government have made a right meatball mess, though not of the Heinz variety, of overseeing what should be one of Europe's leading health services.

Instead, we now have a Third World health service complete with caste system. The poorer you are, the tougher it is, while the wealthy are seen immediately and live longer. The reality is that poor people suffer more and die younger. According to ESRI research on Irishmen aged 55 to 64, higher professionals have a death rate of 13 per 1000 while for semi-skilled men this figure rose to 22 per 1000, and for unskilled manual groups it is 32 per 1000. The mortality rate is almost three times higher among lower income groups than better paid professional groups.

Access to GPs and medicines in primary care, together with access to hospitals when needed, would help reduce the number of deaths among poorer persons. I would not be so direct about this were it not for the Minister's unnecessary and personalised guff handed out here and aimed at the leaders of Fine Gael and Labour, and the respective policy documents of both parties. Our policies are not perfect but they put forward sensible, innovative and imaginative proposals to tackle an unprecedented crisis in the health services and one which is acutely borne by those without large bank accounts.

This is real sleaze. This is why the Minister refuses to embrace Fine Gael policy which is the creation of a unified health system, with a covenant of rights and responsibilities for patients and providers, overseen by a health ombudsman. Unfortunately, indecision and prevarication are the hallmarks of this Government. The Minister has no new ideas, no capacity for decisions, no sense of reform and no feel for the suffering his lack of leadership has caused.

An Leas-Cheann Comhairle:

In fairness to the staff of the House, the Deputy should not continue beyond 10 o'clock at night.

Question put.

A division being demanded, the taking of the division was postponed until immediately after the conclusion of Private Members' Business on Wednesday, 7 March 2001, in accordance with an order of the Dáil of this day.