Private Members' Business. - Health Services: Motion (Resumed).

The following motion was moved by Deputy McManus on Tuesday, 22 May 2001:
That Dáil Éireann notes, that during the four wasted years of the term of office of this Government,
a) many public health services have actually deteriorated causing pain and suffering to those in need of treatment, care and support;
b) despite the urgency of the crisis now facing the health service, at the much hyped special Cabinet meeting held at Ballymascanlon on 14 May, no decisions were made nor any initiatives agreed to improve the situation;
c) the clear divisions between the Minister for Health and Children and the Minister for Finance which are a further obstacle to health care reform;
and deplores, in particular:
–the failure of the Minister for Health and Children to create a customer-focused health care service as promised in An Action Programme for the Millennium, or to produce any comprehensive programme of health reform;
–the failure of the Minister for Health and Children to deliver on the commitment given in An Action Programme for the Millennium to tackle the crisis in hospital waiting lists, as almost 28,000 public patients are waiting for treatment and waiting times in certain specialties have increased;
–the failure of the Minister for Health and Children to substantially improve mental health and autistic services as promised in An Action Programme for the Millennium, especially in view of the restrictive nature of the Mental Health Bill and the deplorable delay in progressing it through the Oireachtas;
–the failure of the Minister for Health and Children to increase income levels for eligibility for medical cards for large families, as promised in An Action Programme for the Millennium, as a result of which many people in need are deprived of access to the level of health care they require;
–the failure of the Minister for Health and Children to tackle the grave inequity caused by the two tier nature of our hospital system;
–the failure of the Minister for Health and Children to provide the additional beds in acute and non-acute hospitals needed to provide for our growing population;
–the failure of the Minister for Health and Children to introduce repeatedly promised legislation to further control tobacco advertising, despite the continuing toll that smoking takes on health and the additional financial burden placed on the health service;
–the failure of the Minister for Health and Children to honour commitments made in February last to ensure speedy repayment of moneys improperly demanded from adult children of those in nursing homes;
–the failure of the Minister for Health and Children to end the practice of keeping patients with intellectual disabilities in psychiatric hospitals;
–the failure of the Minister for Health and Children to ensure adequate community care services to support families caring for dependants in the home;
–the failure of the Minister for Health and Children to deal with the serious shortage of nursing staff or to address the concern of nurses in regard to working conditions;
–the failure of the Minister for Health and Children to fill all the 29 consultant AE and anaesthetist posts announced last October under the winter beds initiative;
–the failure of the Minister for Health and Children to fully progress the commitments made on working times and conditions for non-consultant junior hospital doctors;
–the failure of the Minister for Health and Children to deliver a full national breast cancer screening service and cervical cancer screening service;
–the failure of the Minister for Health and Children to deal with the serious crisis in the orthodontic service, especially in the Eastern Regional Health Authority area where more than 12,000 people are awaiting treatment or assessment;
–the failure of the Minister for Health and Children to adequately fund the child welfare and protection services resulting in growing waiting lists for social work services and inadequate residential care services for many children at risk;
and instructs the Minister for Health and Children to report back to the Dáil not later than the last day prior to the summer recess, on what progress he has made on all of these issues.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann:" and substitute the following:
"–commends the Government for the unprecedented increases in health funding which it has
–been implementing since 1997;
–recognises that this funding has led to significant improvements in a range of important services; and
–endorses the process which has been adopted to facilitate the development of a new health strategy."
–(Minister for Health and Children).
Mr. McCormack: I wish to share time with Deputy Gay Mitchell.
The health service is in a shambles and, despite the Minister's claim of increased expenditure in the health budget, everybody can see that services for patients are getting worse. I cite as an example UCHG. Why has the Minister failed to deal with the hard questions? Why does he not ask how an increased budget is being eaten up while the health service worsens every week? Can he not acknowledge that each year more and more of the budget goes on layers of administration? There are chief executives, managers, programme managers and a full-time office dealing with complaints from patients and their families. The services of cleaning staff have been dispensed with and contract cleaners hired. Does the Minister not ask the hard question as to whether the standard of hygiene has improved at hospitals as a result? It certainly has not improved at UCHG. Can the Minister tell me how many patients have to be readmitted, or have their stay extended, because of cross-infection while in hospital? When the health boards took over from the county councils it took six to replace every one then employed. How many times greater is the number in administration now?
More than a year and a half ago the then Minister of State at the Department of Health and Children, Deputy Fahy, announced that the Department had ordered a report on management at UCHG, but despite my efforts I cannot find out where it is. Did it ever see the light of day or was the then Minister of State bluffing? Can the Minister for Health and Children, Deputy Martin, tell me where the report is? I can tell him that matters are serious at UCHG. While everybody has praise for the doctors and nurses, I could outline cases of patients being on trolleys for up to 36 hours, with 24 hours being commonplace. The longest waiting time on the list is now ten years. Only a few months ago a woman came to my clinic very distressed at receiving a letter from UCHG calling her relative for an appointment, though the person concerned had been dead for seven years. It is a fact and was reported in the local newspaper. Another man came to my clinic who was due to attend for chemotherapy. He was told to ring on the morning he was to attend and on doing so was told there was no bed available. He rang twice a day for 11 days before being called for treatment.
In the case of the appointment of a second consultant neurologist at UCHG the Minister tells me in replies to parliamentary questions that the post was sanctioned in January 2000. Interviews have only recently taken place, more than a year and a half later. The red tape involved in such appointments is simply ridiculous. The Minister is also massaging the waiting lists in what he calls "the validation". In the Western Health Board area, for example, 547 were removed in the validation, which means that the waiting list is now greater than it was in June 1997 when the Government took office. I could go on for an hour but will hand over to my colleague, Deputy Mitchell.

I am glad to have the opportunity to speak on the motion and thank Deputy McManus and her colleagues for tabling it.

Nothing illustrates the way the two tier system operates as clearly as the system of allocation of medical cards and the treatment of patients in primary care. When we think of, and talk about, the health crisis we usually mean the problems in secondary care where it is most acute because of waiting lists and the number of bed closures. When we talk about apartheid in the system we are also referring to secondary health care. We have an apartheid medical health system and the reality is that the better off one is the longer one lives. For professionals aged 55 years and over, the death rate recorded by the ESRI is 13 per thousand. For those on lower incomes in the same age group the death rate is three times that figure. Much of it has to do with the fact that poorer people cannot afford the best of medical treatment and sometimes, because of their low incomes, their diets are not as good. Perhaps they turn to smoking as a way of relieving pressure because they cannot afford other more expensive outlets available to richer people. One would think, therefore, that in trying to end apartheid in the system we would look at these poorer people and, at the very least, ensure in primary care they have access to medicine and are treated well. The point about primary care is that it is much more egalitarian and everyone sees the same doctor if they can afford to go and see one.

The agreement between the Government and the Irish Medical Organisation provides that 40% of the population are entitled to a medical card. Even under this arrangement, only the lowest 40% qualify and because of the mean manner in which the Government applies the rules even this part of the community is not receiving cover. The Government has unilaterally restricted the medical card to 30.32% of the population, as at 31 December 2000, according to a written parliamentary reply received by me today. One in four of those entitled to seek cover under the IMO standing agreement with the Government is denied his or her entitlement at a time of plenty. I do not understand this. As up to 37% of the population have qualified in the past, why have they been removed? Why has the rate of medical card cover fallen to just over 30% when the agreement with the IMO provides for a figure of up to 40% considering it has been 37% and higher in times gone by? This means that a single person on £101 per week is over the new entitlement limit, falling to £89 if single and living with family. The figure is as low as £144.50 for a married couple. Yet, we have an agreement with the IMO to cover those on incomes higher than that basic, mean amount of money provided for by the Government.

The medical card is being withheld improperly from very poor people. Is it any wonder that we have a crisis in secondary care when those on modest incomes cannot access what should be their first port of call, primary care, with all the implications this has for preventive medicine and ultimately for those ending up taking up a hospital bed in secondary care? In policy proposals published last November, Fine Gael proposed doubling the income limits in order to ensure full 40% cover as provided for in the agreement with the IMO immediately. It would mean the following limits. A single person would be able to earn up to £10,200, up from £4,870, a married couple under the age of 66 years would be able to earn £16,820, up from £7,044 and a married couple over the age of 66 years would be able to earn £19,720, up from £8,760, under the Fine Gael proposals. Fine Gael announced a doubling of the limits last November in our document. However, it is still not enough to increase a single income to £10,200 and to say that anyone with an income less than that will get a medical card. An income of £16,820 for a married couple is not generous for medical card cover. However, people on half that income are being disqualified at present. Only 30% or three out of every four people who could be covered by the medical card by agreement with the IMO are not covered at a time of huge budget surpluses.

I propose extending by agreement with the IMO free general practitioner services to children up to 18 years and beyond that age if they are in full-time education, to all senior citizens over the age of 65 years and to those in the lower 60% of income groups with special provision for asthma sufferers and those with similar chronic disabilities. The estimated cost of bringing the medical card up to the full 40% would be approximately £130 million a year. We should add on the free general practitioner services for those people who should be targeted. It is hard to believe that Sir Anthony O'Reilly, Deputy Gay Mitchell or the Minister, Deputy Martin, should be entitled to a medical card or free general practitioner services. If we target it in the way Fine Gael is proposing, it would cost another £300 million. Expenditure on the medical card and the free general practitioner service would, if coupled with a strategic approach to secondary care and to other investment in GP practice development and pharmacies, which we would put forward with a restructured governance of the system, have a major effect in bringing about reform and a successful egalitarian and fair health service. The upper income groups, excluding senior citizens, would continue to be entitled to the drug refund scheme and tax deductions for annual medical expenditure in excess of £100 or £200 for a family.

Without discussing the overall health services, which I have tried to deal with in other debates and in my policy document, how can we justify denying a medical card to a single person on £101 per week? Some people in this House would not go into a restaurant with £101 in their pockets. This is contributing to the problem. We are not taking seriously the needs of the poorest of the poor. We are, therefore, complicating the health system because when these people become chronically ill, they cannot afford to access primary care and they are then taken into the secondary care system. It would help greatly if that could be done.

Perhaps Deputy Gay Mitchell could bring in the people from the IMO to whom he has spoken to speak to the Minister and to others involved in health care. He was not speaking to the same spokesperson who last week at the conference publicly advised that discretionary medical cards should be issued sparingly and only by the chief executive officer. Can one imagine what it would be like if someone in charge of 12,000 staff, as is the case in the Southern Health Board, had to sign each medical card? These are the people with whom Deputy Gay Mitchell has a special agreement and who are objecting to giving the over 70s, the people who built the State, free medical cards. There is something wrong when Deputy Gay Mitchell is quoting them. Perhaps new spokespersons are needed.

These are the type of quick fix solutions we heard about last night. However, there are no simple solutions. Everyone accepts there have been decades of underfunding. I am not a great believer in polls but last week's poll showed that the public blames successive Governments and Ministers for the failure to provide funding. There is no overnight solution to the problem. The Labour Party's solution of universal health insurance would lead to the closure of many local hospitals. That is not the answer, although it does not do any harm to put it on the agenda for discussion. I am sure Deputy McManus is aware that in 1982 the Conservative Party think-tank proposed such a model to Margaret Thatcher's Cabinet. The proposal was leaked and it triggered one of the biggest rows in Thatcher's premiership. It was too right wing even for her at the time.

The Deputy should read the policy.

As the Minister, Deputy Martin, said last night, all studies show that the insurance-based funding system significantly improves the percentage of funding towards administration costs. We heard several Opposition spokespersons refer to the cost of administration. We should try to cut such costs but not by taking on board a proposal such as this from the Labour Party. Deputy Shatter seemed to agree when he spoke in the House on 2 February 2000. He said our health services require radical reform but whether the necessary reform can be brought about by the introduction of a universal health service is questionable. He said that what was needed was less, not more bureaucracy. The Fine Gael Party has now advanced a similar insurance-based model.

We, on this side of the House, are more concerned with reform than with making the health service an electoral gimmick. Many of the issues relate to funding. We have doubled the expenditure on health since taking office. It has been increased by an extra £1 billion this year to approximately £5 billion. Many people would argue that the service is still underfunded, but funding is being provided. We want to ensure we get value for money. The Opposition parties threw a meagre amount at our health services while they were in the rainbow coalition. We are hearing more reports about that, including today's evidence at the tribunal. The Minister has established a value for money audit to ensure that the taxpayer gets the best value for money from our health service. That is critically important. Every public representative will support that approach.

More people are being treated in our hospitals now than when the rainbow coalition was in office. The waiting lists are shorter and more nurses and doctors are employed in the health service. I am not saying all is well. We, on this side of the House, want extra benefits, facilities and services and we will continue to want that. If Deputy Quinn, who was Minister for Finance, and Deputy Noonan, who was Minister for Health, had not cut the number of nurse training places or the funding for reducing waiting lists, perhaps we could have advanced reform more quickly. If they had invested more in the health services, perhaps some of today's hardships would not be experienced by the people whose cases are being trotted out now. The Minister is adopting the right approach. The new health strategy is about people and the service and the Government is providing money for it. It should be supported. We must work together to get a better health service for the public.

It is with increasing bemusement that I have watched this debate unfold last night and tonight. I wonder if people realise that the proponent of this motion, the Labour Party, was not only in Government but in charge of the Exchequer not too long ago and, therefore, had the opportunity to radically alter the State's policy on health expenditure. The Labour Party could have insisted on increasing health expenditure to any proportion or percentage it liked of GDP as the price of staying in Government and I am sure Deputy John Bruton would not have disappointed it. Do the people realise how abysmally it failed when it was in Government? Do they realise that during the period of the rainbow coalition health expenditure barely kept pace with inflation? Yet we have this huge outpouring of mock indignation. Is it any wonder that young people are turning away from politics and that cynicism has grown apace?

By contrast, Fianna Fáil in Government since 1997 has reversed a decade long trend of underfunding of our health services. We have introduced significant improvements in a range of important services and we are engaged in an exciting process of developing a new health strategy to address past neglect, underfunding, inefficiencies and inequality. By contrast, the leader of the Labour Party, Deputy Quinn, as Minister for Finance in the rainbow Government, managed to raise health spending by a shameful £400 million over the 2.5 year lifetime of that Government. Deputy Quinn, the leader of the tax and spend party, as Minister for Finance had no problem taxing but had a major block when it came to spending on health, education and social inclusion.

That Government also had a third component, the late, unlamented Democratic Left, now not-so-sadly defunct. If that party was unhappy with a Government that was not prepared to increase health expenditure at all in real terms, it could have walked away and brought that Government to an end. Where was Deputy McManus's latent indignation then? Why did it not boil up then? Does the Deputy have to go into opposition and wait four years to rediscover her conscience and her indignation about the health care system.

The Minister for Finance, Deputy McCreevy, working closely with the Minister for Health and Children, Deputy Martin, has doubled the amount we spend on health per annum. This year's allocation of roughly £5 billion, together with the increases since 1997, will go some way to rectifying the effects of under funding and neglect which were exacerbated during Deputy Quinn's tenure at the Department of Finance and Deputy Noonan's tenure at the Department of Health and Children.

During the years of the rainbow Government this was a wealthy State. The funds were available for greatly increased health spending. Why was it not spent? It is true that at that time there was not a budgetary surplus. The surplus was to come later, due to the fiscal policies of this Government. Was the existence of a small deficit an excuse for such under funding of the health services on the scale presided over by Deputies Noonan and Quinn?

The Labour Party's fiscal policy document, "New Directions, New Priorities"– the latest chapter from the source of continuous fiction that is the Labour Party policy unit – would return the state coffers to deficit financing. Labour seems ideologically wedded to deficit financing. Why then, was the Labour Party so shy when it came to funding our health services between 1995 and 1997? How can it, with a straight face, criticise the reforming enthusiasm of this Government?

There are huge problems in our health services and we have been first to admit it. We have been the first Government to seriously attempt to tackle them. The country will be delighted to know there is now an alternative. I have read the Labour Party document with great interest. It is on the one hand bizarre and on the other very funny. It is a policy document version of "One Flew Over The Cuckoo's Nest." It is a combination of Thatcherite capitalism and champagne socialism to what end it is not clear. However, there are two ends it will achieve. It will close local hospitals and hugely increase expenditure on administration.

We will not proffer gimmicky, quick-fix solutions as the Labour Party do. We provide the funding. We provide the improvements. We provide the reforms. We provide the way forward in terms of health strategy.

As Minister of State with special responsibility for older people and food safety, I take pleasure in coming before the House this evening to set out the real improvements the Government has been able to effect since June 1997 when the electorate delivered its verdict on the Governmental record of Fine Gael and Labour.

Under funding was the hallmark of the rainbow Government in the area of health, so that when we assumed office in 1997 there was an urgent need for investment in the area of services for older people. To date, as a result of increased investment, imagination and determination, we have succeeded in creating an additional 800 posts in that area. Spending in this area has increased from £10 million in 1997 to £57 million in 2001. For every £1 the rainbow Government invested in services for older people, we invest more than £4. That shows commitment.

The reforms and improvements do not end there. Last year's winter initiative, which cost £25 million, alleviated pressures on acute beds by placing elderly patients in more appropriate facilities such as nursing homes. There are more geriatricians, psychiatrists of old age and paramedics. We are making medical cards available to all people over the age of 70. Heating services have improved, along with carer's allowances and home help. We have also looked at prevention in the areas of cancer, cardiovascular problems and osteoporosis.

Spending on palliative care is up from £3 million to £15 million in 2001. This year palliative care services will be expanded in all health board areas and the report of the National Advisory Committee on Palliative Care will be published this year. We are enhancing existing community care services and developing new ones. We place special emphasis on rehabilitation and stroke care services.

Where the Department of Health and Children can improve the lot of our older people through close co-operation with other Departments, we have proved eager to do so. We have co-operated with the Department of Social, Community and Family Affairs and the Department of Environment and Local Government in the area of housing. In the forthcoming health strategy, the needs of older people will be comprehensively addressed.

The Labour Party motion provides an opportunity to examine the decreases in the waiting lists which this Government through its policies have effected in our health services. It also provides an opportunity to analyse the record in Government of the Labour Party and Fine Gael. In the rainbow Government between 1995 and 1997 they had an opportunity, but failed to effect a decrease in waiting lists.

This Government's policy on waiting lists has been clear. We are committed to reducing public waiting lists. We inherited exceedingly long waiting lists from the preceding Administration. Our policy has been successful. Its policy was not. The figures show that the waiting list at the end of December, 2000, was almost 2,600 lower than it was in June 1997, the date of the last general election. No matter how the Opposition massages and distorts the figures, they are lower today than they were during its watch.

This Government is investing and its policies are yielding results. We are providing the funding to reduce waiting lists through the waiting lists initiative. This year we have allocated funding of £34.5 million under the waiting lists initiative to enable hospitals to carry out procedures and we have reviewed the underlying cause of waiting lists. In 1998, a major review of the cause of waiting lists was undertaken by an expert group established to that end. This group made valuable short, medium and long-term recommendations to minimise waiting lists. These are being put in place. Good progress has been made by a number of the agencies involved.

Some of the long-term infrastructure issues are being addressed by the national development plan. Much of the £2 billion capital investment in our health services will aid a greater reduction in waiting lists. We have initiated a national review of bed capacity. This review involves the development of a long-term investment strategy for the acute and non-acute sectors. It will include a detailed assessment of future bed requirements. We have also initiated the winter initiative. This initiative which involved £25 million investment is targeted at a number of key areas including approval to recruit 25 more accident and emergency consultants, approval to recruit 15 more consultant anaesthetists, provision of at least 500 additional nursing home places, and development of a new acute assessment unit in St. James's Hospital.

We have not cured the problem. The waiting lists remain, but the main point is that they are coming down. There is a long way to go but our policies plainly work. Since June 1997 our hospitals are busier. Last year alone an extra 42,000 patients were treated than in 1999. This places the decreases in waiting lists in better perspective. Waiting lists are being reduced at a time when there are more patients being treated. This is a feature of the economy generally. The health system faces infrastructure pressures because of the growth in our population and the booming economy. The latest figures show that the waiting list for cardiac surgery halved in 2000. There were significant reductions in other key areas. For example, the waiting lists for orthopaedics were down by 29%, ophthalmology, 27% and ENT, 24%. In the past three years almost £80 million has been made available to health agencies to reduce waiting lists and waiting times.

The Fine Gael policy document, A New Patriotism, contains the admission that "waiting lists are a politically created phenomenon". It behoves the Members opposite to examine this statement because, in 1997, Deputy Noonan, as Minister for Health and Children, and Deputy Quinn, as Minister for Finance, cut the funding allocated for the reduction of waiting lists by 20%. This was sanctioned despite the fact that there were 2,600 more on waiting lists than there are today. What we are hearing is something of a hypocritical denunciation of the Government, which is making a brave effort to reduce waiting lists at a time when hospitals are becoming increasingly busy.

Nobody is suggesting that we should spend, willy-nilly, increasing amounts on health services without examining the underlying causes of waiting lists, medical inflation and, more importantly, the high level of spending in the administration of hospitals. There is no point investing money in hospitals if it will not be spent on providing frontline care and reducing waiting lists and not result in a better and more enhanced service for patients.

I remind the House and the Minister that, as Members will be aware from their constituency work, it is often the attitude shown to a patient arriving in hospital which is so important. I make no bones about the fact that we require a more patient or customer focused approach in our hospitals because patients in hospital sometimes feel that their rights are not being respected, that they are not getting their dues or entitlements and that the attitude shown to them is wrong. The Minister has already begun to address this matter. Some believe, for whatever reason, that when they arrive in hospital they are put to the end of the queue or treated in a way that is not humane or proper. This is a feature of all our public services and it must change. If one telephones a local authority or Government office, one is met with an attitude that one can wait in the queue just like everyone else. This is not acceptable because members of the public have greater expectations than heretofore.

I am glad Deputy Martin was given the Health and Children portfolio. His performance in handling the Education and Science portfolio was excellent. The area of health is his next big challenge and I believe he will resolve any problems which obtain.

I welcome the opportunity to speak on this Labour Party motion which affords everyone in the House the opportunity to discuss the current state of the health service and our future policies and strategies in this area.

The Government is committed to developing a world class, equitable and accessible health system. To do so, we need real and lasting improvements. We need to work in partnership with everyone who has a role to play in health care in order to create the root and branch reform which is so necessary. That is what the new health strategy is about. Before we entered office, the system was struggling to survive. There was insufficient investment, derisory increases in spending, cuts in funding to reduce waiting lists and the health professionals who form the basis of the health system found that their skills and dedication were simply not being acknowledged or developed. The system was in crisis.

For four years we have been dealing with this situation and our efforts will culminate in the Government's new health strategy, which will be published this summer. Just as our current economic prosperity was built in partnership with the social partners, the health strategy is being arrived at through public consultation in partnership with the health stakeholders and the general public. At the foundation of the strategy are the reports and assessments we have already carried out of the needs of the health service, the medical manpower forum and the report on junior hospital doctor working practices. These are real efforts to address the needs of health professionals. Similarly, we are implementing the reforms suggested by the Commission on Nurs ing. The 30,000 hard-working nurses who form the frontline of our health services need better opportunities to train and better working conditions which we are attempting to provide, again, in partnership. Another element of the strategy – an element the Opposition has ignored – is the value for money audit. The charge that we are throwing money at the problem is plainly untrue.

These various reports and assessments, with the findings of the largest public consultation ever carried out in the health service and the input of the national consultative forum – which has been established to give health stakeholders a real input into the strategy – will be brought together to form our national health strategy which will be evaluated by outside international experts as it develops. A great deal depends on the strategy and we are doing all we can to ensure we get it right.

Understandably, this huge and complex process has taken time. Members of the Opposition castigate us for this. They would rather that we followed their past example, namely, to do a rush job or find a quick fix solution, which, in the long term, would exacerbate our health difficulties. That is not what the Government is intent on doing. We aim to put in place a health service which will provide the best medical care for the poorest of our citizens, without undue delay or inconvenience. That is the basis of the health strategy.

In the meantime, we have continued with investment. A £2.5 billion increase in health expenditure during the lifetime of the Government against a £400 million rise during the term of office of the rainbow coalition shows our commitment. We have embarked upon the largest building and modernisation programme in the history of the State. Some 50,000 more day cases and 40,000 more in-patient cases have been dealt with in our hospitals since 1997.

The Minister for Health and Children, Deputy Martin, has stressed on a number of occasions that maintaining thestatus quo is not an option. The Government is concerned with reform and improvement in our health services. The investment is delivering and the policies and strategies are being put in place. In the light of his record to date in the Departments of Education and Science and Health and Children, I have no doubt that the Minister, who has the necessary energy and commitment, access to finance, will put in place a strategy which will deliver. As a result, we will have a state-of-the-art health service which will be at the cutting edge of development and deliver, effectively and efficiently, services to customers and patients who must currently spend time on waiting lists. There is always pain before gain. However, in this instance, the Minister will deliver on his commitments.

The Minister and the Government can be quite pleased with the action they have taken in the area of health in recent years. I accept that there are problems, but the Govern ment was obliged to deal with the aftermath of decades of underfunding by successive Governments. The action taken has helped the health service turn the corner, with the result that it is now headed in the right direction. When the Minister finalises the new health strategy and draws together the various policy issues later in the summer, what will emerge will show us the way forward.

The Government and the Minister have tackled many issues which, historically, were never touched upon by previous Administrations. Consider, for example, the area of cigarette smoking and tobacco addiction. I understand up to 7,000 in Ireland die each year as a result of smoking. This is a colossal number and, as someone stated, higher than the number who died of TB each year in the 1940s. Despite this, the issue was neglected by successive Governments and Ministers for Health because there were always other priorities. Now, however, the current Minister is tackling it and new legislation will be brought forward in the near future.

Nobody is suggesting that the health service is perfect. One can be negative and critical and find fault with it, left, right and centre. I have no intention of condoning some of the behaviour which obtains in accident and emergency departments in Dublin hospitals, particularly the Mater. It is frustrating that three and a half years after the Department of Health and Children approved the building of a new accident and emergency department at the Mater not one brick has been laid. The Minister cannot do the construction work himself. Due to changes of plans or whatever, the authorities at the hospital are still discussing, arguing and hiring increasing numbers of consultants instead of getting on with the job. Three and a half years have passed since the Minister gave capital approval for the project.

The experience of most people and patients of hospitals is through their accident and emergency departments. I welcome the fact that the Minister announced months ago that he was appointing new accident and emergency consultants. However, he has not received a great deal of co-operation in that regard because the consultants – who seem to have too much power – seem to believe that the accident and emergency department is the least important part of a hospital. As regards the hospitals in my area, the Mater seems to think people die only from heart attacks, Beaumont seems to think people die only from neurological complaints or something similar and I do not know what they deal with in St. Vincent's.

Is it? Perhaps they think people only die from that. Hospitals appear to be controlled by consultants who are only interested in the national specialty which is their major area of concern. The accident and emergency area is where old and sick people go and it does not get the priority required.

I was delighted to hear of the Minister sanctioning new posts for consultants in the accident and emergency departments. That is the way to treat people, to give them early care and either discharge them or admit them to hospital. One can be negative or look at the good aspects. To listen to complaints in the House and outside, one would think nothing good was happening. A massive amount of money has been invested in the health service in recent years. It is not just money either. Some 14,000 extra staff have been recruited and they cannot all be office staff. More than 4,000 were doctors, nurses and paramedics. Those are colossal numbers.

We hear about waiting lists but the number of procedures and outpatient appointments have increased. Some 80,000 more procedures are performed now than were performed four years ago. That is an enormous increase. The number of nurses has increased hugely. Foreign nurses are being recruited and more nurses are in training. Sometimes all one hears is about nurses not being available which creates problems and lengthens waiting lists. A massive amount of good is being done and many of the structures being put in place will be pulled together by the new strategy which, I hope, will point things in the right direction.

The perception of many people is that, while the Minister ought to be the boss, he is not. He must take on the many vested interests. Even the consultants seem to have different views and shout only for investment in their specialties. They are very good at approving or stalling initiatives of the Minister when they wish to do so. We must all pull together. The Government can provide the strategy and resources but people in the health service must provide the management and get on with the job.

I propose to share my time with Deputies O'Sullivan, Wall, Shortall and Gilmore.

It is exactly 50 years since a Minister for Health was driven from the House by powerful vested interests on the simple principle that he was in favour of universalism in health care. In this case it was health care for mothers and children. Last week I met a young mother who brought her child of two weeks to a general practitioner for a defect in the child's eye. She was asked when leaving if she had paid the £25. She was told the six weeks' post-natal care system only applied to participating doctors. That prompted me to ask what had been achieved in 50 years.

I wish to be positive. Taking up on what the previous speaker said, the House must make up its mind on the universal provision of basic health care. It is a scandal that private insurance pays 9% of the costs of the health system and, at the same time, seeks to benefit from a two tier health system where 80% of those on insurance can have their procedures carried out within four weeks while the rest of the population which subsidises this inequity through general taxation must wait years. I am not interested in going back over old arguments about who is responsible for what. Fifty years ago an attempt to provide universal care for mothers and children from the moment of conception until the children were safe was opposed by powerful vested interests.

The problem in the health service is one of funding and, more important, one of moral courage. It is about whether the courage exists to face those vested interests which stand in the way of putting in place a universal health care system. I listened with interest to those who said we are on the way to having a world class service. One has only to think of all the international reports which note the unique nature of the Irish system, that it appears to be prejudiced against the idea of general universal State care in health.

It is time we lifted ourselves out of this historical morass. This means facing consultants so as to be able to put in place a career structure for junior hospital doctors and junior consultants. It means taking up on the positive suggestions made by groups such as the Irish College of General Practitioners and trying to enhance general practitioner provision by supplementing it with, for example, local clinics. It is ridiculous that minor ailments, including ones which require X-rays and whatever, should be funnelled into the acute hospitals. It means dealing with GPs in a new regime offering a free GP service. It means establishing local and district clinics with paramedics and good nurses who are able to provide this service.

It is clear that many procedures do not take place because of the non-availability of nurses. Those in charge of nursing training say the numbers coming forward now are a fraction of the numbers who came forward before. There was an appalling refusal rate in the past of people who wanted to enter nursing. In addition, one of the effects of speculation in housing is that young nurses cannot afford to live in the cities where hospitals are located. They cannot afford to take the jobs. These are realities.

I met the wife of an 83 year-old patient in my constituency clinic three weeks ago. He was offered a procedure which required him to wait on a trolley. He was not able to do that and simply went away. The manner in which health care is delivered is a mark of a society.

This raises another question, the answer to which I and other Members know the answer. From where did this Irish obsession with means testing come? It comes from the Poor Law. It is as simple as that. It is an inheritance. I do not have any difficulty with paying such taxation as will pay for general universal health care. I regard it as a mark of the society in which I want to live. The obsession with means testing emanates from the old ticket mentality and an enormous amount of resources is wasted on these qualifications.

We who are elected are supposed to stand and act with courage. It was a disgrace that an abuse of a principle of Catholic social teaching destroyed Dr. Noel Browne's scheme in 1951. It was the lowest ebb for the medical profession that its agents searched dustbins to discover who were the authors of documents concerned with that controversy. The issue remains the same. Is it not time we put these silly prejudices apart, faced the vested interests, responded to the public and said that what we need is universal care and that it would be exceptional that there would be any other special provision? Is it not obscene that people seek tax concessions in the Finance Act to provide private medicine with public subsidy, investing in the sickness industry, as it were, at a time when the health service needs radical reform?

I am not interested in trading blame about absence of provision in the past. I am interested in something else, namely, a courageous announcement of a radical re-organisation. We should invite in those concerned, face them and say that privilege and monopoly will not have any place in depriving the public of a general, accessible, democratic, egalitarian health system that could be compared not with the world but with the European Union. We have 80% of the provision of other respectable countries in the European Union. The money is there to do it now. All that is required is the imagination and the political will to face those who are standing in the way of the public's right to adequate health care.

It now appears that even the Minister for Health and Children has come around to the view that a radical reform of the health service is required. Unfortunately, he has not been able to persuade the Minister for Finance and his colleagues in Government of the necessity for this and the need to begin to tackle this issue.

The announcement of the grant of medical cards to all people over the age of 70 is a smokescreen for neglect in many aspects of care of the elderly and the provision of health care for the elderly. The vast majority of people over 70 already have a medical card and it is of little use to them if they cannot get support services in the community, a bed in an acute hospital if they require an operation or an affordable long-stay bed if they are unable to look after themselves and do not have a family member to take care of them.

The concept of providing supports in the community so that elderly people and people with physical disabilities can stay at home, surrounded by friends and neighbours is good and humane. However, this is not happening. Home helps, public health nurses, chiropodists, physiotherapists, occupational therapists and a wide variety of other support services are not there in sufficient numbers to provide the support needed. The back-up needed to make the physical environment suitable is not there. The housing aid for the elderly scheme, the disabled person's grant, aids and appliances – if one gets beyond the waiting list for an occupational therapist for an assessment in the first place – all have long waiting lists. If a person is more than 80 years of age and cannot come home from hospital or nursing home unless one or a combination of these services is available immediately, he will be said to be inappropriately occupying an acute hospital bed. Alternatively he may be sent to a private nursing home which he cannot afford because of the gap between the cost of the nursing home and his income.

Physiotherapy can be most effective in helping a quick recovery from many conditions and after orthopaedic operations. Orthopaedics is one of the specialities which have the longest waiting lists. Time is of the essence if physiotherapy is to be effective, yet a sign in the physiotherapy department of the mid-west regional hospital reads, "Waiting time for physiotherapy – 394 days". What use is that to somebody who needs physiotherapy immediately? Why are we not training more physiotherapists? Clearly, a great number of young people want to train for this profession because the entry requirement for training is one of the highest in the country.

Why is only £200 million provided for capital development of services for older people for the years up to 2006 in the national development plan when countless millions are available for the Bertie Bowl, for example? We know the elderly population will steadily increase during those years but we are seriously lacking in terms of public beds.

I recently asked the Minister for Health and Children the number of long stay public geriatric beds in each of the health board areas but he was not able to tell me. He did not have the statistics. This is unacceptable in an era when we should plan for these things.

The Mid-Western Health Board has closed nearly 50 long stay beds in St. Camillus's Hospital in Limerick in recent years, purely for financial reasons. This is shameful and should not happen at a time when our elderly population is increasing and we are all fully aware of the needs of the elderly. What are senior citizens who cannot look after themselves supposed to do?

There are at least 55 beds ready to be occupied by sick people in the Limerick regional hospital in fully equipped wards. My party leader saw them with me last week. The Minister agrees that we need more beds. I ask him to give us the funds to open these beds. The health service needs the radical reform proposed by my colleague, Deputy Liz McManus, and outlined by Deputy Michael D. Higgins. In the meantime, specific actions can be taken to ease the pain while we are waiting for the cure. Let us see some real commitment to the elderly in the community and in our hospitals and homes.

The Minister for Health and Children has failed to provide adequate child welfare and protection services. On coming to office the Government changed the name of the Department of Health to the Department of Health and Children. This, it seems, was a change in name only because the situation for vulnerable children – those most at risk – has disimproved considerably in the past four years. It is shameful, in the midst of huge wealth, that the waiting list for social workers for child victims of abuse and neglect are getting longer and longer. These are children about whom there are serious suspicions of sexual abuse, physical abuse or neglect and they have been abandoned by the Government. They are left to wait, often for months on end, to see a social worker.

In the Northern Area Health Board area there are currently 686 children on such waiting lists and almost 200 of these are regarded as priority cases. These are children about whose safety there are grave concerns because of the suspicion, and in many cases the sure knowledge, that they are being abused or seriously neglected. Many of these children, who have suffered from State neglect and others who have suffered for other reasons, go on to develop serious behavioural problems and will, undoubtedly, end up before the courts. Even when things have got to the point where a child is, chillingly, deemed to be out of control the State's response is abysmal. Hardly a week goes by without such a case coming to media attention and frequently these children are returned to highly inappropriate settings or, worse, left to their own devices on the streets because the Government seems incapable of meeting their care needs.

The legislative basis for the care of such troubled children dates back to 1908. On coming to office the Government was presented with a Bill to update the law in that area but it chose to postpone the introduction of the Bill for three years and it was not until late last year that another version of what we now know as the Children Bill was produced. That Bill is making its tortuous way through the various stages and will, I hope, soon be enacted. However, there is no provision for the implementation of that legislation and no resources have been made available for the huge additional staff which will be needed to give it effect.

The failure to provide basic child welfare services has resulted from the refusal of the Government to provide adequate resources. The Northern Area Health Board requested an additional £18 million to meet the needs of children in these situations. A measly £6 million was granted by the Government. Very often the Minister and his colleagues are inclined to give the impression that money is not a problem these days but when money is needed the Government is not making it available. If money is needed anywhere it is needed to meet the needs of the most vulnerable children.

The Government has refused to engage in any type of long-term planning for the training of social workers and child care workers. I have concentrated on the most urgent and critical aspects of the child protection services. It is not surprising, in the context of the Government's failures in this regard, that the Minister has also failed utterly to put in place the kind of early intervention that can help to ensure that these problems do not occur at a later stage in a child's life.

Apart from a few very minor pilot projects which the Minister has announced on umpteen occasions, the Government is content to pay lip service to the needs and rights of the most vulnerable children in the country. The Minister should be ashamed of that situation.

I thank my colleagues for sharing their time with me on this vitally important subject. The Minister has responsibility for health and, to all intents and purposes his Department plays a major part in the daily lives of practically every family. The Minister has failed dismally to improve the conditions of, and facilities for, those in need and those who are servicing their needs. However, I am willing to give the Minister an opportunity to improve the situation.

Something should be done in the short term either in hospitals or nursing homes to alleviate the respite care problems that families have. In the local hospital in my constituency, people are spending up to 72 hours on trolleys, chairs and bed tents. Sadly, in practically all cases, it is old people who are affected. This is the aspect that hurts anyone who goes into that hospital. I have seen people in their 70s and 80s, and in one case in his 90s, having to suffer in those conditions. They have no privacy. They have to use a bedpan in an open corridor where people are passing by and they must undress in an open corridor with no protective facilities to afford the privacy that is so important, especially to the elderly.

If the Minister can tell the House that something will be done in the short term to alleviate the problems of those people and their families by addressing their concerns, I am willing to give him a chance. In that case I would say the Minister is willing to do something. If that is not the case, however, and if the Minister leaves the situation as it is, he will be named as someone who failed dramatically to address the needs of the least well off in our society.

In many cases the reason such people are in that position in hospitals is because there are no recuperation or observation facilities to cater for their needs. Since there are no beds available for them in nursing homes or alternative hospital accommodation, hospitals cannot carry on basic accident and emergency duties. These are the major problems that people are experiencing in the health service. The families of those concerned are complaining about these difficulties.

Some £40 million is being spent on Naas Hospital, yet the benefit will only amount to an extra 24 beds. If one takes into consideration the number of people in hospital corridors at present, that means that the problem will not be allevi ated. That is despite the fact that Kildare is one of the fastest advancing areas in the entire country, which is adjacent to Dublin and with part of the county being within the greater Dublin area. Despite major investments in health, problems are still being experienced in my area. Thirty people are on the waiting list for geriatric care in my local hospital but there is not a hope of getting anyone into it.

Last week a family telephoned me about a 94-year-old relative who could not get a hospital place for respite care. Despite the best efforts of the matron and staff who did everything that was humanly possible, it was not possible for that elderly person to receive help because respite care is a thing of the past. So many people are seeking long-term care that we do not have the facilities to deal with such demand and beds that were hitherto available for respite care are being taken up by other patients. The elderly are suffering most, even though they are the most vulnerable in society. Families are on their knees looking after their older members who need full-time care. Such carers cannot even get a day or a week's holiday to escape from the strain of caring for those poor people.

If the Minister can do something about that he will have done a good day's work for which he will be remembered. If he does not, however, he will be just one in a queue of people who have accepted what is unacceptable and will not have done anything for our senior citizens in their hour of greatest need. The elderly have sought comfort, consolation and kindness but none is forthcoming because we have not provided sufficient facilities for health workers to care for the needy.

I am a member of the Eastern Regional Health Authority and I know hospital staff in that region have in all cases gone way beyond the call of duty to meet the concerns of their patients.

There are seven minutes remaining in the slot, Deputy, and you have used seven minutes up to now.

Thank you. Last week I was told of the case of a junior doctor on his 48th hour on duty who was trying to do his best to facilitate his patients within the hospital's remit. The Minister must do something now. He has failed twice in going to the Cabinet table. He must put the case to the Cabinet again and obtain the necessary facilities in the short term. It is no use looking at this matter in the long term because those who are suffering today will not be placated in such a manner and neither will it do anything to ease their pain. The Oireachtas cannot take pride in the fact that people are suffering in such circumstances at present.

I draw attention to the case of an individual whose story highlights so much of what is unjust, unfair and unequal in our health care system which is presided over by the Minister for Health and Children. This is the story of a medical card patient, a man whose wife wrote to the Minister for Health and Children on 21 June 1998 as follows:

I am writing to you to request a total reimbursement of a medical bill due to my husband undergoing an emergency cardiac by-pass operation in the Blackrock Clinic in County Dublin this month. Previous to being taken into hospital, my husband was suffering with increasing chest pains. Consequently, he went to see his doctor who examined him and thought his symptoms were angina. The doctor made an appointment for my husband to have preliminary tests with a specialist in the Blackrock Clinic. Initially, the specialist could find nothing wrong with my husband but when he underwent a stress test he failed it. Following this my husband had an angiogram carried out on him in order to try and flush out any blocked arteries. During this procedure the consultant found a blockage very near the heart, which was so serious that an operation was needed immediately.

This man found himself in the expensive Blackrock Clinic with his medical card. He was told that he had a very serious condition which required immediate surgery. He had two choices: he could either authorise the medical people to go ahead with the surgery, or he could get back in the queue. As I think most people would decide in those circumstances, he and his family authorised the medical people to go ahead with the surgery. He subsequently received a bill for £12,500—

God bless us.

—which he paid through a loan he obtained from his daughter who happens to work in a Third World country. He then appealed to the Minister for Health and Children to pay at least some of this amount because he found himself in a very difficult situation. This matter has been going on for three years now. I have raised it in the House before and I have written to the Minister and the health board about it but all to no avail. As I was told in a reply to a parliamentary question on 10 May:

Any patient, whether a medical card holder or not, who opts for treatment in a private hospital or as a private patient in a public hospital is liable for the costs relating to such treatment.

That scandalously demonstrates the upstairs, downstairs nature of our medical system. The Minister was effectively telling this man he was lucky to be alive and to pay the bill himself. He is lucky to be alive because his doctor realised he had a problem and referred him to a consultant, the man chose to go to a private consultant rather than join the queue and opted for immediate surgery rather than take a chance with his life by joining a long waiting list for the surgery he needed.

If he was a wealthy man, there would not be any question about his right or entitlement to get the best treatment in one of the most expensive medical centres in the State but because he is a medical card patient he was told he must join the queue. It is a scandalous way to treat people who are ill and in need of urgent medical care. There is no justification, if Ireland is to be a civilised country, for essential life and death treatment to be delivered on the basis of whether one can afford the fees in the Blackrock Clinic or one is a medical card patient.

It also highlights another problem particular to my constituency and that of my party health spokesperson, Deputy McManus, and that is the inadequacy of hospital services in my constituency, County Wicklow and the south side of Dublin generally. There is no general or regional hospital between St. Vincent's Hospital in Ballsbridge and Wexford town. There are hospitals such as St. Michael's in Dún Laoghaire and St. Colmcille's in Loughlinstown. The staff of those hospitals are excellent and they deliver a good service but they cannot deliver the full range of hospital services which are available in one form or another in other parts of the country. This region is one of the fastest growing in the State. One only has to reflect on the development taking place and the growth in population in the region, yet there is no general hospital.

People who need hospital treatment in the part of Dublin I represent must drive themselves or be taken by ambulance through heavy traffic to one or other of the city centre hospitals to get treatment. It is about time the Government addressed the critical need for a new regional or general hospital in this area. The management of Loughlinstown hospital is pressing for this as it is urgently needed.

The Government has invested more than £90 million in the provision of extra services to vulnerable children which means that in 2001 alone more than £180 million will be spent to ensure children can be supported by their own families. Thousands of children are availing of family support projects and there are springboard projects in every health board.

The Government introduced the children first guidelines for the protection of children to ensure abuse can no longer take place. Cases of abuses can at least be recognised and identified and the children involved can be supported. We have also increased the allowances and supports for foster carers who provide a home for children who do not have a home of their own.

The Government increased the number of places for children who are very disturbed and need high support or special care from 17 when we entered office to 83, with 56 more due to be provided. Recognising that recruitment of staff is a difficulty, we increased the salary scale to attract the right calibre of people to this difficult work. The Government established the social services inspectorate to inspect children's accommodation to ensure standards are maintained and children are protected.

We have provided more than £7 million towards combating youth homelessness and this has led to Focus Ireland acknowledging in recent interviews that such resources were not ever before invested in this area nor was there such commitment to solving the problem and supporting children and their families to make sure they do not end up homeless.

A wide variety of issues needs to be tackled regarding children and a great deal of work has yet to be done. Major work needs to be done on the co-ordination of services. The national children's strategy has been launched and is being implemented. The national children's office has been established while the national children's Cabinet committee, chaired by the Taoiseach, has met as has the national children's advisory council. Children are being given a voice for the first time throughout the country. That is the type of commitment that has been witnessed from the Government regarding children.

I accept children need to be protected and their welfare must be of paramount importance. They are the most vulnerable people in society but for once in our lives this Government is the one that has recognised that and has begun to provide increased investment, resources and supports for our children in a way not ever witnessed before. More needs to be done but our commitment is to ensure that we continue to do more.

The waiting lists are getting longer.

I wish to share my time with Deputy McManus. "Four wasted years" are three words to describe four years of disaster. It has taken four years for the Government to recognise that there is a growing crisis in our health services. The Government parties are the "Johnny come lately", arriving at the scene of an accident that they have caused. There will be a great deal of huffing and puffing over the next few months but it will be in vain. They know the health services is not the issue that makes the Government's heart tick.

Two of the four wasted years in the health services were trusted to the stewardship of the current Minister for Foreign Affairs. The Minister spent as much time trying to get out of the Department as seeking to achieve things in it. Health care itself was treated with studied indifference. The suggestion that the health service was like Angola may not have described the condition of the health services when he took over, but it does now. There is no better man to recognise that than the current Minister for Health and Children. He should walk carefully across the minefield. One of the mines blew up in the Cooley Peninsula last week.

Realising the mess his Government had made of the health services the Taoiseach took a studied decision upon the resignation of his then Minister for Foreign Affairs, to expose the brightest kid on the block, Deputy Martin, to the crisis in the health service. The rest of the members of the Cabinet hid their smiles as the leader in waiting faced his toughest PR job yet. However, even as health Ministers have come and gone, there has been one consistency in the Government and that is the ideological control exercised by the Minister for Finance. The Minister for Health and Children is the latest Minister to experience Deputy McCreevy's ideological intransigence. "Private is good", hence the tax reliefs for private hospitals in the budget, and "public is bad". This is a simple mantra which he applies to all his projects and it is shared by the Tánaiste, who is, if not his party mate, certainly his soul mate on matters ideological.

The Government's health strategy is a cynical exercise devised to paper over its failures in time for the election. As Sunday's IMS poll has indicated it will not work. Health is top of the agenda and this Government, through its ineptitude, has put it there. The general election has been the decisive and only factor in health policy thinking in this Government. For example, of the extra moneys committed to the service, 40% have been committed this year alone. Under investment was the order of the day before that. I do not subscribe to the view that money will not make a difference. I hope for the sake of the nation's sick and elderly that the additional resources allocated this year begin to come through quickly.

It is not unreasonable that in the age of the Celtic tiger the public should expect more from their health services. A committed Government would seek to make them the best in Europe. What we have got from this Government is disappointment and a PR exercise to patch up on three years' indifference. It will not wash and I hope the Minister and his ministerial colleagues in the Department continue to read out the scripts they used in the debate. I wish them well. God love them, if they come out with that rubbish between now and the next election. I hope the departmental staff continue to write more scripts for them. The occupant of the Chair can tell the Minister all about it.

This will not get the Government back into office and it will only get back what it put in – far too little, far too late. This Government has already earned the "trolley mark" and, given the potential it had, it is its greatest failing.

As somebody who has been in Governments when times were difficult, when there were no resources, and listened to some of the current incumbents on this side of the House who saw that was not a problem, I put it to the Minister, sadly, and on behalf of the people who are on the waiting lists that Deputy Gilmore and others spoke about, that we have the worst of all situations now – a bad Government in good times.

I thank my Labour Party colleagues and the other Deputies for their contributions to this debate on the crisis in our health service. We are now calling on the Members of this House to declare where they stand on this most critical social issue facing society today. If they vote for this motion, they will be standing by those unfortunate people who, because they are sick, poor and elderly, believe that they do not have the power to change the circumstances in which they find themselves.

Sick people lying for days on trolleys in an accident and emergency department are stripped of their dignity. They are powerless. They have no privacy and no peace of mind. Sometimes they need to use a bed pan. Sometimes they vomit. It is a distressing, humiliating experience and none of us here would wish to go through it. In many cases, for an elderly person, lying on a trolley in a hospital corridor is the culmination of a process of attrition over months or even years of waiting to have the hospital procedure they need and have been denied because, inevitably, as their health deteriorates, they often end up as another emergency case and even then, when they are declared an emergency case, they are still forced to wait on a trolley, simply to get a bed.

This situation is an affront to decent Irish people. For most people it is an obscenity that at a time of such plenty, we have a Government that is incapable of dealing with our health care crisis. Let us be clear about that. Money is not the problem. According to a recent survey inThe Economist magazine, Ireland is now the fifth richest country in the world. After years of deprivation, mismanagement of the economy, massive tax frauds, emigration and poverty, we are now rich. We are now free to do what others could only dream of doing. Money is not the problem. A failure of political will, leadership, vision, commitment and understanding are all part of the problem but most disturbing of all is the fact that this Government does not consider health care to be a priority. Building Sports Campus Ireland is a priority. Planning a mega development as a memorial for a Taoiseach is a priority but health is only a topic for discussion at Cabinet. It is an issue for ideological slapstick, as we saw recently.

I want to make it clear that for the Labour Party, health is not just a priority. It is the priority. We are standing by the sick, the infirm and the dying who are entitled to the kind of care and comfort this country could provide but can only provide if it is governed by a leader who is up to the historic opportunity being offered to us.

There is a core value upon which any good health system is built. It is the core value of equality, the dreaded "e" word that the Minister for Health and Children, in his contribution, seemed unable to utter. Equality – care on the basis of need. That has to be the cornerstone of our health service—

Hear, hear.

—and it clearly is not. The testimony given tonight by our colleagues here has outlined that very clearly.

The Minister did not deal with equality in his contribution for an obvious and simple reason. Fianna Fáil does not have a clue how to tackle the inequality in our health system. I listened with interest to the Fianna Fáil Deputies who came in here, and some of the Ministers, who listed their objections to the Labour Party proposal. In his contribution the Minister spent some time listing his objections to our proposals. I thank him for that. It is good for us to have feedback. I thought it was a pity that the concepts in our discussion document seem to be beyond the intellectual grasp of the Minister of State, Deputy O'Dea. Generally speaking, however, it is interesting to see that this document is being read by Fianna Fáil Deputies but let us trade when it comes to ideas on equality.

Let us hear what Fianna Fáil has to offer.

What is the Deputy offering? She is not telling us.

In all the acres of media coverage the Minister for Health and Children has had, there has not been one mention from him or his Government—

The detail is being kept in the cupboard.

—of how he intends to deal with the core value of equality. He talks about many issues and he gets a great deal of coverage, I will grant him that, but he has never faced the difficult issue of how to resolve the basic inequality that exists in our health service that he has not even begun to tackle.

Whatever about the past, there is no reason we should perpetuate the iniquitous, inefficient, under-resourced aspects of our health service. For example, there is no reason cancer patients in the south-east should be denied radiotherapy services. In all, 20,000 people are diagnosed as having cancer each year. Those people deserve urgent attention. They need to see the report, for example, on radiotherapy services fast-tracked and delivered upon. The misplaced urgency concentrated on the Taoiseach's pet project at Abbotstown could, if we directed, transform the lives of cancer patients and of patients in need of emergency care but this Government has no policy on health reform. It is satisfied to wait until the 50 or so reviews, reports and strategy groups come up with proposals, and perhaps then some decisions will be made. That will be too late. The cancer patients cannot wait. Elderly people waiting for hip replacement operations should not have to wait. People losing their sight for want of an eye operation cannot afford to wait.

Deputy Conor Lenihan pronounced on the hospital waiting lists. Let us hear the truth about the hospital waiting lists. The hospital waiting lists are still not down to the level they were at in December 1996.

What is wrong with the Deputy's 1997 figure?

Since then, however, they have shot up under the previous incumbent of the Department of Health and Children. This Minister has made a dint in the figures but some of these people have simply given up, and the Minister has to give credit to the validation process which has reduced a large part of the waiting lists, but let us remember what has been going on during the years of this Government. A total of £67 million was spent on the waiting lists initiative. This is the Government that promised to tackle the waiting list problem. A huge amount of money has gone in but we have not seen the return.

That is the legacy that has been left behind by Fianna Fáil now that it is approaching a general election. There is a legacy of failures which we have mapped out in this motion and each one of us will have an opportunity to vote for the motion. We have a choice. We can vote for the Government and the miserable failures and inadequacies but also the avoidance of the hard question, the central issue about inequality that needs to be addressed and which, over four years, has not been addressed either by this Minister for Health and Children or the previous Minister. They are afraid of the dreaded "e" word. They will not even talk about it or debate it. That is the choice, but there is an alternative. Deputies can vote for our motion. They can vote with the sick, the poor and the elderly who have paid the price for the failure of this Government to tackle the needs in our health service and to ensure that there is real reform along with real funding. These two procedures must be carried out in parallel if we are to secure what we all wish to see, namely, a world class health service which matches our world class economy. We wish to have a health service which meets the needs of those who deserve our care and the professionalism of the medical staff, including nurses, who work so hard despite the many difficulties. I pay tribute to those concerned who, despite the Government's failure, are carrying on because they understand the needs of the patients in their care and have a sense of dedication. These health service personnel and their patients deserve better and we intend to give it to them.

Amendment put.

Ahern, Dermot.Ahern, Michael.Ahern, Noel.Andrews, David.Ardagh, Seán.Aylward, Liam.Blaney, Harry.Brady, Johnny.Brady, Martin.Brennan, Matt.Brennan, Séamus.Briscoe, Ben.Browne, John (Wexford).Callely, Ivor.Carey, Pat.Collins, Michael.Cooper-Flynn, Beverley.Coughlan, Mary.Cowen, Brian.Cullen, Martin.Dennehy, John.Doherty, Seán.

Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.Foley, Denis.Fox, Mildred.Gildea, Thomas.Hanafin, Mary.Harney, Mary.Haughey, Seán.Healy-Rae, Jackie.Jacob, Joe.Keaveney, Cecilia.Kelleher, Billy.Kenneally, Brendan.Killeen, Tony.Kirk, Séamus.Kitt, Michael P.Kitt, Tom.Lenihan, Brian.Lenihan, Conor. McCreevy, Charlie.

Tá–continued

McDaid, James.McGennis, Marian.McGuinness, John J.Martin, Micheál.Moffatt, Thomas.Molloy, Robert.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Flynn, Noel.

O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.Power, Seán.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Dan.Wallace, Mary.Woods, Michael.Wright, G. V.

Níl

Barnes, Monica.Barrett, Seán.Bell, Michael.Belton, Louis J.Boylan, Andrew.Bradford, Paul.Broughan, Thomas P.Bruton, Richard.Carey, Donal.Connaughton, Paul.Cosgrave, Michael.Coveney, Simon.Creed, Michael.D'Arcy, Michael.De Rossa, Proinsias.Deasy, Austin.Deenihan, Jimmy.Durkan, Bernard.Farrelly, John.Fitzgerald, Frances.Flanagan, Charles.Gilmore, Éamon.Hayes, Brian.Healy, Seamus.Higgins, Jim.Higgins, Joe.Higgins, Michael.Hogan, Philip.Howlin, Brendan.Kenny, Enda.

McCormack, Pádraic.McDowell, Derek.McGahon, Brendan.McGinley, Dinny.McManus, Liz.Mitchell, Gay.Mitchell, Jim.Mitchell, Olivia.Naughten, Denis.Neville, Dan.Noonan, Michael.Ó Caoláin, Caoimhghín.O'Shea, Brian.O'Sullivan, Jan.Owen, Nora.Penrose, William.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Reynolds, Gerard.Ring, Michael.Ryan, Seán.Shatter, Alan.Sheehan, Patrick.Shortall, Róisín.Spring, Dick.Stagg, Emmet.Stanton, David.Upton, Mary.Wall, Jack.

Tellers: Tá, Deputies S. Brennan and Power; Níl, Deputies Bradford and Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."

Ahern, Dermot.Ahern, Michael.Ahern, Noel.Andrews, David.Ardagh, Seán.Aylward, Liam.Brady, Johnny.Brady, Martin.Brennan, Matt.Brennan, Séamus.Briscoe, Ben.Browne, John (Wexford).Callely, Ivor.Carey, Pat.Collins, Michael.Cooper-Flynn, Beverley.Coughlan, Mary.Cowen, Brian.Cullen, Martin.Dennehy, John.Doherty, Seán.

Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.Foley, Denis.Fox, Mildred.Gildea, Thomas.Hanafin, Mary.Harney, Mary.Haughey, Seán.Healy-Rae, Jackie.Jacob, Joe.Keaveney, Cecilia.Kelleher, Billy.Kenneally, Brendan.Killeen, Tony.Kirk, Séamus.Kitt, Michael P.Kitt, Tom.Lenihan, Brian. Lenihan, Conor.

Tá–continued

McCreevy, Charlie.McDaid, James.McGennis, Marian.McGuinness, John J.Martin, Micheál.Moffatt, Thomas.Molloy, Robert.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Flynn, Noel.

O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.Power, Seán.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Dan.Wallace, Mary.Woods, Michael.Wright, G. V.

Níl

Barnes, Monica.Barrett, Seán.Bell, Michael.Belton, Louis J.Boylan, Andrew.Bradford, Paul.Broughan, Thomas P.Bruton, Richard.Carey, Donal.Connaughton, Paul.Cosgrave, Michael.Coveney, Simon.Creed, Michael.D'Arcy, Michael.De Rossa, Proinsias.Deasy, Austin.Durkan, Bernard.Farrelly, John.Fitzgerald, Frances.Flanagan, Charles.Gilmore, Éamon.Hayes, Brian.Healy, Seamus.Higgins, Jim.Higgins, Joe.Higgins, Michael.Hogan, Philip.Howlin, Brendan.Kenny, Enda.McCormack, Pádraic.

McDowell, Derek.McGahon, Brendan.McGinley, Dinny.McManus, Liz.Mitchell, Gay.Mitchell, Jim.Mitchell, Olivia.Naughten, Denis.Neville, Dan.Noonan, Michael.Ó Caoláin, Caoimhghín.O'Shea, Brian.O'Sullivan, Jan.Owen, Nora.Penrose, William.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Reynolds, Gerard.Ring, Michael.Ryan, Seán.Shatter, Alan.Sheehan, Patrick.Shortall, Róisín.Spring, Dick.Stagg, Emmet.Stanton, David.Upton, Mary.Wall, Jack.

Tellers: Tá, Deputies S. Brennan and Power; Níl, Deputies Bradford and Stagg.
Question declared carried.