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

The following motion was moved by Deputy Gay Mitchell on Tuesday, 3 July 2001:
That Dáil Éireann, conscious that the voted Estimates for the health services as recently passed will not produce a health service which is fair, or accessible by all, irrespective of income, and which is both effective and efficient in terms of health needs, calls on the Minister for Health and Children to immediately introduce comprehensive measures to protect the rights of patients to due, adequate and timely health services, and calls for the appointment of a health ombudsman to oversee the rights of patients.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
–commends the Government for its unparalleled increases in health funding;
–fully supports the robust targeting of these funds which will lead to substantial improvements
–across the wide spectrum of health and personal services; and
–continues to endorse the process adopted to facilitate the development of a new Health Strategy which will be the focal point of the delivery of health services in the next five to seven years
–(Minister for Health and Children).

I wish to share my time with Deputy Penrose.

Is that agreed? Agreed.

Health issues were debated on a previous occasion, but not much has changed since. In terms of parliamentary questions to the Minister for Health and Children, how does he determine matters of concern in relation to health? I recently tabled a question about respite care places for chronically ill children in the South-Western Area Health Board region, but the Minister could not answer it. He referred it to the Eastern Regional Health Authority and said it was its responsibility to answer it. How does he determine policy if he does not know the position with regard to such cases?

The Minister does not appear to know that, despite the demand for it, there are no facilities for chronically ill children in the South-Western Area Health Board region. Representations have been made to me about this issue by district nurses who visit houses and see such children and wonder what can be done for them. How can the Minister make decisions on such matters if he does not have the facts in his Department? This applies to every other area.

I repeatedly table parliamentary questions about orthodontic treatment, but the Minister's response is to refer me to the regional health authority or the South-Western Area Health Board. It annoys me that he does not know about the health matters of concern to ordinary people. Children become teenagers and then adults while they wait for orthodontic treatment that is never available. The Minister obviously is not aware of this problem. If he was aware of it, he would be able to answer parliamentary questions. He would not have to refer them to health boards and I would not have to wait for replies on behalf of unfortunate individuals who were examined when they were primary school pupils, but still have not received treatment by the time they go onto second level.

Private orthodontic treatment is being sought because structures are not in place to facilitate unfortunate individuals who need such treatment. This problem also applies to chronically ill children because facilities are not available for them. The Department has no means of knowing what is wrong on the ground because matters are referred to health boards. As a result, policy makers in the Department of Health and Children are not aware of the problems. It will not be possible to deal with the demands within the health system if the necessary hands on approach is not taken.

On the last occasion I raised the issue of senior citizens. In the context of senior citizens in accident and emergency departments, I said a system should be put in place that shows what beds are available in the catchment area. This would allow beds in hospitals to be released. However, nothing has been done in that regard to facilitate the people concerned and ensure it is no longer necessary for patients to remain on trolleys in hospitals.

A hands on approach must be taken. However, if the Minister is depending on health boards to supply information, there is a gap in the basic structure required in this regard. I ask him to address this problem urgently in order that his Department and officials know what is happening and it is not necessary for him to refer every question to the various health boards.

I have always had a passionate interest in the provision of an equitable and efficient health care service. I am not ashamed to state that my family depended on a medical card, but I am gutted about how useless it is now. It is a passport to second-class treatment. Thousands are left waiting because they are medical card holders. Anybody whose bank balance allows him or her to pay for private health care can get immediate access to the treatment he or she requires. This is not good enough.

It is evident that the health care system is in crisis. We did not need a by-election to discover this; we have been saying it for the past two years. The symptoms are everywhere if one cares to look. For example, there are staff shortages. People at all levels must work in difficult conditions in the hospital in Mullingar – we are still waiting for phase 2B to open after almost five years. Doctors and nurses are faced with cramped wards which makes it more onerous for people already overstretched and doing their professional best in difficult and overcrowded conditions. I commend them for their professionalism and competency in such trying conditions. They must be applauded, but they and their patients deserve better.

Waiting lists are increasing to a huge degree. Private medicine is booming as a result of inadequacies in the public system, which is suffering from a lack of resources and poor management. Ireland has a system where patients with private insurance get preferential access to health care, while those without such insurance are covered by the GMS or medical card. They are left waiting in an extended queue. Only 6% of our GDP is spent on health, compared to an average of 8% in other EU and OECD countries.

A young child from Newbridge, featured on television tonight, waited eight years for corrective eye surgery. There are waiting lists throughout the country. For example, in County Westmeath and the Midland Health Board area, 26,000 are waiting for treatment. Some 43% of adults are waiting more than 12 months while 74% of children are waiting more than six months. Some 4,500 are waiting for ENT services while 3,500 are waiting for orthopaedic services. Do people realise that the longer one is left waiting, the more debilitated one becomes? This particularly applies to old people.

In the Midland Health Board area, the orthopaedic centre in Tullamore will close for six weeks at the height of this problem. I am aware of the case of a woman who has waited two years for a knee replacement operation. She was ready to go into hospital, but was distraught when she was informed that she could not have the surgery. She is now wondering if she could get immediate access if she got £4,000 from the credit union. This is the type of pain and shame now prevalent in holy Ireland. This country is supposed to ensure equality across the board, but that is not happening. It is a pretence to say the health system can gain. Hypocrisy is abroad. What good is it to give tax cuts to the well-off? Why not give money to the health service, where it is needed, and bring expenditure on health up to 8% of GDP? Those who can afford to pay 42% of their income in tax should be made to do so. I am prepared to pay that level of tax in order to provide equal access to orthodontic treatment for all children and orthopaedic treatment for my grandparents and ensure a decent health care system for all. The Government should tax the well-off, if necessary, and not give in to greed.

I wish to share my time with the Minister for Tourism, Sport and Recreation, Deputy McDaid, and Deputy Conor Lenihan.

I hope the editors of "Oireachtas Report" have focused their cameras on the paltry number of Fine Gael Deputies who have bothered to attend this debate.

The same number as on the Government side.

The sight of Fine Gael Deputies in po-faced affectation of grave concern at the state of our health service will go down as one of the great situation comedies of our time. This is the party which cut funding to reduce waiting lists in the face of a 26% rise in waiting lists and deliber ately, systematically and knowingly underfunded our health service.

(Interruptions.)

This is the party which has no coherent policy or even the appearance of one. We owe Deputy Gay Mitchell a debt of gratitude for giving us the opportunity to put the Fine Gael health policy, such as it is, under the microscope and examine the party's record to see where it stands now.

In the mid-1990s the Fine Gael Party suddenly and unexpectedly found itself in government. The health care system did not improve. It disimproved during the almost three years of that Government due to circumstances almost entirely within its control.

That is not true.

It had its very own Minister for Health and Children from Limerick.

A good man.

They had plenty of funding from the State kitty and the power to bring about change. Here was its chance to cut waiting lists, increase the number of nurse training places, establish a capital modernisation programme and match rhetoric with policy. Why did none of these things happen? Fine Gael Deputies owe it to us to tell us the reason. If they want their promises to improve the health care system to have any credibility, it is incumbent on them to tell the people the reason they failed so abysmally when they had the opportunity.

Why, for example, did Deputy Noonan, as Minister for Health and Children, manage to increase the health spend by a meagre £400 million in the lifetime of that Government? After seven decades of underfunding here was a chance to turn the tide. Why did he fail?

Why did Deputy Quinn, as Minister for Finance, not hand over the necessary money for health reform, if that was the problem? I recall being involved in a radio discussion on this topic recently when I asked the spokesman for the Labour Party that question. He muttered something about a deficit. Surely a small deficit would not be a barrier to Mr. Angry from Sandymount whose avowed economic policy is to tax and spend the country into another recession or die in the attempt? Deputy Quinn has no problem with the theory of spending. His problem is with the practice of spending. He has questions to answer as to the reason he did not provide the necessary money for Deputy Noonan. Why was it left to Fianna Fáil in Government to make the necessary changes? It was not until June 1997, when Fine Gael and the Labour Party were ejected from office, that reform at last began.

Since that time the health spend has doubled from £2.5 billion to £5 billion. Waiting lists have been cut by 4,100 since June 1997. The number of nurse training places has been increased by one third since 1997. The number of procedures carried out in hospitals has been increased since 1997 by 90,000 per annum. These are facts. Why was none of this done when the Fine Gael Party was in government?

I am not insulated from the concerns which Deputies on all sides of the House encounter every day. I have constituents in desperate need of medical treatment and who have been failed disgracefully by the health care system but, at least, I can say I am part of a Government which is making a change and that has begun to turn the tide.

(Interruptions.)

The health service is not a bed of roses but it is improving. What can Deputies on the other side of the House who have been expressing mock indignation for the last two evenings say? If they want to tell the truth, they must say they had their chance but did nothing, they underfunded the health service and failed to reform it or think ahead. They had the money but did not spend it.

Will Opposition Deputies not take a moment of honesty to admit that they bear a large share of the blame for the present state of the health service? Do they not realise it takes years to train health professionals, build wards and introduce new health programmes? If the rainbow Government had initiated those matters, they would be on course by now.

Is Dr. McDaid writing a prescription for the Minister of State.

It is instructive to examine what these people, who failed so abysmally when in government, are now telling the people. We are expected to believe that, like St. Paul on the road to Damascus, they have suddenly found the answers in a blinding revelation. Needless to say, the Fine Gael answers are quick fix ones. As the Minister for Health and Children said last night, the Opposition is playing fantasy health care with the worries of the electorate.

The Labour Party's version of the quick fix solution is, at least, consistent. That party proposes a universal insurance system. The difficulty with that policy is that every major study of the subject has shown universal insurance systems to be inefficient and to direct more funding at health administration and less at the patient. It is a policy which would certainly shut local hospitals and place insurance policies between the patient and the bed. It is foolish and daft and would not work, but at least it has the merit of consistency.

Could no one in the Department write a better script than this?

This reminds of the Nice treaty referendum. The Government says "Yes" but it means "No".

The Fine Gael approach has been downright dishonest. Its policy on health is a movable feast which it changes with the cynical rapidity of Joe Stalin changing his Cabinet Ministers.

The Minister of State should leave down his script and face reality.

The Labour Party has nailed its colours firmly to the mast. Fine Gael nails its colours to any old fence it encounters on its way to Merrion Street. This is hardly surprising. Speaking in this House a year ago, the Fine Gael spokesperson on health, Deputy Alan Shatter, rejected the universal insurance option. His comments were reasonable and worth quoting:

Whether the necessary reform can be brought about by the introducion of a universal health service is questionable. What is needed is less but not more bureaucracy.

Questionable? The Minister of State should look at the policy document we published last year.

Of course, politics is the art of repackaging. When Deputy John Bruton had been defenestrated, despite the best efforts of Deputy Gay Mitchell, Deputy Noonan took the helm after years of trying and in an effort to rekindle the old Quinn-Noonan health dream ticket he immediately mimicked the Labour Party's plans.

That policy was published while Deputy Bruton was leader of Fine Gael. Of course, the truth will not get in the Minister of State's way.

I credit Deputy Noonan with a minimum of intelligence and it was not long before the reality of where adopting the Labour Party's universal insurance system would lead dawned on him. When he realised this we saw another complete turnaround. The latest instalment in the Fine Gael health saga is to use the existing system to deliver health excellence, by reasons unspecified and methods unknown. Having delivered this excellent system we would change to the universal insurance model.

The Minister of State's speech is such a classic I would like to have a copy before me.

I am speaking from notes. The Deputy may read the Blacks tomorrow.

The speech was written by officials.

This is what is being fed to the people. Fine Gael states it will use the present system to deliver health care excellence by methods which are kept as tightly guarded, and will probably prove as disappointing, as the third secret of Fatima and, having delivered health care excellence by these unspecified means, it would switch to a universal health insurance policy. That is the sort of cant being palmed off on people who are elderly, ill or worried about the health care system.

A Deputy

What about those earning £101 a week who cannot get a medical card?

It is manipulative, cynical and downright fraudulent but we should not be surprised. The Fine Gael Party and its leader, Deputy Noonan, see health policy as a ticket to Merrion Street, not as a mechanism to improve the health system. This is a textbook example of trying to take the low road to high office.

The health section of the Fine Gael manifesto is worthy ofAlice in Wonderland. Lewis Carroll will never be dead while Deputy Gay Mitchell lives. However, one sentence in the manifesto is a stark statement of truth which sits very uncomfortably with the rest of the fantasy. It reads, “Hospital waiting lists are a politically created phenomenon.” That is part of the salesmanship from a party which cut funding allocated to reduce waiting lists in the face of a 26% rise in waiting lists. This is probably an unintended but nevertheless astonishing blunt, brutal, belated and all too rare admission of guilt on the part of those on the other side of the House.

A Deputy

The Minister of State can do better than that.

He writes better in the Independent.

I am grateful to Deputy Mitchell and his Fine Gael colleagues for affording me this opportunity to speak on the issue of health. Anyone who examined that party's governmental record on health will have discovered a pattern which was certainly repeated in my Department, and I suspect, across all areas of government. It is an empirical, incontestable pattern of underfunding, neglect, failure to reform and modernise.

Failure to modernise is the key to what is wrong with health services. This is the era of Star Wars technology, of information technology. Today, I can travel to Tory Island off the Donegal coast and book a flight to London, Paris or Rome, on the internet. I will know the departure time, my seat number and whether I have an aisle or a window seat. This is not happening in medicine or, at least, not enough is being put into technology or the proper area of medicine, primary care.

The future of medicine lies in technological development, DNA in the longer term and MRI-MRI angiogram in the shorter term. I qualified over 25 years ago but what I am about to say now was as true then as it is today. When a person as a patient comes to me as a general practitioner the one thing they want to know is whether there is something wrong with them. Unfortunately, because of the litigious era in which we live, the GP will refer a person to a consultant involving a period of waiting where one basically tells the same story. The GP area of medicine does not have waiting lists but has become a signpost to other areas such as ENT, nephrology, cardiology or respiratory medicine. The consultant then sends a person for tests. They then come back at a later date when he eventually gets a diagnosis and tells them either that they need hospital treatment or surgery or they can go home. If it is the former, they end up on the dreaded waiting list.

Let us look at the medical service in terms of supply and demand. I accept that in order to overcome the demand side we need more beds, more consultants and more nurses but tonight let me just concentrate minds on the supply side, that is, the number of patients waiting to see consultants. How do we reduce this number? Let me suggest that improving technology at the primary care level is one way. I suggest establishing strategically placed MRI-MRI angiogram centres on greenfield sites, a technology which will give one an almost on-the-spot diagnosis. This could also involve investment from the private sector which is anxious to get involved. With the help of this technology the GP has the diagnosis and then refers a person to the consultant who by this time would not have to spend so much time in consulting rooms but would have more time to spend with his truly sick patients in hospital or the theatre. By using this method we would not have patients taking up unnecessary bed spaces. For example, if someone comes to a GP with a severe headache, they are sent to hospital where they are sometimes kept for four to five days under observation, quite correctly so. With the benefit of MRI-MRI angiogram, they could be sent immediately for treatment or home to take an aspirin. The MRI centres should be on greenfield sites and at the disposal of GPs in specific catchment areas. At a rough estimate, each centre could serve 5,000 patients a year. The cost of this technology would drop with increased usage. Currently they cost £800 to £1,100, but this could be reduced to £200 or £300. It should also be available to all. These are examples of some of the practical ideas on the future of medicine which I and my colleagues in government have been discussing and examining as part of our health strategy.

On the core issue of spending, the Fine Gael-Labour coalition Government managed to increase health spending by just £400 million. The Government of which I am a member has spent £2.5 billion, a necessary and long overdue increase. Of course, there is more money available today. Our economic policies are successful. However, in the mid-1990s, we were a relatively wealthy state. The money was available but the commitment was lacking. The Minister of State, Deputy O'Dea, pointed out that in January 1997, in a decision which will haunt its protagonists – Deputy Noonan, now leader of the Fine Gael Party, then Minister for Health and Children, and Deputy Quinn, the present leader of the Labour Party, then Minister for Finance – they both decided to cut the funding allocated to the reduction of waiting lists by 20%, at a time when they had risen by 27%. That is a fact. Fine Gael and Labour Party Deputies now claim that the Government alone is somehow responsible for waiting lists but logic eludes them. Let us look behind the Fine Gael rhetoric on waiting lists and look at the facts. During the lifetime of the rainbow coalition waiting lists rose by 6,600. During the lifetime of the Government we have cut them by 4,101. That is a stark and incontestable fact.

When 6,600 patients, men, women and children, found themselves waiting for treatments as a direct result of that Government's neglect, why was the funding allocated to alleviating their wait cut by 20%? Whenever a Fine Gael or Labour Party Deputy addresses his constituents, the media or this House, this question should be put to them. Based on this record why should the electorate trust them to effect the reforms so necessary in our health services?

Having set themselves against an agenda of reform, the Opposition parties advance a series of quick fix health policies. The forced implementation of these policies would ignore the research, the public consultation and the input of our health professionals which have gone into our new health strategy. They would spell disaster for our health services. The Labour Party health policy document states on page 22 at public and voluntary hospitals would be required to cover their operating costs through income from health insurers and patient co-payments, where applicable. This would mean that where smaller local hospitals could not win service contracts from insurance companies, they would not be able to compete with the larger urban hospitals and be forced to close or cut services. Under those Labour Party proposals, the extent of health provision would hinge on the ability of hospitals to negotiate contracts with insurers. This is a right wing, uncaring health policy. All major studies of this model indicate that it leads to an increased percentage of funds being allocated to administration, the sort of policy from which we are trying to move away today.

I wonder if Fine Gael has a health policy.

I will send the Minister a copy.

Initially, Fine Gael planned to tinker around the edges before eventually coming back to the Labour Party policy. It then advanced the Labour Party policy, perhaps because Deputy Howlin made it clear that the Labour Party would not agree with them as a basis for a future coalition Government. Realising how unworkable Labour policy is the Leader of Fine Gael stated in theIrish Independent on 28 May that it now wants to use the existing health system to improve the situation and then opt for the Labour policy – administration, cutbacks, closures. For all its pontificating on the matter it does not apparently have a health policy.

I sent the Minister a copy.

Nurses are highly trained health professionals. It takes years of training to develop the skills required to nurse in our hospitals. Fine Gael and Labour in Government four years ago failed to provide the necessary expansion of the nurse training places that were so utterly necessary at that time. That is a legacy we have to overcome. Deputy Quinn stated here on 21 March that six years ago, as Minister for Finance, he was warned about the state of the nursing profession. He failed to act. Had the increases in the nurse training places been put into effect then there would be more nurses now. That is another inescapable fact. It was left to this Government to begin that agenda of reform. As of December 2000 there were 1,774 more nurses working in the health services than in 1997. We have increased the number of training places to 1,500. Already these new places are attracting trainee nurses. The number of applicants for nursing registration diploma courses is up 21% on last year. This action is delivering results.

We have to look behind the rhetoric to examine the work of the Government on the health services. We have doubled the expenditure. There was a £2 billion capital modernisation programme under the national development plan. There were 90,000 more treatments carried out than in 1997. There were 625 more doctors in the health service and 1,500 more training places. I believe our policies are delivering results. However, the effect of a decade of under-funding cannot be rectified overnight. It will take some years. Lengthy run-in times are a frustrating reality in the health area but I hope the tide is turning.

For the long-term, for the sustained reform so necessary to the health services, we have been developing our new health strategy. The development of such a strategy has entailed a lengthy process of research, negotiation and consultation with our health professionals and the general public. This strategy will shape the health services for years to come. A rushed job would simply not suffice for such a project.

In-depth reports such as value for money audit, the report on the medical manpower and the report of the Commission on Nursing together with the input of our health professionals, whose excellence maintained our health system through the decades of under-funding, have gone into creating this strategy.

On this side of the House, Fianna Fáil in particular is justifiably proud of the fact that in four years it has doubled investment in the health service. The neglect caused in the first instance by the lack of State finances and laterally by the lack of political will on the part of the Rainbow Government had to be stopped once and for all. It is not enough to have turned the tide. We have to reform the system root and branch. Nobody on this side denies there is much still to be done. In four years we have doubled spending, we have introduced significant improvements to our health services and we are in the final stages of developing a new health strategy, the architecture of future reform.

Some 30,000 nurses form the backbone of our health service. They are highly trained and skilled professionals and need to be treated as such and must remain central to our health policy. All over Europe there are shortages of nurses and Ireland is no different. Many of the problems we face relative to the shortage of nurses stem from the abject failure of those in the Opposition benches who reduced training places in the mid-1990s. Since 1997 we have increased nurse training places by 500. Today the number of nurse training places stands at 1,540. We are heavily engaged in promotional campaigns to encourage school leavers and mature persons to enter the nursing profession. The success of these campaigns is reflected in the fact that applications for nursing registration diploma courses is up 21% on last year.

We have improved support for nursing students. Since 1998 maintenance grants for nursing students is up 43%. During the period of the Rainbow Coalition the grant remained static. We are recruiting nurses from abroad. A new visa work authorisation system came into operation in June 2000. Up to the end of April 2001, a total of 1,224 visa authorisations had been issued to nurses from non-EU countries. As of last December there were 1,774 more nurses working in our health services than in 1997. It is not just about attracting new nurses; it is about maintaining nurses in good conditions of employment and treating them like the highly trained professionals they are. We have introduced new flexible working arrangements, payment of fees to nurses undertaking part-time nursing and certain other degree courses, payment of fees and full salary to nurses undertaking courses in all specialised areas of clinical practice. We are also committed to implementing the report on the Commission of Nursing.

The men who say this is the number one issue taking priority over everything else put it at the bottom of the pile when they had the opportunity to do something. When in Government they discussed what they wanted to do with the health system and made decisions. The key decision was to cut by 20% the funding dedicated to reducing public waiting lists. Why should the people believe they can be trusted to cut waiting lists when the record shows them cutting waiting list funding? Was it better than 90,000 fewer treatments were carried out when they were in power by comparison with last year? Was it better that there were 3,500 fewer residential day and respite care places for people with disabilities? Was it better that there were 400 fewer community nursing unit places for older people? Was it better that there was no capital modernisation programme under way? Was it better that there were fewer doctors and nurses in our hospitals? The public does not believe the Opposition's claim that it has all the answers. When it had the opportunity to do something it failed miserably.

It is tempting to continue on the theme outlined by my distinguished colleague, Deputy McGennis, of the Opposition's attitude to the health debate. It is characterised on both the Fine Gael and Labour side by rank opportunism, an opportunism that seeks to alarm patients and everyone else about the health issues confronting the nation's hospitals.

Is that the reason the Government punished them with the increase in the licence?

Obviously they were aided and abetted by their friends in RTE who like this vision of trolleys on corridors and like to dramatise such issues with the onset of a general election. As my colleague Deputy McGennis said, Fine Gael and Labour and, indeed, Democratic Left, had their golden opportunity to advance the health agenda when in Government but did little or nothing. This Government doubled investment in the health services. We know only too well, as pointed out daily, that spend on our health care system is less per head as a percentage of GNP than a great many other European countries. We are in the process of changing that position to enable us to spend more per head as a percentage of GNP on our hospitals and health services. However, it must be done in an orderly way, not the knee-jerk crisis response technique most often used by Fine Gael and the Labour Party, but particularly by the Labour Party.

I am sorry to speak about that party given that none of its Members is present. I guess from its various press releases and PR announcements that it has an obsession of worry and concern for the patient. Yet when the matter is debated here it is absent. That is a sign of its commitment to the health agenda. I think it was my colleague, Deputy Batt O'Keeffe, who wrote about Labour's attitude to health – put publicity before policy and public relations before the patient. That seems to be the Labour Party approach. I hope Fine Gael will not fall into the same trap. If they are in Government after the next election – and perhaps South Tipperary is a pointer in that direction – they will not be in a three party Government. They will be in with three other parties in a four-party coalition backed up by Independents. Having run up the white flag on their own policies in a three party coalition, what will they do in a four party coalition?

Now we are hearing from the party of reality.

(Interruptions.)

What ministries will they surrender? What policies will they surrender? In 1994, they surrendered every single item of Christian democratic right wing viewpoint to be in a coalition with Democratic Left.

Deputy Lenihan knows all about right wing politics.

Deputy John Bruton, who said he was a Christian Democrat before that Government was formed, boasted, when he had formed the Government, that there was a social democratic Government. That was a complete ideological somersault on his part, so incredible that it renders almost pointless the existence of Fine Gael as a viable party with real policies to offer the public.

(Interruptions.)

As soon as they get into Government, they forget their own supporters and their own policies and go along with the suggestions of the Labour Party and any available splinter groups to keep power.

I am sharing time with Deputies Neville, Fitzgerald, Boylan, Connaughton and Ó Caoláin. I listened to Deputy Conor Lenihan with amazement. He does not approve of RTE programmes showing sick women having to go to the courts and sick children waiting for operations. In typical Fianna Fáil fashion, he would push it all under the carpet, let nobody know about it and wait for it to show up in another forum 20 years later. I listened to speakers from the Government side over the last 24 hours. There was one common thread in all their contributions. With the exception of the Minister for Tourism, Sport and Recreation, Deputy McDaid, who spoke with a little compassion, the others were dreary, tired and worn out. Fresh faces are needed in the Department of Health and Children. Every day, on RTE's "Morning Ireland" programme and on local radio, one disaster after another emerges from the Department of Health and Children and one disastrous Minister after another comes on the airwaves. They are rather like footballers who have taken so much punishment that they become weary and dreary. That was demonstrated last Sunday in the by-election result. Those Ministers are tired and we must get rid of them.

Deputies may be aware of a Saturday night TV programme with Marty Whelan. I think it is called "Let's go fly with Marty to America". I wish to put a serious proposal to the Government for implementation during their remaining six or 12 months in office and I am also asking my own party to consider it. To deal with our major problem of hospital waiting lists, lotto funding should be used to bring people for treatment to America, Northern Ireland, Britain and elsewhere in Europe until we clear those waiting lists. Every weekend, people come to my clinics in distress, seeking help to get hospital beds and treatment for their loved ones. I am sick and tired of the lack of response to those problems. Instead of being squandered in other directions, lotto funding should be used to deal with the crisis in the health services.

(Interruptions.)

I notice Deputy Conor Lenihan finds that amusing but, of course, for him and Fianna Fáil, life is a joke. If he wishes to play with his phone, he should go outside the House.

Last Saturday, one of my constituents, a person of a simple nature, fell in his home. He had to wait until a family member could bring him to Castlebar Hospital. He could not understand the doctor on call, nor could the doctor understand him. He was given pain killers and sent home because he could not be transferred to Galway Regional Hospital for attention to a bone injury until the following Monday morning. His GP had to give him further pain killing injections on Sunday. When he went to Galway on Monday, he was sent home at first as there was no hospital bed available. He was subsequently admitted to the casualty department and a bed was eventually found for him in a nursing home. For Deputy Lenihan's information, that is the kind of health service we now have.

Deputy Ring's reference to foreign doctors smacks of racism.

(Interruptions.)

Those who can afford to fly to Dublin or abroad for their treatment and operations will get the necessary attention. Deputy Penrose was right in saying that people on medical cards will suffer, suffer, suffer. This Government's line is wait, wait, wait.

A Government can be judged on how it treats its young and its elderly. This Government has a disgraceful record in that regard, as I will illustrate. In February of this year, I raised the issue of incontinence pads for elderly people with medical cards in nursing homes. These are surely one of the most vulnerable groups in society. I was eventually informed by the public health nursing section of the Mid-Western Health Board that medical card holders who are not in receipt of nursing home subven tion are entitled to a maximum of 120 pads per month, depending on their need and assessment. Those who have medical cards and are in receipt of subvention from a health board do not qualify for an allowance for incontinence wear. That is the lowest form of discrimination that one could experience. How could one justify withdrawing a medical service because a person had a medical card?

I raised the issue in this House during the debate on the Health (Miscellaneous Provisions) Bill. The Minister subsequently informed me that the Nursing Home (Subvention) Regulations, 1993, provide that individual residents in private nursing homes, who are in receipt of subvention from a health board, may not be charged extra for any service which is considered to be essential to their maintenance in the home and which is common practice in most nursing homes. Such services included bed and board, nursing care appropriate to the level of dependency of the person and incontinence wear. He further informed me that, on 26 February, at his instructions, a letter was issued to the health boards requesting them to ensure that medical card holders who have entered or will enter private nursing homes retain their eligibility for incontinence wear under the GMS scheme and that all medical card holders in receipt of subvention be supplied with incontinence wear on the same basis as if they were residing in the community. It is an absolute disgrace that, in some health boards, including the Mid-Western Health Board, this directive has not yet been introduced and that people in nursing homes who require incontinence wear are being charged.

I would like to further point out to the Minister that he quotes nursing home regulations of 1993 which have been breached by the health boards in this instance. That is a disgrace and I ask if he will immediately direct the health boards to refund any moneys which were charged for incontinence wear to patients since 1993. To do anything other than this is to take money from the most vulnerable people, the elderly who are incontinent.

On 21 June this year Kevin Murphy, the Ombudsman and Information Commissioner, was emphatic that people with medical cards are entitled to provision of free long stay care. At present they receive nursing home subvention depending on their level of dependency. The strict interpretation and clear view of the Ombudsman on this issue is that everybody in need of long stay care with a medical card should have it free. I put it to the Minister that the legal position on hospital in-patient services is relatively straightforward. Everybody resident in the State is entitled to be provided with in-patient service, where necessary, by the relevant health board. The services may be provided directly by the health board in one of its own hospitals, or in another publicly funded hospital, for example the so-called voluntary hospitals, or by way of a contracting out arrangement between the health board and a private institution. Such latter arrangements are provided for in section 26 of the Health Act, 1970 and are required to be in accordance with such conditions as the Minister for Health and Children may specify. Where the patient is covered by a medical card this service is free of charge.

The definition of in-patient services provided for in section 51 of the Health Act, 1970 means institutional services provided for people while maintained in a hospital, convalescent home or home for a person suffering from mental or physical disability or accommodation ancillary thereto. As well as covering acute hospital stays the term self evidently includes wider categories of service such as the long stay care of elderly or disabled people. I consider that an elderly person who needs long stay nursing home type care which typically includes nursing care, and who has a medical card, should receive that care entirely free in nursing homes.

I welcome the opportunity to contribute to this important and timely motion. It calls on the Minister to ensure that the rights of patients to due, adequate and timely health services are vindicated and upheld. It is very disappointing that the Minister has sought to amend the motion to congratulate himself on having spent more money and on his long overdue planning of a new health strategy.

A very striking feature of the contributions on the Government side tonight has been the lack of acknowledgement of the serious issues facing the health service and of the suffering facing individual patients. No Government speaker said he or she was sorry that in the past fortnight a woman had to go to the High Court to get her basic right to chemotherapy. The tone of the Government contributions speaks volumes. They simply attacked the Opposition and went back over records from a time when the economy was in a totally different position.

The almost hysterical speeches tonight by a number of people show the Government is in denial of the crisis facing the health service, or certainly that it is not willing to acknowledge the scale of the problem. Until a problem is acknowledged nothing effective can be done about it. I would have been far more impressed if speakers had taken on board some of the recommendations made by Deputy Gay Mitchell in his very comprehensive address last night and during previous debates on health motions. He put forward a range of initiatives which, if taken on board, would make a difference. I hope the Ministers who will speak tonight will address some of the suggestions and respond to them, saying whether they will take them on board. If they are not to take them on board they should say why.

People living in Dublin might suffer more, though people are suffering throughout the country. The waiting lists for Dublin hospitals have risen by an average of 43% since the Government took office. The lists at Blanchardstown hospital and at St. Vincent's in Elm Park show the highest increase at 202% and 102% respectively. The waiting lists for Our Lady's Hospital for Sick Children, Crumlin, rose by 27% in the past three months alone. There are 15,603 people waiting for a bed in a Dublin hospital, that is 59% of the people on waiting lists nationally. The recommendations made by Deputy Mitchell for dealing with the shortage of nurses in Dublin should be taken on board by the Minister. Can the Government justify its failure to the 83% of children who have been waiting for more than one year for cardiac surgery at Dublin's children's hospitals?

I am very happy to support the motion.

I hope, if this motion sponsored by Fine Gael can get one clear message to the Minister for Health and Children and his advisers, it is that the health services are in a shambles. Will the Minister take that on board and make a start and do something constructive about putting in place a proper health care service? It gives me no joy to say this. The Minister must be aware of the problem through dealing with constituents in his clinic. Surely they are coming to the Minister and backbench Deputies with complaints similar to those being raised with me. Are we unique on this side of the House in that people are only coming to us as they have lost all faith in Ministers and Government backbenchers? I do not think this is so, but people feel the Government is not listening.

It gives me no joy to point out to the Minister that there are 26,000 people on a waiting list. These people are in pain and are suffering. Will the Minister take this on board? There are 150,000 waiting for appointments, and they do not know how serious their situation is, or if it is very serious. People are dying as a result of the mismanaged health care service – I say that clearly and distinctly in the hope it will sink in. The Minister must address the management crisis in the health care service. The issue is the breakdown in management, and we need a strong Minister and one who is prepared to tackle this problem.

Throwing money at it will not solve the problem. Some £30 million has been allocated to various health boards for projects within their areas which have not been embarked upon because they cannot make a decision as to where services should be located. Ministerial intervention is called for: the Minister should say enough is enough and that he will no longer stand for it. He took the responsibility from the Taoiseach to act as Minister, and people expect him to act. An example of what I am talking about is the non-existent cancer care services in the North-Eastern Health Board area. Poor female neighbours of mine who have breast cancer problems have to travel to Dublin by public transport to have their operations and follow-on procedures. The Minister is aware of the trauma and pain regular trips to Dublin hospitals causes patients and their fam ilies. At the same time we have had in place for four years a mammography machine which is not operational, but which was recommended for the Cavan general hospital by the Cancer Support Group. Need I say more? It is not good enough and not acceptable. If the Minister is not prepared to deal with this important issue he should do the decent thing and step aside.

I take the opportunity to raise two specific health matters in the very limited time allocated. I put the Minister for Health and Children on notice that discussions on the initial contract between the owners of the Bon Secours hospital in Tuam and the Western Health Board concerning the value of the property appear to have broken down this week. I want the Minister to understand that the people of Tuam and its hinterland will not accept anything less than a community type hospital as outlined by the Western Health Board and agreed by him. Further, the people of Tuam will not stand for a summer of wrangling between two bodies which should have the same ideological mind set in so far as the provision a good hospital service is concerned. I accept the Western Health Board should only pay the going rate for the property, no more and no less and the Bon Secours Order should be comfortable with a fair price. I do not want the rest of the year taken up with squabbling over the valuation of a building, now vacant, and a piece of land. There is no reason an independent group of valuers, expert at their job and acknowledged in the industry as being professional, should not be employed to arrive at a reasonable valuation for the sale.

As the Minister is aware the hospital was closed nearly three months ago. Tuam cannot afford to be without the services of a hospital and any unwarranted delay such as the present impasse on price will not be tolerated. We know the Minister has the money and it is time we got our share of it.

The waiting list for orthodontic services has stretched to between four and five years. If ever there was a two-tier health service – and we have said it time and again here tonight and last night – it is to be found particularly in the dental area. If a family has money their children will get orthodontic treatment almost on the strength of a phone call but if they have a medical card they wait for four or five years. I find it extraordinarily difficult to understand how our health board in the west could manage to clear the waiting lists five or six years ago and in the last few years they are back to where they started. It takes up to £4,000 in some cases for families to pay private orthodontists for what the health board should be doing.

The 12 year old child of a neighbour of mine was told by the school orthodontist that he was not entitled to treatment and this decision was appealed to no avail. A private orthodontist identified a difficult dental problem that would take £2,000 to solve. If that is the way patients are treated in the Western Health Board, then God help anybody who has to wait on their scheme for orthodontic treatment.

I am delighted to have the opportunity to speak on this motion. As all of my colleagues have said, the health service is the most serious issue affecting the Government and the people of this country. We all find a large number of requests at our clinics from people on waiting lists for hip replacements, coronary care and orthodontic treatment. This is affecting all strata of society. During this Government's time in office a two-tier health service has developed – people who are in the public health service on medical cards cannot get a service and people who have private health care are availing of the service.

Throwing money at the situation is not necessarily going to resolve the matter. More money is needed but we also have to look at where the money is being spent. A recent report revealed that 47% of jobs created in the health service over the last three years was in administration and only 7% was in medical care. One does not have to be a genius to work that one out – we have a bureaucratic health service. I am not blaming the people in the administration end of the health service, but do we need 47% extra administrators and only 7% extra people working at the coal face ? We need more doctors, nurses, orderlies and those who are at the forefront providing the service – we certainly do not need more administrators. Whatever has gone wrong has been due to mismanagement and the Government has to make some tough decisions which it has not done up to now. The Minister is waiting for a report on how the health service will proceed for the next seven years, and if he continues the way he has been doing, the difficulties will be multiplied rather than reduced.

Fine Gael's call for the establishment of an ombudsman for the health service is an excellent idea. This would provide somebody to look at the difficulties in the health service. We have to look at the way we run it – is there a need for six health boards in a small country? In 1979 there were 95 people working in administration in all of the Dublin hospitals while today there are over 11,000 administrators throughout the health service. The amount of money that is put in health service administration is unjust – the money should be spent where it is needed so that people who are on public service waiting lists can be called for their operations when they need them. As my colleague, Deputy Boylan, said, people have died because they could not get a bed or the service they required and that is not good enough. I hope that the Government and the Minister for Health and Children will take their responsibilities seriously and initiate the change necessary to have a proper health service.

I support the Fine Gael motion before the House this evening. In the Environment and Local Government Committee over the past number of days the defence of local democracy was one of the central issues which we were seeking to address. I refer to this specifically because there was an example recently in my own county of Monaghan where the real potential of local democracy in giving the lead to communities was demonstrated when all parties and views moulded together in common cause in support of the community we represent. On 21 June we organised – what I believe is a prime example of positive leadership – a maternity services forum for the Border counties which sought to address the critical issue of the closure of maternity services at the local hospital. Under the auspices of the county council and as part of a cross-party team of Monaghan members of the North-Eastern Health Board, I and others helped to organise what was a very successful event. We secured a list of eminent speakers who addressed the forum on all aspects of maternity care.

What emerged most clearly from the contributions was the grave danger posed to all services at Monaghan General Hospital as a result of the withdrawal of its maternity unit by the executive of the health board. Professional opinion agreed that with the maternity unit gone there would be a domino effect which could see the closure of key services, one after the other, until we would be left with what one speaker described as a glorified health centre.

I ask the Minister that the two key resolutions adopted by the forum be taken on board. The forum unanimously endorsed the call for the appointment of a second obstetrician, an in-hospital paediatrician and the provision of an epidural service on request for all mothers-to-be at Monaghan General Hospital. The forum called unanimously on the Minister for Health and Children to make a positive and public intervention that will clearly show the Minister and his Government's support for the retention and development of maternity services at Monaghan General Hospital. Those motions were passed with vocal enthusiasm at the forum and by all opinion, including the representatives of the Minister's own party. We are not being listened to, and this is the real issue. What we demonstrated at local level in working together in common cause should in fact be the template that would apply at this level also – but that is not the case. The real losers are the women of County Monaghan, their unborn children and the lives of generations to come who are being put in jeopardy. We have demonstrated time and again, and 35,000 people, in our low population base, signed a petition supporting the retention and development of the maternity unit at Monaghan General Hospital. These people must be listened to and I appeal on behalf of all the political representation in County Monaghan. I hope that the real needs of real people will be addressed at local and national levels and that we will see the provision for all our people of a level of care and intent on the part of Government that will see a levelling out of the health services regardless of ability to pay.

Ba mhaith liom a rá go bhfuil sé ceart agus cóir go bhfuilimid tar éis an díospóireacht seo a bheith againn le dhá oíche anuas. I welcome the opportunity to discuss the health service. There is no more important issue for the people or the Government, or indeed any of us as individuals. Each of us wants to see a health service that is able to respond quickly to the needs of people, be they young or old, a health service that would be reformed and well funded, inclusive and able to allay their fears and give them the care and help they require. While I recognise that much has to be done in the health service it is important both sides of the House recognise what has been done as well and that real progress has been made in the last number of years.

It is important both sides of the House recognise what has been done as well and that real progress has been made in recent years. That progress has come about as a result of the increases in health funding and the substantial investment in the health services. That has been discussed by Deputies on this side of the House in recent nights. Both sides have recognised that investment alone is not enough. We can talk about figures but unless that is put in the context of an overall health strategy, we will be working in isolation. That is why the new health strategy is in the final stages of its preparation.

After four years.

It is a health strategy which has involved detailed consultation and discussion with everybody involved in the health service, particularly the users and the patients. Thousands of submissions have been received. It is based not only on the views of people, but on factual reports. It is based on a value for money audit, the manpower report and the Commission on Nursing to ensure that this strategy is one which can set out over the next few years how the increased investment, and the commitment to investment, can be used to benefit people. It is important we recognise what has been and continues to be done during the course of this Government. The investment is bringing down waiting lists. In the four year term of this Government, those figures are now 4,101 fewer than they were. I acknowledge there are still many people waiting, but at least there are fewer people on the waiting list.

There was a specific reference to children waiting for surgery, something our funding is targeting. It is aiming to ensure that no child will have to wait longer than six months. It is important to say the lists and the waiting times have reduced substantially. The decreases are evi dent. In regard to children waiting longer than six months for cardiac surgery, there has been a decrease of 78%, a very welcome decrease. For children waiting for general surgery, there has been a decrease of 16% and for children waiting for ophthalmology, there has been a decrease of 50%. These are all real indicators of how the money is being spent to benefit children and to make sure they are getting the health treatment and care they deserve. That applies not only to children but to everybody.

Some 90,000 more people got treatment last year than, for example, in 1997 when this Government took office. There are more doctors, nurses and paramedics. There is more capital investment in hospitals. Deputy Fitzgerald referred to St. Vincent's Hospital. The £160 million which has been promised and is being spent in investment in that hospital will not only benefit her constituents and mine but people from all over the country who use that hospital.

I refer to the extra 4,000 people we see by way of doctors, dentists, nurses and paramedics. There was a reference to administrators but let us focus on the people who are carrying out the practice on the ground. Let us focus on the medical cards for the over 70s which will make a real difference to their lives. Let us focus on the extra nurses who are making a real difference in our hospitals.

I refer to the implementation of the cancer strategy. Some £60 million has been spent over the past four years. It is a cancer strategy which aims to provide breast checks to ensure breast cancer problems in women can be detected early and be treated. There is increased North-South co-operation in a number of areas which we can see in relation to cancer and joint research and action. It is the way forward.

Minister, you have one minute remaining.

I was going to speak about children given that nobody else mentioned them in the two days of the debate. I recognise a great deal has to be done but that much is being done. The Opposition say its members are the only people who care, but they are not.

Nobody over here said that.

They are not the only people who have people coming to their clinics with difficulties – we do too. Deputy Fitzgerald was implying that none of us on this side have a heart – we do, we care. We know our constituents and we understand the needs of the people.

We are just saying the Government is incompetent.

The Government understands what needs to happen. We know that investment has to go into the health service and that is why we are doing it. We know it has to be reformed and that it has to be inclusive and that is why we are preparing the strategy. We know what is needed for this health service. In the same way as we know what needs to be done, the Opposition needs to recognise what is being done.

I wish to share my time with Deputy Allen and Deputy Gay Mitchell.

It is entirely appropriate that my maiden speech, as a Member of Dáil Éireann representing the people of South Tipperary, should be on the lack of equity and accessibility in the health services. The crisis which is besetting what should be a showcase health service was the main focus of the by-election campaign we fought in recent weeks.

The main emotions experienced by those who have access to the health services and those medical, nursing and paramedical staff who work in the health services are fear and anger. For patients, it is fear of being left on a trolley for days in the overcrowded casualty department, fear of being on a hospital waiting list for years on end or of having to travel to Dublin for oncology services or fear that because one is denied a medical card, one's modest income will not stretch to pay for the essential medication for one's sick child.

Medical and nursing staff are fearful too. They are stressed by the overcrowded conditions, by long working hours and by inadequate equipment. They are angry about the lack of policy direction, about staff shortages, about the pressure on beds and about having to think of discharging a patient early to make way for someone who is even in more need. General practitioners are angry about seeing their patients' conditions worsen while they wait for an appointment or test and about having to telephone a consultant to plead for a special appointment or to get a very sick patient higher in the queue. Anger and fear are the emotions engendered by a health service which the Government has described as excellent.

Last night the Minister accused the Fine Gael party of playing politics with the health service. It is the politics of this Government which is crippling the health services. It is the politics of spin, hype and photo calls. It is the politics of leaving everything to the last minute and having the promises made just in time for the election manifesto, but too late for many patients.

In constituency, health board area and in the rest of the country, the lack of a national health strategy is painfully obvious. It is obvious in the fact that the chief executive officer of the South-Eastern Health Board has described his main anxiety as the lack of hospital beds in this area. It is painfully obvious to the 1,623 men, women and children on the South-Eastern Health Board waiting list whose chance of and right to a speedy admission is now further away than ever.

Let us look at the facts of this excellent health service. The nurses at St. Joseph's Hospital in Clonmel have had to take radical action to ensure proper patient care in dreadful conditions. Thousands of people are in the queue to join the queue to see a consultant, including a young man from Carrick-on-Suir who has already been waiting five years for such an appointment and who, like others, has not even got on a hospital waiting list. Some 7,000 people in South Tipperary could have a medical card tomorrow if the Government would revise the miserly income limits. Some 10,500 people nationally have been waiting well over a year for hip replacements or for cardiac operations. Almost 11,000 will be marking their first year on the hospital waiting list any day now. The South-Eastern Health Board is already under funded by £1.3 million in the first four months of this year due to the additional overtime payments because of staff shortages. This is the reality of the excellent health service about which we talk.

The Government is failing all the people on the hospital waiting list. It is failing all the people it unjustly deprives of a medical card. It is failing our nurses and doctors who have to work in stressful conditions. It is also failing the elderly. Most people hope to have an active old age but a sizeable minority of older people are likely to need special care. In light of a rapidly increasing older population, the challenge to provide adequate support both at home and in the community is significant. For many, the prospect of paying for essential nursing home care is a nightmare. At present, the average subvention is £116 per week. Families require an additional £10,000 to £15,000 per annum to meet the remaining costs. This is not realistic for the majority of families. Increased nursing home subventions would alleviate hardship and anxiety for many elderly people and their families. Fine Gael believes that elderly people and people with disabilities should be given every support necessary to allow them to live independently in their own homes and communities. The reality is that such supports are not provided for many people. It is essential that affordable, accessible and high quality nursing home facilities are provided to ensure people can avail of short-term, long-term and respite care where it is needed.

Many facilities for the elderly are under-funded. St. Patrick's Hospital in Cashel requires an urgent injection of more than £1 million to enable it to continue to provide high quality care in high quality surroundings. Many older people can manage at home with the assistance of minor aids such as stair rail fittings, walk-in showers, wheelchairs or ramps. Thousands of elderly people are awaiting assessment for such assistance, some up to two years. Even when they are assessed, they must wait years before the work is carried out. For older people who experience difficulty climbing stairs, for example, this can prove very distressing.

The scheme of housing aid for the elderly is in a shambles. In my own health board area – the same applies in many other health board areas – the budget for the scheme will be used up by April. This means that only a maximum of 33% of applications can be processed and funded in any one year. This is a outright disgrace. We are supposed to assist elderly people to live independently. We are supposed to keep people out of hospital and help them to live with dignity. However, with a budget which lasts for only four months of the year, how can we fulfil these objectives?

I congratulate Deputy Tom Hayes on his maiden speech. Although my time is limited, I want to address three points. The Minister of State spoke about decisions based on strategy. One cannot make decisions on the future of our health services based on bogus figures such as those outlined by the Minister in regard to waiting lists. The Minister cited figures for in-patient waiting lists. I tabled a number of parliamentary questions to his Department on out-patient waiting lists to ascertain the true extent of the crisis and was informed that it did not compile figures in this area. I became suspicious and carried out my own research. I asked the Southern Health Board to provide me with the number of out-patients on the waiting lists and the information makes for very interesting reading.

The Minister informed the House that 535 people are awaiting in-patient appointments at Cork University Hospital. He neglected to inform us that 5,266 people are awaiting out-patient appointments. The Minister stated that 512 people are awaiting orthopaedic surgery in the Cork area but this hides the reality that 1,240 GP-referred patients are awaiting out-patient appointments. He stated that some 600 people are awaiting in-patient appointments in Tralee but omitted the fact that 2,000 people are awaiting out-patient appointments. The Minister stated that 5,000 children are on waiting lists for in-patient orthodontic treatment but failed to say that a further 5,000 are awaiting preliminary out-patient appointments to assess their needs.

Scandalous.

The Minister is resorting to hype and propaganda and is playing games with a very serious issue. I challenge him to outline the true extent of the problem in our hospitals. If the figures provided by the Southern Health Board are indicative of figures nationwide, we have a huge crisis on our hands.

The Minister prides himself on being open about the facts. The centralisation of services in the Dublin area has resulted in turmoil and conflict in the Irish Blood Transfusion Service. Some time ago, the Minister announced that Mr. Phil Flynn had been asked to assess the internal workings of the IBTS. Yesterday, in response to a parliamentary question I tabled, the Minister refused to publish the report. He is hiding the facts. I challenge him to produce this report in order that we can see the true extent of the problems in the IBTS.

Due to time constraints, I cannot comprehensively address the third problem I wished to raise. The Minister must immediately provide the funding necessary to prevent elderly people being evicted from nursing homes throughout the country and to alleviate the problems experienced by their families who live in fear of mounting debts. He should note the comments made last Thursday week by the Ombudsman at a meeting of the Committee on Health and Children.

I thank those Members who contributed constructively to this debate. One or two of the contributions made were nothing more than vulgar abuse. They did not add to the debate and certainly will not read well on the record. While I will not accuse the Minister for Health and Children of vulgar abuse, his contribution represented political point scoring and did not address the issues. Given the extent of the difficulties in our health service, this does not augur well. I found the opening comments of the Minister for Tourism, Sport and Recreation, which were similar to those I have advanced, very interesting. Investment in primary care must be considered in the context of reforming the health service.

On 13 February, the House debated a motion tabled by Fine Gael condemning the prolonged and systematic improper extraction by health boards of money from vulnerable old people in need of nursing home care and from their families with the full knowledge of the Department of Health and Children. I pointed at that time to an extraordinary catalogue of bad practice and financial impropriety in regard to which the Department failed to take appropriate action. The Minister in reply stated:

My Department has instructed the relevant health boards to take immediate steps to pay all outstanding arrears. I assure the House that my Department is continuing to pursue the matter vigorously with the health boards concerned.

What price the Minister's assurance and commitment? Six months on, only one-sixth of the repayments have been made. Some £4.5 million extracted by the State from vulnerable old people and their families is still outstanding. So much for urgency and commitment. The Midland, Southern and North-Western Health Boards have not paid any money at all in spite of the Minister's assurances and the remainder have paid a paltry £254,000.

£1.2 million.

This is an absolute disgrace but why should we be surprised? What more can we expect from this Government and this Minister? In the new language which has emerged under this Government, "urgency" means one waits and waits and "priority" means one forgets about something altogether. The Minister has remained inactive, inert and ineffective. He offers empathy and assurance but when has he actually taken action? This is a further nail in the coffin of the Minister's credibility. He must ensure this money is paid back immediately.

I wish the Minister of State, Deputy Hanafin, would realise that we do not think Members on this side of the House have a monopoly of wisdom and understanding of this problem. Members on all sides of the House have a heart. I do not understand the lack of strategy, leadership and competence. That is what the Minister of State is paid for. The Government has been in office for four years and failed dismally. It has failed the poor, in particular.

If one is wealthy, one can have whatever one wants because one can pay for it. If one is not wealthy, one must go on a waiting list and a waiting list to get on that waiting list. That is how the numbers have been reduced. As the consultant about whom the Minister, Deputy McDaid, spoke cannot be seen for months and years on end, some cannot even get on a waiting list. That is the reality of the health system.

The figures are being massaged.

It is based on injustice and wholly unacceptable. I ask the House to support the motion.

Amendment put.

Ahern, Dermot.Ahern, Michael.Ahern, Noel.Andrews, David.Aylward, Liam.Blaney, Harry.Brady, Johnny.Brady, Martin.Brennan, Matt.Brennan, Séamus.Byrne, Hugh.Callely, Ivor.Carey, Pat.Collins, Michael.Cooper-Flynn, Beverley.Coughlan, Mary.Cowen, Brian.Cullen, Martin.Daly, Brendan.Davern, Noel.Dennehy, John.Doherty, Seán.Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.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.Lawlor, Liam.Lenihan, Brian.Lenihan, Conor.McCreevy, Charlie.McDaid, James.McGennis, Marian.McGuinness, John J.Moffatt, Thomas.Molloy, Robert.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Donoghue, John.O'Flynn, Noel.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Malley, Desmond.O'Rourke, Mary.Reynolds, Albert.Roche, Dick.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Dan.Wallace, Mary.Walsh, Joe.Woods, Michael.Wright, G. V.

Níl

Allen, Bernard.Barnes, Monica.Bell, Michael.Belton, Louis J.Boylan, Andrew.Bradford, Paul.Broughan, Thomas P.Browne, John (Carlow-Kilkenny).Bruton, John.Bruton, Richard.Burke, Liam.Burke, Ulick.Carey, Donal.

Connaughton, Paul.Cosgrave, Michael.Coveney, Simon.Crawford, Seymour.Creed, Michael.D'Arcy, Michael.Deasy, Austin.Deenihan, Jimmy.Dukes, Alan.Durkan, Bernard.Farrelly, John.Fitzgerald, Frances. Flanagan, Charles.

Níl–continued

Gilmore, Éamon.Gormley, John.Hayes, Brian.Hayes, Tom.Higgins, Joe.Higgins, Michael.Hogan, Philip.Howlin, Brendan.McCormack, Pádraic.McDowell, Derek.McGahon, Brendan.McGinley, Dinny.McGrath, Paul.McManus, Liz.Mitchell, Gay.Mitchell, Olivia.Naughten, Denis.

Neville, Dan.Ó Caoláin, Caoimhghín.O'Keeffe, Jim.O'Shea, Brian.O'Sullivan, Jan.Owen, Nora.Penrose, William.Rabbitte, Pat.Reynolds, Gerard.Ring, Michael.Ryan, Seán.Sargent, Trevor.Sheehan, Patrick.Stagg, Emmet.Timmins, Billy.Upton, Mary.Wall, Jack.

Tellers: Tá, Deputies M. Ahern and S. Brennan; Níl, Deputies Bradford and Stagg.
Amendment declared carried.
Motion, as amended, agreed to.