I welcome the opportunity to make a contribution to this debate. I would like, specifically, to address the part of the Fine Gael motion where the House is invited to condemn the Government in relation to the health service.
While the advisers to its leader are busy attempting a last minute dramatic reinvention of his style, the basic thrust of the motions put before the House remains the same. Every week we hear another tirade, using selective or invented statistics in an ever more desperate attempt to undermine the Government's standing.
The Opposition as a whole has been extremely inventive in the different tasks it has taken. My favourite remains the way in which Labour and Fine Gael believe that we should be held accountable for the major increase in waiting lists which took place in their last six months in office. To that can be added the display we saw in the House earlier when Fine Gael attempted to attack the Minister for Defence and the Government for implementing a decision for which its leader had lobbied. Never letting facts get in the way of an attack and never missing an opportunity to trade on innuendo, the tactic of playing the man not the ball is alive and well and played out with ever more predictable regularity on our airwaves.
The bottom line on our record on health is that we have cut waiting lists, dramatically increased investment, provided new services, hired new professionals and provided the most comprehensive blueprint for development and reform in the history of our health services. Let us nail one lie here and now, implementation of the health strategy is not only well under way, critical aspects of it are ahead of time. More than €250 million is being spent to develop the services outlined in the strategy. In just one area, hospital treatment, the first expansion in bed capacity in decades is under way – 709 beds are coming onstream this year versus an original target of 650 beds. Some €113 million is being provided to reduce waiting lists and waiting times.
Compare this to the record of the leaders of the Opposition when they were taking the decision. Deputies Noonan and Quinn looked into their hearts and decided that waiting list funding needed to be cut and reduced it to €10 million in 1997. Five years on, in spite of regular requests, both refuse to justify this decision.
When coming into office the Government recognised the need to improve the level of investment in the health services. I am pleased to record that we have achieved our goal, but we recognise that more is required. Future policy is clearly set out in our health strategy and the reviews of primary care and of bed capacity. I am continuing these improvements during 2002. Some basic facts, which cannot be refuted, are that ongoing revenue spending on the health services for 2002 is approaching €7.7 billion; on the capital side, the 2002 spending level is €497 million; and, as a percentage of GNP, health revenue expenditure now stands at 7.8%, which is the highest figure in almost 20 years. We, as a Government, have delivered an increase of 125% in funding for the health services.
The establishment by Government of a national development plan represents the single most important event in the development of the health capital infrastructure. In 2002, funding of €497 million is available, the largest ever capital programme agreed by a Government for the health services. The 2002 funding represents a 33% increase on the 2001 outturn. This funding will allow for the continued progression of major projects in the health sector such as hospitals and community facilities. Every region in the country has a major investment programme in its health facilities and equipment.
The staffing of our health services continues to be another of those critical issues affecting our ability to meet the increasing service demands across all programmes. The total staffing figures for the public health services have increased from about 68,000 in 1997 to about 86,000 at the end of 2001. That is an extra 18,000 people. As a consequence of the increased funding provided in 2002, this number will rise by approximately 6,000 to 92,000 overall.
I will give the House some more facts. A total of 1,640 places nationally will be available from this year on the new nursing degree programme. This is a record number of places. The recruitment of nurses continues to run strongly ahead of the numbers leaving with a net increase of 1,896 as of 31 October 2001. There are 340 more consultants than in 1997. We have developed the National Health Strategy to move away from short-term approaches to planning and to provide a blueprint for the whole health system to realise ambitious and wide-ranging change over the next seven to ten years. The Government's commitment to health as a key priority area is underlined by the ambitious targets set in the strategy. As I said at the outset, this year is seeing major funding for the strategy and major progress in implementing it.
Equity in health care is one of the principles on which our new health strategy is based and one which this Government is committed to addressing in the implementation of the strategy and through service developments across the board. The overriding necessity here is the need for access to services. Services need to be built up, waiting lists reduced and activity increased and specific groups such as children and those with disabilities require targeted service developments to address previous neglect and unmet need to ensure equity. A broad strategic focus is essential to deal with these sort of problems and no single narrow approach will address the real need for better, more equitable health care services for all.
The health strategy, Better Health for Everyone, sets out a range of actions which are specifically directed at disadvantaged groups and are concerned with ensuring that these groups do not continue to suffer the most ill-health. Actions to reduce inequality include the implementation of the National Anti-Poverty Strategy and targets for the reduction of health inequalities. These include targets for reducing gaps in premature mortality between the highest and lowest socio-economic groups. In addition, there are provisions to eliminate the barriers that exist for disadvantaged groups in terms of making healthier choices easier for these groups and supporting them at community level to understand and access services. There are also specific programmes of action for groups such as Travellers, the homeless, drug misusers, prisoners and asylum seekers and refugees, all of whom have a real risk of poor health status.
The second national goal of the strategy is fair access. It is concerned with ensuring that equal access for equal need is a core value in the delivery of publicly funded health services. There are three strands to this goal. The first is to clarify eligibility through legislation and communication with hard-to-reach groups. The actions set out in the strategy will ensure that all those eligible understand their entitlements, can easily access services they need and can be sure that no matter where they live, there is a standard approach to their eligibility for services. As part of ensuring fair access the strategy identifies the need to provide equitable access to services. This is primarily concerned with improved access to hospital services for public patients. It also attempts to recognise other barriers which affect people's ability to access services.
The strategy recognises that health for disadvantaged groups is a complex issue which needs to be tackled in a number of ways. We need to ensure, firstly, that people are healthier and therefore less likely to need health and personal social services and, secondly, that when they do – once they are deemed eligible – no other barriers such as transport or opening times prevent them from accessing the services they need. The Government has set out a range of measures to make more people eligible for services. Our commitment to their introduction is clearly stated in the strategy. The proposals are broadly aimed at the most vulnerable in society. Those on low incomes, especially families with children or a child with a disability, will be targeted. There is also provision for young children and the elderly. All of these groups have very high health care needs compared to the rest of the population.
These proposals are a key element of the fairness part of the strategy. However, the strategy also recognises that extending eligibility will not guarantee that people get the services they need. There are other barriers to equity in the system and dealing with these has been prioritised to ensure the eligibility framework in the future can really support equal access for equal need. The Government is fully committed to extending medical card coverage to more people on low incomes and there will be targeted increases to ensure more children, in particular, are covered by these measures. Such actions always have to be considered in the light of the whole range of priorities for the health services.
I will now outline some of the developments this Government has been responsible for implementing during its term of office in the past five years. Since coming into office it has placed heavy emphasis on the development of new accident and emergency services. A total of 16 major capital investment projects have been initiated, catering both for new facilities and for extensive refurbishment and enhancement of existing facilities. Some 1.2 million patients are now seen annually at accident and emergency departments. Funding of €7.3 million is being provided in 2002 to further these developments.
It is worth reflecting for a moment on the waiting lists that existed when the Government came into office in 1997. At that point there was the equivalent of just €10 million available to tackle waiting lists. My predecessor Deputy Cowen and I have increased this figure substantially each year and it now stands at almost €44 million. Fine Gael showed with its recent national campaign that when its members do not like the waiting list figures they simply invent their own. The mass indifference which has greeted its campaign showed clearly that it is fooling no one. I recently released the hospital waiting list figures for December 2001. The total represents a decrease of 6,080 or about 19% since December 1997. These figures should be seen against the background of a hospital system which is continuing its high productivity. The total number of people treated last year as in-patients or day cases in acute hospitals was 920,000. Compared with the 786,000 people treated in 1997, this is an increase of 134,000 or 17%. This is the biggest ever increase in hospital activity in this country.
This Government has ensured that more people are being treated and they are being treated more quickly. There is much more to do, but there has been progress. Some €65 million is being provided in capital and revenue to meet the requirements of the first phase of a programme to provide a total of 3,000 new acute beds in the next ten years. Our target in the health strategy was to increase acute beds by 650 in 2002 but I was able to announce plans for an additional 709 beds in the current year. I am confident that these additional beds will bring much needed relief to the acute hospital system. A sum of €30 million is being provided in 2002 for the purchase of treatments for public patients. The treatments will be purchased either from private hospitals in Ireland or, if necessary, from abroad. I have appointed a person to head the team and consideration is being given to a number of options. This, together with the waiting list initiative and bed capacity funding, will ensure that significant improvement in access to acute hospital facilities can be achieved in 2002.
This Government has allocated more than €103 million to cancer services. Since 1997, 64 additional consultant posts have been created including support staff. In recognition of the need to develop cancer services further, the National Health Strategy has identified the need for the preparation by the end of this year of a revised implementation plan for the National Cancer Strategy. This plan will be developed by my Department in conjunction with the National Cancer Forum and will set out the key investment areas to be targeted for the development of cancer services over the next seven years. I notice that Deputy Noonan has toured the country promising new services and new developments wherever he thinks they might help the Fine Gael patient to live a bit longer. I have no doubt that this will continue to fool no one.
Additional revenue funding for the development of services for older people has increased significantly from €12.7 million in 1997 to an additional €72.9 million in 2001. This has resulted in the approval of more than 1,300 additional staff for services for older people. From 1998 to 2001 more than 550 additional beds were provided in new community nursing units and more than 1,250 day places per week have been provided in new day care centres. This year alone, additional funding of €87.8 million is being made available for further development of the services.
While it likes to posture on this issue, I never hear the Opposition defending its record on disability services. We have no problem defending a record which is delivering the largest ever expansion in services. Additional revenue and capital funding has provided around 840 new residential places, 296 new respite places and more than 1,500 new day places in addition to the enhancement of other services. We have provided additional funding for physical and sensory disability services – capital and non-capital – of more than €175 million since coming into office. Additional developments in the period from 1997 to 2001 include more than 550 care places and 125 therapy posts. By any yardstick it must be acknowledged that in the last three years of this Government there has been a huge change in the level of funding for people with disabilities. It has been unprecedented. We readily acknowledge that there is some distance to go to meet all of the needs identified in the Intellectual Disability Database. We are currently developing the physical and sensory disability database which will give us a clear and objective picture of needs against which we can allocate sufficient resources to meet them.
We will not pretend the agenda is complete or adopt the complacent approach which characterised health policy when Deputies Noonan and Quinn were making the decisions. We have no problem defending our record. We are targeting investment, increasing services, developing new approaches, hiring new professionals and delivering in the acute, primary and continuing care areas. We have produced the most ambitious and comprehensive strategy for investment and reform in the history of our health services and are funding and implementing that strategy.
I am very pleased to reject the Opposition's typically superficial attack and look forward to putting our record before the people.
