Dáil Éireann debate -
Wednesday, 7 May 2003

Vol. 566 No. 1

Leaders' Questions.

Mr. Kenny

Each day, during which the crisis in the health system is upon us, some 38 people do not receive vital and necessary procedures. This means that 38 families – parents, children and grandparents – will be denied the right to such procedures. By the time we reach 17 May, the first anniversary of the day the Government bought its way back to power, nearly 400 people will have been denied access to medical treatment. In a full year that will amount to almost 14,000 people.

The Taoiseach promised before the last election to end waiting lists within two years. What contribution to the ending of waiting lists will be made by the closure of a further 250 beds? Does the Taoiseach have confidence in the Minister for Health and Children's ability to deliver the effective world-class health service that was promised by the Government? I do not doubt that the Taoiseach's reply will include telephone numbers, such as the sum of €9 billion that is being spent on the health services. Will he deal with the human cost of cutbacks, however, as distinct from the economists' version which does not treat people as people, but as statistics? The Minister, Deputy Martin, seems to be keen to leave the Department of Health and Children without having to make a difficult decision. He blames everybody and anybody other than himself and his Government colleagues.

Increased charges have been levied across the country in relation to VHI costs and visits to accident and emergency departments. Is the Taoiseach happy that there is sufficient money in the system to deliver the service to which the Government committed itself two years ago? Is he confident that the person who is sitting beside him, the Minister for Health and Children, is capable of delivering the world-class service to which the Government committed itself, but in respect of which people are being denied vital procedures?

Mr. Connaughton

Hear, hear.

The Taoiseach

I will not give a litany of figures if Deputy Kenny does not wish me to do so. I share the view of everybody else who would like to see a world class health service in which people can be treated and patients can be looked after. The Government's objective continues to be to provide an efficient and top-class in-patient and out-patient service to all who require it. The Minister for Health and Children is doing his best and he has my confidence in that regard. While there are difficulties within the system, we should not forget that thousands of additional patients are being treated as in-patients and out-patients every year. The figures have increased substantially in recent years, but I will not recite them all again.

There are problems in some areas of the health service, particularly in the Dublin hospitals where 81 beds have been closed. There are fears that other beds will have to be closed if issues relating to the 2001 and 2002 budgets are not sorted out. As the Minister, Deputy Martin, said during Question Time, meetings between the ERHA and the Department of Health and Children are taking place today. There will be further meetings between the authority, the Department and the Dublin academic teaching hospitals after the weekend. It is hoped that they can resolve some of the issues, which arise from the fact that the hospitals overspent in 2001 and 2002. Under the 1996 legislation, the additional moneys that were spent are subtracted from the hospitals' funds for this year. This creates cash-flow and financial difficulties for the hospitals. Such difficulties do not exist in many other aspects of the health service. In conjunction with the ERHA, which is directly responsible and accountable in this area, the Minister is endeavouring to deal with the problems.

While I do not want to direct a barrage of figures at Deputy Kenny, it is only fair that I should point out that almost 400,000 in-patient and day cases are being treated in the ERHA area. This figure is much higher than the relevant figure some years ago. It is clear that if more resources were available, we would open more than the 709 beds that were opened this year. The Minister has kept to his commitment in that regard and has published the health strategy. The Cabinet is in the final weeks of dealing with the implementation of the strategy. Members of the Government have to grapple with difficult and complex areas and to come to a successful conclusion shortly. The position will not change overnight, but the Government's efforts will improve it into the future. The Minister is determined to deal with both of these separate issues, with my support and the support of the entire Cabinet.

Mr. Kenny

The Taoiseach has said that the Minister for Health and Children is doing his best. If that is true, how can the increase of 87% in patient waiting lists at Beaumont Hospital since 1997 be explained? There has been an increase of 23% in the Mater Hospital and 108% in St. Vincent's University Hospital. How can these figures be explained? Are the Minister's best efforts good enough in this regard? How can one say to the six in ten adults who have been waiting for ENT surgery for more than a year that the hospitals over-spent last year? Would such an explanation suffice for the seven out of ten young children who have been waiting for more than six months for similar operations? How can one tell the 50% of young children who have been waiting for more than six months for vital cardiac surgery that they cannot and will not be treated until next year because the hospitals over-spent last year? How can one say to such people that the Minister is doing his best?

The Taoiseach, who is in charge of the Government, said last year that waiting lists would be eliminated within two years. About 29,000 people are on waiting lists at present, a figure that will rise. The impact of the closure of a further 250 beds will exacerbate the problem. As a Dubliner, the Taoiseach is aware that even Ken Doherty could not come from that far behind.

The Taoiseach

Overall, waiting lists are down 22% – that is the figure. In-patient waiting lists are not 29,000; they are 18,000.

Ms O. Mitchell

That is because the Government changed the way in which they are calculated.

Mr. Connaughton

The Taoiseach is very selective when quoting figures.

Ms O. Mitchell

The Government divided the figure in two by changing its method of calculating waiting lists.

The Taoiseach

Cardiac surgery, which was the huge difficulty—

Mr. Allen

The real figures are in the death notices.

The Taoiseach

I do not think that is the right thing to say.

Mr. Allen

It is correct.

The Taoiseach

It is not true.

Mr. Allen

I can provide plenty of examples.

The Taoiseach

Waiting lists for cardiac surgery have been halved all over the country, as a result of the extended facilities in Galway, St. James's Hospital and Cork. There has been an enormous reduction in waiting lists in most of the specialties.

Mr. Connaughton

Most people cannot get in.

The Taoiseach

They are the official figures.

Mr. Connaughton

They cannot get in.

The Taoiseach

There are more beds in the system that there ever were.

Ms O. Mitchell

What country is the Taoiseach talking about?

The Taoiseach

Only 81 beds have been closed.

Ms Burton

Only.

The Taoiseach

There is a potential problem.

Ms McManus

Thanks a bundle.

The Taoiseach

Some 709 more were opened up.

Mr. Kenny

The Taoiseach promised to end waiting lists.

The Taoiseach

The reality is that the Government is concerned—

Mr. J. O'Keeffe

It was not concerned when it was making promises last year.

The Taoiseach

—to ensure that it can keep the system at its best.

Ms McManus

The Government is responsible.

The Taoiseach

We are keen to continue to resource it. We have put in a substantial amount of resources this year. It is not just about resources, as it is also about how we manage this for the future and how we deal with the difficulties that exist. That is what the Government is committed to do. One should not ignore the fact that tens of thousands of people are receiving quality services. There are ongoing difficulties in accident and emergency services. Many more people are being seen and helped throughout the range of in-patient and out-patient services and day care services. We have to try to build on the fact that the vast and overwhelming majority of patients are cured. That is what we are endeavouring to do in the health strategy, which has already been published. Within the strategy, we are trying to deal with the three reports which are before the Government, two of which have been completed and one of which has almost been completed. That is what we will do.

Mr. Durkan

Little done, an awful lot to do.

Mr. Rabbitte

How can the Taoiseach, as leader of this Government, say that there are more beds in the system than ever before? Was it not the man beside him, Deputy Martin, who published the document with such brouhaha and said that 3,000 additional beds were required? Was that not in the health strategy which is now in tatters like the reputation of the Minister? Is that not the reality?

What is the point of the Taoiseach stating to the House that there are more beds in the system? Does he pay any attention to the statement by the chief executives, one from the Mater Hospital in the Taoiseach's constituency, and consultants? They pointed out the implications of the closures announced this week which are equivalent to closing one acute hospital in Dublin. Some 14,000 treatments are delayed while people in the community are in pain waiting for access to a hospital bed.

Deputy Kenny reminded the Taoiseach of the anniversary of 17 May. Does the Taoiseach remember where he was one year ago yesterday? It goes without saying that he was not in the House, as he seldom is. The Taoiseach was in the lavish headquarters of the Fianna Fáil press office for the purposes of controlling the election where he announced, with the dauphin who sits beside him today, the document that committed to eliminating waiting lists within two years. Does he remember the promise to eliminate waiting lists within two years? The Taoiseach has failed to publish the figures for last December. When he said that he would cause waiting lists to be eliminated, did he simply mean that he would not publish the figures?

This is beyond a laughing matter. If the current Minister cannot do the job, the Taoiseach should try to find someone who can as he had to do in the area of transport. For five years, the Government had a Minister responsible for transport who could not make a decision and that is why we are in the current mess. Is the Taoiseach going to do the same with people's lives? These people, some with life-threatening illnesses, are not statistics; they are awaiting care. While they cannot get access to a hospital bed, the Taoiseach stands up in the House to say that there are more beds than ever in the system. What world are we living in? This is a real crisis for real people who need real doctors to attend to them.

The Taoiseach

Deputy Rabbitte probably does not want to hear that he was not in the House this time last year either as we were in the middle of a general election campaign. He did not have to be glib about that.

I said that while 81 beds were closed, 522 additional beds have been put into the system. Unless I have failed to count correctly, there are more beds in the system. I am merely giving a factual statistic, as I did with regard to waiting lists being down by 22%. I am simply providing a record of the figures.

I am not saying there are not people to be cared for or current difficulties in some hospitals, particularly the academic teaching hospitals which are spending almost €900 million – I think €872 million is the correct figure – and treating in excess of 380 in-patients and day cases, an increase on previous figures. However, neither Deputy Rabbitte nor anyone else should, when there is a substantially increased number of patients and beds compared to last year, create the perception that the service is worse than it was.

I am not endeavouring to give the perception that there are not people on waiting lists or that we do not need to do more in terms of numbers and resources to improve the position. That is the factual position and we should deal with it. That is why I stated that a lot of time was spent over the Easter break moving to the next stage of the health strategy, building on what was published in autumn 2001 and considering the reports to see what more can be done to better manage the funding of almost €10 billion, an enormous increase which Deputy Kenny acknowledged, which has been put into the system.

I acknowledge there are difficulties in the four hospitals because they went over their allocations and the service plans agreed with the ERHA in 2001 and 2002. As a result of the 1996 legislation on accountability, that is taken from their allocation in 2003.

Mr. R. Bruton

What were they to do? Should they turn patients away and send them home?

The Taoiseach

That has created a difficulty for the hospitals. I have met and spoken with many of those concerned over the Easter break and I know of the difficulty. The Minister has been engaged in discussions with the hospitals and the ERHA is currently meeting with officials of the Department of Health and Children. The Dublin academic teaching hospitals, the ERHA and the Department of Health and Children are sitting down to see how they can deal with this situation.

However, let us not say a situation is being created where less people are being seen in hospitals. There is a problem as long as anybody is on a waiting list although I do not think I will ever reach the day where nobody is on a waiting list. Nonetheless, we should try to reduce waiting lists as much as possible, maximise the resources available and try to achieve the maximum throughput for those resources. That is what we are trying to do.

Mr. Rabbitte

I wonder what is different today from one year ago. The Taoiseach now says that we will never get to the day when there will not be a waiting list. At the top of the treasury management building one year ago, there was no waiting list at all. How can the Taoiseach say that this applies only to the Dublin teaching hospitals? That is not the case. What about the James Connolly Memorial Hospital or the children's hospital in Crumlin where one of the wards is being closed?

Ms O. Mitchell

What about Tralee?

Mr. Rabbitte

Essential surgical beds are being taken out of the system. What, indeed, about Tralee?

This is not an abstract question. The Taoiseach says that there are more beds than ever in the system. He also claims to be an accountant. Is it correct that there are 522 additional beds?

Mr. Martin

There are.

Mr. Rabbitte

Some 350 are blocked and 250 were closed this week.

The Taoiseach

They are not blocked.

Mr. Rabbitte

If one adds 350 to 250, one gets 600 and that is more than 522. That is the reality.

The Taoiseach

And one million plus one million is two million.

Mr. Rabbitte

The Government health strategy calculated that 3,000 additional beds were needed to bring us back to where we were when MacSharry and Haughey wreaked havoc between 1987 and 1989. Yet the Taoiseach comes to the House to say that there are more beds than ever in the system. How are those caring for relatives on waiting lists for God knows how long supposed to react to such a statement from the head of Government?

This is not an abstract question. We are talking about real people. A head consultant said last night that 14,000 treatments are delayed. It was the Taoiseach who published the health strategy, who rubbished everyone else's health policies this time last year, who said that Fianna Fáil had the money and the know-how, who appointed Deputy Martin as Minister, who is making a mess of things and who is the head of this Government. It is his job to answer these questions for the people.

The Taoiseach

I will not go into what I said about bed numbers as that is on the record. Deputy Rabbitte is correct that there were many difficulties in the 1980s, some caused by my party and some by the hospital closure programme brought in by the Deputy's present party. However, we should not get into that because doing so will not sort out problems or provide health care for anyone on a waiting list today.

As Deputy Rabbitte puts questions to me, it is only fair that I put back to him that it is the Government—

Mr. Quinn

That is not so.

Mr. R. Bruton

It is the Taoiseach's response we want.

Ms O. Mitchell

The Taoiseach won the election on his promises.

The Taoiseach

Can I reply to Deputy Rabbitte?

Ms McManus

The Taoiseach should shoulder the burden.

The Taoiseach

There is 162% more funding than a few years ago and waiting lists are down by 22%.

Mr. R. Bruton

If the Government doctors the figures.

The Taoiseach

Hospital activity is up 17% and the hospital treatment fund is dealing with 4,000 patients. Deputy Rabbitte mentioned Tralee which has the lowest waiting list of any hospital in the country. There have also been new initiatives by the Minister for Health and Children in regard to Crumlin. It is not that we do not have problems but neither should we paint the health service as being in a hopeless position—

Mr. Connaughton

Once the Government got in.

The Taoiseach

A recent survey carried out by the health associations showed that 90% of those who received treatment in our hospitals were very satisfied and thankful for that service. We have problems in certain areas which must be managed.

Mr. Allen

The lotto winners are happy too.

The Taoiseach

We must implement a health strategy that brings us forward. Rather than just ranting about it, we will work to try to achieve that and provide a quality health service to people in an efficient way to allow them get into hospital for those necessary treatments.

Mr. J. Higgins

Will the Taoiseach use An Bord Pleanála's refusal, on health, safety and environmental grounds, of planning permission for the proposed natural gas facility in Mayo as an opportunity to change the extraordinary terms agreed by the former Minister, Deputy Burke, with the oil companies in 1987, and further changed when the Taoiseach was Minister for Finance in 1992? Under these terms the Irish people were to buy back their own natural resource from a major multinational company without a penny in royalties, with all costs to the company going back decades being written off against taxes and with no independent assessment by this State of the extent of the deposits independent of the companies which stand to gain massively from their exploitation. It is crucial that there is now new thinking as to how this natural resource is used for the benefit of all our people. The Minister of State, Deputy Fahey, would be better off trying to bring creative thinking to bear on this situation rather than acting as an unofficial PR man for Royal Dutch Shell. Will the Taoiseach look to the past, where the development of crucial natural and national resources – electricity generation, peat harvesting and sugar production – were thrust forward by dedicated State companies? Is it not clear that we now need a State exploration recovery agency for natural gas particularly to benefit our people so that funding can go to the health service and other badly needed areas and not bloat further multinational corporations?

An ndéanfaidh an Taoiseach an rud ceart anois do mhuintir Iorrais, do mhuintir Mhuigheo agus do mhuintir na tíre uilig? An dtosnóidh sé arís ar an ngás nádúrtha a thabhairt i dtír ar bhonn atá buntáisteach do mhuintir uilig na tíre seachas é a dhéanamh ar mhaithe le proifídí thar cinn a sholáthar do na comhluchtaí móra ilnáisiúnta, mar atá i gceist anseo?

Mr. Kenny

Go raibh maith agat—

The Taoiseach

There are two aspects to the Deputy's question. I remind Deputy Higgins that at the time the tax incentives and the various initiatives were introduced in the late 1980s or the early 1990s, there was no exploration whatsoever going on in this area. With regard to the one in which I was involved with the then Minister for Energy, Deputy Molloy, there was almost no activity in any of the Irish natural resources. Unfortunately, within our own corporate sector there is neither the resources nor the willingness on the part of people to undertake the level of expenditure that would be required. It is not that they have no interest but the required level of expenditure in the testing and various exploration programmes simply does not exist. I recall examining the various submissions at the time and the fact that the expenditure was not available. It is idealistic and Nationalistic to say it is a pity that these projects are not picked up by Irish people but that is not often possible. That is a question which relates also to this particular company in the Corrib field where somebody can come in, put in a vast amount of resources – somewhere of the order of €150 million – employ a lot of people and then nothing happens, which affects other initiatives.

On the second part of the Deputy's question, I fully respect the decision of An Bord Pleanála, as I always do. It is to be hoped that the ruling does not end efforts to tap into the vein of energy off our coast because there are the knock-on issues of jobs and investment in infrastructure which has the potential to deliver. An Bord Pleanála's decision in relation to post-construction of the terminal at Bellanaboy for the development of the Corrib gas field has implications for the process of that development. That has to be examined now to determine if that project and the related developments are to be dropped. The company now has to decide whether it will apply for new planning permission to see what progress it can make and if anything else will happen. It defers also the future of gas supplies to the towns and the communities in the north-west which are hoping to get this opportunity. Substantial additional costs have been incurred by the developer as a consequence of the delay in the planning process which have been borne up-front in terms of the development of the Mayo-Galway export pipe line. Those costs are unlikely to be recovered by way of full projects but the company has to make an assessment to determine where it goes now but the Deputy will appreciate that there are no other companies waiting around to pick up this project. Unfortunately, that is not the way exploration works. There are no Irish companies willing to put in several hundred million euro on exploration, with all the risks involved. I wish that was the position, but it is not.

Mr. J. Higgins

In the early 1990s, the oil and gas companies knew the potential which existed off our shores. Does the Taoiseach not accept that it was a massive problem that this State had no independent assessment of those resources and put itself completely in the lap of the multinational corporations? One of the Taoiseach's handlers told a newspaper this weekend that the Taoiseach would be keeping more aloof and would be more presidential in this new Dáil term. For myself, one President in this State is more than enough but speaking of staying aloof, Fianna Fáil did not stay aloof from these companies which were its regular guests in its tent at the Galway races. Politically, the Taoiseach's party has been very close to these corporations and there are inexplicable questions as to why they were given these terms. Rather than being presidential, the Taoiseach should answer questions in a straight manner for the next eight weeks. That would be a real contribution to the Irish people.

I asked the Taoiseach about the possible role for the State in the development of these natural resources. Is the Taoiseach aware that there are many Irish workers who have returned here from abroad with a lot of expertise in exploration, and others still working abroad who would like to come home if their energies and expertise were harnessed by the State?

Does the Taoiseach accept the principle that our country's wealth should be for the benefit of all the people, not faceless shareholders in glass towers in New York, Tokyo, London or elsewhere? If the Government was guided by that principle, we would strike out and create new methods, including bringing the State to bear on the development and recovery of these resources as happened with crucial national industries of the past.

The Taoiseach

I wish I did not have to say this but a number of the Irish companies and their shareholders which tried to get involved in our natural resources got fairly well burned. There are many examples of those companies. Many others which are still in the business of our natural resources have had to vastly supplement their losses with profits from other businesses in which they are involved to try to keep them afloat. That is the reality. Unfortunately, there are no companies in this area within the Irish system. There may be some individual staff who come home and take up employment but they are not coming home with the investments to take up projects like the Corrib gas project or any of the others. I am sure the Deputy knows that in most of these projects, the investment necessary to do the exploration, the drilling and testing over many summers involves enormous sums of money. The risk for companies doing this and the amount of testing they have to do are enormous. There is no potential within the Irish system for people to invest several million euro in such projects. The tax benefits there, as good as they are, have not stimulated much activity for Irish people or others. Only a few people are interested in the Irish market. That is the way it goes and I must respect the decision of An Bord Pleanála. Unfortunately, however, there will be fewer investors after a decision like last week's because there are other places to go.

Mr. J. Higgins

Set up a State company.

The Taoiseach

Imagine if I was in here explaining that hundreds of millions in taxpayers' money – particularly today when we have been talking about health – was gone because some drill hole off the north west or in the porcupine had failed. I know the Deputy does not even believe that. That is the reality of what the alternative is.

Mr. J. Higgins

What do I not believe?

The Taoiseach

That we could do that. Not even in the worst days of eastern Europe did they try to put money into those kinds of—

Mr. J. Higgins

I am not a member of Fianna Fáil. That means—

The Taoiseach

Those countries did not and I accept what the Deputy said.

An Leas-Cheann Comhairle

That concludes Leaders' Questions. We now move to Questions to the Taoiseach.