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Dáil Éireann debate -
Thursday, 8 May 2003

Vol. 566 No. 2

Private Members' Business. - Severe Acute Respiratory Syndrome: Motion (Resumed).

The following motion was moved by Deputy Olivia Mitchell on Wednesday, 7 May 2003:
That Dáil Éireann believing that there has been a further serious erosion of confidence in the public health service arising from:
– the mishandling of the SARS threat by the Minister for Health and Children,
– the issuing of inadequate, confusing and contradictory communications,
– the lack of a speedy and comprehensive public information campaign, and
– the Minister's failure to resolve the dispute with public health doctors at a time when the need for their expertise is greatest;
notes that these failures are symptomatic of a more general failure by this Government and its predecessor to effectively and efficiently manage the health service at a time of unprecedented spending; and calls on the Minister for Health and Children to address this crisis of confidence and provide the leadership and clarity of purpose which his office demands by:
– immediately resolving the public health doctors' dispute to provide 24 hour, seven day public health cover,
– ensuring that when threats to public health arise, a clear, co-ordinated and effective public health communications strategy is implemented without delay, and
– publishing as a matter of urgency his proposals for the reform of the health services, including clear and transparent definition of functions, responsibilities and accountability of those charged with the development of policy and the delivery of service.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
– endorses the speedy and comprehensive response by the Minister for Health and Children to the threat of SARS which is fully in accordance with World Health Organisation guidelines and endorsed by them, including in particular:
– the prompt and ongoing public information campaign alerting members of the public to the signs and symptoms, causes and transmission modes of SARS and travel advisories in relation to travel to and from affected areas;
– the detailed guidance provided to health professionals in relation to the diagnosis, clinical management, surveillance and contact tracing for suspect and probable SARS cases and to airline crew and cleaning staff in relation to the possible in-flight care and follow-up procedures for a suspect case of SARS;
– the comprehensive operational framework established to provide an integrated public service wide response, comprising:
– an expert committee
– an interdepartmental planning group
– a health service implementation group, and
– a communications group;
– acknowledges the Minister's efforts to resolve the public health doctors dispute within the framework of public sector pay policy, in particular the social partnership agreement, Sustaining Progress, and calls on the Irish Medical Organisation to continue talks with a view to resolving the dispute having regard to the serious threat posed by infectious diseases, including SARS; and
– notes the intention of the Minister for Health and Children to bring proposals to Government shortly for the reform of the health services.
–(Minister for Health and Children).

I wish to share time with Deputies Michael Moynihan, Brendan Smith, Moloney, O'Connor and Kelleher.

Is that agreed? Agreed.

I welcome the opportunity to address the House on the Fine Gael motion on SARS. Before dealing with the substance of the Opposition motion, it is critically important that we put the SARS issue into proper context and perspective.

The portrayal of SARS and the SARS epidemic by not alone the Opposition but certain sections of the media has been wholly disproportionate to the threat which SARS poses to this country. This is not to downplay for one moment the significance of SARS as a worldwide health threat. Indeed, it poses such a threat in the Far East. In terms of Irish public health, it does not pose the level of threat portrayed by the Opposition. Let us look at the facts.

The SARS phenomenon is a peculiarly south-east Asia phenomenon although there was an outbreak in Canada. In a population of more than three billion people the disease has been contracted by fewer than 6,500 people. There have been 450 deaths. During that period, tens of thousands of people have died from other communicable diseases such as AIDS and malaria. In the European Union, with a population of more than 300 million people, there has been less than 30 probable cases. There has not been one single death from SARS in the European Union. In Ireland, there has been one probable case and no deaths. Yet, in the face of all these facts some would have us believe that the black plague and Ebola type virus and judgment day is upon us.

Before we debate the substance of the Opposition motion or the merits of the Minister's response we have to have some degree of perspective. The Minister's response has been proportionate, timely and effective. Let us look at the timing of the response. The outbreak was formally notified to the health authorities on 16 March, less than two months ago. Within days of that notification, the National Disease Surveillance Centre issued protocols and a warning to all hospitals and health professionals. This was the appropriate response given the circumstances of the situation facing us. Some people would have had us close all our airports and ports and adopt foot and mouth like measures appropriate in that case but not in this one.

Health was not high on the agenda.

The appropriate course of action was to disseminate information to hospitals, health boards and health professions. They are the people charged with dealing with this issue and are the ones who required the information in the first instance. Within days of that immediate response and within ten days of the first notification, an expert group was established to monitor the situation and to make ongoing recommendations. That group has met more than 17 times on a twice weekly basis. This response, before one case of reported or suspected SARS in this country, showed the appropriate degree of urgency required in the circumstances.

The recommendations of the expert group have been speedily and effectively implemented by the Government and health boards. It is important to point out that the Government has been wholly and completely supported by the World Health Organisation in each and every action taken by it. That includes measures such as protocols, guidance for laboratories, the appropriate travel advice and public advertisements. All this points to one inevitable conclusion: the Government and ministerial response has been proportionate to the threat posed, timely in its response and effective in its results. For the Opposition to suggest otherwise flies in the face of the facts. All this was done in the context of the very difficult circumstances posed by the public health doctors strike which did not help mat ters. It is extremely unfortunate and regrettable to link the public health doctors industrial dispute with the SARS issue. That strike, like any other in the public service, particularly in the health services, is a source of concern. However, the fact that this dispute coincides with the evolving issue concerning SARS should not be used as political ammunition by the Opposition.

I fully support the Minister's contention that the public health doctors strike and the industrial relations issues which arise from it should be dealt with on their merits and on the basis of the benchmarking report and Sustaining Progress. While I do not wish to go into issues concerned with the public health doctors strike, it is important, for the reasons I have explained, to say that the offer on the table taken with benchmarking and Sustaining Progress represents an extremely substantial offer to the doctors and should, in my view, form the basis of further negotiations and utilisation of the industrial relations machinery.

Despite some of the hyperbole and exaggeration and, indeed, the invective, not alone by the Opposition but also in certain sections of the media, all the facts point to the Minister's response being proportionate to the threat raised, timely and effective in its outcome.

I welcome the opportunity to contribute to this debate and in the brief time available to me I will deal with two or three issues related to the SARS epidemic and the hysteria created regarding SARS a couple of weeks ago. Everybody, including politicians and the media, has an obligation to ensure that the cases they are reporting or the issues they are putting before the people are not hyped out of all proportion. Certainly there were one or two days on which, if one was listening to the media, one would have thought we would be besieged by SARS within a matter of minutes. All of us, particularly those of us in the public eye, have an obligation to ensure we bring forward a measured response to it.

I welcome what the Minister has done in setting up the expert committee, and issuing various press releases and press briefings it has given. It has interpreted the guidelines given by the World Health Organisation on the SARS epidemic and leaflets and the information have been given out at airports and points of entry. A pile of information has been put out there. There was a public deficit of information and, as the previous speaker stated, this is a SARS epidemic, not in a European context but in an Asian context and we should be mindful of that.

One of the other issues I want to deal with this morning is the impact on the Special Olympics, on which some towns have taken different positions. I know, first hand, the amount of work which has been put in by the Special Olympics committee, by the organising committees and by all those background staff. They have put in enormous work to ensure the success of the Special Olympics in 2003. This is a massive opportunity for Ireland to show what we can do for the Special Olympics and what we can do in sports. All the host towns right around the country have had committees working throughout the past 12 months to ensure that the visitors who will come to participate in Special Olympics get the royal treatment they so richly deserve. While we have to be mindful of public health and of the threat of SARS to the health of the nation, we must wait until at least two to three weeks before the Special Olympics commence before we take a decision on going ahead with the games or on stopping certain countries participating. The Minister and the various committees set up will be mindful of all the trojan work which has been done in getting the Special Olympics here.

There are several Departments working on the special committee which has been set up to co-ordinate the measures regarding public policy and the protection of public health. The information in the public arena at this stage is far greater than it was on 18 March or in February when the first threat of SARS arose, when few people thought it had any implications for this country. There have been parallels drawn with the foot and mouth disease crisis. The reality is that when we ensured that foot and mouth disease was kept out of this country, we all said, "Oh yes, they made the correct decisions at the time, it was great." At the time of the hysteria about foot and mouth disease, however, there was as much concern and it is definitely not fair when the Opposition stated that animal health was given a higher priority than human health. This Government, and particularly the Minister in recent weeks, have done ferocious work and made great efforts to ensure that the safety and health of the individual is put to the top of the agenda. I commend the Minister for that. The information which is being co-ordinated and put before the people has to be welcomed in this instance.

On the hysteria which was created, we public representatives and the media have a duty not to overstate the concerns facing the public. I appeal to the Minister, to the Government and to all the host towns to ensure that taken into account in whatever decisions are taken regarding the Special Olympics is the trojan work which has been done by the committees throughout the length and breadth of the country on this. I commend the Minister and the Government for setting up the committee to advise the people on the public health threat.

I am glad to have the opportunity to make a short contribution on this important subject matter. First, I congratulate the Minister for Health and Children, Deputy Martin, the Ministers of State in his Department and their departmental officials on the work they have done in the past six weeks or so in ensuring that there was an active campaign to prevent the spread of this serious illness to this country. I am glad the Minister outlined last night in his contribution that the World Health Organisation fully endorsed the measures which have been put in place in this country to prevent the establishment of the disease here and to prevent its spread. At European level, we can be fairly confident and assured that, fortunately, there have been no deaths from this illness throughout the European Union. The Commissioner, Mr. David Byrne, mentioned on a radio programme the other night that the spread of this disease throughout Asia, in particular, and the measures taken to prevent its spread to Europe, show that there is a need for better co-ordination at European Union level on disease prevention measures in general and on the improvement of the public health systems.

I agree with Deputy Moynihan that at times there was mass hysteria in the media and some of the chat shows on national radio, in particular, and on other radio stations were doing a great disservice to the public at large. I know many of the commentators in the national media assume on to themselves expertise on practically every subject under the sun, but I did not know they had gained expertise in SARS. There was much misinformed comment. At times it frightened people. In the area of public health, we public representatives or people who have access to the broadcast media or to the written media have a serious obligation to ensure that we speak in a knowledgeable fashion about any disease which poses a serious threat to public health.

I am glad the Minister outlined the measures which have been put in place from early March by his Department and by his officials in ensuring that the various SARS issues would be addressed cogently and properly here. The Minister established the expert group and that expert group worked in collaboration with, and under the guidance of, the World Health Organisation. The first reference to this I saw on television was a reassurance for the public at large, where Mr. Sheehan of the Mater Misericordiae Hospital spoke with great authority and great expertise. He outlined the problems, and the measures being taken here and throughout Europe, to deal with and to prevent the spread of SARS. He imparted his knowledge in a manner which people with no medical or nursing knowledge could understand and he introduced a great sense of balance into the debate.

I am glad the Minister stated last night that he will bring to Government proposals to reform the health services. As a small country with a small population, we have far too many health structures. The acute hospitals throughout all of the 26 counties should work under a hospitals agency. The remit of the health boards is far too wide. They must deal with acute hospitals, nursing homes for the elderly, community welfare problems and providing personnel such as occupational therapists and others to deal with the processing of housing grants and grants for the disabled. There is need to streamline the services and the work of the health boards. The area of primary health care needs to be addressed and one issue which has been brought to my attention constantly, particularly by parents of young children, is the lack of access at times to GPs and to the primary health care sector after hours. In my area we have the "doctor on call" system, which has also been organised in other parts of the country. That is a positive system that works quite well. Doctors cannot work seven days a week and 24 hours a day as many were asked to do in the past. When the Ceann Comhairle was practising as a GP he did not have the opportunity to cease work at 5 or 6 o'clock in the evening. Working seven nights a week was surely good training for politics. Given that both parents are generally working, if GP practices were available until 6 or 7 o'clock in the evening it would relieve some of the pressure on accident and emergency departments. While GPs should not have to work all hours of the day and night, a better balance can be struck which would assure the public of access to the health service.

I am happy to have the opportunity to speak on the issue of SARS and how it has been handled in recent weeks. I am forced to recognise it has been of great concern for members of the public, not least for those who will participate in the forthcoming Special Olympics.

I was delighted to be able to attend the Oireachtas Joint Committee on Health and Children on 1 May. Those who attended heard the contribution of Dr. Jim O'Flanagan, the CMO at the Department of Health and Children, and his colleagues. I was pleased to hear the reassurances they gave, which were accepted. After hearing their contribution I was satisfied with the action taken by the Minister and officials at the Department of Health and Children.

For reassurance purposes it is worth repeating the action that has been taken. When the existence and possible implications of this condition were first identified in March, at the request of the Minister staff from the National Disease Surveillance Centre and the Department spent the St. Patrick's Day festival weekend making the appropriate international contacts and sought out the required information regarding SARS. They put in place the initial comprehensive public information professional guidance required in the State. That we have satisfied the guidelines of the WHO confirms the appropriate, considered and responsible action by the Minister.

The Minister does not need me to come to the House to congratulate him on his ability as Minister for Health and Children. Nevertheless it is worth recognising that on receipt of the initial report following the St. Patrick's Day festival weekend, the Minister established an expert group under the chairmanship of Dr. O'Flanagan to advise him on the issue and to make recommendations as to the appropriate actions to prevent the establishment and spread of SARS. At that juncture the Minister had the foresight to recognise what needed to be done and clearly the action was taken immediately to put the public mind at rest. The recommendations, which have been published on public notices and on the Department's website include: accurate well informed easily accessible readable information for the public; and sound practical preventive measures including such basics as washing of hands, identification, etc.

Ignoring the condemnation in radio phone-ins, overall I am satisfied that the leading authority in health matters recognised that the Minister was to the forefront in making all the necessary arrangements to prevent the spread of SARS and more importantly to put the public mind at rest. If the public had been in the same room for the meeting on 1 May, they would have been reassured that the Minister and his officials were to the forefront.

I wish the Minister well as he tries to tackle the issue of health reform. I flag one issue that will affect all public representatives and specifically Members of the Opposition who have called for health reform. When that health reform comes about and once it affects Members' vote gathering abilities in their constituencies, they will not sign up to that reform and will side with the public focus groups which will demand services in each county. I have experience of that over the years. I am well aware of the implications for public representatives when the cancer strategy was rolled out. Local public representatives were more concerned for their futures rather than for the future of the health service.

Based on our experience of SARS and the whole health programme, we must learn that we cannot have health services at every crossroads and in every county. We must turn our backs on the day of flying the county flag and the ability of a public representative to be judged on what health services he can secure for his county.

I wish the Minister well. He has given good sound leadership in the Department. He has a tough road ahead.

Will the Government invest in the health service?

If Deputy McGrath checks the level of investment by this Administration and the previous one he will recognise that money has not been the issue.

The Government has wasted the money.

The Deputy should compare it to other EU countries.

I can point to the fact that—

The Deputy should check with the INO.

—in many of the initiatives rolled out by the Minister, when it came to satisfying the local public representatives, Members of the House saying one thing up here and another down in their constituencies has been the root cause of most of the issues now affecting public health.

Typical Fianna Fáil.

I remember when Deputy Michael Noonan, as Minister, rolled out the national cancer strategy for which I congratulate him. Unfortunately when it came down to the constituencies, members of his own party could not support that strategy. We in the midlands were left waiting and 1,200 people annually had to travel to Dublin for cancer treatment when this Administration provided the funding for that service in the midlands but unfortunately could not get the support for it.

When will the Government put the radiotherapy service in Waterford?

Deputy Healy will have his opportunity to contribute.

When the Minister and the Fianna Fáil Administration provided the funding for that service, I had to witness Opposition Deputies going to the High Court to try to stop a service from being rolled out in Laois and Offaly. As he moves on gloriously as Minister for Health and Children, I beg him to ignore the pretence of those flying the county colours and ensure that what we have put into the programme for Government will be delivered on the ground. I am certain the way forward is to ensure that we have a regionalisation of services.

I wish the Minister well. I am more than satisfied with the way he has handled the SARS issue. I am disappointed with those who have tried to use the SARS issue to create difficulties for the Minister, but he has proved his ability and mettle. I look forward to his continuous reign in the Department of Health and Children for the next four years.

I am sure he is not.

I am convinced that at the end of his four years, we will be able to look back and recognise that the priority of the Government was to save lives and not save votes.

There are just five minutes remaining in the slot. I call Deputy O'Connor.

That puts me under real pressure. I heard the leader of the Labour Party suggest that Charlie O'Connor needs a little therapy because of certain Government policies. As all my colleagues know, I am fit and well, very calm and happy to support the Minister this morning. Both in the debate here in the past two days and elsewhere I am worried by the hysteria, which upsets people. I ask my colleagues to be a little calmer, do as I do, represent their communities and do not panic because this is an important issue.

People often refer to war-time. Let us get behind the Minister on this issue.

Like Fianna Fáil got behind us when we were in Government.

The Opposition can score its little points if that is what it wants to do. I would probably do the same myself – although a little more responsibly. Let us get behind the Minister and understand he has a tough job to do. It is in all our interests that that job is done. Like my colleagues, I have much contact in my constituency and in my local hospital at Tallaght. I am very pleased with the assurances I am being given by the senior consultants at Tallaght Hospital who have made clear that in a situation where they would have difficulties, they are in a strong position to respond.

I wish to use the example of Tallaght Hospital to make a point about the rest of the country. The winter vomiting bug has been a problem in a number of hospitals in recent years yet strangely there have not been any problems in Tallaght Hospital, nor indeed in St. James's Hospital. The reason for this is that a modern infrastructure exists in these hospitals.

I am glad to see the Minister of State, Deputy Tim O'Malley, in the House and urge him to take this lesson on board. If we provide a new and proper infrastructure and sufficient single isolation wards in our hospitals then the professionals who are dealing with infection can respond in the proper manner. Both Tallaght and St. James's hospitals have shown the way. When Cherry Orchard Hospital was closed as an infection hospital, provision should have been made, and should still be made, to provide more single room accommodation in all hospitals. That is true in Dublin and elsewhere and that is the message we should put out.

Like other Members I have a background of involvement in a health board. I am privileged to have been a member of a health board since 1994. I took a decision to step down from it and let other colleagues get involved. I look forward to the proper reform of the health service. The announcement being prepared by the Minister is something we should welcome.

I welcome the opportunity to speak on this issue. I urge everybody involved in the Special Olympics to heed the advice of the Department with regard to bringing athletes here from around the world. While it may be necessary to have a voluntary quarantine system in some countries prior to the arrival of participants, every effort should be made to ensure that the Special Olympics goes ahead and that resources are made available to ensure it is a successful event. There is no doubt that there has been a great effort put in by the athletes who have been in training for many years and by the communities here who are hosting the various participant countries. I urge everybody to have a calm, rational debate on this issue.

SARS is severe acute respiratory syndrome but in this country it is sensationalist, alarmist reporting syndrome because that is what we have had for the past number of weeks. Certain elements of the media and the Opposition have been most disingenuous in trying to hype this out of all proportion. This has happened to such an extent that people in the Chinese community have reported a drop in trade in restaurants because of the extreme fears that have been generated by irresponsible reporting. There is no doubt it is a highly contagious, infectious disease of unknown origins. At the outset people were justified in having major concerns but I have confidence in the mechanisms that have been put in place. Some elements of the media have realised that we were not as at risk as was thought heretofore. I commend the Minister and the Department for trying to fight a rearguard action because of the sensationalist and alarmist reporting by certain sections of the media. They were eventually able to reassure the public. The Minister made some decisions back in March when nobody knew of SARS. It shows that he and his staff were on top of their briefs. I again commend the Minister and the Minister of State, Deputy Tim O'Malley, who is present.

There are some who believe that SARS is a load of hype and that those of us who have expressed concern are being alarmist and hysterical. The contributions from Deputies Power, O'Connor and Kelleher would seem to indicate this. Although we, on the Opposition side, have been branded in those terms, the charge is not warranted. If we look at the facts relating to SARS we know now that the virus is both stronger and more contagious than previously thought. The mortality rates are higher; they have gone up from around 10% to 20%. There is no definitive test for SARS. It affects people in different ways. Obviously the most vulnerable are those over 60 but one of the first victims was a healthy 46 year old – the doctor who discovered the virus. Why did it affect that particular individual who was very healthy?

The greatest alarm has been caused by the statements made – and I do not think they were alarmist – by some of the Chinese leaders who now believe that once it gets into the countryside in China we will have a serious problem because they simply cannot cope in those areas. Furthermore, those in the WHO believe that once it gets into Africa we will have a real epidemic. We have seen the problems in regard to AIDS in Africa. I was in Johannesburg last summer and it is a mass ive problem which is out of all control at this stage. That is not being alarmist. Those are the facts. Once SARS gets into the African continent we are looking at a serious problem because of cheap air travel and new immigration patterns. The globalised world we live in will mean SARS will spread quickly.

I called on the Taoiseach to recall the Dáil as I wanted to ask questions of the Minister. I wanted the Minister to come to the Oireachtas Joint Committee on Health and Children to answer questions and I put down priority questions to the Minister on this issue. Those questions were not allowed. We will not get an opportunity to ask questions of the Minister even in this debate which is all about statements. That is most regrettable because, as Deputies, we need to reassert the primacy of politics. If we cannot have accountability here – and I put a lot of the blame on the Government parties on this one – they are making this House irrelevant as a consequence.

I said at the health committee that there was a mixed message in regard to the SARS case here which led to the perception of bungling. We were told that the test was negative yet it was put forward as a probable case. As Darina O'Flanagan said, there is no definitive test, which means we are very much in the dark about SARS. Dr. Kiely came before the health committee and said that the infectious disease regulations had been changed on 28 March and SARS was now a notifiable disease. However, when Dr. O'Flanagan came before us she said:

There is an urgent need for a structured out-of-hours public health service to manage SARS. The legislation allowing for quarantine and other public health measures needs to be reviewed, including designating suitable facilities for quarantine. There is also a need for a formal review of the requirements for isolation beds to deal with SARS and other emerging infectious diseases. A cascade system for rapid dissemination of advice to health care professionals is required.

Does the Government have any plans to update the legislation and for the current legislation to be reviewed? I ask the Minister of State to note it as I would like a reply to this question.

I reject the allegation that the IMO and the public health doctors are being opportunistic. The Brennan review was agreed and signed off by both the Department of Health and Children and the chief executive officers in April 2002. The review group was of the view that there was a need for a formally structured out-of-hours cover arrangement. What Dr. Fenton Howell said needs to be looked at. There is currently no safe way to deal with SARS. There is no out-of-hours structure which is what is required. We were told that this was hampering the way we are dealing with SARS. It is absolutely vital that we deal with it.

Yesterday the Minister of State's colleagues, the Minister for Health and Children and the Taoiseach, denied that the health services were in crisis. No matter how one defines the word "crisis" they cannot deny that there is a massive crisis of confidence among the public in the capacity of the Government and, indeed, of the State, to deliver and provide for the health needs of our people. That is a fact. The responsibility for that lies, in the first instance, certainly in recent years, on this Fianna Fáil – Progressive Democrats Government which, since 1997, has failed miserably to grasp the nettle of real and fundamental reform of the health services in this State and to ensure that we have a health service based on equality and fairness. That is what we critically need. It is no wonder there is a crisis of confidence, therefore, in the entire political system. That is evident in every walk of life today when health services, such a fundamental need of every human being, are in such a state at present. In recent days, there has been an announcement of the further closure of 250 beds in the five teaching hospitals in Dublin.

Twelve months ago, this Government went before the electorate promising to do away with waiting lists within two years. However, we now have a situation in which waiting lists are going to increase as an inevitable consequence of the closing down of hospital beds. This morning, we learned that another ward of 25 beds is about to close at this country's major children's hospital in Crumlin. As a result, there will be catastrophic effects on children from Dublin and all over this jurisdiction. Some 2,000 fewer procedures will be performed in regard to the surgical needs of children in this State as a consequence of that decision. That is the information we have this morning from doctors at Our Lady's Hospital, Crumlin. This is an outrage. This is the backdrop also to the closure of essential services in hospitals such as in Monaghan and Dundalk, an issue which I have raised in this House time and time again. That is now being employed as a template for further contraction and closure of essential services in other hospitals around the country. Is it any wonder people are concerned to see our health services in such a state? We have seen the public reaction to the advent of SARS, which cannot be viewed in isolation from all the other elements to which I have referred. All of these matters must be seen in context.

This Fine Gael motion, which I support, was prompted by the initial mishandling of the threat of SARS, which has compounded the crisis of confidence in the capacity of this Government to deliver on health. In my view, the Minister for Health and Children, Deputy Martin, has completely failed to reassure the public that effective measures were in place to prevent the spread of this disease in Ireland if, indeed, it were to have any grip here. Now, it has arrived – we know that – we must take on board the statement by the GPs that the guidelines issued by the National Disease Control Centre were unclear. We must note that, in the Seanad, the Minister admitted that the World Health Organisation guidelines were breached in regard to a suspected case of SARS here in Dublin. Although he subsequently stated that the patient in question had been given the all-clear, we now know that was not the case. At the very time of that public reassurance, when the Minister was trying to assuage the fears of the people of this country, the SARS threat became mired in confusion and in the bureaucracy which abounds in our health service.

An Leas-Cheann Comhairle:

The Deputy's five minutes are up.

I will come to a conclusion. Clearly, from the beginning, there was a lack of control. That is the real concern. People recognised that point. This is not about creating political capital out of real concern and fear. This is about seeking real address of something that may yet prove to have tragic consequences, not only for people in other distant lands but, indeed, here at home.

I welcome the opportunity to speak on this motion. Despite the promises made in relation to SARS precautions, I have not yet received a supply of surgical masks in my surgery at Mulranny, County Mayo. The present situation is that Government policy is actually deciding whether people live or die. That is the reality. As the Government is not providing enough money to run the services, there will be less services and people will not have access to them. A recently leaked report has indicated that Waterford cannot have a local radiotherapy unit and that cancer patients must come to Dublin for that service. With the latest cut-backs, there will now be less beds for those people. Where will they get the required treatment, in view of existing deficiencies? The bottom line is that Government is deciding whether people live or die.

All of us have been elected to do what we can for people. We are told it is all about people, but is that really the case? It seems to be more about big party politics, money and so on. Is it not time to take the big parties out of the picture? Talk of political consensus is used to exclude me and my fellow Independents. However, in the last election, the people said they will no longer stand for that. They are no longer interested in big parties or big interests; they are interested in their real needs, of which health is the greatest need of all. Health budgets are a life and death issue, in terms of their implications for people on trolleys in hospitals, a situation which continues to deteriorate. Is it not time to take health budgets out of the hands of Government and political parties and, instead, deal with the matter on the basis of a political consensus? My question may sound naive, but I believe such a change is necessary to avoid a continuation of the present situation.

The SARS issue simply exposed the problem that there was no out-of-hours public health ser vice. The current strike would not have occurred if the real situation which has pertained for years had been addressed. Fever hospitals have been closed in my county, Mayo, and in Cherry Orchard, Dublin. Cases of gastro-enteritis, measles and bacterial meningitis are unnecessarily infecting other people, in the absence of proper provision. We are wide open to infection. This should not be the case. There has been a gross proliferation of bureaucracy, all because of party political hackery. Our health boards are full of party political opportunism. That is how our health service is being run and it is wrong.

Not surprisingly, the Minister for Agriculture and Food could not answer my specific questions on maternity and accident and emergency services at Wexford General Hospital during the Adjournment debate last night. Accordingly, I now seek detailed answers to those questions from the Minister for Health and Children. Will he clarify whether all accident and emergency departments which do not have a specific A&E consultant could be closed on 1 July? What steps is the Department taking to deal with this issue? Alternatively, we will have to draw our own conclusions as to what will happen.

In relation to the motion before the House, there is a fine line between public information and scaremongering. In the context of contagious diseases, SARS is low risk at the moment. Measles is currently causing more harm in Ireland, due to low immunisation rates, which is an ongoing problem. SARS will, eventually, arrive in Ireland and we must have an effective containment response in keeping with the threat posed. There has been a certain lack of clarity on this issue. That could, perhaps, explain the recent behaviour of local councillors in Clonmel, which reminds me of a recent film in relation to the Salem witch hunts of two centuries ago. The less said about that type of mass hysteria, the better for everybody, including the general public. There is plenty of time for a measured response to the issue in relation to the Special Olympics and SARS. In my view, the anxiety of the general public and the media in relation to SARS, is based on the present very real crisis in the health services.

Deputies:

Hear, hear.

That is due to the lack of concern, not specifically on the part of the Minister of State, Deputy Tim O'Malley, but on that of his Cabinet colleagues. In the case of this Government, the situation appears to be that politicians are indifferent as patients die. I ask the Minister of State to respond to the questions I posed during the debate last night as soon as possible. I ask the Taoiseach to put party politics aside and support the last demand of this motion which would alleviate media, public and Opposition concerns about the health service. We are not getting clear information. Yesterday when we discussed this matter during Question Time, the Minister broached the subject by saying that he would make available the reports he is due to receive. I look forward to reading them because they may help to clarify matters for all of us.

All we have heard from the Government benches this morning is a strategy of blaming the media and the Opposition. The fact is, however, that there is very serious concern not just about SARS but also about the entire health service, which is suffering from a crisis of public confidence. That crisis of confidence has affected the SARS issue. Incompetent handling of the suspected SARS case in Dublin has done serious damage to the public perception of how SARS is being dealt with. The suspected SARS case was variously described as "negative", "suspect" or "probable", while the patient was missing for a number of hours also. The totally incompetent handling of that case has raised serious doubts in the public mind as regards how the issue is being dealt with by the Minister and his Department.

Yesterday we learned that the mortality rate from this illness, far from being 7% or 8%, is approximately 20%, particularly among older people. That is further cause for concern, with the fact that SARS is much more contagious than had been thought previously.

The crisis of public confidence in the health service is continuing with patients on trolleys and public hospitals in Dublin having announced approximately 250 bed closures. In addition, the Government has refused to install a radiotherapy unit in Waterford Regional Hospital for the south-east region and it has reneged on its election promise to issue 200,000 extra medical cards. There is a direct threat to our accident and emergency units and maternity departments and, apparently, we will see the relevant reports during the current session.

The manner in which the health service has been managed by the Minister and his Department provides serious cause for public concern as regards health services generally and SARS in particular. In addition, an out-of-hours public health service is totally lacking.

Thank you, a Leas-Cheann Comhairle, for the opportunity to contribute to this motion on the SARS threat and the urgent need for radical reform of our health services. We must face the reality that if one wants a decent health service, one will have to invest in it – to pretend otherwise is to do nothing for patients. We are aware of the problems and many members of the public are sick to the teeth with all the reports and talk of health strategies. They want action and leadership, which is urgently needed from the top.

In the middle of a public health crisis concerning SARS, the last thing we want is a Minister who cannot handle industrial relations problems with public health doctors. We need leadership and confidence but the Government has provided neither. It is a scandal for any Government to be shutting down wards, including 104 beds in the Mater Hospital recently. We have a health crisis, yet the Government is shutting down hospital bed capacity. There is something radically wrong with a Government that fails to provide funding for hospitals when people are ill, but there is something equally wrong with a society that allows this to happen. Irish society is now at a crossroads and faces a clear choice: we can go down the selfish road of tax breaks and tax cuts or we can invest in public services. This is the real world and we have a choice to make.

Sections of the Government seem to gloat in the idea of pushing the cutbacks agenda. The political and economic views of George Bush appear to be rampant in our Cabinet. In my own constituency of Dublin North Central I have seen proposals to reduce meals-on-wheels services by 14%, while the home carer's service has been cut by 9%. We can spend €100,000 to lock up a young person in Mountjoy, while we invest only €15,200 on a child's primary education. These are the ethics and values in contemporary Ireland. We seem to be walking away from the noble goal of a just society. We are turning our backs on our own people and are going in a direction that is repugnant to the vast majority. Meanwhile, Ministers are touring the country giving lectures on the state of the nation.

We must be vigilant about SARS but we should never make scapegoats of people with disabilities, including those who will be participating in the Special Olympics. We should have a clear public health policy but it must always be implemented with equality and fairness. Informed decisions represent the name of the game. I fully support the public health doctors' efforts to get a fair wage for providing 24-hour cover, seven days a week. The Minister should roll up his sleeves and resolve this dispute. The Cabinet should back him and stop playing these silly games. I urge all Deputies to support the motion.

Yesterday, in response to our analysis of the health situation, the Minister said that talk was cheap. However, should I repeat the Minister's words to an 80 year old lady in my constituency who needs oxygen around the clock? She also needs home help and had such help for 17 hours a day, but due to the North-Eastern Health Board's cutbacks that allocation was reduced by seven hours. Following a protest, four hours were restored. Is it right to tell that lady that talk is cheap or that her case does not count for the Minister? Is that the way to treat the sick and elderly in the north-eastern region or, indeed, anywhere in the country?

The budget for the North-Eastern Health Board's service plan was rejected by members of that health board, yet the Minister's signature is on a document insisting that the strategy should stand. The impact is clear – 85,000 hours of home help have been cut from the health board's budget this year. That represents 85,000 fewer hours of caring for the sick and elderly who cannot help themselves. The cutbacks will affect hundreds of people who need care, including home help. Talk is cheap to them because there has been no action by the Minister. All they get is more pain, suffering, isolation and no concern for their future.

Incontinence pads are being rationed in the North-Eastern Health Board area. One lady has been informed that the board is going to cut back on the amount of such pads to be issued to those who require them, so will bowel movements be made to order now? Talk is cheap but such decisions are breaking people's hearts as well as the carers who look after them. As the Minister knows, home carers are active for much longer than just the hours for which they are paid. They provide care and concern far beyond the hours which are now being cut. The cutbacks are placing carers in an invidious position because their income is being cut, yet their primary concern is to care for the sick and elderly.

The Minister's administration of the country's health services is both shameful and disgraceful. His budgetary approach is based on the existing level of services as of 1 January 2002 but he has forgotten the promises that were made in the run-up to last year's general election. Many of the services got into difficulties last year, but the Minister provided extra funding to the home help service in the North-Eastern Health Board area. The funding provided for 2003, however, was based on the amount provided at the start of 2002 rather than the amount that had been provided by the end of that year. This shameful cutback relates to very important matters.

I bring to the attention of the Minister the case of a gentlemen whose wife has had a stroke. She is in a bed in an acute hospital that needs the bed for other patients, but she cannot go home. The adjustments to her house that are needed cannot be made because the Government has not provided funding for the disabled person's grant. Her bathroom needs to be adjusted so that it can be wheelchair accessible, a downstairs room needs to be converted into a bedroom and a carpet needs to be replaced by new flooring that can bear the weight of a hoist that needs to be installed. The Minister has said that "talk is cheap", but what do his words mean to her? The Government has not taken action on this issue.

Since January of this year, 90 applications for the disabled person's grant have been approved by the North-Eastern Health Board in relation to County Louth. The grant is needed to bring sick people home and to provide better facilities, such as downstairs toilets and heating, for those who are unwell and living at home. That no money has been granted by the Government for the disabled person's grant is causing untold pain and suffering across the country.

I also bring to the attention of the Minister the case of a man whose wife is at home, having had a stroke. She cannot benefit from the disabled person's grant. The toilet and the bedroom are upstairs and she needs to be carried up the stairs each night, but her husband is not always able to do so. He telephones me about the issue when he is exhausted in the mornings. When I contact the health board to ask the officials what is happening in this case, they tell me that money is not available to look after the lady in question. The matter has been examined by the health board, which has determined that extra facilities are needed. Such cases are replicated in thousands of homes across the country. This shame reflects on the Minister's administration and his comment yesterday that "language is cheap". His remarks are cheap because they are doing absolutely nothing for these people. That is what is wrong.

I spoke about the health board cutbacks of about €1 million in the home help system, but can I provide another figure? More than €250,000 has been spent on taxi fares relating to acute hospitals in counties Louth and Meath, money which should have been spent on other services, such as the disabled person's grant. I do not doubt that taxis are essential for elderly persons or those with no transport late at night, but the Department of Health and Children needs to examine whether it is getting value for money. Talk is cheap, but the Minister should ensure that he is getting value for the money he is spending. This is a serious issue that needs to be addressed.

I will give another example, which relates to nursing home care. People's access to the nursing home of their choice is being restricted on a month by month basis. Subventions are not available to those in acute hospital beds if the quota for that month has been exceeded by the health board, which means that such people cannot leave hospital to go to a nursing home for which they are prepared to pay. It would be cheaper for the Minister if they could do so, as they would not use up an acute hospital bed. They cannot go home because they cannot adjust their homes as a consequence of the shortfall in the disabled person's grant scheme. It is a shameful and disgraceful situation.

Another issue relating to nursing home care has been brought to my attention by the members of the Irish association of nursing home owners, whom I met a week ago. They told me that health board officials in some parts of the country are going into private nursing homes to bring patients to the board's hospitals. That may be fine for some patients, but it is unacceptable to take people out of a nursing home, away from a community and the care they are receiving there, if they have happily lived in it and been fully subvented by the health board for four or five years. The Minister needs to look at that situation. The health boards are trying to save money where they can, but the Minister is not providing the money they need. As I have said, last year's budget was supplemented during the year. The level of services being provided at the end of 2002 should have been the starting point for 2003. The Minister's actions are completely wrong and shameful.

I also bring to the Minister's attention an issue I have raised many times. I refer to the quality of care in nursing homes and the health boards' inspections of nursing home care. I stress that 90% or 95% of nursing homes are excellent. This talk is cheap because I am talking about something the Minister can actually do. He can insist that health boards place on their websites reports about nursing homes that have been compiled by officials. Such a measure would ensure that the excellent quality of care would be transparent and made available in the 95% of cases I have mentioned and that details of the 5% of nursing homes that do not provide good care would also be accessible. Officials from the health boards can tell the Minister that the care provided is disgraceful in some cases. People will not avail of nursing homes that provide inadequate care. This is a cheap, simple and easy thing for the Minister to do.

It is not cheap.

The Minister needs to look again at what he is doing and where is he is going. It is shameful that ordinary poor people are suffering directly at his hands. The Minister is responsible and not anyone else.

It is appropriate that we should discuss this problem in the House today. It is unfortunate that speakers on the Government benches have criticised my party for putting down this motion, as it would have been negligent of Deputy Olivia Mitchell and Fine Gael not to have discussed health issues, particularly SARS. Nobody needs to be reminded that there are major problems in the health service. Those who are trying to avail of it are particularly aware of the difficulties. It is important that such problems are continually raised in this House as long as they remain, if that is what is needed to achieve a resolution.

It is obvious that the criticism being aimed at the Minister for Health and Children relates to the initial handling of the SARS crisis. A certain impression was created when people encountered news reports of the epidemic, even if its import may have been exaggerated by the media, which needs to sell its stories. The impression among the general public was that nobody was in charge. People do not just look at the national media, as CNN and Sky News are quite popular here. The world has become a very small place and people can receive information from all parts of the world. Their opinions are influenced when they see people affected by SARS throughout the world. I saw this morning on CNN, I think, that the first case of SARS has been reported in Russia. The syndrome is spreading to many countries and it seems inevitable that there will be a case here, although I hope this will not happen. If the proper procedures are not in place and people do not have confidence in the measures that are being taken, there will be mayhem and a further loss of confidence. It is very important that people can have confidence in the Minister's stewardship of the health service and this crisis.

This year's staging of the Special Olympics will represent the first occasion on which it has been held outside the United States. As it will be the biggest event ever to be staged by Ireland, it is very important that it should go ahead. Similarly, it is important that all necessary precautions are taken to ensure that people coming here are free of SARS and that quarantine facilities are put in place if they are required by athletes and their family members from the infected countries.

We should be as vigilant about the SARS aspect of the Special Olympics as about the other preparatory work, which has been excellent and one of the greatest examples of what this country can do regarding the organisation of a major event. However, SARS is an aspect of that event which worries people. While it is easy to criticise the people of Clonmel and say they jumped the gun or were hysterical, they were concerned and people have a right to be concerned. There is no point in Members coming to this House to criticise people for being concerned about their health. We must do something about the problem and ensure that the necessary precautions are put in place so that we could cope with a crisis if it arose.

The criticism of the Minister with regard to the handling of SARS is linked to the wider issue of the health services, and I am sure the Minister accepts that. I have referred several times in the House to the situation in County Kerry. I realise that Deputies have referred to their home bases and I take this opportunity to raise what is happening in my county regarding the health services. Despite assurances from the Minister for Health and Children, other Ministers and local representatives before and since the last election that there would be no closures in Tralee, the hospital is now faced with the closure of a ward containing 30 beds from June to August. That is the busiest time of the year in Kerry, when the population doubles and accident and emergency services are put under particular pressure.

As a result of the closure, there will be no elective admissions despite the hospital having one of the longest waiting lists in Kerry for out-patient admissions. Procedures for gall stones and hernia operations will not take place for three months, except in emergency cases. It is unfair that the people of County Kerry should be subjected to this type of treatment. Bed closures in Dublin are a major concern but there are closures all over the country. The people of Kerry are getting the rough end of the stick in regard to medical care in the Southern Health Board region. The Minister looks after his own city and county well but County Kerry is not getting a fair deal.

I compliment Deputy Olivia Mitchell for bringing this matter before the House. I am delighted that SARS is being debated. From the day the motion was put forward, there was some small bit of action from the Department of Health and Children. The Minister's handling of this issue, and that of his Department, was nothing short of disgraceful and it was only taken off the agenda over recent months by the war in Iraq. That was wrong. SARS is a serious disease. It is the first time since the period 1915-19 that the world has witnessed an uncontrollable disease. The consequences of foot and mouth disease and the precautions it necessitated were witnessed recently in this country. However, in this case, where people's health was at risk, no precautions were put in place. People were walking in and out of this country going to China and elsewhere and nothing was done until a couple of weeks later. That was wrong. The Government should have acted immediately this disease was notified to the World Health Organisation.

With regard to the health services generally, I am surprised that the Minister has stuck with this Government despite the way it has hung him out to dry. If I was in the Minister's position, I would tell the Taoiseach to give me the resources to deal with the health services or I would resign.

Hear, hear.

Fair play to the Deputy. Is that why he is going to Europe?

If the Minister did that he would be doing the decent thing for the sick and weak in this country. I know there are plenty of vultures behind the Minister who would take on the job and make a bigger mess of it than he and his Department have.

They would have a try in any case.

There is a new trend in the health services. People are being told that they are to be called the following week for their operations in the Mater, Beaumont or other hospitals, but they must telephone the hospital on the morning of the operation to make sure a bed is available. People are fasting and working themselves up for an operation but on the morning that they ring in to the hospital, no bed may be available. This discourages patients and upsets their families. There is no point in the Minister pretending this is not the case. People have telephoned in to find no beds available for the emergency operations they need.

Despite that, the Minister lectures Fine Gael and the country that people should be doing more for themselves, particularly those who could keep family members at home to save the State money. The Minister says he has no responsibility for the health boards but he has. The issue of home helps is the greatest national scandal. I know of a man waiting for major stomach surgery who rang his hospital last week to ask whether there was a bed available for him – there was no bed. The health board knows he needs an operation but it told this man that he cannot be given home help at this time. However, when he has his operation he can be given home help. He needs the home help now because he is sick. When he has surgery, he will need medical help and he will get that as well as assistance at home. He needs that help now also, not to be told when he rings the hospital that there is no bed available for his operation.

The Minister should call in the chief executive of every health board and tell them that it is a Government priority and Government policy that money must be put into the home help service. The Government cannot say that it wants people to keep their families at home and then, when they make an effort, the State lets them down in terms of resources. For example, I recently spoke to a man who had been receiving 7.5 hours of home help per week. He got a telephone call from the health board yesterday and was told that that help was being taken away. That man needs medication daily and cannot cook or wash. He was getting some service from the health board until a health board official rang him to say that he can no longer have home help. What kind of society would do that? The Minister should tell the Taoiseach today to put in the necessary resources or he will be on his way to Cork.

I welcome this opportunity to respond to the debate on the issue of SARS and I want to keep to that issue, unlike some other speakers who have discussed every item in the health area.

If the Minister of State read the motion, he would see that it is not just about SARS.

As the Minister made clear to the House in this debate, he and the Department moved immediately to respond to the threat of SARS to Ireland and quickly put a comprehensive plan in place. The essential ingredients of that plan are as follows: a prompt and ongoing public information campaign alerting members of the public to the signs, symptoms, causes and transmission modes of SARS and travel advisories regarding travel to and from affected areas; detailed guidance provided to health professionals regarding the diagnosis, clinical management, surveillance and contact tracing for suspect and probable SARS cases, and to airline crew and cleaning staff regarding the possible in-flight care and follow-up procedures for a suspect case of SARS; and a comprehensive operational framework established to provide an integrated public service-wide response, comprising an expert committee to provide clinical advice and guidance regarding the management of the disease and other public health issues, an interde partmental planning group to co-ordinate cross-sectoral issues, a health service implementation group to ensure a prompt and integrated response at regional level, and a communications group to co-ordinate all communications relating to SARS, in particular, information to the public.

Our plan is kept under constant review and is updated almost daily in light of information and guidance from the World Health Organisation. As the Minister pointed out to the House, experts from the WHO have endorsed the measures which we have put in place to prevent the establishment and spread of SARS in Ireland. However, SARS is a new and unpredictable condition and the outbreak continues in the most populous country on earth. This is a serious cause for concern and we cannot, therefore, become complacent. It is my Department's intention to continue with and indeed bolster our plans should that become necessary. We are determined to continue to draw upon the most up-to-date international and national information and expertise to inform our approach to this disease, collaborate with our European Union and World Health Organisation partner member states in the fight against SARS and to maintain a state of readiness to deal with the illness as it evolves.

I now wish to turn to the strike by public health doctors, who are members of the Irish Medical Organisation. A national strike by any group of health care workers will always have implications for our health service. I wish to state again both on my own behalf and on behalf of the Government our serious concern at the national strike action by public health doctors in pursuit of a 30% pay claim.

It should be noted that groups of staff at every level across the health system enter claims about a variety of issues related to their terms and conditions of employment. Such claims cannot be conceded simply because they have been demanded. I also wish to put on record that this claim has been lodged in relation to the current duties and responsibilities of these doctors and is separate to any pay increase that the Irish Medical Organisation has indicated it will demand for the implementation of changed working practices that may be required in the future.

It is important to clarify again the background to the current dispute, especially in view of the ongoing variety of selective historical accounts that are being circulated.

The regional public health function was established in 1994 with an agreement that a review would be undertaken within two years of the public health departments being established. This process took longer than expected. Consequently, the review began only in 1999, the Brennan report being published in April 2002. The IMO was an equal partner and co-owner of this review process. The HSEA and the Department of Health and Children accept the recommendations contained in the Brennan report. However, the report reflects the diverging views between the parties on the issue of consultant status for public health doctors. The chairman's role was that of facilitator to the working party and not that of an arbitrator. His comments in relation to the status of directors and specialists were no more than a personal view and, as such, had not the status of a recommendation.

The Brennan report acknowledged that there might be a need to revisit its recommendations following the implementation of proposed changes recommended by the health strategy and the primary care strategy. These changes, and the forthcoming reports on health service structures, will have significant implications for the future role of public health doctors and, as such, must be taken fully into account in any negotiations process.

In 2002, the Public Service Benchmarking Body recommended increases of up to 14.2% for public health doctors based on their current duties and responsibilities. The benchmarking body acknowledged that it was not in a position to take account of the issues raised by the Brennan report in relation to the restructuring of public health service provision.

Management has made an offer of 10.5% to the IMO. With benchmarking and the Sustaining Progress national agreement, the application of this increase would result in increases of up to €29,000 for public health doctors between now and 2005.

Despite the HSEA asking the IMO to have all outstanding issues referred to the Labour Court, the IMO refused and began strike action on 14 April. This action has continued, despite management indicating its willingness to discuss the implementation of the recommendations of the report of the Public Health Review Group, including the development of a structured out-of-hours system.

I acknowledge that the professional input made by public health doctors to the management of infectious diseases and other public health threats is significant. I also believe that the response of the health system is hampered by the absence of their input. My Department and I have done and are doing all in our power to facilitate the resumption of negotiations on the outstanding issues.

I again take the opportunity to appeal to the IMO to call off its industrial action and, in accordance with the terms of Sustaining Progress, to participate meaningfully in negotiations under the recognised industrial relations machinery with a view to having outstanding issues resolved as speedily as possible.

With regard to the reform of the health system, the Minister last night outlined the three reports currently pending which will inform the formulation of a comprehensive reform programme for the health system. He indicated his intention, in consultation with his colleague, the Minister for Finance, to propose an integrated reform programme to the Government, based on the findings and recommendations of these reports, in due course.

I wish to share time with Deputies Durkan and Olivia Mitchell.

An Leas-Cheann Comhairle:

Agreed.

Many might wish that this motion was only about the SARS disaster. Many speakers in the debate concentrated on the Minister's ineptitude in handling the SARS threat but the Fine Gael sponsored motion is much broader than that. The motion also deals with the failure of the Minister, Deputy Martin, and the Government to effectively manage our health service over the past number of years. That was a period of unprecedented prosperity yet there has been a serious deterioration in our health services.

The Minister may continue to issue press releases stating that there is no problem but his PR people and his spin doctors are losing the battle. To quote Deputy Ring, if he paid the real doctors as much as he is paying his spin doctors we might have a better health service, with fewer people on waiting lists and lying on hospital trolleys. The Minister should put money into the services and dispense with his PR team because he and the Government are losing the PR battle.

The editorials in every newspaper yesterday condemned the Government on its disastrous handling of our health services. They cannot all be wrong. An article yesterday in The Examiner stated that the sick are being told to endure the infirmaries and the electorate is being screwed by the most dishonest and disreputable Government this country has had to endure since the foundation of the State.

Where now is the Government's health strategy, launched in technicolor before the general election?

That is right.

It was big on aspiration but low on implementation. The Taoiseach vowed that the strategy would deliver major improvements in the health service throughout the country. The Minister, Deputy Martin, said it would immediately benefit a substantial number of people. That was all before the election but, one year on, the health strategy has delivered nothing.

One of the promises of 3,000 additional acute hospital beds is already gone. Instead, we have bed losses and ward closures in every hospital in the country. Another promise was to reduce waiting lists. There are no waiting lists figures available from the Department of Health and Children but a decision by the five Dublin hospitals to reduce patients by 14,000 this year will increase waiting lists. That is happening in other hospitals throughout the country also.

The empty Government promises have done nothing to stop the decline of a terminally ill service. It was a con job before the election. Up to the time of the election it was spend, spend, spend but since the election it has been cut, cut, cut. I know what I am talking about and I will give the Minister the figures from the health board with which I am most familiar, the Western Health Board.

In June last year there was a deficit of €16.6 million. In other words, up to the time of the election the Western Health Board had to spend €16.6 million more than its budget. By the end of December, when the election was over, there was a saving of €24 million and the Western Health Board had a surplus of €8 million.

That is a scandalous position. Was there collusion between the Minister and the executives of the health board or did they take it upon themselves to spend everything up to the time of the election, pretend everything was okay and then cut back after the election? That is what happened. How was there a saving of €24 million in the six months following the election? In the second half of the year, the budgets for mental health and services for older people was under-spent by €4 million. Community care was under-spent by €2 million. A total of €17 million was put into the corporate contingency fund. That €17 million was already cut from the community care, mental health and services for older people budgets, including housing grants for the elderly. What kind of accounting systems operate in the Western Health Board if there can be a deficit up to the election and a surplus of €8 million at the end of the year?

As there was a surplus of €8 million in the Western Health Board, the Department made provision for a further €2 million but a reply to a Dáil question stated that given the financial pressures elsewhere in the system and the projected outturn for the board, it was considered appropriate to stick to the original budget. In other words, the Western Health Board, as a result of its bad bookkeeping, lost a further €2 million. Will the Minister wake up to what is happening in health boards throughout the country?

One cannot get respite care for the elderly or a home help for a few hours since the election. In the first half of last year, I had no bother getting those services for people from the Western Health Board because it was running up a deficit of €17 million. Since the election one can get nothing because not alone is it sticking to its budget, but it is saving the €17 million it overspent before the election. Did the Minister ask the heath board why it did this prior to the election? Did the board get the nod to pretend everything in the garden was rosy? The health board's housing staff were forced to work under extreme pressure from management to stall and refuse many genuine hardship applications for grant aid. The Minister should wake up to this. The people will not be conned. They know this happened. They will take it out on the Government the first opportunity they get. Perhaps the Minister should take Deputy Ring's advice and have a little word with the Taoiseach.

I listened with interest to the reaction of the Minister and the Government to the motion. The Minister's first comment was it was about politics and the blame game continued with various Government speakers blaming the media and public hysteria. Lack of confidence in the system to respond causes public hysteria and the public has lost total confidence in the Department of Health and Children as administered by the Minister.

Deputy Martin and his ministerial colleague, Deputy O'Malley, are both nice guys.

I thank the Deputy.

However, they are totally incompetent and they have failed miserably to provide even the most basic health services to the public.

This is not a laughing matter.

There is nothing funny about this issue. This motion relates to public concern about the health service and the confidence of the public in the Minister's ability to provide a service when it is needed and it is not about politics or the blame game.

With regard to SARS, the public was concerned about how competent was the Department in providing what was required to address the issue. The example set was a patient who was brought to hospital, sent home and returned to hospital by taxi. No restrictions were in place and the public's reaction was panic. People know well the Department and the Minister are not in control. This motion is about the lack of public confidence in basic health services and not about the blame game. The Minister repeatedly points out that more and more money is spent every day. That is one of the underlying reasons the public has even less confidence in the system. By his own admission, more money is being spent but nothing is happening.

There are countless vacancies in vital services throughout the State. However, another 250 hospital beds will be taken out of the system in response. There has not been enough nursing or general medical staff in our hospitals since the previous Administration took up office yet the nursing organisations are considering sending nurses abroad because of bed closures here. This is farcical and the two Ministers present must know that. When they return to their offices, surely the will examine what are the causes of these problems and ask their officials what, in God's name, is going on.

The debate is not about blame and politics. It is the Government's last resort when it blames the media, public hysteria and the Opposition for the ills that beset its Departments. Never has such an appalling mess been made of a Department in the history of the State than that of the Department of Health and Children under Deputy Mar tin's stewardship. He is a nice guy and this is not personal. While I hate saying this, both he and his Minister of State, Deputy O'Malley, are appalling failures. The motion is about their failure to provide an adequate and secure health service to the public.

They know that.

When they want to blame somebody, they should kindly blame themselves and respond to the people who correspond with us on a daily basis. They ask us what is going wrong and why they cannot rely on the health service and be assured that when they are ill, they will be safe and secure in calling on various health agencies.

A few weeks following the agreement of the much vaunted new partnership programme, public health doctors are on strike. What kind of agreement was it? The Minister signed the agreement and hailed it as the last resort in resolving his problems. Suddenly the mortar has come unstuck and the reality is there is no agreement. The Minister has papered over the cracks and provided nothing. This is the second time he has perpetrated such a move on an unsuspecting public in 12 months following a similar dispute prior to the general election.

The State is supposed to provide services to look after its people. Various initiatives have been introduced to compensate for our lack of ability to do so. However, sending patients overseas to avail of services that are available here is the laugh of all laughs.

Last night I said that in life, by and large, we make our own luck and the Minister could not put the disasters of recent weeks down to bad luck. In one sense luck played a part in that he has been extremely lucky in his mishandling of the SARS issue, in that what was a disaster—

Of course, absolutely.

—could so easily have been a catastrophe. If SARS had been more virulent or more infectious, it is possible there would have been very few of us here to tell the tale.

Come off it. This is classic hysteria.

It is not. The Minister continuously failed to grasp the point. Nobody knew how dangerous SARS was but the public expected the Government to be able to handle a health threat and it was not. The issue is the health service was unable to respond.

I was amused by Fianna Fáil backbenchers having the gall to tell us not to be political and to support the poor, old Minister. When they were not content with blaming the Opposition for over-reacting, they blamed the media and members of the public who called "Liveline" and other programmes. It was everybody's fault expect the Minister's and Fianna Fáil's, as is always the case.

The motion is not about scaremongering or harking back to something that should be swept under the carpet. The health system was ill-equipped to deal with an infectious disease and that lesson must be learnt. The public demands that the Minister learns it and demands of us that we make sure that he learns it. Last night the Minister cited the fact that there was only one probable cause as proof of how well he handled the issue. He entirely missed the point again as the motion is about his incompetence and the public's concern that if he failed to manage a manageable disease on the far side of the world, what hope has he of hauling the health service out of the mess into which he has allowed it to slide.

No matter what fine talk there is about politics, governance and democracy, the bottom line is people elect governments to look after them. They pay no attention to what we are doing 90% of the time but they want to know that there is somebody to look after them if a disaster was to occur. When Marian Finucane invited a Minister of State on to her radio programme last year to discuss the national emergency plan, nobody believed there would be a nuclear accident. However, they assumed if one occurred, somebody would be in charge and would know what to do. The realisation that there was no plan sent people into a panic. That has also happened in regard to the health service and there has been a complete loss of confidence in the Government.

The Minister would like to think that SARS is yesterday's news and it is time to get on with the next business but the worry for all of us is how will the health service respond to the next threat. Will there even be a health service? Unfortunately, in the modern world, we are constantly exposed to the danger to chemical or biological attacks and new diseases can spread at a frightening pace because of our mobility. We want reassurances that the Government will be able to deal with future attacks and there will not be mismanagement with confusing and contradictory messages being given to the public.

The Minister is happy that his spin doctors are back in place and doing the necessary work for him on SARS. However, there are more gaps to be plugged in the health service than merely in regard to his public relations. The health service is in crisis but there is little sign that the Minister, the Taoiseach or the Government backbenchers recognise that. The Taoiseach only shows a passing knowledge of what is going on in the health service.

The imperative now is for the Minister to start earning his salary. His first job is to resolve the public doctors dispute and then he must publish the reports on the reform of the health service. Reform is the only thing that offers any hope. The reports must be acted on and cannot be left, as the health strategy was, as worthy documents which might have saved the health service if only the Minister bit the bullet. I commend the motion to the House.

Amendment put.

Ahern, Dermot.Andrews, Barry.Ardagh, Seán.Aylward, Liam.Brady, Johnny.Brady, Martin.Breen, James.Brennan, Seamus.Callanan, Joe.Carey, Pat.Carty, John.Collins, Michael.Cooper-Flynn, Beverley.Coughlan, Mary.Cowen, Brian.Cregan, John.Cullen, Martin.Curran, John.Davern, Noel.de Valera, Síle.Dempsey, Noel.Dempsey, Tony.Dennehy, John.Devins, Jimmy.Ellis, John.Fahey, Frank.Finneran, Michael.Fleming, Seán.Gallagher, Pat The Cope.Grealish, Noel.Hanafin, Mary.Harney, Mary.Haughey, Seán.Hoctor, Máire.Keaveney, Cecilia.

Kelleher, Billy.Kelly, Peter.Killeen, Tony.Kirk, Seamus.Lenihan, Brian.Lenihan, Conor.McCreevy, Charlie.McDaid, James.McEllistrim, Thomas.Martin, Micheál.Moynihan, Michael.Nolan, M. J.Ó Cuív, Éamon.Ó Fearghaíl, Seán.O'Connor, Charlie.O'Donoghue, John.O'Flynn, Noel.O'Keeffe, Batt.O'Keeffe, Ned.O'Malley, Fiona.O'Malley, Tim.Parlon, Tom.Power, Peter.Power, Seán.Ryan, Eoin.Sexton, Mae.Smith, Brendan.Smith, Michael.Treacy, Noel.Wallace, Dan.Walsh, Joe.Wilkinson, Ollie.Woods, Michael.Wright, G. V.

Níl

Allen, Bernard.Boyle, Dan.Breen, Pat.Broughan, Thomas P.Bruton, Richard.Burton, Joan.Connaughton, Paul.Costello, Joe.Cowley, Jerry.Crawford, Seymour.Crowe, Seán.Cuffe, Ciarán.Deasy, John.Deenihan, Jimmy.Durkan, Bernard J.Enright, Olwyn.Ferris, Martin.Gilmore, Eamon.Gormley, John.Harkin, Marian.Hayes, Tom.Healy, Seamus.Higgins, Joe.Higgins, Michael D.Hogan, Phil.Howlin, Brendan.Lynch, Kathleen.McCormack, Padraic.

McGinley, Dinny.McGrath, Finian.McGrath, Paul.McManus, Liz.Mitchell, Gay.Mitchell, Olivia.Morgan, Arthur.Naughten, Denis.Neville, Dan.Ó Caoláin, Caoimhghín.Ó Snodaigh, Aengus.O'Dowd, Fergus.O'Shea, Brian.O'Sullivan, Jan.Pattison, Seamus.Penrose, Willie.Perry, John.Quinn, Ruairí.Ring, Michael.Ryan, Seán.Sargent, Trevor.Shortall, Róisín.Stagg, Emmet.Stanton, David.Twomey, Liam.Upton, Mary.Wall, Jack.

Tellers: Tá, Deputies Hanafin and Kelleher; Níl, Deputies Durkan and Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."

Ahern, Dermot.Andrews, Barry.Ardagh, Seán.Aylward, Liam.Brady, Johnny.Brady, Martin.Brennan, Seamus.Callanan, Joe.Carey, Pat.Carty, John.Collins, Michael.Cooper-Flynn, Beverley.Coughlan, Mary.Cowen, Brian.Cregan, John.Cullen, Martin.Curran, John.Davern, Noel.de Valera, Síle.Dempsey, Noel.Dempsey, Tony.Dennehy, John.Devins, Jimmy.Ellis, John.Fahey, Frank.Finneran, Michael.Fleming, Seán.Gallagher, Pat The Cope.Grealish, Noel.Hanafin, Mary.Harney, Mary.Haughey, Seán.Hoctor, Máire.Keaveney, Cecilia.Kelleher, Billy.

Kelly, Peter.Killeen, Tony.Kirk, Seamus.Lenihan, Brian.Lenihan, Conor.McCreevy, Charlie.McDaid, James.McEllistrim, Thomas.Martin, Micheál.Moloney, John.Moynihan, Michael.Nolan, M. J.Ó Cuív, Éamon.Ó Fearghaíl, Seán.O'Connor, Charlie.O'Donoghue, John.O'Flynn, Noel.O'Keeffe, Batt.O'Keeffe, Ned.O'Malley, Fiona.O'Malley, Tim.Parlon, Tom.Power, Peter.Power, Seán.Ryan, Eoin.Sexton, Mae.Smith, Brendan.Smith, Michael.Treacy, Noel.Wallace, Dan.Walsh, Joe.Wilkinson, Ollie.Woods, Michael.Wright, G. V.

Níl

Allen, Bernard.Boyle, Dan.Breen, Pat.Broughan, Thomas P.Bruton, Richard.Burton, Joan.Connaughton, Paul.Costello, Joe.Cowley, Jerry.Crawford, Seymour.Crowe, Seán.Cuffe, Ciarán.Deasy, John.Deenihan, Jimmy.Durkan, Bernard J.Enright, Olwyn.Ferris, Martin.Gilmore, Eamon.Gormley, John.Harkin, Marian.Hayes, Tom.Healy, Seamus.Higgins, Joe.Higgins, Michael D.Howlin, Brendan.Lynch, Kathleen.McCormack, Padraic.McGinley, Dinny.

McGrath, Finian.McGrath, Paul.McManus, Liz.Mitchell, Gay.Mitchell, Olivia.Morgan, Arthur.Murphy, Gerard.Naughten, Denis.Neville, Dan.Ó Caoláin, Caoimhghín.Ó Snodaigh, Aengus.O'Dowd, Fergus.O'Shea, Brian.O'Sullivan, Jan.Pattison, Seamus.Penrose, Willie.Perry, John.Quinn, Ruairí.Ring, Michael.Ryan, Seán.Sargent, Trevor.Shortall, Róisín.Stagg, Emmet.Stanton, David.Twomey, Liam.Upton, Mary.Wall, Jack.

Tellers: Tá, Deputies Hanafin and Kelleher; Níl, Deputies Durkan and Stagg.
Question declared carried.
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