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Dáil Éireann debate -
Thursday, 29 May 2003

Vol. 567 No. 7

Adjournment Debate. - Hospital Services.

I thank the House for the opportunity to address the major crisis that exists in our health system in terms of a lack of services and ward closures. One year after the general election, many of the major issues in our health system have not been addressed in a planned and coherent manner. Successive Governments have failed to provide the necessary infrastructure to support vulnerable citizens.

I will not accept any excuses today. I am demanding the elimination of all health, disability and social service waiting lists within a three year period. This can be achieved through prioritising public spending and using the money more effectively. We also need accountability from our decision-makers. The reality is that not enough money is being spent on health and disability issues. The Government has admitted that waiting lists will not be eliminated. Despite its promise to grant 200,000 additional medical cards, not one has been issued. There is an employment freeze on 800 jobs in the health service, 300 beds have been closed and all Dublin hospitals are facing a shortfall of more than €100 million this year. In addition, the Minister and Government are sitting on their hands during a strike by the public health doctors. The Minister should pay them and let them get on with their jobs.

People are angry and they are sick and tired listening to and waiting for health reports and strategies. They are demanding action and real solutions to the problems that exist. The health system is sick and we all need to work together to make it better.

We are also faced with the nightmare scenario of people with intellectual disabilities. Some 1,711 people are awaiting residential services, 861 need day-care services and 462 people are without any service. Parents and service providers at St. Vincent's centre on the Navan Road and at St. Michael's House in Ballymun are crying out for funding and proper services, as a matter of right. This simply is not good enough. This is the Minister of State's watch.

It is a disgrace that the Minister for Health and Children, Deputy Martin, when discussing our health services on "The Late Late Show" last Friday night made no reference to the crisis that exists for families of children and adults with intellectual disabilities. Shame on him. If he was serious about dealing with this problem, he and the Government would introduce a supplementary budget on health and disability issues. I would support such a motion. The Minister can do it. The Cabinet was able to find the €42 million required to bail out the Minister for Education and Science. Why can it not come up with a creative idea to fund our health and disability services and eliminate waiting lists once and for all? With the right political will, it can be done. It will take courage and vision and will require tough decisions in the interests of the poorer sections of our society, a just society for which we all work; it is not just an economy.

It is time to stand up to the bully boys and girls in the House and tell them to keep their extreme economic brands of politics to themselves. The health budget is more than €9.158 billion and staff costs are put at €5 million. One does not have to be a rocket scientist to know that we are not spending enough on frontline services such as beds and accident and emergency services. The Minister should discuss that with his French and Spanish counterparts the next time he meets them at an EU meeting.

Last week, 25 patients had to await admission in the accident and emergency department of Beaumont Hospital. That happened on just one morning. That number will soon rise to 50 or 60 patients. The in-patient waiting list at that hospital is 2,513 and for the Mater hospital it is 2,167. This is the real state of our health system. It is not acceptable and this Government must act now.

I am happy to respond to the Deputy, who indicated that there is a crisis in our health services and that there is a need for prioritisation. He also said that not enough money is being spent and made other comments which might, possibly, make good by-lines.

On the point of not enough money being spent, a previous Government, made up of Independents, introduced the Health (Amendment) No. 3 Act 1996, the accountability procedures of which are now being applied to hospitals and forcing them to operate within their budgets.

I was not a Member at that time.

I wish to highlight the increased levels of funding the Government is providing for the health service. This year the approved level of spending nationally for health services is in excess of €9 billion. The health service has received an overall increase of 162% since 1997. This is a clear indication of the Government's commitment to improving and maintaining the quality of services in difficult and changed economic circumstances. This extra investment in recent years has brought significant results, including record levels of activity in the acute hospital system and a range of additional services provided in the major programmes of care. This investment has been matched by increases in the quantity and quality of health care outcomes.

We should guard against undermining the achievements of all who work in the health service. It is important to remember that every day thousands of patients have satisfactory experiences of the health service and successful outcomes. There are many good things happening in the health sector. While there has been a substantial amount of adverse comment about the service, nobody can deny that the system is providing more and better services than ever before.

Activity levels in our acute hospitals continues to rise. In 2002 alone there were 963,000 in-patient discharges. This figure represents approximately 2,600 patients being discharged each day of the year and an overall increase of nearly 5% on the number of discharges in 2001. In addition, there were 1.2 million attendances at emergency medicine or accident and emergency departments and over 1.5 million attendances at acute hospital out-patient departments.

Day activity is now a significant component of hospital based care. Evidence shows that much of the growth is the result of technological and medical innovations such as less invasive surgery and advances in anaesthetics. There was an increase of 13% in the number of day cases between 2001 and 2002, similar to the increases experienced in preceding years. This increase reflects the increasing ability of the hospital system to treat more patients on a day basis where patients are admitted and discharged on the same day.

Due to the nature of any health care system not all treatments can be made available to patients immediately. Hospital facilities must be used to best effect and it is sometimes necessary to place patients for non-urgent treatments on a waiting list. Our objective is to reduce waiting times significantly in the short-term with a particular focus on those waiting longest for treatment. Despite pressures on the acute hospital system and the influence of factors such as the winter vomiting bug, considerable progress was made by health agencies in reducing waiting times for public patients in 2002.

There has been a significant reduction in the number of adults waiting longest for in-patient treatment. The total number of adults waiting more than 12 months for in-patient treatment in the nine target surgical specialties fell by 30% from 7,402 to 5,209 in the period June to December 2002. Some individual specialties have shown greater reductions. The specialty of cardiac surgery, for example, showed a reduction of 47% in the numbers waiting more than 12 months in the period June to December 2002 while the specialty of gynaecology showed a decrease of 45% in the same period. The total number of children waiting for more than six months for in-patient treatment has fallen by over 31%. The most significant reductions have been in the specialties of general and plastic surgery where the number of children waiting more than six months for treatment has fallen by 52% and 44% respectively in the period.

The Eastern Regional Health Authority has reported a near 3% reduction in the in-patient waiting list between September and December 2002. This has been achieved at a time when the acute hospital system has been under pressure from increased demands on emergency services. The total number of patients on the public hospital waiting list represents just 3% of all discharges from acute hospitals in 2002.

A sum of €43.8 million is available to health agencies in 2003 under the waiting list initiative. A further €3I million is available under the national treatment purchase fund, NTPF, to target those waiting longest for treatment. To date, approximately 4,300 long waiters have received treatment under the NTPF, the work of which has raised issues in relation to the accuracy of numbers reported to be waiting longer than 12 months for treatment. As a result, the Minister for Health and Children recently announced his intention to bring forward proposals, in consultation with the NTPF, ERHA and the health boards, for a new system of management and organisation of waiting lists nationally.

The single most important limiting factor for admission to hospital is bed availability. In this regard, the Department of Health and Children conducted a review of acute hospital bed needs, something I sought as chairman of the ERHA. As a result of this review, the Government decided to provide an additional 3,000 beds in acute hospitals by 2011. A total of 550 of these beds are in operation and the remainder will be brought into use shortly. My Department is examining the regional issues associated with the allocation of the remainder of the 3,000 acute beds. In relation to bed closures, it is a feature of all acute hospital systems that some beds are out of use for short periods due, for example, to ward refurbishment, essential ward maintenance, staff availability and infection control measures.

Under the Health (Amendment) (No. 3) Act 1996, otherwise known as the accountability legislation, health agencies are required to deliver a level of service consistent with their approved budgets. Given the level of funding available this year, the structuring of overall service plans by health agencies for 2003 may involve some containment of service activity in order to manage within budget. We acknowledge that the Eastern Regional Health Authority and the health boards have some difficult decisions to make regarding their service provision and priorities therein. The ERHA and the health boards are actively examining the most effective and efficient means to manage cost and activity in the context of working with available resources.

I assure the Deputy of the Government's resolve to work closely with the various health agencies with regard to ensuring an efficient and effective health service that meets the needs of the population. Within the next four weeks the Minister for Health and Children, Deputy Martin, will come to the House to make some major reforming announcements regarding the provision of health services in the years to come.

Will they take people off trolleys?

We will look forward to receiving feedback from all stakeholders whereby they can make a meaningful contribution on how we should reform and restructure the health service. Every Member of the House wants a world class service that is accessible to all whenever the need arises.

The Dáil adjourned at 5.25 p.m. until 2.30 p.m. on Tuesday, 10 June 2003.

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