That Dáil Éireann,
— the promise by the Fianna Fáil Party prior to the 2002 general election to eliminate hospital waiting lists within two years;
— its promise to extend medical card entitlement to a further 200,000 people;
— that action 89 of the Government's health strategy promised greater equity for public patients in acute hospital services in a revised contract for hospital consultants to be delivered by the end of 2002;
— the promised delivery in the health strategy of a new model of primary care throughout the State;
— noting that:
— according to most recent figures there are 27,212 people on hospital waiting lists;
— while 36% of the population was entitled to a medical card a decade ago less than 30% are so entitled today;
— the consultants' contract has not been renegotiated nor revised;
— there has been minimal progress on primary care since 2001;
— views with concern the continuing drive towards over-centralisation of hospital services including the closure of maternity, accident and emergency and other acute services at hospitals around the State and calls for the restoration of said services at those hospitals affected;
— deplores the continuing failure to reform and resource mental health services resulting in continuing hardship for people with mental illness and the failure of the State to meet international human rights standards in this regard;
— urges a reconsideration of the planned configuration of radiation oncology units in Dublin, Galway and Cork only and calls for the acceleration of plans for the overall improvement in cancer treatment services;
— deplores the mismanagement of our health services at central Government and health board level as shown by the number of investigations into serious incidents, including fatalities, in a number of health board areas, and the delayed and unsatisfactory nature of those investigations;
— considers that reform of health administration structures as proposed by Government will create a democratic deficit;
— affirms that the two-tier, public-private system is inherently inequitable and inefficient and, after decades of underfunding of our health services, the two-tier structure is now causing increased resources to be used in an ineffective manner;
— supports an all-Ireland approach to health care delivery to harmonise and maximise resources on an island-wide basis and urges greater priority for this approach by Government;
— asserts the basic right of equal access to the best health services for all regardless of ability to pay and seeks the phasing out of the current two-tier public-private system which subsidises the private health care business at the expense of the public system, to be replaced by a truly reformed health service with care free at the point of delivery and funded from general taxation;
— calls for the establishment of a Cabinet committee on health chaired by the Taoiseach to spearhead the phasing in of a reformed health service; and
— demands the resignation of the Minister for Health and Children.
I will share my time with Deputy Crowe and Deputy Ferris.
I regret the Minister for Health and Children is not yet in the Chamber for this important debate. This motion is comprehensive but the two most important words in it are "basic right". Only a rights based approach can address the complex problems which beset public health in general and the health services in particular in Ireland today. The absence of such an approach has allowed inequality to abound in the delivery of health services and because of inequality we are making the least effective use of the increased resources now being spent on health.
The constitution of the World Health Organisation sets out the fundamental principles which should inform health policy. It states: "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." The reality in Ireland today is that the enjoyment of the highest attainable standard of health is subject to distinction based on social and economic condition. The actual structure of our health services sustains that inequality.
Who now denies that there is a two-tier system in our health services? The Government's health strategy in 2001 admitted that "there are significant inequalities in the system at present" and many of the proposed measures also represent such an admission. However, a decade previously the then Fianna Fáil Minister for Health, Deputy O'Hanlon, not only admitted that we have a two-tier system but defended it. He said in this House: "That has been the position since the foundation of the State and this system, with its integrated mix of public and private care, has served the nation well." Despite the glaring inequalities which have been exposed in the debate on health in recent years, the unequal model defended by the then Minister, Deputy O'Hanlon, in 1991 and his predecessors and successors has been maintained.
This is the Government's preferred model for health care delivery in the 21st century. The core of the motion before the House is the rejection of that model, the identification of many of the inefficiencies and inequities that flow from it and the presentation of a radical alternative. The Government will argue that it has devoted unprecedented resources to health. It has, but this has come after decades of underfunding, and because of the Government's refusal to challenge the two-tier system vast amounts of public money continue to subsidise the private health care business. Meanwhile public patients suffer.
In 2002, Fianna Fáil made a commitment to the people to "permanently end waiting lists in our hospitals within two years". That promise becomes due on 17 May next but there are more than 27,000 people on hospital waiting lists. As the Minister stated in reply to my parliamentary question last week, this is a decrease of only 7% since 2002. That is 93% short of what the people were promised. If that rate of decrease were maintained, it would take more than 14 years to end waiting lists.
The lack of coherence in Government policy is shown by the treatment purchase fund. This was supposed to be a temporary measure but the Government now relies on it as its primary means of addressing waiting lists. It is a perfect illustration of the inefficiency that this Government is funding. While beds in public hospitals remain closed due to lack of resources in the public system, treatment is being purchased in the private system. It is a short-term fix while the need to increase bed numbers and staffing levels in the public system is neglected. It is the patients of the future who will suffer as our public health infrastructure is allowed to wither.
The National Economic and Social Forum report, Equity of Access to Hospital Care, states that structural change is necessary to address the two-tier public-private system in hospital care and, most significantly, it states that this system is left unchanged in the Government's health strategy. However, the Government's amendment to this motion states that the Government relies on that strategy to deliver equity of access. The Government is totally exposed.
The failure to renegotiate the consultants' contract and to require all new consultants to work exclusively in the public system is in many ways the key to all the other failures of the Government in the health sector. It is, above all, a failure of political will to challenge vested interests and to put the public patient first. I am not advocating a policy of confrontation, but fairness and equity must be at the heart of the system. The privileged position of consultants, their undue power in determining policy and their lack of accountability for work in the public system while profiting from private practice are all inherently unfair and inequitable.
The Minister has described consultants as "kings in their own domain". He has been thwarted by them on many occasions, for example, in the disgraceful delay in proceeding with the investigation of difficulties among consultants in Cavan hospital. More seriously, the victims of malpractice in the obstetrics and gynaecology unit at Our Lady of Lourdes Hospital, Drogheda, have been disgracefully treated as a result of the lack of accountability of the professional bodies. The Minister has done precious little to challenge this.
The Minister's party also promised "to extend medical card eligibility to over 200,000 extra people, with a clear priority being given to families with children". In their 2002 programme for Government, Fianna Fáil and the Progressive Democrats promised to "extend medical card eligibility in line with the recommendations of the National Health Strategy". The strategy promises to increase medical card income guidelines. Once again, there has been zero delivery and low income families with children who do not qualify for the medical card are now worse off than they were two years ago.
The failure to extend medical card qualification and the failure to develop primary care as promised makes the closure of services in local hospitals even more grievous. Look at how communities have united in defence of these hospitals. Listen to their voices. The Government has failed to listen to them heretofore. The Hanly report is a recipe for the closure of more services and, possibly, hospitals in a number of locations. Our party welcomed the long overdue reduction of working hours for junior hospital doctors recommended in the Hanly report but we deplore the use of that issue as a trojan horse to close services in local hospitals throughout the State.
Monaghan and Dundalk were the guinea pigs. Monaghan Hospital has had its maternity, paediatric and accident and emergency services taken from it. Primarily, it is women and children who are worst affected by these cuts. This will continue throughout this State if the Hanly plans are implemented. Sinn Féin, in conjunction with local communities and all who wish to see justice and equity in health care delivery, will continue to defend our hospital services and we demand the restoration of those services that have been axed from the hospitals I have mentioned.
This motion is not just about identifying the undoubted failures and broken promises of this Government. It is also about setting out an alternative and urging real public debate. We make no bones about it. The model of health care delivery we advocate will mean that the wealthy in our society will be required to contribute more in taxation than they do at present. All taxpayers, irrespective of income, should be guaranteed that the best use is being made of their money. That is not the case at present. In that context people would not challenge taxation. Instead they would demand a rejection of funding inequity and its twin, inefficiency.
It must be acknowledged that progress has been made in recent years. Tribute should be paid to all those people throughout the health services who have contributed to progress. For a transformed health service we need to harness their talents and their dedication. However, they need leadership with vision and a strategy based on equality. This Government has given them neither and has broken its commitments to the people.
There can be no confidence in a Minister and a Government with such a record, not only since 2002 but since 1997. That is at the core of this motion and what we seek to address. We want to see the mandate on which the people returned this Government honoured, respected and implemented. That has not happened, nor does the Government intend to do it. Accordingly, we say to the Minister for Health and Children, Deputy Martin, that it is time for him to go.