Health Care: Motion (Resumed).

The following motion was moved by Deputy Ó Caoláin on Tuesday, 2 March 2004:
That Dáil Éireann,
— recalling:
— 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.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"commends the Government and its commitment to provide a high quality health service directed at those most in need and acknowledges:
—that equity of access is one of the key objectives which underlines the health strategy;
—recognises the extensive additional resources, both capital and revenue, which have been allocated to the health services since 1997 and welcomes the increase of over 200,000 patients treated in acute hospitals in that period;
—endorses the innovative health service reform programme which has been initiated by the Government as reflected in the health strategy, Quality and Fairness —A Health System for You, and in its consideration of the Brennan and Prospectus reports;
—welcomes the report of the national task force on medical staffing, the Hanly report, which outlines a blueprint for the reduction in the working hours of non-consultant hospital doctors and provides a model for developing services in the regions around the country which includes doubling the number of consultants;
—notes the reduction in waiting lists, and in particular notes the significant reductions achieved in the last year in the number of adults waiting more than 12 months for in-patient treatment in certain specialities, e.g., cardiac surgery down by 78%, gynaecology down by 65%, vascular surgery down by 60%;
—commends the national treatment purchase fund for arranging treatment for over 11,000 patients since July 2002;
—acknowledges the 34% increase from 1,292 to 1,731 in consultant numbers which has taken place in the last six years;
—notes the 32% increase in the number of nurses since 1997;
—endorses the Government's investment in providing an extra 568 beds for public patients only;
—acknowledges the investment of €46 million into GP co-ops which has provided 24 hour GP availability around the country;
—notes the investment of €400 million in the development of appropriate treatment and care services for people with cancer. This includes an additional 85 consultants;
—commends the €54 million investment in the cardiovascular strategy which has resulted in a 200% increase in cardiology procedures and the recruitment of 109 cardiac rehab staff, 139 health promotion officers and 17 consultant cardiologists around the country; and
—commends and supports the Minister for Health and Children in his approach to modernising the health system through the development and implementation of strategies underpinned by solid investment."
—(Minister for Health and Children).

I wish to share time with the Minister of State, Deputy Callely, and Deputies Nolan, Dennehy, O'Connor and Devins.

I welcome the opportunity to reply to the motion. I commend the strategic and forward-looking approach of the Minister, Deputy Martin, who spelt out a series of major initiatives and improvements in health care that have been implemented since 1997. I wish to address some specific issues to further illustrate the commitment the Government has shown to developing health services.

Deputies opposite raised a number of issues in regard to mental health and I wish to respond to some of them. Deputy Neville spoke at length on the issue of suicide, which is a serious social problem in this country. In 2002, 451 deaths were due to suicide, an increase of three on the 2001 figure of 448. The high incidence of suicide in the general population is not confined to Ireland, it is a growing global problem. Apart from the increase in the overall rate of suicide here, a disturbing feature is the significant rise in the male suicide rate. Young males have shown a significant increase in the rate of suicide. These are worrying trends which require further research so that better strategies are developed to help those particularly at risk.

The Department of Health and Children has given special attention in recent years to the resourcing of suicide prevention initiatives. Since the publication of the report of the national task force on suicide in 1998, a cumulative total of more than €17.5 million has been provided towards suicide prevention programmes and for research. This year more than €4.5 million is available to the various agencies working towards reducing the level of suicide and attempted suicide. This includes funding to support the work of the health boards, the national suicide review group, the Irish Association of Suicidology and the National Suicide Research Foundation for its work in the development of a national parasuicide register.

Contrary to what Deputy Neville suggested, considerable progress has been made in the implementation of the recommendations contained in the report of the task force on suicide. Ongoing strategies and prevention programmes across the health boards are continuously reviewed by the national suicide review group and are reported annually in its annual report. This report is laid before the Oireachtas each year and meets the requirement of the Health (Miscellaneous Provisions) Act 2001, which provides that the Minister for Health and Children will make a report each year to each House of the Oireachtas on the measures taken by health boards in the preceding year to address the problem of suicide.

To further develop suicide prevention programmes, the Health Boards Executive, HeBE, in partnership with the national suicide review group and supported by the Department of Health and Children, has commenced work on the preparation of a new strategic action plan for suicide reduction. This plan will be action-based from the outset and will build on existing policy as outlined in the national task force report in 1998. All measures aimed at reducing the number of deaths by suicide will be considered in the context of the preparation of this action plan.

The issue of mental health services for prisoners was also raised, which is of particular concern to the Government. As the prison population has expanded in recent years, the services of the Central Mental Hospital have come under increasing pressure, resulting in delays in the transfer of mentally ill prisoners to the hospital. In 2002, the Government established a special committee to draw up a service level agreement on the admission of mentally ill prisoners to the Central Mental Hospital with a view to eliminating these delays. The committee comprised representatives from the Department of Health and Children, the Irish Prison Service, the East Coast Area Health Board and the Department of Justice, Equality and Law Reform. The service level agreement was finalised in 2003. This year, additional funding of €1 million and capital funding of €1 million is being provided to the Central Mental Hospital to allow measures to be taken to increase the hospital's capacity to admit prisoners with a mental illness.

A project team on the redevelopment of the Central Mental Hospital held its inaugural meeting in February 2003. The team's remit is to critically examine all options for the redevelopment of the hospital. Representatives from the Department of Health and Children and the Irish Prison Service are on the project team and they participate in the team's meetings. The project team is due to report in the coming months.

Since 1997, in excess of €80 million in additional revenue has been invested in mental health services. The total annual revenue spent on mental health services is now over €600 million. This has allowed for developments in programmes such as child and adolescent psychiatry, psychiatry of later life, liaison psychiatry, rehabilitation psychiatry and suicide prevention programmes and support for the voluntary sector.

Under the national development plan, capital funding of €190 million is being provided to develop mental health facilities. This will aid the development of acute psychiatric units linked to general hospitals as a replacement for services previously provided in psychiatric hospitals. The plan will also provide for more community facilities such as mental health centres and community residences, which will accelerate the phasing out of the old psychiatric institutions.

The national health strategy, Quality and Fairness —A Health System for You, recognised the need to update mental health policy to take account of recent legislative reform, developments in the care and treatment of mental illness and current best practice. In fulfilment of this commitment, an expert group on mental health policy was established in 2003 to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future. The expert group will examine all aspects of mental health care and treatment, including many of the issues raised by Deputy Neville. The group requested submissions from interested organisations, individuals and the general public in October 2003. In excess of 140 submissions were received. These submissions are now being considered by the members of the group. The expert group is expected to complete its report by June 2005.

I emphasise the Government's commitment and my personal commitment to the further development and improvement of the mental health and suicide prevention services in the coming years. The Government's record to date in investing in services for people with disabilities is concrete evidence of its ongoing commitment to improving access to the necessary supports for these individuals and their carers. It is our intention to continue this commitment.

It is easy for a party on the Opposition benches to table a populist motion on health. It is one we could debate every day of every week in the House, but this would involve much repetition. I compliment the Minister and the Ministers of State for their work in improving the health service. There is no substitute for a sustained programme of investment and reform in the Department of Health and Children. The Government parties are the only ones interested in developing the health services rather than just using it as a political football, which has been the case to date with the Opposition.

That is provocative stuff. Who wrote it for the Deputy?

The sole object of the Government's policy is to develop a basic service where employees are enabled to work to the best of their abilities and where every patient has equal access to high quality care. Every Deputy and public representative comes across individual cases where services are not available as quickly as they would like. That will always be the case. Deputies on the other side of the House should not fool themselves in thinking things would change overnight if they got into Government. They should not fool the public either.

No, but it will not take seven years.

The Government has increased the level of health spending by over 188% since 1997 and it will continue with this unprecedented investment. The ten-year health strategy that was announced should be read repeatedly by some of the Deputies. One area in which there was much progress was the out-of-hours doctor service, of which I have first-hand knowledge. It was a pilot scheme introduced in the South Eastern Health Board region and has expanded throughout that region. There is some out-of-hours doctor service in each health board area at present. I understand that the scheme has full coverage in the North Western Health Board area.

The ten-year health strategy sets out a programme of investment and reform that will stretch over the next decade. It provides for the largest bed capacity expansion in the history of the health service. A sum of €118 million was provided —both capital and revenue —to meet the first phase of the programme, which will provide a total of 3,000 acute beds over the period to 2011. The Department has been informed by the Eastern Health Authority and the health boards that 568 additional beds have been commissioned to date. Funding is in place to support the commissioning of over 700 beds under this initiative.

As I stated, we could talk about this issue every day and still not make progress. The Government has shown its commitment by investing heavily in the health services. I compliment the Minister and the Ministers of State on the work they are doing.

There are 18 subsections in this motion and I can only consider one or two of them in the five minutes allowed to me. I will touch on the all-Ireland approach and the issue of waiting lists. When I deal with performance-related issues in the House and when I speak on motions, I try to make comparisons between office holders, but I cannot do so in respect of Sinn Féin Members of the Oireachtas because they have not had ministerial portfolios in the State. However, the days of Sinn Féin members being critics on the sideline are over. They have held ministerial portfolios in the North and therefore they are now open to comparison.

For obvious reasons, one of the politicians I study most and with whom I am mostau fait is my constituency colleague, the Minister for Health and Children, Deputy Martin. I am a great admirer of his work. I compared him with his counterpart in the North, the Sinn Féin MP, Bairbre de Brún, to see how both had handled their health portfolios.

As Deputy Nolan stated, when others come into office they may make promises. Bairbre de Brún held her Ministry for almost four years, from November 1998 to October 2002 —obviously, this period allows for a fair comparison —and while Ms de Brún was Minister for Health, she presided over what I saw as a real rather than a fictional health crisis, which involved waiting lists at record levels, the closure of acute services at local hospitals and the imposition of severe budgetary limits.

In 2002 there were 58,000 patients on hospital waiting lists in Northern Ireland, which was more than double the number on the waiting list in the South at the time. The waiting period for treatment in the North was the longest in the European Union. In 2001, there were just over 50,000 on the waiting list. Bairbre de Brún promised she would reduce this to 48,000, which is a modest target by anyone's admission. However, instead of a reduction there was a rise of about 8,000.

The number waiting for more than 12 months for cardiac surgery and for more than 18 months for other specialities rose by 2,124 when Sinn Féin was in office. When asked about these disastrous figures during the last election —I remember the interview —Ms de Brún seemed to be very complacent and stated her target for the next year was to prevent waiting lists becoming longer by keeping them as they were.

We can make comparisons. I have more figures, which are publicly available if people wish to know how different parties compare.

They are, but the Deputy is not comparing like with like.

Allow the Deputy to continue without interruption.

I must be hitting some target as some shots are going home. The Deputy is getting a bit worried.

I have no problem with the Deputy's contribution but he should tell the whole story.

I heard Bairbre de Brún place all the blame for the crisis in the health service on the decisions of the Tories in the 1980s. This sounds fairly familiar. The private profiteers certainly milked the health system and most people are aware of the private finance initiative, which really milked it. There was chronic bed shortage in the hospitals. In the South, people got elected on the hospital issue but the most recent election on the island was in the North. Amazingly, in that election Sinn Féin lost a seat to a hospital candidate.

That is wrong. On a point of information, Sinn Féin did not lose a seat——

No points of information are allowed. The Deputy will have an opportunity to contribute at the end of the debate.

As a member of the British-Irish Interparliamentary Body and a chairman of a sub-committee——

The Deputy should state the facts.

Deputy Ó Caoláin's party shouted people down for 30 years, but he will not do it now. As a member of the British-Irish Interparliamentary Body and a chairman of a sub-committee, I drew attention to the need to have an all-Irish practice. I mentioned the issue of tourism in this respect last week as I was chairing one of the three committees. Not everybody participated but we encouraged those who did to get involved.

I know the Minister was very strong regarding the all-Ireland approach, which was mentioned specifically. It is interesting to note that Sinn Féin always calls for this, but when in power the Minister for Health in the North, Bairbre de Brún, was accused publicly of failing to engage with the Government to create cross-Border health services. This is a fact.

Now the centralisation of hospital services is on the agenda, as well as health care for all.

The Minister, Deputy Martin——

Allow Deputy Dennehy to continue.

There was plenty of consultation but no decisions were made. This is why I would like to compare like with like. The days of sitting on the sideline and saying improvements would be made if one held ministerial office are over. Sinn Féin has elected representatives in this House, regardless of whether it likes it. More importantly, it was at the ministerial table in the North and its record on health is open to examination.

If Sinn Féin tables more motions, we will be able to examine its other ministerial portfolio in the North and we will be delighted to make similar comparisons. Sinn Féin failed badly and when it attained a position of power it did not use it, as the figures suggest.

I was tempted at one stage to second the motion in the belief that I might get Sinn Féin out of my way. I am sure that would not have worked out either. I commend the Minister, Deputy Martin. He has done a great job, far better than his Sinn Féin counterpart in the North. I wish him well and long may he continue the work he is doing.

Full marks for the Fianna Fáil researchers.

Having listened to the debate, I am happy to say I must be the only person who has a perfect relationship with the Deputy's party colleague in my constituency. I thank our Sinn Féin colleagues for tabling this motion, as the Minister did last night. I am very sad Sinn Féin spoiled what might have been a decent enough motion by demanding the resignation of the Minister. That was uncalled for. I believe very strongly that the Minister, Deputy Martin, is doing a tremendous job for this country. We should be wishing him well and encouraging him to do the job we all want him to do.

I remind my Sinn Féin colleagues and Deputy James Breen that I am a sensitive soul and I hope they will not heckle me too much but let me get through my four and a half minutes.

I speak as somebody with experience of the health service. I had a heart attack five years ago and thank God I survived it. I was treated well in Tallaght hospital. I had a little problem a few months ago and ended up on a trolley for the best part of two days in that hospital and therefore I can speak with experience other than my experience as a public representative. I am not a bit afraid to speak about my experiences and raise issues on behalf of my constituents in Dáil Éireann, as I do every day. I try to do so in a positive way, but I am not afraid to admit, as did the Minister last night, that there are difficulties, and we should proceed with that in mind.

It is a shame I have only a few minutes, but I want to talk about the hospital in Tallaght. Some will know that, with other colleagues, including Deputy Crowe, whom I am happy to see in the House, I represent the Tallaght area. We campaigned for a long time for a first-class hospital. It was opened in June 1998 and has made a tremendous contribution to the health and well-being of a wide catchment area. For those who do not know much about Tallaght and the surrounding area, not only does the hospital, which is an amalgamation of the Adelaide, Meath and National Children's Hospitals, cater for Tallaght, which is the third largest population centre in the country, but for the catchment area which stretches all the way down through Wicklow, into Carnew. It caters for a wide area, is doing an excellent job and has rendered good service to the country in the six years since it opened. The hospital treated 183,000 patients in 2000 in comparison with 163,000 who attended when it first opened in 1998. The Ceann Comhairle knows a great deal about the hospital because as Minister for Health he was one of the enlightened Ministers who in the early days of the administration of 1987 backed the hospital when many people said the people should go to Blanchardstown.

Tallaght hospital is a success. Recent developments there include very positive progress in urology, the breast treatment clinic, which deals with 1,200 new patients annually, the new Ulysses pain management programme, the back pain clinic, the diabetes shared care project, the patient first project, which was very exciting, the National Children's Hospital and the adult accident and emergency department which, as other colleagues will testify, is very busy but is doing its job in a positive way.

A patient liaison officer was recently appointed to Tallaght hospital, which many colleagues will welcome and which hopefully will be taken up in other hospitals. The hospital has shown the way in patient development and we should applaud the work done there. Whatever is happening in the background in regard to the proposed merger between St. James's Hospital and Tallaght hospital, it would be positive for Tallaght hospital. It is very important Tallaght hospital is not downgraded and those negotiations should take account of the concerns of patients and the staff who manage the hospital. I look forward to the Minister keeping us informed in that regard.

I am delighted to have the opportunity to speak on this motion. It is somewhat amazing that the proposers of the motion should be so out of touch with what is happening in the health service that they would put down such a motion. It is all the more amazing when one considers the performance of their party's Minister for Health in the last Northern Ireland Assembly. She was the Minister from November 1998 to October 2002 during which time she presided over the lengthening of waiting lists from 50,000 in 2001 to 58,000 in 2002, making it one of the longest queues in the European Union. They must live in never never land, with their eyes and ears closed to the real improvements that have occurred in the health service in the Republic.

Two aspects of the health service indicate clearly the dramatic improvements which have occurred. In 1999 the Government launched its cardiovascular health strategy. Since then €54 million has been invested in its implementation, 800 new staff have been employed of which 17 are additional consultant cardiologists. This has resulted in a very real and substantial increase in heart diagnostic and treatment service. It has also resulted in more accessible, equitable and better quality care for patients with cardiac conditions. Heart disease has been a major cause of mortality and morbidity in Ireland for far too long. The Government is committed to dealing with this growing scourge. The announcement on Monday of the appointment of two additional cardiologists and a cardio-thoracic surgeon to University Hospital Galway is an example of this commitment.

The proposers of the motion do not want to acknowledge these dramatic improvements but the people in the west are delighted with the new services. No longer must patients travel to Dublin for invasive investigations and very soon cardiac surgery will be undertaken in the west. Great work is being done in Galway and Sligo hospitals in the field of cardiology, particularly by Dr. Kieran Daly who, since his appointment as cardiologist in Galway, has spearheaded the drive to make University Hospital Galway a leading institution for cardiac disease prevention and treatment. Craoi too has played an important role and is an example of people supporting their local hospital's quest to provide the best possible service.

Until recently waiting lists were on an upward curve but that has been reversed and now, in most cases, any adult waiting longer than six months and any child waiting longer than three months for surgery will be facilitated by the national treatment purchase fund. The Minister provided approximately €31 million for the fund in 2003 to help reduce waiting lists. That and active intervention at local level have resulted in this dramatic improvement which contrasts sharply with the experience in Northern Ireland under the tenure of the Sinn Féin Minister for Health. The Opposition does not want to acknowledge these improvements and many others that have occurred in the health service during the reign of Deputy Martin as Minister for Health and Children. I reject the motion and commend the amendment to the House.

I am happy to have the opportunity to speak on the provision of services for older people. When I travel the country I meet thousands of people who bring to my attention the good work and services that most people appreciate. Despite all the Opposition has said there is a good and bright side to the picture. There are gaps in services and variances between the regions but we can and will address these problems. We have outlined how best to address this in our health strategy document, Quality and Fairness — a Health System for You. Every Irish person wants to see a first-class health service in place. While most people lead an active and healthy life, there is a sizeable minority who will require some service at some time, and we all want the comfort of having that service available when and where it is required. The health strategy makes clear the Government's commitment to continuing to reshape service delivery and further develop services to reflect the strategy's underlying principles.

Our health strategy is of particular significance in the development of services to older people. The principles of service delivery are the provision of community supports and strengthening primary health services to allow people remain in their own homes for as long as practical, with dignity, independence and a good quality of life. This also requires provision of high quality, non-acute residential services for older people offering the full spectrum of services and involving older people and their representatives in the planning and development of services for them.

The Government demonstrates its commitment to services and these principles by the actions and resources made available in recent years for service development. Community supports are vital to maintain older people in their own homes for as long as possible. Long-stay residential care should be a last option in care planning for older people, with the real community supports for older people who wish to live in their own homes. Numerous studies have highlighted that older people would prefer to remain living at home rather than go into long-stay care. The Government is committed to developing the various community needs and home support schemes required.

Since my appointment as Minister of State, I have been encouraging service providers to introduce personal care packages and home subvention for older people as an alternative to long-stay residential care. Personal care packages are specifically tailored to meet the individual's needs and will prove to be hugely beneficial as they are rolled out.

Members will also be aware that I established and chair the interdepartmental group on the needs of older people. This group is to examine a range of issues that impact on the lives of older people. Its goal is to bring a positive influence to bear on the various services provided to older people.

I am proud to stand over our record. Since 1997 the Fianna Fáil led Administrations have increased spending on care services for older people by nearly €300 million. It is a pity I have run out of time as I had considerably more to say.

The Minister was enjoying it.

I wish to share my time with Deputies James Breen, Harkin and Gregory.

Is that agreed? Agreed.

I will cover four major topics. In 1997 some 30% of the population had medical cards. While this figure is now below 30%, when allowance is made for those over 70, fewer than one in four people have a medical card on income grounds alone. A further 200,000 medical cards would cost the Exchequer approximately €140 million per year. If we were to give medical cards to additional patients even in 2005, we would need to make allowance for that in this year's budget. Due to the huge costs involved, this issue must be addressed now. It will not be addressed on a whim some time next year. This issue has gone on for far too long. It is a matter of major urgency for all our patients that we are depriving so many people of medical cards. It is a disgraceful service.

Members on the Government side have referred to the good things that are supposed to have happened in the health services. While certain good things have happened, under development of specialist services in the regions outside Dublin, Cork and Galway persist. While the media mainly focus on accident and emergency departments and maternity services, there is under development of services across all specialities. Given that even the Hanly report indicates where these deficits occur, it should be blatantly obvious to anybody in the Department of Health and Children.

How will the recommendations of the Hanly report be implemented if we do not discuss industrial relations issues? I will overlook the GP issues, which will be a problem in five years time. I will forget about trying to train the ambulance service and just focus on the consultant's contract. If there is no change, thestatus quo will remain. If more than half the consultants work in Dublin, Cork and Galway, there is no reason for them to help the Department of Health and Children in changing their contracts to implement the Hanly recommendations. I do not see how the Hanly recommendations will be implemented purely on the consultant contract issue alone, forgetting about GPs and the ambulance service.

Objection to the two-tier health system seems to have cross-party support. Last week during the debate on the Finance Bill, the Minister for Finance, Deputy McCreevy, said he would welcome a meaningful discussion on altering this system especially when the taxpayer is paying for the public service and the Minister is giving tax concessions to the private sector. We know it is responsible for gross inequality in our health care system and people are being disadvantaged. The chairmen of the Oireachtas committees on Finance and the Public Service, and Health and Children should initiate an urgent discussion on this fundamental policy matter as to how we organise our health services. I am surprised the Government has not taken the initiative to have some discussion on the issue at this level.

Dublin has five public hospitals and we are told there is a bed crisis. However, 30% of those beds are given to private patients. There are three private hospitals in Dublin alone. This matter does not seem to come up for discussion and certainly was not addressed in the Hanly report. I discussed this matter earlier with the Minister for Health and Children, Deputy Martin, during Priority Questions.

I am resigned to acknowledging that there will be no radiotherapy unit in the south-east in the next 15 to 20 years at least. I will have to encourage the people in the south-east to establish a charity foundation as has been done in the Mid-Western Health Board region and encourage the health board to allocate a site at Waterford Regional Hospital. Like many services provided by voluntary organisations, we will have to reach out to the generosity of the people to see if this service can be provided for the patients in this region.

Much has been made of the improvements in the health services. However, we lack a policy to take us through the 21st century outlining how we will organise our health services. The present system of depriving the most needy of a medical card and the disjointed way of running public service hospitals with consultants with private contracts in other hospitals, and public beds used for private patients with no system of accountability as to how this is organised is a recipe for disaster and it results in inequality.

I am glad to have the opportunity to speak on this motion, which has my full support. I have listened to the Minister trot out figures indicating the billions that have been spent on health since 1997. I ask the Minister to come clean and acknowledge that this money has been unwisely spent and squandered. During my youth I read Lewis Carroll'sAlice’s Adventures in Wonderland. If Lewis Carroll had been in this House last night, he could have penned a new book entitled “Minister Martin in Wonderland”.

In the Minister's contribution he claimed there was a 130% increase in occupational therapists, 71% increase in language therapists and 37% increase in medical and dentistry workers. I would like to know where all this staff is based. They are certainly not in County Clare. I know of people who have been on waiting lists for more than six months waiting to see occupational therapists. I do not even mention the people who need to be seen by these professionals to have work carried out in their houses under the essential repairs grant scheme. A huge number of school children are waiting to see speech therapists. Those lucky enough to be seen get therapy on a fortnightly basis. This service does not go far enough to meet their needs. Young children have to wait up to six years for orthodontic treatment having waited years for their assessment. The Minister should speak to their parents and explain where these professionals are situated.

On a visit to Ennis General Hospital four years ago, the Minister committed £15 million to upgrading the hospital. It was an empty promise. Now as we approach the local elections, the Minister has given the go-ahead for a design team for Ennis General Hospital. What future has this hospital according to the Hanly report? That report clearly states there will not be 24-hour accident emergency cover in the hospitals in Ennis and Nenagh when its recommendations are fully implemented. Mr. Hanly confirmed this to me at last week's Mid West Regional Authority meeting in Kilkee. This is not good enough for the people living in these two areas as evidenced by the thousands who turned out to protest at the downgrading of these essential services. The people of Clare will not stand idly by while resources and money are ploughed into other services and their health services are downgraded.

The Minister claims that waiting lists have been reduced. However, I know of people who have been waiting 12 months for hip operations. What hospital waiting lists have been reduced? Perhaps I could recommend that my constituents in need of care apply for their surgery. The Minister said radiotherapy services are being considered for Waterford, Limerick and the north-west. That is not what the people want to hear. Why is the Minister failing to guarantee the unit in Limerick where £600,000 had been collected to provide this much needed service?

The Minister might deny there is a two-tier health service. He should wake up from the dream, leave wonderland and the fairytale behind and face the reality that is this country's health service. Those who have money and can afford to pay for treatment will get it instantly and, it is hoped, live happily ever after. For those who have a medical card, the outcome is not so rosy. They must wait in the dungeon that is called the waiting list.

No one is expecting the Minister to wave a magic wand. On behalf of my constituents I ask the Minister to make one wish come true by giving favourable consideration to the setting up a dementia unit at the Clare care centre in Clarecastle. As I have already stated in this House, €200,000 has been collected voluntarily for this project.

I wish to record my support for this motion, in particular the assertion that the current two-tier system should be phased out. I particularly resent the Government amendment which hypocritically claims to be committed to the provision of high-quality care for those most in need and to have a key objective of equity of access underlining its health strategy. Nothing could be further from the truth. Equity of access to health care simply does not exist in this State for the public patient who must endure the demeaning indignity of the waiting lists at our public hospitals, the trolleys in the corridors and waiting areas at accident and emergency units.

I wish to refer briefly to the case of one constituent whose family contacted me this week to ask me to help their son whom they feared might become suicidal because of his urgent medical need. That young man, in his early 20s, had been admitted to the accident and emergency unit of a major Dublin hospital in June of last year. By the time he was seen, having spent Sunday and part of Monday in casualty, his condition required immediate surgery and a colostomy operation had to be performed. For a young man, this was psychologically as well as physically traumatic. However, he was assured that a reverse procedure would be possible and would be carried out within two to three months. That young person counted every day until the three months was up. He heard nothing and contacted the hospital only to be told that there were no beds, a ward had been closed and he would have to wait. He waited and heard nothing. Today, nine months later, that unfortunate young man is still waiting, despite repeated calls to the hospital and the traumatic nature of his condition. The answer remained the same. There were no beds available for a patient who, like him, would require to stay for seven days or more.

When his family contacted me I checked with the hospital administration and was given the same response. I spoke to his consultant who told me that the chances of getting him in were remote. Wards were closed, beds were in short supply and taken up by accident and emergency and urgent cancer patients. Incredibly, no one had advised this young person, even at that stage, when he had been waiting for six months, to apply to the national treatment purchase fund. I put him in touch with that service. Again he was told he would have to wait in the hope that it would provide the hospital care he desperately needs.

How does that person's appalling saga rank in the Government's notion of equity of access, not to mention quality health service for those most in need? How can any Minister for Health and Children stand over that situation? Is that what the Minister for Health and Children, Deputy Martin, is commending to this House?

I was totally incensed by some of the words of the Minister, Deputy Martin, last night but because of time constraints I will simply confine myself to his reference to the big story for the west. He told us we have a full range of services in place. I invite the Minister to the west to see for himself because either his backbenchers from the west are misleading him or it is a case of there being none so deaf as those who will not hear.

I will make a two-minute visit to the west and north-west. In recent days a report emanating from the medical adviser of the Northern Eastern Health Board indicated that major surgery should be taken out of Cavan General Hospital. Across the county boundary, Monaghan General Hospital has been off call since July 2002. If somebody suffers a serious illness in Monaghan, he or she is brought by ambulance to an already overcrowded and overworked hospital in Drogheda. The Minister says there is a full range of services. In reality, there is hardly any service.

In County Mayo, if a person is unfortunate enough to fall and break a leg while climbing Croagh Patrick, there is no orthopaedic service in Castlebar General Hospital and he or she will have to travel to Galway. People who are not from the west do not realise that the distance from north Mayo to Galway is roughly the same as the distance from Dublin to Galway. Consider what it would be like to break one's leg in Dublin and have to travel to Galway for treatment. Deputy Breen has outlined the system in Clare, so I will not go into that.

I want to examine the situation in my constituency of Sligo-Leitrim. I acknowledge that genuine efforts have been made by the North Western Health Board under severe constraints to improve the services at Sligo General Hospital and I acknowledge the provision of a new oncology department with excellent and committed staff. However, we still await the operation of a chemotherapy clean room. We have no timeframe for the roll-out of BreastCheck, despite the Minister's promise. Before Christmas there was a nine-month waiting list for results of smear tests. We still await a radiotherapy service and accommodation in the renal unit in Sligo General Hospital leaves much to be desired. There is also a real fear in Sligo General Hospital that its services will be downgraded. I ask the Minister for a commitment that, rather than the services at Sligo General Hospital being downgraded, the hospital will be enabled to continue to develop and expand.

Let me bring to the attention of the Minister a letter from 19 members of Club Cluainin in Manorhamilton, County Leitrim. I received it on 24 February this year. They stated that when Deputy Martin announced on national television that under the Hanly report no accident and emergency department at any hospital would be closed, they could not help but wonder what he was really saying as they had seen and experienced on a daily basis over the past two years the closure of their accident and emergency service and the scaling down of their community hospital and adjacent nursing home facilities. That is the level of services to the communities in north Leitrim. If the Minister tells us that we have a full range of services in the west, that is another example of what the Minister accused the Opposition of last night, namely, crass misrepresentation.

As my colleague, Deputy Gormley, said last night, the Green Party strongly supports this motion. It highlights one of the many reasons for deep cynicism among the public regarding this Government. The promise to abolish waiting lists in two years sounded fanciful but it is completely fanciful when one sees that now there are more than 27,000 people on the waiting list on the eve of the end of that two-year period.

In the meantime, an issue that does not get enough attention when we are talking about funding and the politics of health, is the level of suffering which I have encountered travelling around the country. This is particularly the case in Waterford where oncology and radiation services are not available and where ambulance trips to Dublin perhaps five times a week are required. When the patient gets to Dublin he or she is brought from hospital to hospital because the ambulance is effectively a bus bringing a number of patients to different services. The physical pain as well as the time and the huge expense of that does not seem to be factored into the Government's plan for regional health care in the rush to centralise on the basis that consultants in some cases want that type of central organisation. It is strange that the Government does not see the bigger picture.

Others have talked about different hospitals. I was in Monaghan General Hospital a number of months ago. There is a deep concern for quality of patient care in that area if patients have to go, for example, to Our Lady of Lourdes Hospital in Drogheda and are expected to make their own way home, as has happened. It is a matter of considerable distress and frustration for the people who are working in various hospitals around the country.

Ennis is another example. People in Kilrush and Kilkee are extremely nervous about the possible downgrading of the accident and emergency department there. It is likewise in Bantry and even in Tallaght, Beaumont and St. Ita's in my constituency. These areas have their own story to tell and they all add up to a considerable abrogation of responsibility on the part of the Government. That is a firmly held belief which can be confirmed by going to individual houses around any constituency.

I spoke to the family of a woman in Garristown who has an intellectual disability and who cannot gain access to a day care centre, even though there is one down the road in County Meath. Due to the fact that she lives in County Dublin, because of bureaucracy she cannot be admitted there. There is a level of inflexibility and intransigence in the health service which is in need of reform. There is no doubt that such reform is not happening.

The quality of life indicators about which we in the Green Party often talk are a clear measure of the areas on which the health service needs to focus and in respect of which the Department of Finance needs to take note. If one listens to the Minister for Health and Children talk about investment in the health service, one would think that he is the Minister for Finance. The quality of life indicators show that, regardless of the amount provided, the funding is not working. Asthma is on the rise. In 1983, 4% of children presented with asthma, in 1992 the figure rose to 11.5%, in 1998 it rose to 18% and it is now estimated to stand at approximately 29%. Anti-microbial resistance is also on the rise and drug use and abuse of alcohol are also serious problems.

Smoking should be taken into account in the quality of life indicators. I applaud the Minister on the smoking ban and the reduction in the level of bronchitis. Ultimately, however, many of the trends, including that relating to obesity, are going in the wrong direction. That is a real indictment of the Minister.

I wish to share time with Deputies Upton, Sherlock and O'Sullivan.

I listened with interest to what the Minister had to say in respect of his portfolio and I honestly want to believe what he said about the various aspects of care and attention available to senior citizens, but unfortunately the reality does not measure up to that which he outlined. There are major and ongoing problems for senior citizens. Let us consider, for example, the case of a senior citizen trying to reside on his or her own. The home help system has been reduced dramatically in my area and the level of service provided is on the basis of one and a half hours per day per five-day week. There is only one home attendant in the entire area who must try to deal with all the senior citizens who live there.

When these people can no longer be cared for in their own homes and are obliged to seek the nursing subvention or the enhanced subvention, their families and loved ones encounter major difficulties. I have checked with all the nursing homes in my area and found no evidence that there is a three-tier payment in respect of nursing home subvention. There is the first payment of approximately €146 which rises to a maximum of €192. However, that is not reflected anywhere in the figures one obtains from nursing homes. They tend to quote one figure and that is all.

If one considers that figure, the payment of €192 and the old age pension, one will see that all these people are approximately €200 short of gaining admittance to a nursing home in the least expensive part of the South Western Health Board area. The closer one gets to Dublin, the wider the gap becomes.

I have tabled questions to the Minister in recent months and it has emerged that the enhanced subvention is practically impossible to obtain. He should carry out a detailed investigation into the enhanced subvention. I am informed that, in the first instance, there is a waiting list for this subvention. How will we circumvent the problem of providing alternative secondary care to senior citizens, if it is not available in his or her own home, by getting them into nursing homes if there is a waiting list for the enhanced subvention? That is the difficulty we face. We are creating problems at accident and emergency level because many senior citizens who are admitted to hospital emergency units and who need secondary care and cannot return home are not able to gain entry to nursing homes because they or their families cannot meet the costs involved. The position regarding the enhanced subvention must be addressed. If action is taken in this area, many of the problems in respect of people lying on cots or in corridors will be dealt with.

I spoke to the general manager of Naas hospital last week and he informed me that six people there were seeking admittance to Athy. However, the respite and assessment ward at that hospital had been closed and he was obliged to try to get them into nursing homes. The latter is not feasible under the mechanism that is currently in place in respect of the nursing home subvention and the enhanced subvention.

I give an undertaking to the Deputy that I will come back to him on that matter.

There is a mechanism in place which could alleviate many of the problems relating to overcrowding if action is taken. I hope that such action will be taken in the short term. We will then see progress being made in terms of the care of elderly people in our society. There is an ever-increasing number of such individuals because people are living longer than heretofore. We must address this matter and take positive action in respect of it.

I will communicate further with the Deputy on it.

I wish to relate a number of incidents which highlight the inadequacies in the health services. A couple of weeks ago, Professor Plunkett of St. James's Hospital saw fit to activate the emergency plan because the service at the hospital was totally inadequate to deal with the number of patients in the accident and emergency department on the evening in question. Whether the plan was actually activated is irrelevant. The consultant in charge of the unit saw fit or thought it necessary to activate an emergency plan to deal with the situation because he felt that the people in the hospital were not being adequately treated. There was somewhat of a flurry in the newspapers about the incident for a day or two and then it all went away and we heard nothing further. That is the first major incident to which I wish to refer.

Yesterday, a constituent of mine informed me that her father-in-law had gone missing from a Dublin hospital. The man in question suffers from dementia and was found four and a half hours later on a public road. Nobody noticed that he had been missing for approximately three hours. This is another indicator of the inadequacy of the services being provided in our hospitals.

I had occasion last night to visit a member of my family who is currently in a large hospital in Dublin. He informed me that where there would normally be eight nurses on duty, there are only five. He had no complaints about the quality of the service being provided by those on duty and he was highly complimentary to those individuals because he said that they were stretched to the absolute limit. In effect, there were five people doing the work of eight. How can a quality service be delivered in such circumstances and is it not unfair to expect such a service from those people who are trying to deliver it under those stressful conditions?

Last week, I raised with the Minister of State, Deputy Callely, the case of a young man who suffers from Asperger's syndrome and who also has an eating disorder. It emerged that, in effect, there is no place in this country at which that individual can be treated. I stand open to correction, but I am informed that there are three public beds available in the ERHA area for the treatment of people with eating disorders. That statistic, if accurate, is appalling. In any event, the number of places available is small. The syndrome to which I refer is increasingly being highlighted and there is a need for more urgent awareness in respect of it.

In recent times I have received numerous representations from elderly people in my constituency who are dependent on the home care service. That service has fallen flat on its face and is completely inadequate. It has either been cut back or is no longer available. The latter has happened in the Terenure, Inchicore and Dolphin's Barn areas in my constituency. This is a matter of major concern to people who simply cannot manage on their own.

The question of medical cards and the income limits relating thereto is extremely serious for many families, a number of which have been significantly stressed and stretched financially because they are just above the income limit and are not entitled to medical cards. The latter places huge financial constraints on these people. The 200,000 promised medical cards must be urgently delivered to those people.

Deputy Devins referred earlier to the national treatment purchase fund. I welcomed this initiative because it at least removed people from the waiting list. However, it must be a most excessively costly way of delivering a health care service.

The motion before the House calls for the resignation of the Minister and I fully and wholeheartedly support it. My reason for so doing is that the Minister has failed to increase the income limit for medical cards. A statement issued by the Southern Health Board indicates that no provision for so doing was made in the service plan or in the plan made by the Minister in respect of the health boards. The income limit for a couple is €200, plus an allowance of €25 for each child. A couple without a medical card will pay €40 to a general practitioner and a similar amount to a pharmacist in a week. People are suffering as a result.

The Minister failed to increase the number of community hospital beds for elderly people and those in need of them were advised to go into private nursing homes. There are 400 people on the Southern Health Board waiting list for enhanced nursing home subvention, some of whom have not yet received the subvention. Many families have sold their homes to pay for beds. The Minister is in breach of the Health Act by not fulfilling his obligation to this vulnerable section of society.

As previous speakers stated, orthodontic treatment for children is a failure with families having to borrow to avail of a service which should be available to them free of charge. Last week, a family had to borrow €2,000 to pay for an ophthalmic service their consultant should have provided without charge if it was properly funded.

The replies issued by the Minister to recent parliamentary questions I have tabled on consultant staffing appointments at Mallow General Hospital, which have been due since 2001, are inadequate and unsatisfactory. There is significant opposition to the Hanly report which proposes to change the role of general hospitals which are so important to people, in favour of so-called centres of excellence. Before he resigns, the Minister should withdraw it.

I commend Sinn Féin for giving us the opportunity to address this issue. The various Ministers who have been present during the debate have heard a litany of health service failures being cited from around the constituencies and a litany of individual cases in which the health service has failed to deliver the needs of citizens.

The Government has excelled in producing reports, of which we have seen hundreds in the seven years of the current and previous coalition Governments of Fianna Fáil and the Progressive Democrats. If people could somehow cure their ills with reports, most of which are languishing on the shelves of health boards, we would have a healthy population. Nothing constructive is being done to improve the position on the ground and people continue to wait.

The two-tier health service referred to in the motion, a matter addressed in a Labour Party policy document, is growing further apart instead of converging. I agree with the comment of one of my colleagues that the commitment to equity in the Government amendment is laughable given the current circumstances. On the one hand, people in the public health system are unable to get the services they require and must sit on trolleys for days on end, while on the other, those able to pay can quickly avail of services. This is wrong and the longer we put up with it, the worse it gets because the two tiers drift even further apart.

The first two promises mentioned in the motion, to eliminate hospital waiting lists and extend medical card entitlement to a further 200,000 people, have been left aside. Two years after they were made, the waiting lists have not been eliminated and an increasing number of people are waiting for services, whether on the official lists or on the waiting list to get on to them. In a recent newspaper article the Minister referred to the Government's promise on waiting lists as an "error". How are people expected to have faith in politics if Ministers describe pre-election promises of this nature in such terms? The failure to extend medical cards is depriving families of the most basic essential services which all health systems should be providing. The current position is scandalous.

I will now address the issue of radiation oncology and the provision of radiotherapy services. I come from a region which has been forced to resort to a charity to obtain a radiotherapy service for its citizens. As a member of the health board until last June, when I gave up my local authority seat, I recall that we repeatedly proposed to provide a radiotherapy service, partially through private means. We received no response because the report on radiotherapy services was considered gospel, despite the fact that many holes have been picked in it since.

Consultants in the Deputy's region acknowledge that the report is good.

People to whom I have listened, including consultants and other medical professionals, have picked holes in it.

They said it was an excellent text.

Deputy O'Sullivan without interruption, please.

I have heard many other people state, for example, that travelling is a major issue.

The Minister should listen to some of the Government backbenchers. It would save him the trouble of going out to the plinth.

Deputies are playing politics with patients.

The director of public health of my health board produced a report which stated that 40% of people in my region for whom radiotherapy was the most appropriate treatment were not receiving it. The primary reason was that they could not travel to Dublin or Cork to receive the treatment because they were either too ill or found it too difficult to travel. Radiotherapy entails spending six weeks away from home to receive a couple of minutes treatment each day. The Mid-Western Hospitals Trust has provided money for a service, the hospital has provided a site and the Mater Private Hospital will provide the treatment. The trust must even provide the funds for the treatment of public patients in the early years of this project, which is disgraceful.

The two junior Ministers from my constituency, Deputies O'Dea and Tim O'Malley, welcomed this development on the public airwaves, having failed to secure a penny of public money to provide the service. They should hang their heads in shame. It is appalling that we are now dependent on charity to provide our health service. While I am delighted we achieved the goal of having a radiotherapy service in the region, we did so ourselves, with no help from the Department.

Will the Minister provide funding to treat public patients in the new facility? We will provide the capital funds and the site, and the service to private patients will be provided privately. I ask the Minister to provide the funds to treat public patients. I do not, however, wish to be selfish and confine my request to the mid-western region. The same should apply to the south-east and north-west, which do not have a service. I am not sure of the position in the north-east. The absence of a radiotherapy service in these regions means that people are not receiving the optimum treatment for cancer which is scandalous.

I support the comments of Deputies on the issue of elderly care. There is a large gap between nursing home subvention, even the enhanced subvention, and the cost of nursing homes. We urgently need more long-stay public beds. In my region, St. Camillus's is overflowing and many people who should be in long-stay beds are clogging up beds in public hospitals, with families worried they will not be able to pay for nursing homes.

In addition, a sufficient number of home helps and housing aid for the elderly and disabled person's grants are not available within a period appropriate to the needs of those who require them. If these kinds of supports were made available quickly in people's homes, they could frequently be discharged from hospital and live at home in their communities. Instead, we have waiting lists of one or two years and by the time supports become available, they are no longer useful because the person is already in long-stay care.

Some of them will have already passed away.

These are simple, practical supports which are essential if we are to have a health service which delivers. Unfortunately, while we have had a range of reports, the service people require is not being delivered on the ground. I hope the Minister will take on board the points made in this debate. I do not believe his intentions are bad and I honestly believe he wants a good health service. However, he relies too heavily on strategies and reports, some of which are out of touch with matters on the ground, which are not being implemented.

As elected representatives, Deputies have considerable experience of the health care deficits in our communities and should be listened to. I do not necessarily believe many of these proposals in terms of care of the elderly will cost a great deal of money but they require attention in terms of the things which make a difference to people's lives and to the quality of their health.

Will the Minister reconsider the extension of the medical card scheme to a further 200,000 people as promised by him prior to the previous general election? The percentage in that regard has decreased rather than increased in recent years. Such a decision would make a huge difference to those families just outside the income guidelines.

I am glad Deputy O'Sullivan struck a more constructive note in her conclusions. Many worthy things can be done to improve the health service. It is not a matter of litany. A sum of €10 billion per annum is being spent on the health service. That figure has increased from £2.6 billion in 1997.

Inflation accounts for much of that increase. The Deputy should give us the facts.

Members can criticise everything or we can constructively examine whether we are getting a good return for the patients and citizens of this country. We can work together in that regard.

We could meet the need.

It would be helpful if we could meet the need.

On the other hand, we can play the politics of the last trolley. That is exactly what the Opposition are engaging in.

The Minister of State is breaking my heart.

It is not about politics; it is about services.

Services are vital, I do not dissent from that.

The Minister of State does not remember when he was on this side of the House.

That is a long time ago.

It may not be long before he is over here again.

(Interruptions).

I would like to peruse——

The Minister of State should tell that to the people on the trolleys.

This motion tabled by the Sinn Féin party——

I have been watching the Minister of State working himself up to this for the past while.

I was perusing the Sinn Féin motion.

I hope the Minister of State read it because the Minister for Health and Children did not.

I did. It contains many worthy sentiments and a crucial passage which states, among other things, that Sinn Féin will introduce a truly reformed health service with care free at the point of delivery and funded from general taxation. The national health service introduced by Aneurin Bevan in Britain in 1946 is now a failure.

A health service we hope to introduce not only here but on the island of Ireland.

Perhaps the Deputy's compatriots across the Border——

Order. Allow the Minister of State to speak without interruption, please.

The Minister of State can be party to it if he wishes. We invite him to be part of it.

The Deputy's compatriots have had too long an association with the British Government and British rule——

We have seen what the British Government did with the health service not only its own country but in ours.

A Leas-Cheann Comhairle, may I be allowed to speak, please?

The Minister of State should talk sense.

The Deputy's compatriots have had too long an association with the British Government and British rule which has corrupted his party into thinking that British solutions to Irish problems work. They do not.

Indeed, they do not.

This motion proposes a discredited British solution that has no reputable precedent in international health care thinking today.

That is nonsense. It is the only possible caring solution and the only real alternative to the two-tier system that I want to perpetuate.

Order, please. Allow the Minister of State to continue without interruption.

I am concerned about the endless cavilling in this House about our health service which detracts from the tremendous work being done in that area given the resources available.

Not enough is being done.

Our doctors and nurses are doing tremendous work.

People are not-——

(Interruptions).

People have died while on waiting lists.

Members come into this House week after week cavilling about a machine here and a nurse there. We are not facing up to what our voters are telling us. A great deal of money, all from the income tax receipts of this State, is being invested in the health service.

(Interruptions).

People are demanding real health care delivery.

Week after week, there is never a constructive proposal on how this money and service can be managed——

It is in the motion and the contributions of Sinn Féin Deputies.

Excuse me, Deputy, I am entitled to speak in this House. The Deputy cannot deny me that right.

The Minister of State should also listen.

The Minister of State should address the Chair.

I will. Week after week these motions urge the Government to do this and that without a single constructive proposal on how to improve the service.

It is right and proper they are tabled. The Government is not doing anything. It is pretending to deal with the problem.

The Government is taking a hands-off approach.

The demand articulated in this motion is that nobody should pay and everyone should get everything for nothing. That has not worked in any other country.

It sounds like a Fianna Fáil manifesto. It smacks of 2002.

I regularly read it in the literature circulated in my constituency. That is not our policy. The current Minister has established a solid, strategic reforming approach to the health service. I want to reiterate that, not alone has there been an increase in funding, the reports criticised by Deputy O'Sullivan are designed to ensure we improve existing structures in our health service, that the taxpayer gets value for money expended on this service and that the services are provided where they are needed.

It is not happening.

The Opposition parties have not expressed interest in discussing those three key issues in terms of the health service.

What is the Minister of State going to do about it?

The Minister of State has not listened to the contributions of other speakers.

The Opposition is not interested in deciding where the services should be provided in the best interests of the patient as distinct from propping up its local vested political interests.

That is rubbish.

It is balderdash.

The Deputy is not interested in that. I have a passionate belief in this. The Deputy is not interested in doing a proper financial evaluation of the service and he is not interested in the reform of its structures.

Is that the best contribution the Minister of State can make?

It is more than the best. There are fundamental issues at stake in terms of the welfare of patients.

That is right.

Patients should not be used and abused for political purposes. We can either get together and sort out this service or we can go on with the same cant every week.

The Minister of State has had his turn.

He should listen to himself.

The Minister of State should withdraw that allegation.

I wish to share time with Deputy Morgan. Inné, ní raibh an fhírinne á insint ag an Aire nuair a dúirt sé nár leag Sinn Féin síos a fhís don chóras sláinte. B'fhéidir nár bhac sé, cosúil leis an duine in aice leis, an t-Aire Stáit ina Roinn, an rún a léamh ina iomlán. Dá mbéadh sin déanta aige, thuigfeadh sé cad atá i gceist againn. Bhí sé ansin soléir dó i dubh agus bán. Sé atá san fhís ná fáil réidh leis an gcóras sláinte míchothrom atá againn faoi láthair agus, ina áit, córas sláinte poiblí do chách a bhunú a bheadh saor in aisce agus íoctha as an gcóras cáineach ginearálta ina bhfuil lucht an rachmas ag íoc a chuid cothrom, rud nach bhfuil siad ag déanamh faoi láthair.

Sinn Féin proposes these fundamental reforms because it believes everyone has a basic right to equal health care. We are not alone in this belief. It is not a "loony left" notion. The international community reached that consensus on the issue more than half a century ago. The right to health is reflected in Article 25 of the Universal Declaration on Human Rights. It is also reflected in Article 12 of the International Convention on Economic, Social and Cultural Rights.

In keeping with those instruments, the World Health Organisation asserts that the enjoyment of the highest attainable standard of health is a fundamental right of every human being without distinction of economic or social condition. It also concludes that the Government has a responsibility in this area and the realisation of this right can be fulfilled only by the provision of adequate health and social measures. Yet, when we look at this State, we realise the Government is in breach of these international standards. The equal right to health care is, in fact, violated by the Government on a daily and systematic basis through its insistence on clinging to and pouring taxpayers money into a failed two-tier health care model, the same model which has created a situation where those who are ill and at risk of early death, those most in need of health care and the vulnerable are least likely to get it due to delays, shortages, inadequate provision and discrimination on the basis of inability to pay and other grounds.

Yesterday, the Minister for Health and Children said he was proud of his record and trotted out fancy facts and figures to deflect from his failures. Is he proud of the crisis in St. James's Hospital, Dublin? Last year, I asked the Minister to investigate the case of a man who died following 12 hours on a hospital trolley without being seen by a doctor. My father-in-law spent two days on a hospital trolley in an accident and emergency cubicle which he shared with a patient on another trolley having watched a Minister jump the queue. Another friend was referred to the same hospital with an abscess. Following two days on a seat in the corridor, he had to undergo emergency surgery to save his sight because the infection had spread and his face had swollen to twice its normal size.

Is the Minister proud of his Government's record on reducing the major health inequalities in this State? After ten years of the boom, he has not managed to address any of these. If he continues the way he is going, he will not address any of them and it appears likely that the situation will worsen. Is the Minister proud to preside over the appalling scandal that is the chronically under-funded and neglected mental health care service? Some reports have been lying on Ministers' desks for the past 20 years.

Health care rights for all should be among the highest priorities of any Government. For the Government of the fourth wealthiest state in the world to preside over the current state of affairs in our health care system is nothing short of a human rights scandal revealing mismanagement and incompetence of the highest order. It is on this charge that the Minister stands indicted by this House, and he should resign.

I thank all the Deputies and Ministers who contributed to this debate and to the Deputies who came into the Chamber but, because of time constraints, were unable to make a contribution.

Contrary to the assertion of the Minister, Deputy Martin, last night, this motion is as much about identifying the alternative model of health delivery as it is about failed Government policy. The Minister also claimed that we recognised none of the progress made in recent years. That is not true. In his opening remarks, Deputy Ó Caoláin specifically acknowledged such progress and commended those at all levels of the health services who have contributed to that progress with dedication. I do so again, but we cannot and will not accept the unreal picture of a health service heaven painted by the Minster last night. That is not the experience of the people we represent —those on waiting lists, people on low income denied medical cards and the people who suffer and die on waiting lists and hospital trolleys. We will continue to expose the Government's betrayal of those people.

Incredibly, the Minister stated last night that Sinn Féin was the only party in the House not to have presented an alternative budget. The opposite is the case. We are the only party in this House to have presented, since 1997, seven pre-budget submissions, including proposals on health and taxation reform. As far as budgets go, it is deeply ironic that a member of this Government should criticise us on that basis.

The Minister for Finance has admitted that he does not know the cost of the range of property-based tax reliefs for developers and property speculators which he is extending to 2006. These include tax giveaways for developers of private hospitals, which is yet another example of the private health industry being subsidised by the Government.

The Minister said we were presenting no alternative. Again, that is not true. Deputy Ó Snodaigh has just alluded to this point and it warrants further comment. It took this Government, with all of its resources, four and a half years to publish its so-called national health strategy. In the same year we published a policy document entitled Health for All. The Minister and his backbenchers should study it. We propose a model of State-funded and delivered health care instead of the grossly unequal two-tier structure we have currently.

We were accused by the Minister of being selective but absent from the Government amendment and from the Minister's speech is any reference to the Fianna Fáil promises to end waiting lists permanently within two years and to extend the medical card to 200,000 people. There was no explanation and certainly no apology to the electorate for these broken promises. Neither did the Minister address the fact that more than 45,000 people have had their medical cards withdrawn since the Fianna Fáil promises were made. He chose not to mention the fact that he had to reveal in a reply to a parliamentary question last week that just a few weeks away from the target date of the Fianna Fáil waiting list promise, more than 27,000 people are on those waiting lists.

Deputy Dennehy's contribution was so inaccurate that it scarcely warrants comment but, for the record, Sinn Féin did not lose any seats in the recent Northern elections. On the contrary, we won half a dozen extra. Would some of the Members opposite inform him of that? The comments from Deputies Dennehy and Devins regarding the performance of my colleague, Bairbre de Brún, during her term of office as Minister for Health was as misleading as it was inaccurate. Bairbre was working in a British colonial state coming off the back of Thatcher's reign of destruction and budgeted from London. This State appears to be developing some of Thatcher's policies.

Why do we not rejoin it in accordance with the Deputy's motion?

The institutions were closed down three times.

Excuses, excuses.

If they are excuses I ask the Minister of State, Deputy Brian Lenihan, to ask his colleague, the Minister for Health and Children, who is sitting beside him, about it because, last evening in this Chamber, he praised my colleague, Bairbre de Brún, and I commend him for being big enough to do that.

I am not criticising Bairbre de Brún.

Equal access to health care must be a guiding principle for all health policy.

All your guys came down lobbying——

Underlying this Government's failure to deliver an equitable, accessible health care system is its failure to accept that fundamental principle. As my colleague, Deputy Ó Caoláin, outlined last night, the core of the Sinn Féin motion before the House is the rejection of the public-private mixed model of health care, the identification of many of the inefficiencies and inequalities that flow from it and the presentation of a radical alternative. Sinn Féin is committed to working for a national health service free at the point of delivery for all citizens, from the cradle to the grave, and funded from general taxation underpinned by a right of access for all.

Follow the British.

We will deal with that.

The Minister of State would know all about following the British.

When we look at health care systems throughout the world, we see that universal provision is not some pipe dream. Political will makes it possible, but I do not see much of that on the Government benches. There exist several models for universal care where the standards are higher and waiting times lower than we have in this State. Canada and Cuba are two examples, although the Minister of State, Deputy Lenihan, said there were none earlier. We are now giving him some.

I would look to Cuba ahead of Britain.

Instead of travelling to New York to see the effect of the smoking ban there, perhaps the Minister, Deputy Martin, should have despatched the Minister of State, Deputy Lenihan, to some of those countries to examine their health care services.

Is the Deputy suggesting Havana for the cigars?

Sinn Féin is in no way unclear regarding the necessity to fund properly the national health service we are advocating. Deputy Ó Caoláin made that clear last night when he said:

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 ... Instead they would demand a rejection of funding inequity and its twin, inefficiency.

Health care cannot be subject to free market economics. This is what has been attempted. Under such a regime, the very wealthy will live and the poor will be allowed to die. This ideologically driven and blind adherence to a free market economic model of health delivery is the very thing which created one of the most inequitable systems of health care in the world, that of the United States.

All the Minister's statistics will not make any difference to the expectant mother who is forced to give birth at the side of the road in conditions reminiscent of a Third World country. It will not make any difference to low income families who cannot afford to take their children to their general practitioner because they have not qualified for a medical card. It will not make any difference to the woman who finds she has advanced breast cancer which was not caught in time because the breast screening programme has not been rolled out across this State.

All attempts at reform being undertaken are doomed to failure by the refusal to address the two-tier nature of the health system. The measures outlined by the Minister yesterday amounted to putting a small plaster on a gaping wound. We go on subsidising private health care through allowing public consultants to treat private patients in public hospitals and by giving tax breaks for private health insurance which half the people of this State have been forced to purchase.

We go on to further subsidise private health care by paying for public patients to be treated in private hospitals through the national treatment purchase fund because they cannot get beds in public hospitals which are clogged up by consultants' private patients.

The right to proper health care has been infringed by the failure to address the malpractice in the health service, including the failure to hold anyone accountable for the infection of citizens of this State with hepatitis C and AIDS; the Neary scandal where caesarean hysterectomies were carried out on women in a deliberate act of mutilation; the barbaric carrying out of symphysiotomies on women without their knowledge or consent, after they had given birth, in many cases. The procedures currently in place have not been delivering for patients.

To those backbenchers who come from constituencies where health services are being closed down, I say, now is your chance to truly represent those who elected you by supporting this Sinn Féin motion.

Amendment put.
The Dáil divided: Tá, 69; Níl, 52.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Aylward, Liam.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Browne, John.
  • Callanan, Joe.
  • Callely, Ivor.
  • Carey, Pat.
  • Carty, John.
  • Cassidy, Donie.
  • Collins, Michael.
  • Cooper-Flynn, Beverley.
  • Cregan, John.
  • Cullen, Martin.
  • Curran, John.
  • Davern, Noel.
  • Dempsey, Noel.
  • Dempsey, Tony.
  • Dennehy, John.
  • Devins, Jimmy.
  • Ellis, John.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Keaveney, Cecilia.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McDowell, Michael.
  • McEllistrim, Thomas.
  • McGuinness, John.
  • Martin, Micheál.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Connor, Charlie.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Batt.
  • O’Malley, Fiona.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Roche, Dick.
  • Ryan, Eoin.
  • Sexton, Mae.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Dan.
  • Wallace, Mary.
  • Walsh, Joe.
  • Wilkinson, Ollie.
  • Woods, Michael.
  • Wright, G. V.

Níl

  • Allen, Bernard.
  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Burton, Joan.
  • Connaughton, Paul.
  • Crawford, Seymour.
  • Crowe, Seán.
  • Cuffe, Ciarán.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Ferris, Martin.
  • Gilmore, Eamon.
  • Gogarty, Paul.
  • Gormley, John.
  • Harkin, Marian.
  • Hayes, Tom.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Kehoe, Paul.
  • McCormack, Pádraic.
  • McGinley, Dinny.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Ryan, Eamon.
  • Ryan, Seán.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Stagg, Emmet.
  • Stanton, David.
  • Twomey, Liam.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Hanafin and Kelleher; Níl, Deputies Ó Snodaigh and Durkan.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 69; Níl, 52.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Aylward, Liam.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Browne, John.
  • Callanan, Joe.
  • Callely, Ivor.
  • Carey, Pat.
  • Carty, John.
  • Cassidy, Donie.
  • Collins, Michael.
  • Cooper-Flynn, Beverley.
  • Cregan, John.
  • Cullen, Martin.
  • Curran, John.
  • Davern, Noel.
  • Dempsey, Noel.
  • Dempsey, Tony.
  • Dennehy, John.
  • Devins, Jimmy.
  • Ellis, John.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Keaveney, Cecilia.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McDowell, Michael.
  • McEllistrim, Thomas.
  • McGuinness, John.
  • Martin, Micheál.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Connor, Charlie.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Batt.
  • O’Malley, Fiona.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Roche, Dick.
  • Ryan, Eoin.
  • Sexton, Mae.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Dan.
  • Wallace, Mary.
  • Walsh, Joe.
  • Wilkinson, Ollie.
  • Woods, Michael.
  • Wright, G. V

Níl

  • Allen, Bernard.
  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Burton, Joan.
  • Connaughton, Paul.
  • Crawford, Seymour.
  • Crowe, Seán.
  • Cuffe, Ciarán.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Ferris, Martin.
  • Gilmore, Éamon.
  • Gogarty, Paul.
  • Gormley, John.
  • Harkin, Marian.
  • Hayes, Tom.
  • Healy, Séamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Kehoe, Paul.
  • McCormack, Pádraic.
  • McGinley, Dinny.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Ryan, Eamon.
  • Ryan, Seán.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Stagg, Emmet.
  • Stanton, David.
  • Twomey, Liam.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Hanafin and Kelleher; Níl, Deputies Ó Snodaigh and Durkan
Question declared carried.