Dáil Éireann debate -
Tuesday, 4 May 2004

Vol. 584 No. 5

Private Members’ Business.

Hospital Waiting Lists: Motion.

Ms McManus

I move:

That Dáil Éireann:

—notes that this week marks the deadline for the ending of hospital waiting lists following the commitment given by the Taoiseach, the Minister for Finance and the Minister for Health and Children on 6 May 2002 that, if returned to office, they would "permanently end waiting lists in our hospitals within two years through a combination of bed capacity, primary care, secondary care and targeted reform initiatives";

—deplores the failure of the Government to honour the commitment made and the cynicism displayed in making a promise that they clearly had no intention of honouring;

—condemns the continuing unacceptable waiting lists which at September 2003, the latest date for which figures are available, showed more than 27,000 people waiting for treatment, with more than 9,000 waiting for more than a year;

—calls for the immediate introduction of targeted initiatives to ensure a prompt reduction in the numbers and end the suffering and distress of so many people awaiting treatment, including:

—opening all hospital beds currently closed or under threat of closure;

—ensuring a full nursing complement in acute hospitals with waiting lists;

—tackling the crisis in accident and emergency departments;

—taking measures to relieve "bed blocking";

—providing additional new hospital beds and commissioning new units awaiting opening; and

—enhancing community care.

I would like to share my time with Deputy Sherlock.

An Leas-Cheann Comhairle

Is that agreed? Agreed.

Ms McManus

I am concerned that the Minister for Health and Children has not bothered to come to the House. He has no difficulty appearing on television and spinning yarns to the public, but he is not willing to come to the House to debate the issues which are within his remit and on which he has failed so abysmally.

This motion is tabled by the Labour Party with the sole purpose of ensuring that the thousands of patients who have been left on hospital waiting lists can finally get the treatment to which they are entitled and the justice they deserve. They have been subjected to the most cruel deception by the Taoiseach and the Minister for Health and Children who promised an end to the long wait and who promptly reneged on their word.

The latest published figures show that 27,308 adults and children are waiting to access the health care they need and 20% of adult patients are waiting for more than a year. Many thousands more are on the hidden waiting list, waiting for an appointment to see a specialist so that they can then join those already on the hospital waiting lists. All these people know that if they could afford health insurance, they would not be forced to wait, but because they are public patients, they are stuck and the Government deliberately denies them the access to health care they need.

In a panic response to this motion the Minister for Health and Children has released a statement to try to cover up the extent of his failure. The figures published at the end of September 2003 showed 27,212 people waiting. Those published today for the end of December 2003 show an increase to 27,318.

In an attempt to disguise the extent of its failure the Government has handed responsibility for the issue to the national treatment purchase fund. It, in turn, has invented a new validation system which as far as one can gather — it is all very murky and unclear — is a comparison of the actual waiting list numbers and those presenting for national purchase treatment fund treatment. The shortfall of 4,500 is not explained in any coherent fashion. We do not know if patients who are described as not available for treatment are unavailable because they are too sick to avail of care, how many have died while waiting in vain for treatment or how many have gone into debt to pay for private care. However, we know that those described as postponing treatment at their own request still, undoubtedly, need treatment and it is dishonest for anyone, including the Minister, to try to claim otherwise.

The Minister for Health and Children again makes fraudulent claims when he says health strategy targets are being met. The target set in the health strategy was that, by the end of 2002, no adult would be waiting more than 12 months. We know from today's figures that 20% of patients, approximately 6,000, are still waiting more than 12 months and that others are waiting even longer. No massaging of the figures by the Minister can disguise that fact. Many of these people are elderly and infirm. They need and deserve the best health care the country can afford.

Before the last general election, the Taoiseach promised that, come this week, no patient would be left on any hospital waiting list anywhere. The Fianna Fáil manifesto declared: "Fianna Fáil will permanently end waiting lists in our hospitals within two years through a combination of bed capacity, primary care, secondary care and targeted reform initiatives." This was a solemn undertaking made to the people. The Taoiseach said health would be the number one spending priority even if, in his own words, the economy falters. The public now knows the truth. It knows it was swindled by Fianna Fáil and that the Taoiseach made an empty, dishonest, fraudulent promise. The Fianna Fáil Minister for Health, Deputy Martin, promised 200,000 new medical cards and 3,000 new beds. These commitments were also bogus. The Fianna Fáil Minister for Finance, Deputy McCreevy, promised there would be no cutbacks. He said: "No cutbacks whatsoever are being planned, secretly or otherwise." That promise turned out to be spurious also. Immediately after the election a Government memo outlining €900 million in cutbacks was issued to the Cabinet.

Fianna Fáil has people to collude with it on its project of misleading the public. The Progressive Democrats Party has supported, every step of the way, what has been proposed at Cabinet. The Government turned its back on the illness and suffering of thousands of people waiting for health care and jettisoned its commitment. It raised medical charges, instituted a staff embargo and made savage cutbacks that targeted the most vulnerable. For 12 months before the general election of 2002, the money tap was turned on and public expenditure increased by 27%. Once the election was won, the tap was turned off and the splurge ended along with the hopes of thousands of hospital patients. So steeped in cynicism is the Government that it is now preparing for a second time to manipulate the health needs of sick people to win votes in the run-up to the local and European elections. It is again planning to turn on the money tap for electoral advantage.

The Labour Party is having this debate so that, this time, patients will not be made to suffer. We will not tolerate the brand of Fianna Fáil trickery that had Ray Burke transporting trees into a newly built housing estate for the duration of a by-election in Dublin West. Once the votes were counted, the trees vanished. The Labour Party is determined to ensure that Fianna Fáil and the Progressive Democrats do not pull the same stunt twice. This is why we have tabled this Private Members' motion: to hold the Government to account and to ensure that those in need of health care can access the care they need through the locked doors of medical units that have been callously kept closed by the Government, and through the introduction of effective measures to deal with the crisis.

This week, a confidential Government aide-mémoire was leaked to The Sunday Tribune. It sets out the stark reality that health has never been a priority for the Government. In fact, the needs of patients have been cruelly and deliberately set aside. Despite the urgent need to expand capacity within the health service, the Government decided to spend the money elsewhere. It chose other priorities. According to the aide-mémoire:

Some €400 million capital funding has been invested in a number of new health facilities that are ready for equipping, commissioning and opening. Many have been completed and have been waiting to open across a range of health care programmes. With the introduction of the existing level of service bases for conducting the Estimates process, funding was not provided for the opening of new units in either 2003 or 2004. If these units are not opened in 2004 the investment that has already been made in the units will not be properly utilised. It should be noted that there is an ongoing cost to the Exchequer in maintaining completed and vacant facilities by way of security, depreciation and other non-pay costs, for example, heating.

In other words, it is deliberate Government policy that is keeping these new health facilities closed. Not only are patients paying the price for this policy, the taxpayers are also paying the cost of unnecessary security and maintenance in unopened facilities.

Being in Government is about making choices. Instead of choosing to spend money to alleviate the suffering, pain and illness of those on hospital waiting lists, as it promised it would, the Government chose to spend the money elsewhere. They squandered an equivalent amount on an electronic voting system that was so unreliable it had to be abandoned. A ministerial ego trip became the priority instead of health. Here was a voting system that nobody wanted, nobody requested and ultimately nobody could stand over. This resulted in €50 million being flushed down the drain by an irresponsible, arrogant Cabinet headed up by a man who promised to abolish hospital waiting lists within two years.

We now know because officials from the Department of Health and Children have spelled it out in black and white that this €50 million would have opened up a whole range of new medical facilities and that had this been done, a great amount of suffering and sickness would have been alleviated. For example, the Government could have opened new and expanded accident and emergency departments at Cork University Hospital, Naas General Hospital, James Connolly Memorial Hospital and Roscommon County Hospital. Instead these units continue to lie idle.

In the meantime the crisis in the emergency services has deepened in the past two years. Hundreds and hundreds of patients have been laid on trolleys or sat on chairs in accident and emergency departments across the country. Patients have been treated on occasion in the car park of Beaumont Hospital. On 5 February 2004, in an unprecedented move, St. James's Hospital was forced to invoke its major incident plan because clinicians were simply overwhelmed by the demand. In Wexford Hospital, the situation was described as chaotic.

The Irish Nurses' Organisation itemised the overcrowding in accident and emergency departments, stating the number of patients waiting on trolleys and chairs on one day as follows: Tallaght Hospital, 42 patients; Naas Hospital, 37 patients; the Mater Hospital, 30 patients; Beaumont Hospital, 28 patients; St. James's Hospital, 28 patients; James Connolly Memorial Hospital, 23 patients; St. Vincent's Hospital, 13 patients; St. Colmcille's Hospital, six patients — a total of 207 patients on trolleys and chairs. On the same day in Limerick Hospital, 33 patients were waiting on trolleys and chairs. In Cork University Hospital there were 18 people waiting and in the Mercy Hospital, Cork another 11 patients were waiting in this way. That is the true human cost of the failure of the Minister for Health and Children, Deputy Martin.

In December 2001, in the run up to the Taoiseach's solemn promise to the people, 26,126 were waiting for hospital treatment and in the most recent figure, it has risen to more than 27,000. Hospital units have been constructed and completed that would have eased this pressure but are being deliberately kept closed. According to a Government aide-mémoire, 220 new beds could have been added to the current bed numbers, as well as increased theatre capacity for example at Our Lady’s Hospital for Sick Children, Crumlin, Limerick Regional Hospital, South Tipperary Hospital, Clonmel. There could have been increased capacity in intensive care, coronary care and high dependency units for example in Portiuncula, University College Hospital Galway, James Connolly Memorial Hospital and at Naas Hospital. We could have developed cancer services in Cork and Galway and opened new hospital buildings at St. James’s Hospital, James Connolly Memorial Hospital and Naas Hospital and we could have fully commissioned a new trauma and elective orthopaedic service at Mayo General Hospital. I have not mentioned Mullingar Hospital, because my colleague, Deputy Penrose will deal with it tomorrow, but it is probably the longest standing scandal.

It is clear the Government had within its powers the capability to address the needs of critically ill patients and patients waiting for elective procedures. It could have done what it promised, introduced improved bed capacity, primary and secondary care and targeted reform initiatives. What did it do? The Cabinet spent €50 million on e-voting machinery and €15 million on an equestrian centre. It looked after the horses and machines, but forgot about people. The Government refused to spend the money on opening health care facilities as they came on stream. Let us be clear, all the Cabinet, including the Taoiseach, the Minister for Finance and the Minister for Health and Children bear responsibility for what has happened and what has not been done.

The Labour Party raised the crisis in our health service on many occasions in the House. Our view is expressed in the motion before the House and is vindicated by the contents of the leaked departmental memo which states:

The challenges currently facing the acute hospital system include shortage of beds, unacceptably long waiting times, long delays in A & E departments, frequent cancellations of elective admissions, inappropriate occupancy of acute hospital beds, unacceptably high bed occupancy levels.

One issue that we would have added to the list is the unequal treatment between public and private patients. It skews the treatment that people can access when they need it. Treatment is not delivered on the basis of need, but on the basis of income.

Belatedly I welcome the Minister for Health and Children. I know Deputy Martin has had a busy schedule, spinning yarns to the public, but people will not be fooled by the gloss he is able to put on the bad figures.

The aide-mémoire prepared by Government officials is substantially the same as the Labour Party has articulated and repeated in the motion before the House tonight as being the outline of the underlying problems in the acute hospital services, in particular. This is in direct contrast to the smug assurances given many times in this House by both the Minister for Health and Children the Taoiseach and the Tánaiste on the state of the health service. Not only does the memo spell out the real and parlous state of the health service, it reveals the mendacity of a Government that deliberately prevented people gaining access to the new facilities that have been constructed under the National Development Plan but have been kept closed under the Fianna Fáil and Progressive Democrats Government. The memo states that €400 million worth of facilities are lying idle across the country and if they were opened they “would have an immediate impact on relieving pressure on services such as acute hospitals, services for older people, mental health services, services for persons with intellectual disability or autism and adult homelessness”.

We are calling on the Government to open these units immediately, not because there is an election in the offing but because patients needs access to health care and they have been denied this access for too long. We are also seeking in the motion that all hospital beds currently closed or under threat of closure be re-opened. Earlier this year, the Eastern Regional Health Authority promised to open 196 acute and non-acute beds. Will the Minister for Health and Children tell us how many have been opened and the current number of closed beds across the country? In recent days I have received a complaint that approximately 30 to 40 beds will be closed in Tralee Hospital for a number of months for "budgetary reasons". How can the Minister stand over such closures?

It is bizarre and perverse that on the one hand, Government policy is supposed to be committed to providing new beds, while at the same time hospital beds are closed to save on running costs. In the latest figures, it is estimated that 50,000 bed-days were lost in the first six months of 2003. When money was allocated to re-open beds to deal with this problem particularly in the Eastern Regional Health Authority area, another aspect of bed closures, the lack of nursing staff, suddenly became the issue. According to the national survey on nursing resources, published by the health services employers agency in February 2004, there are still 675 nursing vacancies. In one case alone, there are 59 vacant posts in Beaumont Hospital, one of the largest and busiest hospitals in the country where the total number of nurses fell in 2003. In all acute hospitals that have waiting lists, a full nursing complement must be guaranteed and it is up to the Government to introduce the necessary measures to meet that target. The dedication and the hard work of the existing nursing staff cannot be relied upon indefinitely to prop up a failing system. There will be no nursing graduates next year due to the introduction of a new nursing degree programme. Surely that prospect is sufficient to focus the Government on the gravity of the situation.

There is a need to tackle the blocking of acute beds by patients who could and should be in rehabilitation beds. Again, the Government promised much but did not deliver. The PPP nursing units never materialised. There are hundreds of private nursing home beds vacant, yet waiting lists for rehabilitation places and budgetary pressures determine an inappropriate use of acute beds in our hospitals.

The motion seeks that a real emphasis be put on community and primary care. Regrettably, the record shows that, far from supporting a policy shift towards primary care, all we have got from the Minister, Deputy Martin, and the Minister for Finance, Deputy McCreevy, is greater inequality and unfairness at that level of care. Today only 27.7% of people have medical cards on income grounds. This is the lowest level since the GMS card was introduced in 1972. This country has become wealthy in the meantime, yet we cannot ensure that people on modest and low incomes are protected in the way they were in 1972. In 1977, almost 39% of the population was covered by the GMS scheme. The income limits rise with the consumer price index but not with wages or social welfare rates. Fewer and fewer low paid workers have medical cards, yet medical costs are increasing much faster than the CPI. GPs' charges have increased and most of the increases are the direct responsibility of the Minister for Health and Children. He increased costs in the drugs refund scheme, accident and emergency charges and in-patient hospital care.

One family doctor said at the recent IMO conference that they have all seen people putting their own lives and the lives of their family and children at risk because they cannot afford to see a doctor. What kind of legacy is that? What Minister for Health and Children can stand over a situation where people cannot access their family doctor because of the cost of doing so? No other European country would tolerate this situation, yet the Minister can blithely continue on as if a promise to provide medical cards is something which simply exists to be broken. The Minister for Health and Children promised 200,000 new medical cards prior to the last general election. Since then the number of medical cards has decreased. There are 100,000 fewer medical cards in the system than previously. It is a scandal that low income families, living in one of the wealthiest countries in Europe, cannot afford to bring their children to the doctor.

Another IMO member said, in reference to the debacle regarding the over 70's deal which the Minister bungled following the budget announcement by the Minister for Finance, that people with less need were prioritised over people with more need for purely cynical political reasons.

I have no doubt that when the Minister for Health and Children responds he will go through his usual rigmarole, explaining how more money is being put into the system and everything is hunky-dory. No doubt he will refer to his primary care strategy, but he will not tell us the fully story. He will not admit that seven of the ten primary care projects are bogged down, funding has dried to a trickle and the entire process appears to be going nowhere.

We have had, and continue to have, a Minister for Health and Children who has not dealt with the real issues in the health service, real issues that impact on patients. The record is clear. Thousands are still waiting for hospital care. There are fewer medical cards and greater injustice at primary care level. New hospital wards and operating theatres are locked and existing beds are closed. When a need has gained his attention, the Minister's response has been to commission yet another report. Approximately 147 reports, commissions and task forces have come out of his Department since 1997. I heard today that the Government is producing €1 million worth of reports each week. It would be interesting to know if that is true because I have it on good authority.

I suspect that the Minister is blinded by the flow of expert advice he had unleashed. He no longer sees the needs of patients. Today he is confronted by an increasing number of patients on hospital waiting lists and his response has been to manipulate the figures and make false claims. It is as if nothing has changed. The only difference is that in the meantime the plans have become more grandiose, more ambitious and more out of touch with what people who are trying to access health care need. This is evident in his whole approach to local hospitals and his policy of closing accident and emergency departments.

Concerns are now being raised about the Minister's approach by health professionals, people working in the health service who have knowledge that none of us here have. They are increasingly worried about his neglect of the nuts and bolts which are now slipping off the programme, particularly proposed legislation. The Government can no longer give a timeframe for such vital and basic legislation as the medical practitioners Bill or the nurses Bill. All this has been put aside while the Minister concentrates on his major health reform project.

He has no answer to the serious concerns being raised by health professionals about the working time directive to be implemented on 1 August. The Minister has made it clear that he will not seek a derogation of the working time directive, and the deadline will be met. He has made it clear that he will not appoint new junior hospital doctors. He has also made it clear that no extra consultants will be in place on this date. The question that has been asked by people working within the service, including doctors, nurses and managers, is how will this be done. The obvious way the directive requirements will be met is by reducing out-patient clinics and operating theatre hours, which means reducing patient care.

Too often patients have to pay the price for failure of Government policy. It appears that we are again facing patient suffering and patient pain being prolonged unnecessarily because the Minister for Health and Children is unable to meet the basic needs to put in place the patient-friendly and efficient measures sought in the motion before us tonight. The motion seeks to ensure that the crises in accident and emergency departments are tackled, that bed blocking is reduced significantly, new beds are put in place, existing beds are maintained and that people, including children, who get sick know they can see their family doctor and no longer put theirs or their children's lives at risk because the Government has failed to deliver on a promise made to the Irish people.

The Minister for Health and Children is continuing to spin as best he can, even though he is running out of credibility.

Mr. F. McGrath

He should resign.

Ms McManus

The promises will still be made during this election campaign. The dishonesty will persist but there is one difference to which I look forward. This time the people will not be fooled.

Mr. Sherlock

This motion deplores the failure of the Government to honour the commitments it made and the cynicism it displayed in making promises it clearly had no intention of honouring. The Government amendment refers to the health strategy, Quality and Fairness — A Health System for You, but the Minister for Health and Children knows nothing about quality or fairness. As was stated earlier, the Labour Party opposes the Hanly report which proposes to change the role of general hospitals to implement the European working time directive which requires that junior doctors work fewer hours.

It is a fact that 90% of people treated in hospitals in this country can be treated in the general hospital system without recourse to larger hospitals. The Minister proposes to change the role of our general hospitals, but it will not be easy for him. Mallow General Hospital provides acute medical and surgical facilities, including ear, nose and throat surgery. There is also a 24 hour accident and emergency service with an ambulance base and out-patient and physiotherapy services as well as a laboratory and other ancillary services.

We must not forget the human cost if this report is implemented because it will make it difficult for people living in the areas west and north of Mallow to visit relatives and friends if services are moved to Cork. This applies particularly to older people. There is a distinct advantage to patients when they are healing if their families are in close proximity to the hospital. That is what is described as a sociological argument although I do not know whether the Minister knows anything about it.

Consultants, general practitioners, nurses and the general public have opposed the Hanly proposals. If they were implemented nationally, the current network of 38 general hospitals would be reduced to 12 providing services 24 hours per day, seven days per week. The centralisation of acute care would mean that many patients would have to travel much longer distances than at present to get to hospital. The Hanly report proposes a paramedic ambulance service to cope with this problem. However, that is not acceptable because we have plenty of experience of delays in ambulance services.

I have asked the Minister many times to provide for radiologists, geriatricians and a CT scanner in Mallow. This has been ongoing since 2001. I am well aware that the chairman of Comhairle na nOspidéal is a consultant at Cork University Hospital and is a member of the Hanly group. Therefore he knows what is required. However, the body has begun to downgrade the hospital by stealth. He knew what was envisaged by the Hanly report and, consequently, no appointments have been made of a radiologist or obstetrician and no provision has been made for a CT scanner.

I hope the Minister's officials will listen to my next point. I received information from the Department of Health and Children that it costs €746 per day to treat a patient at Cork University Hospital, while at Mallow General Hospital the rate is a comparatively cheaper €475. How can one justify that with 90% of people being treated in our general hospital at half the rate? The north Cork region has a population of more than 90,000 but no extra beds are being provided in this region, especially in community hospitals, to cater for the elderly. Families have been given subvention claim forms and are being encouraged to apply for beds in private nursing homes. Subventions are not being paid which is resulting in major financial difficulties for families.

In a recent reply, the Minister informed me he had provided €21.4 million to facilitate the discharge of patients from the acute system to more appropriate settings, thereby freeing up acute beds. I will outline a number of cases which have occurred in the past week. A lady referred from the north Cork area who was a carer for her husband was told it would take until the end of 2005 before she would be seen for a gynaecological treatment in Cork University Hospital. We should think about that.

A lady from the Fermoy area whose son was caring for her had an operation in Cork University Hospital. The son was informed he had no choice other than to fill in a claim for subvention. He had no idea what that meant because they had nothing but her pension and a carer's allowance. He was told there were no beds and his only choice was to complete that form. An elderly lady of 78 years in the Fermoy area who was being cared for by her daughter was referred to Dromcollogher in County Limerick, far from her own people. Her respite care had ended there and she has now gone to Tipperary because the Alzheimer Society has provided for her there. More than 500 people are waiting for enhanced subvention in the Cork area and it is always stated that the Minister is not providing the money. The Minister is not closing hospitals but he is downgrading them to be half-way houses for half-cured patients.

In regard to the issue of medical cards referred to by Deputy McManus, an elderly lady recently cried when she went to a chemist and had to pay for what was prescribed for her family from money she could not afford because their income was marginally over the limit. A doctor's letter was submitted with her application but it was rejected. Standing beside this woman was one of the wealthiest people in the area who presented a medical card. The Minister should think about that because it is what he is presiding over. The person in question could not afford the medicine but the elderly wealthy person produced a medical card which is outrageous. I am glad Deputy McManus referred to this issue about which the IMO at national level has also spoken out. General practitioners are annoyed that their letters of recommendation are being ignored by health board officials.

This motion should not be opposed by the Government but rather taken seriously and implemented. If the Minister thinks he will implement the Hanly report in our region, he has another think coming.

Minister for Health and Children (Mr. Martin)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"commends the Government's commitment and concentrated effort to reducing waiting times for public patients and:

—notes that some €250 million was being provided to reduce waiting times for patients between 1998 and 2003;

—acknowledges the extensive additional resources which have been provided for acute hospital services since 1997 and notes that over one million patients were treated in acute hospitals in 2003;

—notes the reduction in waiting times and welcomes the substantial progress which has been made in meeting the targets set out in the health strategy, Quality and Fairness — A Health System for You;

—commends the targeted approach being adopted in relation to the long waiters to the extent that 80% of patients now wait less than one year for surgical treatment;

—acknowledges the reduction in cardiac surgery waiting lists where adult waiting lists have fallen by 90% and children's waiting lists have fallen by over 90%;

—welcomes the initiatives taken to reduce the number of inappropriately placed patients in acute hospitals;

—welcomes the initiatives being taken with regard to the staffing of emergency medicine departments;

—acknowledges the investment of €46 million into GP co-ops which provide 24 hour GP availability;

—notes that almost 600 additional acute beds were provided in 2002/2003;

—acknowledges the 41% increase in consultant numbers in the last six years and the 32% increase in the number of nurses; and

—welcomes the achievement of the national treatment purchase fund for arranging treatment for 13,000 patients since July 2002."

Tonight's debate allows me to report on the significant progress that has been achieved on hospital waiting lists. I remind Deputies that waiting lists stood at 23,000 in December 1994 when Labour and Fine Gael assumed control of the health services. In their programmes for Government they spelt out clearly, "We will continue the progress of the past two years in reducing waiting lists." Despite their pledge the waiting lists rose by 27% under the rainbow coalition, from around 23,000 in December 1994 to around 30,000 in June 1997. That was the record of the caring coalition. What was the reaction of the rainbow democratic alternative to this state of affairs? In January 1997, in the face of a 27% rise in waiting lists, they cut the funding on the reduction of waiting lists by 20%.

This Government's programme — from which the Labour Party could learn much — is founded on two key concerns: first, to invest in services and, second, to bring about significant reform. In terms of investment we have made considerable progress since the Labour Party was last in Government. There can be no arguing that this year the Government will invest almost €10.2 billion in health in comparison to a paltry £2.5 billion donated by the rainbow Administration when it was in office.

Mr. F. McGrath

People still cannot get beds.

Mr. Martin

Put simply, it is the parties on this side of the House that have increased the health spend by 188%. It might pain the Deputies opposite to admit it but the facts show that it is Fianna Fáil and our partners the Progressive Democrats who have shown the political will to reverse the historical under-investment in our health services.

Mr. F. McGrath

People are still on chairs.

Mr. Martin

The last seven years, since the Taoiseach formed his first Administration, have brought substantial additional spending on health care — on capital projects, on staff and on the day-to-day running of a continually increasing level of services. More and more patients and clients have benefited from the extra resources we have put into our health system. That is the bottom line. More and more patients have benefited, year on year. That is there for all to see.

Ms Lynch

When will the women of Cork get BreastCheck?

Mr. F. McGrath

The Minister is on a different planet.

Mr. Martin

We are proud of this record and we can stand over the level of investment we have allocated to our health services. The question the Labour Party must ask is whether it is proud of what took place on their watch, or was it a case again of Labour wrestling with its conscience, with its conscience losing?

As for the Labour Party's criticism of our reform record, we have set out not just a challenging programme of reform of which the Hanly task force report is just one vital element, we are now set forth on implementing the most comprehensive reform programme in the recent history of Irish health care. As Deputy McManus is well aware, earlier this year the Government announced decisions regarding a new health services executive which will include a national hospital office, a primary and continuing care directorate and a shared services centre. Taken together, these structural reforms represent the biggest single national reorganisation of the health system since 1970.

Mr. Sherlock

Is Fianna Fáil voting for that?

Mr. Martin

Work is well under way to make these changes a reality.

I also propose to share my time with the Minister of State at the Department of Health and Children, Deputy O'Malley.

Ms Lynch

I thought the Minister was about to mention BreastCheck.

Mr. Sherlock

He is making no sense.

Mr. Martin

I did not interrupt speakers. We are in a House where the principle of free speech should be honoured and I would appreciate the opportunity to complete my speech.

It is important to put the provision of acute hospital services in context. Over the last two or three decades there have been numerous important advances in surgical technology and in anaesthesia. These advances have greatly improved the range, the safety and the effectiveness of the surgical procedures that can be offered by modern health systems. However, as a consequence there have been dramatic increases in the demand for surgical procedures, especially elective procedures. Day activity is now a significant component of hospital-based care in Ireland. Evidence shows that much of the growth is the result of technological and medical innovations, such as less invasive surgery and advances in anaesthetics. There has been a staggering increase of nearly 80%, from 249,472 to 440,817, between 1997 and 2003. This increase reflects the increasing ability of the hospital system to treat more patients on a day basis where they are admitted and discharged on the same day. The funding has gone to that 80% increase, but that is rarely acknowledged in the House.

The nature of any health care system is such that not all treatments can be made available to patients immediately. Acute services have to be provided in a way that uses hospital facilities to best effect. Patients who require elective treatment may have to wait because beds, staff and operating theatres are being used to treat emergency cases. The balance to be achieved is to ensure that the available resources are used efficiently and that treatment can be delivered to patients in a reasonable time.

From the beginning this Government wanted to focus clearly on reducing waiting times for public patients who required admission to hospital for elective treatment. In order to keep the focus on waiting times we set ourselves ambitious targets both in the health strategy and in the programme for Government. I make no apologies for the setting of these targets, as without targets we would have nothing to aim for. Those targets have allowed the Government to maintain a particular focus on those waiting longest for hospital treatment.

I was very pleased earlier today to announce significant progress in relation to identifying the true position of elective waiting lists in this country. This significant progress has in particular been achieved through the work of the national treatment purchase fund. The NTPF is a health strategy initiative with the task of achieving reductions in waiting times and particularly to offer treatment to those who have been waiting longest. I will set out for the benefit of the House some of the information reported by the NTPF today. The NTPF has reported that waiting times have fallen significantly in the last year, with 37% of patients now waiting between three and six months and 43% waiting between six and 12 months for surgery. Therefore 80% of patients now wait less than one year for surgical treatment. This represents a major reduction in the length of time patients have to wait.

The NTPF has a multidisciplinary team which has been working with individual hospitals to identify patients on waiting lists for surgical procedures. The NTPF has undertaken validation of those waiting longest for treatment and this suggests that the figures reported to the Department of Health and Children overstate the number of persons who are available for treatment. The Department, in consultation with the NTPF, has carried out a comparative analysis of the number of patients reported to be waiting for surgical treatments and it has become clear that the number of patients reported to the Department includes patients who are not actually waiting or available for treatment.

Having set up the NTPF on a statutory basis with effect for 15 May 2004 I have also decided to transfer responsibility for the recording and publishing of waiting list figures to the NTPF. The NTPF, in conjunction with the Department and health agencies, has undertaken a verification process which takes account of the constant movement of patients on and off lists — "the flow factor". The NTPF has taken account of such factors as patients not being available for treatment, patients not being medically suitable to undergo treatment, patients no longer requiring treatment and patients postponing treatment at their own request.

When those factors have been taken into account the NTPF has estimated that a large number of patients, approximately 4,500, can be removed from the Department's reported figure.

Ms McManus

Will the Minister give way for a question?

Mr. Martin

I certainly will not. The Deputy should let me finish.

Ms McManus

The Minister is very touchy.

Mr. Martin

No, I am not. I am pressing ahead.

An Ceann Comhairle

The Minister, without interruption.

Mr. Martin

I am putting the information on the record.

Mr. Durkan

A sensitive subject. The Minister is getting 4,000 people off the lists in one day.

Mr. Martin

I accept these figures are disappointing news for the Opposition.

Mr. F. McGrath

The Minister should go to Beaumont.

An Ceann Comhairle

Deputies will have an opportunity to speak later.

Ms McManus

This is not information, it is spin.

Mr. Martin

It is not spin. This is the report of the NTPF.

Mr. Durkan

It is massage.

An Ceann Comhairle

The Minister is entitled to exactly the same courtesy in the House that the Labour Party received when proposing the motion.

Mr. Martin

The Opposition should go back outside the door with their umbrellas.

Ms O. Mitchell

I suppose we are only imagining people on trolleys.

An Ceann Comhairle

Does Deputy Mitchell want to concede some of her time to the Minister?

Mr. Martin

Based on its detailed interaction with individual hospitals the NTPF has identified a group of 19,591 patients who are reported to be waiting more than three months for specific procedures, mainly surgical, and the NTPF will target this group during 2004. There are 4,040 patients waiting more than 12 months for treatment included in the 19,591, who represent 20% of all those waiting. A certain percentage of the identified group of patients is expected to be removed through further validation. This is done by going to the patient and asking them if they want an operation, as that organisation can provide it. That is how those figures are assessed by the NTPF. It is a different methodology and a different approach.

Mr. Durkan

Why did the Minister not mention that before?

Mr. Martin

It has not been done by me or by officials in the Department but a multidisciplinary team with medical and nursing inputs. That is how this is happening. Those are objective facts. By arranging an estimated 12,000 treatments in 2004, the national treatment purchase fund will make further significant progress in reducing the average waiting times for surgical procedures.

In 2004 I have allocated €31 million to the health boards and Eastern Regional Health Authority as base funding for consultant and other support staff costs associated with reducing elective waiting lists. I have also increased the funding for the national treatment purchase fund to €44 million in 2004.

Ms McManus

More spin.

Mr. Martin

Therefore, the total amount of dedicated funding available to tackle waiting lists in 2004 — €75 million — is the same level of funding provided in 2003, despite the spin and misleading comments of Deputy McManus at the joint committee last week. However, the national treatment purchase fund now has the significant lead role in tackling waiting times and waiting lists. Opposition Deputies appear to find it difficult to accept the facts.

Mr. Sherlock

We are speaking facts but the Minister is not doing so.

Mr. Martin

Waiting times for surgical treatment have been reduced. In the specialty of cardiac surgery alone adult waiting lists have fallen by 90%, from 1,477 to 150, and children's waiting lists have fallen by 91% since 1997, from 109 to 10. One will never hear that from the Labour Party, the Fine Gael Party, the Green Party or Sinn Féin.

Mr. Hayes

We hear it from the Minister.

Mr. Martin

It has been a dramatic improvement because of increased surgical provision, new units in St. James's Hospital, in particular, on the adult side and in the Mater Hospital and Cork University Hospital.

Mr. Hayes

What about the unit in Clonmel that the Minister is not opening?

Mr. Martin

The national treatment purchase fund has substantial capacity to treat patients and will continue to focus on reducing waiting times even further. The fund's target is to treat more than 12,000 this year and has the capacity to treat a minimum of 1,000 patients per month — 800 in Ireland and 200 in four private hospitals in England. Maintaining referrals at this level will result in waiting times for surgical operations being reduced in line with the health strategy targets of three to six months. Almost half of all hospitals now refer patients waiting between six and 12 months. Nine hospitals — 38% — refer patient waiting three to six months, 11 hospitals — 46% — refer patients waiting six to 12 months, and four hospitals — 16% — refer patients waiting 12 to 24 months.

Much progress has been made to reduce waiting times and we are on track to achieve the targets set out in the health strategy. The transfer of responsibility for waiting list figures to the national treatment purchase fund will result in a more accurate and complete picture of the numbers waiting and, more importantly, the length of time they wait for their procedures. The important issue is that patients wait for treatment for the shortest possible time and that the lists tell us correctly how many patients are available for treatment.

It is important to stress that treatment can be fast-tracked for patients who are willing to travel outside their local hospital or health board area. The fund has capacity available to treat more patients. Since the fund commenced arranging operations for patients, some 13,000 patients have been treated. It is also important to note that in a recent survey of patients who had their treatment arranged by the national treatment purchase fund, some 98.5% of patients treated were either satisfied or very satisfied with their treatment. Surely the level of satisfaction in that survey is testament to the significant progress being made by the national treatment purchase fund. Can we have some acknowledgement from the Opposition on that achievement? A clear message is being delivered here. There is no need for the majority of patients to wait more than six months for elective surgery.

Ms O. Mitchell

Now it is the patients' fault.

Mr. Martin

Nearly 40% of acute hospitals will now refer patients who have been waiting more than three months to the national treatment purchase fund. Patients who have been waiting more than six months for treatment can contact the national treatment purchase fund directly or through their general practitioners to arrange treatment. We appeal to people to do that.

While the national treatment purchase fund has the task of dealing with the immediate needs of patients, the increasing capacity of the public hospital system to treat an increasing number of patients is a product of the significant investment by the Government in health services. This year we have provided a gross allocation of €10 billion for the health service which is almost double the level of funding in 1997.

No one can deny that the hospital system is providing more and better services than ever before. Activity in our acute hospitals continues to rise. The reported number of patients on hospital waiting lists must be seen in the context of a continuing increase in the number of people treated in public hospitals. The number of patients discharged from hospital having been treated as either an in-patient or as a day case in 2003 was more than one million. This is the first time the number has exceeded one million and represents a 4.7% increase over 2002. This also represents a 27% increase in the number of patients treated compared with the number in 1997, which was approximately 785,000. The money is being spent on increased activity, procedures and treatments and more people being treated in the system.

Mr. Durkan

What about the massage of the figures?

Mr. Martin

These figures were objectively obtained. I do not have control over their compilation. Everybody knows about the system which is producing those activity figures in respect of who is being discharged from hospital. The system is independent from me and has been independent of different Ministers. That is well known. It is the bottom line. It might be hard to accept that but that is the reason there is such pressure on our acute hospitals. I pay tribute to our acute hospitals and staff who have dealt effectively with the expanding numbers due to the increased population.

Mr. Durkan

Is that the response of the aide-mémoire or the other way round?

Mr. Sherlock

What about the elderly patients?

Mr. Martin

The single most important factor for patients who await admission to hospital is bed availability.

Mr. Sherlock

What about the elderly patients?

Mr. Martin

The extent of the shortfall in acute capacity has been identified by a report entitled, Acute Hospital Bed Capacity — A National Review, and it indicated a requirement for an additional 3,000 acute beds in acute hospitals by 2011. I introduced the first phase of this process in January 2002 which provided funding in excess of €117 million, capital and revenue, for an additional 709 acute beds for public patients. That money was put into and invested in the system. That represents an increase of 6% on existing capacity and some 584 of these beds have been commissioned to date.

These additional services are now being provided by an increasing number of medical consultants. According to the Comhairle na nOspidéal report on consultant staffing on 1 January 2004, there were 1,824 consultant posts in the public sector in Ireland. This represents an increase of 41% in the last six years. No other period in the history of the State can equate that rise in consultant staffing levels and numbers. These are facts and they are resulting in increased activity. On the issue of nursing, a matter raised by Deputy McManus, there are repeated claims that there is a nursing crisis——

Mr. Durkan

Is there no crisis?

Mr. Martin

——but little acknowledgement that 8,200 more nurses work in the system than in 1997 while the annual number of nurse training places has also increased by 67%.

Mr. Hayes

Why is there more frustration in the nursing profession than ever before?

Mr. Martin

In 1994, when Labour and Fine Gael assumed responsibility for the reform of the health services, there were 1,179 pre-registration nurse training places in Ireland. The issue of medical manpower was already a pressing issue, and nurse shortages were becoming a serious issue. In its programme for Government, the rainbow Government spelt out: "It is now a matter of urgency that the issue of medical staffing is addressed." Rather than heed its pledge, the coalition of the callous then cut back nurse training places. When it left office in 1997 the number of pre-registration nurse training places had declined to 982.

To be fair to the then Minister for Finance, Deputy Quinn, who could have funded additional places, he made the astounding admission in the House before the previous general election that, as Minister for Finance, he was warned about impending nurse shortages and said: "I confess I did not listen to those voices at the time as well as I might have and the problems the Minister for Health and Children now has are, in part, related to that." This is despite the fact that he had pledged to address these shortages in the Labour-Fine Gael programme for Government. Deputies opposite should remember that when they talk about broken promises.

Mr. Durkan

Memories on the Government side are short.

Mr. Martin

They have some neck. Many of the difficulties and delays experienced in emergency medicine or accident and emergency departments reflect system-wide issues. To deal with the current pressures on acute services both in the shorter term and in the longer term I shall outline briefly some of the key actions that I have taken. It has been widely documented that there are a number of patients in acute hospital beds who have completed their acute phase of treatment and are ready for discharge to a more appropriate setting. The availability of suitable sub-acute beds is a particular problem in the eastern and southern regions. In this regard I have allocated €12.6 million to the respective health boards to facilitate the discharge of patients from acute hospitals to a more appropriate setting, thus freeing up acute beds. This funding allows for the funding through the subvention system of additional beds in the private nursing home sector and ongoing support in the community.

In the Eastern Regional Health Authority some 250 patients have been discharged from acute hospitals as a direct result of this recent initiative. I am also pleased to note that the Eastern Regional Health Authority is reporting that it has been successful in agreeing the re-opening of the vast majority of acute beds in the eastern region which were temporarily closed.

Ms McManus

How many beds?

Mr. Martin

All except a small single-digit number. All closed beds in the Mater hospital have been reopened. I will supply the Deputy with the figures.

Mr. Durkan

What about the ones that were never opened?

Mr. Martin

As part of the winter initiative package in 2000-2001, I provided additional funding of some €40 million aimed at alleviating service pressures and maintaining services to patients. Part of this investment package was aimed at the recruitment of additional emergency medicine consultants and consultant anaesthetists. To date, 20 additional emergency medicine consultants have been recruited. Further appointments are being progressed by the health boards and the ERHA. There are now 51 emergency medicine consultant posts in acute hospitals, which is a 260% increase in numbers since 1997 when there were 14 consultants posts. I have had enough lectures about emergency medicine and accident and emergency cover.

Mr. Sherlock

What about the radiologists for Mallow?

Mr. Martin

In 1997 when this Government came into power there were 14 consultant posts and there are now 51. I will deal with Mallow hospital later. The Deputy need have no worries in that regard. The Fianna Fáil-Progressive Democrats coalition has done far more for Mallow hospital than the Deputy or his party ever did.

Mr. Sherlock

The Minister should go to the hospital and tell them that.

Mr. Martin

The availability of senior medical staff in emergency medicine departments should facilitate rapid clinical decision-making, enhanced management, diagnosis and treatment of patients.

With regard to primary care, emergency medicine departments sometimes have to deal with injuries and conditions which are more appropriate to a primary care setting. Government support for the development of general practitioner out-of-hours co-operatives on a national basis for the period 1997 to 2003 amounted to €46.5 million. In time, these co-ops can be developed to provide a much wider range of services to ensure that communities, irrespective of size and distance from major urban centres, enjoy appropriate access to primary care services. That has been a significant achievement in a very short period of time and it has been a very significant investment. The Government is well on the road to completing that over the next two years.

I have demonstrated to the House this evening that this Government has achieved significant reductions in waiting times, particularly for those waiting longest for admission to hospital for treatment; it has made significant progress in meeting the health strategy target of no patient waiting more than three months for elective treatment; it continues to keep the focus on waiting times for public patients through the operation of the national treatment purchase fund; it has been instrumental in providing the necessary investment that has resulted in unprecedented levels of acute hospital activity; it continues to ensure that patient access to appropriate care and treatment remains at the centre of health policy.

The Opposition's approach is to promise everything but never to provide a framework within which anything can be achieved. Much hypocrisy which has been heard tonight — for example, the criticism of the over-70s deal, despite the fact that the Deputies opposite welcomed it and voted for it in the lobbies of this House.

Ms McManus

Not the deal.

Mr. Martin

They voted for the measure and then went on before the last general election——

Mr. Sherlock

The ordinary people cannot afford to pay.

Mr. Martin

——to promise free GP care for everybody, irrespective of means.

Mr. Durkan

The Government promised 200,000 extra medical cards. Will the Minister apologise to those who did not receive them?

Mr. Martin

Where is the consistency in approach? There has been a dramatic increase in the numbers participating in the drugs payment scheme since it was reformed by my predecessor some years ago and which opened it up to the public to a greater extent than previously. There has been a significant expansion of that scheme in terms of the numbers who avail of it and in terms of the expenditure attached to it. That is another fact rarely mentioned by the Opposition.

(Interruptions).

Mr. Martin

Regarding Mallow and Fermoy hospitals, the acute hospital review under Hanly never looked at Mallow but that will not prevent——

Mr. Sherlock

What about the radiologists in Mallow?

Mr. Martin

——Deputy Sherlock from endeavouring to enhance his or his successor's electoral opportunities on the back of Mallow hospital once again.

Mr. Sherlock

There is a conflict with the statement made by the Minister.

Mr. Martin

It seems to be all right for the Labour Party to make any sort of announcement it wishes before the general election but the Government can make no announcement before the general election regarding anything to do with health or it will be portrayed as electioneering.

Ms O. Mitchell

The poor little Government.

Mr. Durkan

There is no evidence to support it. The promises were so broad even the general public were not conned.

Mr. Martin

Day after day Labour Party and Fine Gael politicians are running around the country trying to wrap the local hospital around them. I visited Mallow hospital recently and witnessed the increased Government expenditure on that hospital, which has resulted in increased staffing, increased activity and equipment, and better facilities.

Mr. Sherlock

What about the radiologists?

Mr. Martin

The Government looks after Mallow hospital.

Mr. Durkan

Is the Minister going down to Mallow himself?

Mr. Martin

I was down there already. We had a very constructive engagement with the consultants——

Mr. Durkan

That is what it is called.

Mr. Martin

——and with the staff.

Ms O. Mitchell

The Minister is a master of rhetoric. This is spin.

Mr. Martin

It is about time we stopped trying to downgrade hospitals such as Mallow with rhetoric. We must accept that such hospitals have a significant role to play——

Mr. Durkan

We agree with the Minister on that point.

Mr. Martin

——in the future of Irish health care.

This Government is planning the most ambitious programme of change in the health service for over 30 years. The key elements of that programme will be a significant rationalisation of existing health services agencies; the establishment of a health service executive which will be the first ever body charged with managing the health service as a single national entity; the establishment of a health information and quality authority; the re-organisation of the Department of Health and Children to ensure improved policy development and oversight; the modernisation of the system-supporting processes; the strengthening of governance and accountability across the system.

Mr. Sherlock

Will the Government fund subventions for the elderly? There is not a word about the elderly.

Mr. Martin

I will let the Opposition worry about protecting the status quo. The Government will get on with reforming structures so that more money goes straight to where it is needed, to direct patient care.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I am pleased to share time with the Minister, Deputy Martin. He will go down in history as one of the most courageous Ministers for Health and Children ever.

Mr. Durkan

That was said about some of Napoleon's generals.

Mr. T. O’Malley

He has proved himself already with his very courageous initiative on smoking. Many people attacked him when he proposed that ban.

Ms O. Mitchell

It was his own people only.

Mr. T. O’Malley

I did not interrupt the Deputy.

Ms O. Mitchell

I did not speak yet.

Mr. T. O’Malley

The Deputy is speaking now when I am endeavouring to speak. This Government has done more than any other Government in the history of the State to reduce hospital waiting lists. It has the courage to attempt to reform the health services, unlike other coalitions who knew about the problems in the health service and did not have the guts to take on the vested interests and change the system.

Mr. Durkan

I remember the leader of one coalition who did not realise it was so bad.

Mr. T. O’Malley

There is much guff from the Opposition. They are very successful at being loud. They have one problem which constantly manifests itself right around the country: many people working in the health service are becoming tired of the constant moaning and complaining about the alleged problems in the health service. This Government is aware of the problems. It is starting in a courageous manner to reform the health service.

The health boards have been in existence for 30 years. They have achieved much in their time but change is required. The Government is well aware that there are problems in the health services. It has initiated significant changes and will have the courage of its convictions to implement those changes.

The waiting list initiative and the treatment purchase fund have been set up by the Government. The proof of the pudding is that there are now 13,000 patients, all medical card holders, who have been treated in an effective manner. The Minister referred in his contribution to the satisfaction rating of the patients at 98%.

Mr. Durkan

What about the other 2%?

Mr. T. O’Malley

That is the patients talking.

Mr. McCormack

They are the ones who have been treated.

Mr. T. O’Malley

Does the Deputy begrudge it to them?

Mr. McCormack

No.

Mr. T. O’Malley

The Government will continue and hopefully another 13,000 patients will be treated under the national treatment purchase fund this year. Eighty per cent of patients now wait less than one year for surgical treatment. The figures for 2004 show that 20% of patients wait over 12 months and 2.5% wait over 24 months. This is very positive news for patients in that those who have been waiting longest have now been either treated under the national treatment purchase fund or have been offered treatment. The fund's target is to treat more than 12,000 patients this year and it has the capacity to treat a minimum of 1,000 patients per month.

This Government is proud of its unprecedented initiatives on reforming the health services. I look forward to continuing to work with my colleague, the Minister for Health and Children, on the initiatives he has taken on behalf of the Government.

Ms O. Mitchell

It is pathetic of the Minister to try to blame the Opposition for the problems in the health service, given that the Fianna Fáil Party has been in Government for 15 of the past 17 years and 20 of the past 27 years. If blame has to be apportioned for problems in the service, all of it lies at the door of the Government. Its attempt to blame the Opposition parties reflects the poverty of its excuses.

Two years ago, in the run-up to a general election, the Minister promised to eliminate waiting lists. This week, in the run-up to another election, we have heard a further promise to miraculously make available money, staff and resources to open new facilities. Suddenly, this money which has long been absent has become available. This time, however, the public will not believe it. Having been forewarned by promises made at the previous election, they will view this one with jaundiced eyes and require concrete evidence before believing the emperor has new clothes.

That promise was made yesterday. Today, presumably in response to this motion on the Government's failure to eliminate waiting lists by the deadline of this week, the Minister started to spin again. The figure for people on waiting lists, which stood at 27,000 this morning, miraculously declined by 4,500 by lunchtime.

Mr. Durkan

That is good progress in half a day.

Ms O. Mitchell

This is the second time the Minister has tried to manipulate the manner in which waiting lists are presented in order to confuse and confound everybody.

Mr. Martin

On a point of order, the figures are not mine but were produced by another body.

Ms O. Mitchell

They are never the Minister's figures.

Mr. Martin

The charge of manipulation is unfair and unjust.

Ms O. Mitchell

Irrespective of who draws up the lists, how they are manipulated and what spin is put on them, the fact remains that even using a new accounting method discovered just in time for today's debate, a staggering 22,500 people still await treatment. The Minister's boast is that the figure has been reduced to 22,500 after two years, despite the large amount of money at his disposal. What happened to the 4,500 people in question between this morning and lunchtime? According to the Minister's statement, they were either not available for treatment, not medically suitable for treatment, no longer in need of treatment or requested postponing treatment. How do we explain this? The answer is that they either emigrated in despair, were too sick to be treated, died, or moved into the private system. The reality is that nobody recovered miraculously or if someone did, the Minister should start selling relics.

This motion is not only about political point scoring and another broken promise but the price people pay for the Minister's broken promises. Sick and disabled people, the elderly and those in pain pay the price in pain, suffering, lost mobility, lost jobs and lost lives. Chronic waiting lists are not just another problem in the health service but the manifestation of the accumulation of many problems in the health service which have remained unresolved. They are the bottleneck into which indecision, shortages, inadequacies and inefficiencies have fed. Consequently, as the motion states, ending waiting lists is not solely a matter of bed capacity but of staffing and equipping beds and a range of other measures.

Let us examine the Government's record on bed capacity. It has known for years from numerous reports that there are not enough beds in the system and the Minister has accepted that. Not since the time of the MacSharry cutbacks of the 1980s and even before that has the problem been so acute. Even the Hanly report accepted the need for an additional 3,000 beds as recommended in the health strategy. Despite giving a commitment to provide this number of beds over ten years, as with so many other promises, the Government's undertaking appears to have run into the ground.

What is most disturbing is the absence of preparation to deal with the problem, not only in terms of developing physical infrastructure but as regards staffing — consultants, nurses or the many specialist health care professionals required. Where will the professionals be found to provide the beds the Government continues to promise on foot of the Hanly report? The problem is not only one of money but that the staff required have not been recruited not to mention trained.

We cannot even retain those whom we train. Endless warnings have been made about the need to match the number of those in training with service needs. Like so many other well signalled disasters, however, these warnings have been ignored. It was precisely this lack of foresight in health and other sectors that killed the Celtic tiger. In other words, demand outstripped the supply of skilled manpower, which fed into higher labour costs and prices and, ultimately, resulted in a loss of competitiveness. The Government has learned nothing from that, yet it expects us to slavishly believe the promise in the Hanly report that we will have hordes of consultants touring networks of hospitals to treat people at will. Increasingly, such fanciful promises sound like the ravings of someone less and less in touch with reality. Perhaps the Minister is very much in touch with reality and the Hanly report and all the other reforms are nothing more than an effort to distract attention from the crisis now pervading virtually every sector and layer of the health service.

Growing hospital lists and trolley clogged accident and emergency departments are all part of the same problem. They are two sides of the same coin which are widely reported, visible, quantifiable and shocking. Other waiting lists, however, are not reported in the media and while they may not be as visible or quantifiable, they are just as shocking. We do not hear of the children who will never be able to communicate because they were unable to get speech therapy at the crucial time of their lives, or of those who become permanently disabled or lose mobility because of a lack of physiotherapy.

The real scandal, the real hidden waiting list, is the one that causes the greatest distress and suffering and results in the highest morbidity and mortality. It is the list of those waiting to see a consultant in the first instance, a group of people without even a diagnosis, much less a treatment, who sit on referral lists for endless months and about whom we never hear.

If we had a sufficient number of consultants, this would not happen. If we did not have the ludicrous position in which virtually the only way to become a consultant is through Government appointment, perhaps it would not happen. If, instead of rationing access to care for patients, consultants were competing for business, perhaps it would not happen. If that idea is too revolutionary, we should at least have some transparency about waiting lists. Why are the public and general practitioners unable to find out which consultants have long and which have short waiting lists? This would enable them to at least make choices. Surely, in this age of consumer information, this is not too much to ask.

If we had more consultants, there is no doubt that demand for expensive, acute beds would be reduced, people would see their consultants before their conditions deteriorated and consultants would have more time to organise tests outside acute hospitals without feeling the need to admit patients and cluster them as a time saving exercise.

We were also promised improved and enhanced primary care as a means of reducing waiting lists. A strategy outlined a brave new world of primary care in which demand for hospital admission would be reduced through targeted intervention, early detection and ongoing illness management but virtually nothing happened. Even this year, primary care is the only area in which Government expenditure is falling as fewer and fewer families can afford to attend their general practitioners. More families must now make a choice as regards which members can attend a GP. They must prioritise between the breadwinner and the sickest, oldest and youngest family members and decide which of them will get part of the family's limited budget to pay for a visit to their general practitioner.

These are the kind of devastating choices families have to make as a result of this Government's broken promises. There are families who are on waiting lists to see a consultant for a worrying and maybe painful condition, families who have loved ones awaiting admission for elective surgery, and families whose elderly parents lie for several days on trolleys. All these families place their trust in the Minister and the Government. No matter how the Minister spins it, and he is good at doing that, they know he has failed them. He will pay the price for this.

Mr. McCormack

This is the second anniversary of the Government's promise to eliminate waiting lists. That is a fact no matter what the Minister states. It raised hopes for many people that their loved ones would receive treatment, but these hopes have been dashed. Waiting lists were to be ended this week. Instead, there are 23,000 to 27,000 on the waiting list, depending on when the Minister speaks. How many patients are waiting to see a consultant to get on a waiting list? How many young children and young adults are on orthodontic waiting lists? Waiting time in the Western Health Board area is now four years, yet only a minority of those seen can get on the orthodontic waiting list. It was two years only a few years ago. After deceiving the people at the previous general election by promising to eliminate the waiting list, there are now 23,000 to 27,000 people on that list. All the Department and the Minister have done is massage the figures by writing to people asking them if they are still on the list and if they have had a procedure carried out privately. The Government tried the same approach in the run-up to the previous election, as a family informed me. They eventually received an apology from the Western Health Board as their loved one was dead for seven years.

How often do we see appointments made and then cancelled? I extracted information from the Western Health Board to the effect that there were 4,296 deferrals in 2003. Of that figure, 2,026 had procedures deferred once and 865 had procedures deferred more than once. There were 985 procedures deferred for lack of beds. Consultants deferred 406 procedures, 275 were deferred by hospitals and 638 had their admission date changed. What should I say to a man from an island off the Galway coast who has had an appointment cancelled three times? He comes to Galway, stays in a bed and breakfast, reports to the hospital having fasted for the night only to be told there is no bed. At the same time, the Western Health Board had a surplus of €15 million in 2002-03. How can it have such a surplus with service like that? The 31 beds in St. Anne's ward were closed. Had they been opened with the surplus, that man might have been treated. He was told he could not be seen that day, he then waited around Galway all day before getting a boat back in the evening. That is the reality.

An elderly patient had his surgery cancelled six times at University College Hospital Galway. If the reward system that the Minister is implementing is followed, health boards will cut back to stay within their budgets and be rewarded financially at the end of the year. It is no credit to the Western Health Board if it stays within its budget in 2003 because it was achieved through serious cutbacks. Many appointments were cancelled in 2003 and I am informed that it was because no beds were available in the hospital. No matter what the Minister of State says in his defence of the Government, that is the reality. I hope the people remember it on 11 June and I will tell the disappointed people that the worst thing possible in politics is to deceive people.

The Minister told them he would eliminate hospital waiting lists although he knew he could not do it, and now he knows he has not done it. The waiting lists are now at 25,000, yet the Minister was to have abolished them by this week.

Mr. Durkan

We are not giving the Minister full credit for some of his achievements. In the past 24 hours we have witnessed a miracle comparable to the miracle of the loaves and the fishes or the conversion of St. Paul. In the space of four hours the Minister has miraculously cured 4,000 people and removed them from the waiting lists. He could not do that for the past two years so I congratulate him. I give him full marks for spin and presentation. I remind him of the Cabinet meeting last week when this aide-mémoire was prepared. It should have been prepared by senior civil servants in the Department unless they were assisted. I suspect they did their job and produced what was required. It happened about the same time that word broke that €50 million had been squandered on little machines whose buttons people could press. This had no approval from the House. There was much panic at that stage. The Government decided to do something to deflect attention from the real issues.

I do not know the terms of reference for the report the Minister received. He has successfully massaged the figures. He stated that 98% of those who were treated under the national treatment purchase fund expressed satisfaction. What has that got to do with the waiting list? Surely he did not expect them to say that the treatment was awful. Did he ask the other 2% what concerned them?

Mr. Martin

There were many doubts about it before.

Mr. Durkan

He did not refer to the 22,000 that he managed to leave on waiting lists. He was supposed to have eliminated waiting lists after two years. The Minister is beginning to suffer the affliction of memory failure which has beset Government Members of the House in recent years. I remember him stating that waiting lists would be eliminated in two years, which have now elapsed. What has he done? He reduced them by 4,000 in half a day. What about the other 22,000?

What about the hospital beds that have been provided for in the Estimates but for which no staff are available? This has happened in Naas Hospital, Blanchardstown Hospital, Maynooth Community Hospital, and with the recent clumsy efforts at Peamount Hospital. His Department funds facilities such as Peamount. The farcical aspect is that we were suddenly reassured the pulmonary care facilities at the hospital would be provided elsewhere. Lo and behold, the next patient referred from a hospital for treatment at Peamount was refused admission. It is typical of the ham-fisted way in which the Minister and his Department have gone about their business. He has failed the people and has failed to deliver on the promise he made before the last general election to abolish the hospital waiting lists. His time is up.

Debate adjourned.