Health Services: Motion (Resumed).
The following motion was moved by Deputy McManus on Tuesday, 25 October 2005:
That Dáil Éireann:
—notes that over a year has passed since the Tánaiste became Minister for Health and Children and that since her appointment the problems in the health service, in particular for emergency patients, has actually deteriorated;
—records with regret the unnecessary death of Mr. Pat Joe Walsh at Monaghan General Hospital;
—deplores the abject failure of the Tánaiste and Minister for Health and Children to ensure delivery of her ten point plan to resolve the accident and emergency crisis;
—recalls that the Tánaiste and Minister for Health and Children said on 25 January 2005 that the accident and emergency crisis was a litmus test for her and for the Government;
—expresses its concern at the continuing serious overcrowding in accident and emergency units, which reached unprecedented levels during the summer months and notes that according to the Irish Nurses Organisation (INO) as recently as 11 October there were more than 300 patients on trolleys;
—recognises that, despite the Tánaiste and Minister for Health and Children's promise that there would be significant improvement by this autumn, 378 patients in the main Dublin hospitals are still inappropriately occupying acute beds and waiting times for accident and emergency patients have increased; and
—acknowledges the deep public anger at the massive waste by this Government in the health service amounting to hundreds of millions of euro on botched projects like PPARs and FISP;
calls on the Taoiseach and the Tánaiste and Minister for Health and Children to:
—accept political responsibility for the delivery of health services;
—deliver on their promises in regard to the accident and emergency crisis;
—open immediately all outstanding hospital wards and facilities;
—develop as an urgent priority, community nursing units to relieve pressure on the acute hospital sector;
—re-balance the incentive system that is creating a dearth of GPs in areas of disadvantage and adding pressure to accident and emergency departments;
—ensure supports are put in at community level so that patients can be cared for in, or close to, their homes; and
—tackle the worrying rise in MRSA infections effectively.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
—expresses regret at the tragic and untimely death of Mr. Pat Joe Walsh at Monaghan General Hospital recently;
— welcomes the initiation of an independent report into the circumstances of Mr. Walsh's death;
— looks forward to the Health Service Executive implementing operational policies in the light of this report and others so as to ensure patients in each region receive all necessary treatment to the highest standards of safety and care;
—commends the Tánaiste and Minister for Health and Children and the Government for the substantial reform actions taken in the course of the last year including:
—the establishment of a single, unified Health Service Executive with maximum financial responsibility and accountability to replace the outdated former health board system;
—the comprehensive range of initiatives to deal with all the factors causing difficulties to patients at accident and emergency;
—the first ever independent audit of cleanliness across major hospitals;
—the opening of new acute beds throughout the country to bring the total to 900 more than in 2001;
—the opening of new accident and emergency departments in Cork University Hospital and Connolly Memorial Hospital, Blanchardstown;
—a 29% increase in medical card income guidelines, the largest increase in 30 years;
—the introduction of doctor visit medical cards to enable families on modest incomes visit their GP free of charge;
—the impetus for the Health Service Executive to seek tenders for a GP out of hours service in north Dublin;
—the resolution of industrial relations disputes and the opening of contract talks with representative bodies of consultants, non-consultant hospital doctors and general practitioners;
—the development of a national radiotherapy network to provide essential cancer services for patients in each region of the country;
—a specific focus on the needs of older people and the development of long-term care policy, including the preparation of clear standards for nursing home care; and
—establishing after 29 years a clear and legally sound basis for contributions by care recipients to the cost of shelter and maintenance in residential care;
—welcomes the efforts which are being made by the Health Service Executive to address the issue of hospital acquired infections, including MRSA; and
—expresses confidence that the continuation by the Tánaiste and Minister for Health and Children and the Government of substantial reforms matching increased investment will deliver improved care for patients.
—(Minister of State at the Department of Health and Children, Mr. S. Power).
I wish to share time with Deputies Devins and McGuinness.
I am pleased to have an opportunity to contribute to this debate this evening. The only aspect of the Opposition's motion that I can agree with is the expression of sympathy to the family of the late Mr. Pat Joe Walsh. However, I believe that a politically hostile motion is not the most appropriate format in which to express our sympathy.
Last night I met 15 members of the Walsh family and found them understandably heartbroken at the sad, sudden and tragic loss of their uncle, brother and father on 14 October, in the early hours of the morning, at Monaghan General Hospital. They have many questions to which they want answers and I want answers too. That is why we have established an independent investigation of all of the circumstances surrounding the death of Mr. Pat Joe Walsh, from the time he left Drogheda Hospital on 13 October to the time he died at 7.30 a.m. on Friday, 14 October. We want answers, not just for the family and the public, but to make sure that those that have responsibilities, whether political, medical or administrative, take those responsibilities seriously. I am told that we will have the report of the investigation within eight weeks and I very much look forward to receiving it, as do the family of Mr. Walsh.
I wish to deal now with the political aspects of this motion. I suppose that it is a backhanded compliment to me that Opposition Members choose to judge me after 12 months as Minister for Health and Children.
Although they do not even turn up.
Myself and Deputy James Breen are here.
Their expectations of my performance were obviously great. I am sure their expectations were not just of me personally, but are the same as those they would have of any ministerial office holder, including their own. Therefore, I invite them to take any one year period when their own Ministers were in office, between 1993 and 1997, and to show us any lasting reforms that led to improvements in health care from a patient's perspective.
Let us begin with Deputy Howlin, as Minister for Health in 1993. He got off to a very bad start, as Mr. Fergus Finlay reminded us in his book, Snakes and Ladders, on page 162——
This is not worthy of the Tánaiste.
Mr. Finlay writes, "Brendan was the one who took the most persuading. He didn't want to be Minister for Health....Dick had to tell him there was no other option, but he was the most reluctant Minister".
How was Deputy Howlin, as Minister, judged? We are told he "lost his nerve", that he had "simply made things worse." Who said that? Deputy McManus said it in the Dáil on 31 March 1993, when he was only three months in office. She accused him of introducing greater inequalities and said, "Any attempt to disguise this fact by the Minister is pure blabber". Always the bitter word. The party rosette may have changed, but the discordant song remains the same.
Why does the Tánaiste not talk about her record?
I want to talk about Deputy McManus' record.
The Tánaiste's record is pretty pathetic.
Is Deputy McManus implying that hers is better?
My record is a lot better. When I was Minister I was able to do things in housing that this Government has not done.
When Deputy Howlin launched the health strategy, Deputy McManus told us it was "a great disappointment" that "simply does not do the business". She went on, predictably, to say that "It includes slavish concessions to private health care". That was on 4 May 1994. The same, transferable speech 12 years later. The Ministers may change, but Deputy McManus's words remain the same.
When Deputy Noonan became Minister for Health in 1997, he invested £10 million in the waiting list initiative and the numbers on the list went up from 27,000 to 32,000.
I am always happy to listen to constructive criticism and to suggestions from those who have suggestions to make. However, I am reluctant to take lectures from those who do not believe in collective Cabinet responsibility, who have no policy achievements, who are constantly carping and involved in negativity, who have never led, developed or implemented Government policy and who constantly make false claims.
Let us now deal with those false claims. Deputy McManus tells us the number of hospital beds, per head is lower now than it was five years ago. Five years ago there were 12,612 beds. Now there are 13,707 beds, which represents over 1000 additional beds in that five year period. She told us that 480 acute beds were closed because the INO said they were closed. This is not so, as shown by the HSE. She says that the policy on medical cards for terminally ill patients has changed but it is the same policy that was implemented 30 years ago when the late Mr. Brendan Corish was Minister for Health. The Deputy said that treatments for patients by the national treatment purchase fund were cancelled. That is not true.
Of course it was true. The Tánaiste should stop misleading the House.
She said there was a taxi fare of €600 for a patient but she was wrong again.
The Tánaiste should get her facts right, at least. This is embarrassing.
Deputy McManus has no policies. She is drifting along on flotsam policies, like the proposal for free GP cards for everybody, even the rich.
Let us contrast the records on primary care and GP cards in particular. This year the Government has increased the income guidelines by 29%, the highest increase since 1974. What happened between 1993 and 1997? In 1993, there was an increase of £2, which is €2.54, in 1994 the increase was £1 or €1.27. When Democratic Left came into Government, the figure was £2, or €2.54 and in 1997, it was £1.50, or €1.91. In those five years, when the Labour Party was in Government, the increase was €10.80, which is 11%. Since 1997, it has increased by 64% and last year by 29%.
We have also changed the method of assessing people's entitlement to medical cards. We have moved to disposable income, where tax and PRSI are deducted from income, as are reasonable expenses on mortgage, child care, travel to work or rent. It is the single greatest innovation in 35 years, together with the introduction of the doctor-only card. I strongly believe in a tiered, graduated level of benefits, not an all-or-nothing system based on one means test.
Deputies McManus and Rabbitte have described the doctor-only card as a yellow pack card. Let us see what they had to say about it on a different occasion. This is what Deputy McManus had to say to Deputy Howlin, the then Minister for Health, on 31 March 1993: "If he had chosen to introduce a free GP service and let people pay for their drugs for the time being, it would have made some kind of sense". That is from the woman who is now pouring scorn and acid on my GP card, not because it is me——
The Tánaiste promised medical cards but she did not deliver them. That is why she has GP cards.
What of the Deputy's throw-away remarks on universal insurance, which would cost €1 billion? She has now acknowledged that it could not be implemented in the lifetime of a single Government and Fine Gael has run away from that idea. At least Deputy Howlin delivered a health strategy in 1994. The deputy leader of his party has not delivered any policy on health since 2002.
I am confident that we are making major progress in health reform. We have ended the incoherence of the health boards, though many of the problems and legacies of the plethora of bureaucracy that was our health board structure are still with us, as we have seen recently. We now have the HSE in place, which has its accountability clearly defined in legislation. The CEO of that organisation is not just the accounting officer but is also responsible, on a day to day basis, for the management of our health services. It is a sea change in health management which will make an enormous difference.
The Opposition voted against the establishment of the HSE and Deputy McManus, earlier this year, called on me to postpone its introduction.
The HSE is not an end in itself. It is merely an enabler of change, reform, accountability and of the creation of a consistent and equitable health service for all our patients. We are only at the beginning of the journey but the signs are encouraging.
I have been asked by the Leader of the Opposition to issue a political directive to the HSE, under section 10 of the Health Act, regarding surgical procedures at Monaghan General Hospital. Politics have bedevilled hospitals in this country for many years — party politics, medical politics and office politics. The only sure thing is that when politics comes first, patients come last. There will be no political directives from me interfering with the management of hospitals. I will not undermine the mandate given by the Oireachtas to the HSE to professionally run, in the interests of patient safety and care in each region, our hospital system.
Accident and emergency has been a major pressure point for some time in the health service. Each day, on average, accident and emergency departments throughout the country see 3,400 patients. Thankfully, the vast majority of these patients are seen speedily and do not have to wait overnight on trolleys for admission to a hospital bed. There are many diverse factors that lead to overcrowding in accident and emergency units. There is no single solution to the difficulties. We need a wide range of initiatives to put right the problems which have been in accident and emergency departments for some time, which is what we are doing. We have, for example, gone to tender in the north side of Dublin for out-of-hours GP services, the first time this has happened. It will make a major impact on the accident and emergency departments in the Mater and Beaumont hospitals and, to a lesser extent, at Blanchardstown hospital. We have also bought long-term and step-down beds so that those who can be discharged from the acute hospital system can move to a more appropriate setting. A national hygiene audit, the first ever, has been completed and the results will be published. We will not sweep the results under the carpet because we need to know what the situation is in our hospitals if we are to achieve higher standards. We need base data. We have opened new accident and emergency units at Blanchardstown, Naas, Roscommon and Cork and shortly a new 25-bed unit will be open at the Mater Hospital in Dublin.
The past year has been one of reform, breaking barriers to innovation and clearing away some of the ossified legacies of the past. It has been a once in a generation change in health management and accountability. It has been a year of major innovation in medical card benefits. It has been a year when the focus has been on the difficulties in accident and emergency. It has been a year when we sorted out the 29 year legal mess surrounding long-term charges, when we delivered a national policy on radiotherapy, when we delivered multi-annual funding for disability and when we have had new treatments, new beds and new investments. It has been an exciting year, but no one year can sort out our health services. What the one year can do is set us on the right road. That is the road we have taken and that will deliver results. It is the road that will ensure that Ireland has a world class health system.
There is the carping, negativity and wrong suggestions that constantly come from Deputy McManus. She gave Deputy Howlin three months in office when he was Minister and we have a lot of notes to compare. All the comments are the same. Any good suggestions will be taken on board. Wrong suggestions will be challenged but, above all, the people know the Government is committed to health reform and it will succeed.
Deputies
I am pleased to have an opportunity to speak on this Private Members' motion concerning the health services and the current Minister for Health and Children. Like the Minister, I agree with the Opposition on just one aspect, that is, to express my deepest sympathy to the family of Mr. Pat Joe Walsh on his untimely and unnecessary death at Monaghan General Hospital. As has been stated, there is now an official inquiry into the circumstances surrounding his death, and it is appropriate that objective comment should be delayed until the findings of that inquiry are available. However, I was absolutely appalled by the behaviour of some politicians who immediately after the tragic death of Mr. Walsh tried to turn his sad death into a political football. It is worth remembering that they did so in the absence of hard facts surrounding his death. Such actions are unwarranted and, in truth, do the political system more damage than good. It may achieve for the politician involved a measure of short-term gratification in the publicity stakes but as to ascertaining the underlying mistakes, it is of no use at all. Once the inquiry is finalised, it is important that corrective measures are put in place as soon as possible so that a totally unnecessary death such as that of Mr. Walsh——
Can I ask the Deputy a question?
Not unless the Deputy wishes.
(Interruptions).
Will he name the politicians to whom he is referring?
The Deputy is out of order. Deputy Devins should be allowed to continue without interruption.
I congratulate the Minister on her achievements during her first year in office. She set out her stall quite clearly as to what she wants to achieve. I am vice-chairman of the Joint Committee on Health and Children and she attended the committee each time we asked her to do so. She has at all times been up-front and practical. One of the goals she set herself is to tackle the accident and emergency crisis. It is well recognised that a major help in ensuring accident and emergency units function efficiently is the presence of acute medical assessment units. In that regard, I ask the Minister to help expedite the establishment of such a unit at Sligo General Hospital.
The use of units such as this in other hospitals in the State has been shown to be of great benefit in reducing the waiting times in accident and emergency. Sligo General Hospital staff have prepared an extremely cost-effective plan for the establishment of such a unit. I have no doubt that such a unit will be of great help in ensuring the efficient workings of the accident and emergency unit in that hospital.
The Minister has made it her priority to deal with the accident and emergency crisis and I commend her for the progress to date. I have no doubt that the speedy establishment of the acute medical unit in Sligo will be an important facility to complement the great work done there by the accident and emergency staff in dealing with the various medical and surgical problems presented to the unit. Will the Minister use her good offices to get that unit sanctioned as soon as possible.
Another unit which is of great interest to those living in the north west is the provision of radiotherapy services. This is an area about which I have spoken to the Minister previously and I know she will be meeting a delegation from the north-west region shortly to discuss the provision of such a radiotherapy unit. It is an issue on which there is great degree of cross-party support in the House. At the recent Fianna Fáil Ard-Fheis in Killarney, a unanimous motion was passed requesting the establishment of such a radiotherapy unit.
I look forward to discussing the issue more fully with the Minister in the near future and I commend the amendment to the House.
The previous Minister, Deputy Martin, introduced the reform package in regard to the health services. Any of us who deal with the issues at the coalface, particularly in regard to health, will be aware that it was the one area where reform was absolutely necessary. I commend the Tánaiste since taking over the portfolio of Minister for Health and Children on the work she has done to date. She is to be commended for undertaking the difficult task ahead and for introducing the reforms. As Members on all sides of the House will be aware, previous Ministers always had to fight a political battle to effect change, not just party politics but politics within the whole medical area. This was seen through the health boards in the old system.
If a swift change is to come about, it will only be by political co-operation. Far from tabling motions such as this, the Opposition would serve the system much better if it worked in close co-operation with the Minister to ensure the difficulties we all experience in the health services are overcome. There is no way round this issue. In any company that faces challenges in the commercial market, there is a need for everyone involved, workers and management alike, to co-operate and ensure the necessary reforms are introduced, put in place constructively and funded properly. It is only by doing so we can move forward in regard to the changes and services that will be necessary in the future. I say this as someone who has often complained and suggested change, whether in regard to the services provided in my constituency, the services that are available nationally or issues such as MRSA. I know the Minister has conducted that audit throughout the hospital. I want to draw attention to the many public meetings that have been held and the concerns expressed on the issue. I urge the Minister to undertake whatever change is necessary in the workplace to make people acknowledge the issue of MRSA and to assist and support those at the coal face delivering services to ensure patients are properly monitored and informed and, where necessary, receive the support necessary in their own homes because the issue is not being dealt with properly or constructively.
If political parties work together, they will bring about the necessary change to ensure a proper health service. The co-operation of consultants and other professionals is also needed. St. Luke's Hospital in Kilkenny has often been cited by all political parties as an example of best practice in the delivery of health services. It is in receipt of funding for its accident and emergency unit, outpatient facility and a proper stroke unit. That happened as a result of funding from the Department through the HSE and the co-operation of consultants and others working in the hospital and interested in achieving change.
Funding is needed and when taxpayers invest €12 billion of their hard earned money in the service, they want results. Value for money and appropriate change for patients will not happen until political parties recognise that the issue is not only about the Minister and the Opposition playing its role but about putting the patient first. The patient will be put first in the effort the Minister is making to introduce the substantial reform needed. The Government is committed to providing the funding required to make that happen and achieve reform.
The Government parties have had eight years.
It has taken a long time to change the culture within the health service and to provide the capital funding needed. It will take more than Deputy McGrath to ensure that happens. The Minister is committed and she has the bottle to take on the Opposition and the medical profession to turn the health service around. It is in all our interests that this is done sooner rather than later.
I encourage the Minister to examine what families require to care for the elderly and sick family members in their homes. If the appropriate packages are introduced, families will gladly look after their loved ones in their homes, particularly the elderly who wish to stay at home rather than in a hospital or a nursing home.
I wish to share time with Deputies Gormley, Connolly, Finian McGrath, Gregory, Healy and McHugh.
Ba mhaith liom tacú leis an rún ar mo shon féin agus ar son Teachtaí Shinn Féin. Arís eile táimíd ag plé géarchéim sa chóras sláinte. Arís eile, níl ag an Rialtas mar freagra ach féin-mholadh.
I support the motion and I oppose the Government amendment. I challenge the Government to go to the doorsteps and ask the people to sign up to the hymn of praise of its health record and of the performance of the Tánaiste and Minister for Health and Children that was presented earlier. They will receive a very cold reception in the households of County Monaghan. Once again, a tragedy in my native community is the focus of a motion on health before this House. The death of Pat Joe Walsh outraged people throughout the State. It was needless and avoidable and the system killed him — a system that dictates that emergency surgery cannot be performed in Monaghan General Hospital. The doors of the operating theatre were literally locked against Pat Joe Walsh. Those with the skill to save his life were prevented from doing so in that hospital.
I emphasise again that no matter what the inquiry finds out about the availability of beds in other hospitals, this man could and should have been operated on in Monaghan hospital, if only the staff had been allowed to do so.
I tabled a parliamentary question on the inquiry into the death of Patrick Walsh in which I sought the terms of reference. The Minister replied earlier that the terms of reference are still being finalised. The report is due for completion within a timeframe of eight weeks. I would like the Minister to outline if that is eight weeks from the date of the initiation of the inquiry or from the completion of the terms of reference. The terms of reference should include investigation of the policies at HSE and governmental level that contributed directly to the latest tragedy. It should not be confined to the immediate circumstances of the admission of Patrick Walsh to Monaghan and his subsequent death.
The Taoiseach stated in the House last week that no protocols would prevent a medical person doing his or her duty but they do and they have done repeatedly in the case of Monaghan and other hospitals where services have been taken away needlessly. The Taoiseach met the Community Alliance on the day of Patrick Walsh's death. He surely knows the depth of feeling in County Monaghan about the downgrading of our hospital. There is also a determination and I can assure him and this Government that we will not rest until the downgrading of the hospital is halted and services are restored.
It was revealed last week that a patient with a life threatening vascular swelling had to be taken by his family from Our Lady's Hospital in Navan to a Dublin hospital because of the unavailability of vascular cover in the north east. The patient was operated on in St. Vincent's Hospital and was told later by the surgeon that if he had not been brought to Dublin, he would not have survived. This is another case, which highlights that people in the north east — Cavan, Monaghan, Louth and Meath — are being treated like second class citizens where acute hospital services are concerned. News of the plight of this elderly man and of his family came less than a week after the death of Patrick Walsh. It reinforces the demand for a complete revision of acute hospital policy so that life saving services can be accessible to all, regardless of location or ability to pay.
Sinn Féin wants to end the two-tier public private system, the apartheid in the health services. Before the last general election, Fianna Fáil said it wanted "the end of the two-tier health system". This year the Tánaiste introduced a scandalous plan to give land on public hospital sites to the developers of private hospitals and, in doing so she denied that we have a two-tier system. How can progress be made when the two parties in Government disagree fundamentally in their diagnosis of what ails the system?
It is by no means the only inconsistency. If the principle of universal access to the general medical services scheme is accepted for the over 70s, why is it not accepted for those under 18 or for the entire population? According to a reply to another parliamentary question I tabled earlier, the Minister's Department estimates the additional cost of granting medical cards to all those under 18 years would be €223 million. The total cost of the PPARS and FISP fiascos and the useless electronic voting machines is €245 million, well in excess of what would be needed to extend the scheme.
I express my sympathy to the family of Pat Joe Walsh. Earlier, Deputy Devins stated a number of Members were making political capital out of his case, which is a cynical view. However, the health service is the most important political issue as we approach the next election. The motion recalls that the Minister stated on 25 January 2005 that the accident and emergency service crisis was the litmus test for her and the Government. She also stated that she wanted to deliver a world class health system to which I replied, "In your dreams". The Tánaiste took offence at the remark.
The Deputy said the same about the economy. He is defeatist and should be positive.
I recall what I said. If the Tánaiste believes that by privatising the health service in the American way she will deliver a world class health system, she can continue dreaming. The gap between rich and poor will widen, the two-tier health system will be exacerbated and matters will be made worse. That is not just my opinion; many medical experts say the same. One only has to read the columns of The Irish Times where those concerned have written on this matter.
There has been support for both sides.
It has been mostly in support on what the Opposition states. As we enter the next general election, we will oppose this point of view. The debate will be between the American model and the Nordic model, which I favour. Why can Sweden, Denmark and other Nordic countries deliver a brilliant health system? We now have 25% fewer beds than we had in the 1980s but 25% more population.
We have 50% more treatments.
The Tánaiste's solution is to centralise and have less accountability in the system. She is correct in stating that I opposed plans for the Health Service Executive. When the tragic death of Patrick Joseph Walsh was announced, the person sent out to bat for the Tánaiste was Professor Drumm. The HSE's function is to be the Tánaiste's mudguard and we have less accountability and less democracy.
Health boards were criticised in the past but this morning Deputy Sargent recalled a vote by the South Eastern Health Board regarding abuse in the Ferns diocese. A councillor proposing a motion on abuse received the support of only one of his colleagues. He may have been defeated but we know a vote took place and there was accountability. We can ask people who voted down that proposal why they did so. Now we do not have accountability. The HSE appears before the Joint Committee on Health and Children every so often and certain questions can be posed.
The Tánaiste said she would set up a parliamentary division of the HSE. Questions have been referred but I still await replies. When will this division be set up and when will the staff do their job effectively? When will we have democracy and accountability? During the Tánaiste's tenure we have had greater centralisation, less democracy, less accountability and a much worse health service. That is the reality and it will be the record of the Tánaiste as we enter the next general election.
I welcome the opportunity to speak on this matter. We find ourselves speaking about Monaghan in controversial circumstances. I welcome the timely establishment of the eight-week investigation and hope it is completed in that timeframe by an independent individual with no ties to the north eastern health area. I welcome the early admission of the existence of three additional beds, however unpalatable it may be, and that the Walsh family referred to a productive meeting with the Tánaiste.
The terms of reference will concentrate on hands-on staff and direct care givers rather than the root causes of the problems, namely, the policy makers and the configuration of health and hospital services. We referred to health experts but is there any expert group that could ignore a letter signed by all consultant surgeons in Cavan and Monaghan requesting that Monaghan Hospital be allowed cater for acute surgical emergency? Such a letter was sent on 15 September, one month before the death of Patrick Joseph Walsh. The only additional resources these consultants sought was additional on-call theatre staff. Would any expert group not listen to service providers flagging problems? It beggars belief that they did not listen here.
I have further questions for these worldwide experts. Is it logical to take consultant surgeons from two hospital sites, place them in one hospital site and then request them to drive back daily to perform surgery in the original hospital? This is a waste of time, resources and money. Would any world authority consider it best practice to have six programme managers for acute hospital services in a five-year period, employed in an acting capacity and in charge of a multi-million euro budget? That has happened. In a ten-year period we have had seven Ministers with responsibility for health, from different parties in the House, in charge of a multi-million euro budget. Does that make sense? The lifetime of a Minister is something like 18 months and I do not know how anyone gets to grips with the brief in that period. There is a lack of consistency and if we saw the same happening with school heads, it would not last. Any private industry attempting the same would go bust immediately.
I thank the Leas-Cheann Comhairle for the opportunity to speak on this important motion on the crisis in health services. The Tánaiste and the Government must accept the major problem we have. After eight years in power and considerable resources available, it is not good enough that people are still on trolleys in accident and emergency departments, children and adults with disabilities are on waiting lists, children cannot receive speech therapy or occupational therapy and insufficient community support exists for mental health patients. It is a crime and a scandal and is unacceptable in this day and age. A figure of 300 people on trolleys every day is a disgrace when 500 new beds would resolve this priority issue.
I propose three sensible ideas to resolve this problem once and for all. An action plan, including the accident and emergency ten-point plan, should be implemented immediately to improve matters in the short term. A hospital development plan should be drafted, with a definite timeframe and funding commitments, for the additional acute and non-acute beds promised in the Government's health strategy. There should be better management of existing resources and the lifting of employment ceilings upon nursing and other frontline staff. All closed beds should be opened with appropriate staffing and admissions and discharge policy should be properly administered.
Independent Deputies in this House frequently propose practical solutions to the problems in the health services. I urge the Tánaiste to listen to our views and end the nightmare for patients. I have always supported reform in our health services in this House and will continue to do so in the interests of the patient.
I support this motion as it concerns people, patients, a quality health care service and acceptance of political responsibility for the delivery of health services to the citizens of the State. I urge all Deputies to support this motion as the Government must face up to the urgent and immediate needs of our citizens.
Earlier this year, when the Tánaiste was 100 days in office as Minister for Health and Children, the Independent Deputies tabled a motion similar to the one before the House tonight. At that time, nothing had changed. In particular, the chaos in accident and emergency departments was worse than it had been previously. After one year of ten-point plans and a range of promises and commitments, very little has been done.
The same dreadful scenario continues in the accident and emergency department in the hospital most critical to my constituency, the Mater Hospital. A constant stream of reports of people in their 80s left for days and nights on trolleys is a shame and a scandal for a country heralded as one of the richest in the world. It is only when an elderly family member must seek medical care that the extent of the scandal is brought home to people. There is a shortage of beds and trolleys with elderly patients forced to find a chair on which to spend the night while waiting for a trolley on which they must subsequently wait for a bed. Meanwhile, disruptive and often violent elements are crowded around them. I have had many desperate, anguished calls from relatives who cannot understand why the Government remains inactive and incompetent on this vital issue and seems incapable of decisive action.
I support my fellow Independent, Deputy Connolly, who has given a strong voice to those campaigning on the Monaghan Hospital crisis.
I record my disbelief and regret at the manner in which Mr. Pat Joe Walsh was allowed to die in Monaghan General Hospital. Whoever is responsible for Mr. Walsh's untimely death should be held to account for it.
I support the motion. In the brief time available I want to express my sympathy to the Walsh family on the death of Pat Joe Walsh in Monaghan General Hospital. Unfortunately, that death was the result of a pre-Hanly policy, which is now a Hanly policy, and it is a scenario we can foresee happening in many hospitals throughout the country unless the Hanly proposals are set aside. In terms of the policy decisions that were taken, there is no doubt that if the Hanly proposals are implemented, other cases such as that of Pat Joe Walsh will occur throughout the country. I ask the Tánaiste to put on record her position regarding the Hanly proposals. The Taoiseach has already said he will not be proceeding with them. I ask the Tánaiste to tell us whether she agrees with the Taoiseach and to outline her view on the Hanly proposals.
I support fully the call in the motion to open immediately all outstanding hospital wards and facilities. In 1986 and 1987, 50 beds were closed in St. Vincent's Hospital in Tipperary town, in my constituency, and the service in that constituency has been in a serious condition since. A total of €30 million has been spent on facilities in Clonmel and €12 million in Cashel but those facilities remain closed. The facility in Clonmel has been closed for over two years and the one in Cashel for over 12 months. I hope those facilities will be opened immediately.
I want to speak about a deplorable situation that has been allowed to continue in two towns in my constituency. Over a period of time alterations were carried out to Áras Mhuire nursing home to provide two palliative care beds. The building works have been completed for a number of months but it has not been possible to open those beds because the staff have not been provided. We now have the farcical situation where approval has been given to employ the number of staff required but they cannot be employed because there is no money to pay them. It is difficult to imagine that there is no money to pay nursing staff to run two palliative care beds in Tuam, County Galway when the Government is continually boasting about the amount of wealth being created in the country. It is unacceptable that there is no money to allow two beds to be operated so that people who are terminally ill can have a little comfort in their last days. It is a disgrace to allow that continue without providing the small sum required. In her contribution the Tánaiste asked for good suggestions. My first suggestion is that she end that disgraceful situation.
I want to refer to the Tuam campus project. I appeal to the Tánaiste and the Government to give approval for Tuam community hospital to proceed and also to give approval for an ambulance base to be located in Tuam to serve the north east Galway area, which is an ambulance black-spot. The case for this entire project has been made by me in this Chamber on numerous occasions but time does not allow me go into it tonight. The case was made to the Tánaiste by Tuam town commissioners last January and she promised them on that occasion that she would get back to them within four weeks with a decision. That is 36 weeks ago and the Tánaiste has yet to get back to them. My second suggestion to the Tánaiste, and it is a good one, is to act now on this urgently needed project.
Last Monday, because of the chaos in the accident and emergency unit in University College Hospital Galway, consideration was being given to closing accident and emergency services completely and declaring a major emergency. That is an indication of the seriousness of the matter. There is little point in the Tánaiste or the Government saying it is an operational matter. It is simple; the buck stops at the door of Government.
I wish to share time with Deputies Burton, Gilmore and O'Sullivan.
The Deputies have five minutes each.
At the outset I offer my sympathy to the family of Pat Joe Walsh, a man who could and should be alive today. I compliment Patients Together, Janet Byrne and her mother in particular for the excellent work they have done in highlighting the dire situation in the Mater Hospital over a sustained period.
Speaking on the first Private Members' motion this year, in January 2005, the Minister for Health and Children laid out her stall. She stated: "It is a fact that people judge our health services by their experience of accident and emergency units". The Minister's speech is peppered with references to the accident and emergency service and its importance in the health system. The Minister further stated:
I have stated that long waiting times at accident and emergency departments are not acceptable to me or the Government. . . .that is why we have given top priority at the Cabinet committee on health to improving accident and emergency services. This is why I have brought forward a fully-funded ten-point plan for accident and emergency services for this year.
We are bringing the greatest focus possible to improving accident and emergency services. Each factor that has caused delays in accident and emergency units is being addressed and each action is being implemented.
That was the tenor of the Minister's speech in January of this year. What has happened in the 12 months since the Minister's appointment?
Has her top priority been addressed by her ten point plan?
Let us not even talk about her lesser priorities or those objectives that were not priorities. Unfortunately, the answer is a resounding "no".
Last month I tabled a question asking the Minister to outline the improvement in the accident and emergency waiting lists at the Mater Hospital in the 12 months since she took over stewardship of the Department of Health and Children and promised action on accident and emergency waiting lists as her top priority. She did not answer the question but passed it on to the Health Service Executive from which eventually, after a period of time, I got an answer. The answer did not cover the full period of September to September but September to June and showed not the expected decrease the Minister promised but an alarming increase, from 21 to 36, or a 70% increase, in the daily average number of seriously ill people waiting over six hours on trolleys or chairs. That increase occurred throughout the summer months despite the usual annual reduction of numbers in accident and emergency units in the summer months. Undoubtedly, as the winter months approach the numbers will further increase.
I want to give the Minister one example of the current situation in the Mater Hospital. On Sunday, 9 October 2005, a 50 year old man with heart trouble collapsed at 4 a.m. He was rushed to the Mater Hospital by ambulance. He was placed in a chair in a storeroom with three other patients because the accident and emergency department was overcrowded. At 2.30 p.m. he was told he would have to undergo a series of tests but that it would be three to four days before they could be done as he was 35th on the list. He was told he would have to remain on the chair for that period and that if he left he would have to sign himself out to ensure the hospital would not incur any liability. He signed himself out and he and his wife are determined never to set foot in the accident and emergency department again, regardless of what happens. While in the hospital he said there were not enough chairs even in the storeroom and that some people were sitting on the floor eating their lunch before he left the hospital at 2.30 p.m. A man who had been on a chair beside him for three days also signed himself out in that storeroom before he left in utter despair. There was only one ladies and one gents toilet. The two toilets were being used as a bathroom, with people washing in the hand basin and changing their clothes in the bathrooms. Those people had been waiting for days on end.
The Minister concluded her remarks on 26 January as follows:
Accident and emergency departments form a litmus test for me, the Government and the people... By focusing our analysis, funding and energy on this area, we will achieve tangible improvements. I look forward to keeping the House and the Oireachtas Joint Committee on Health and Children well informed of our progress.
The Minister had a different story tonight. She told us a Minister for health cannot be expected to do too much in any one year. She did not show us the results in accident and emergency services in terms of what she promised and the areas on which her ten-point plan had been delivered.
It has improved substantially.
The Mater Hospital situation has deteriorated rather than improved. We expected some improvement. We did not expect regression.
It is now more than 3,000 days since the Fianna Fáil-Progressive Democrats Government took office and the health service is worse. It is now more than one year, 391 days since the Tánaiste, Deputy Mary Harney, was given a mandate to reform the Department of Health and Children. Connolly Hospital in Blanchardstown is an indictment of the Minister's year of failure and the Government's 3,000 wasted days.
The long promised re-built hospital sanctioned and funded by the rainbow Government and by the sale of hospital lands, finally opened last year. This new building was to be the first phase of an ambitious programme to bring the hospital up to the standards of the other major Dublin hospitals. Phase two was to follow and include upgraded accommodation and acute medical facilities for older people. Phase two was also to include additional specialist services for children and for cancer patients.
Is the Minister aware of the state of unit four, unit five and other units in the hospital, which care for hundreds of elderly people who are looked after by the fabulous staff, particularly in the day hospital? These units date from the 1950s when the hospital began life as a TB sanatorium.
During her private visits to the hospital to sell tax breaks to consultants and developers, did the Tánaiste take the chance to look at these buildings, which would not be out of place in Romania? Does she know or care that because of her refusal to commit funds to the second phase——
A Leas Cheann Comhairle——
That was the Minister's answer to me at the end of August.
I ask the Deputy to correct the record.
There is no provision for interruptions.
That was her answer to me at the end of August.
No. I have not been to Blanchardstown Hospital.
Deputy Burton without interruption.
I have not made a private visit to the hospital.
In her reply to me last week, she confessed to two meetings at the hospital with consultants and with the developer.
She has not been to the hospital.
The Minister should listen.
The Deputy should get her facts right.
I am told that it will now be at least another year before these units can be relocated to long-promised accommodation in the old hospital buildings. The apparent abandonment and long-fingering of phase two of the hospital is a disgrace and a betrayal, particularly of older people in the hospital's catchment area.
The Minister, Deputy Harney's only fresh idea concerning the health services has been to induce the construction industry to get involved in building private hospitals through increasing tax breaks. Labour fought a sustained campaign to get phase one opened and it looks as if we will have to get the banners out again to get phase two.
In a reply in the House last week, the Minister confessed that she had one meeting with the consultants, her private adviser and an official from the Department of Finance, followed by another meeting with the developer, Mr. Bernard McNamara, to discuss the notion of a private hospital on the public lands of Connolly Hospital.
Yes, the matron and the manager.
Private hospitals will make a small number of investors very rich. Not only will they get public land at Blanchardstown to build on, but they will also be given guarantees of custom from the national treatment purchase fund and their investments can be used to reduce or eliminate their tax bills. This is a sweetheart deal between the Government, the Minister for Health and Children and Ireland's super rich that puts profit before people. For the public patient it may well mean more delays for treatment. For the health insurance customer it will mean ever-increasing premiums. In case the Minister is unaware, most workers are now forced to buy private health insurance because of the chaos described by my colleague, Deputy Costello.
These private hospitals are for routine day operations, in addition to knee and hip replacements and grommets for children. They will not have emergency facilities, ICU intensive care or crash teams if somebody becomes ill. The public hospitals will ultimately have to take the responsibility for anyone becoming seriously ill. Many eminent doctors have questioned the wisdom of the headlong rush to tax-sheltered medicine.
In her address to the House earlier, the Minister said "There will be no political directives from me interfering with the management of any hospital or hospitals". Why then did she tell me last week that she sent a policy directive to the HSE to go for private tax-break hospitals? What is the difference between a political directive and a policy directive? The initial letter may be the same in both words but the understanding is very different.
The Minister holds the responsibility for anyone becoming seriously ill. We want a health service for everyone, not just the wealthy.
This morning I attended the funeral of a constituent — a lovely, creative man in his early 60s who died last weekend in St. Vincent's Hospital. On Tuesday evening last week, I received a phone call from this man's wife. She told me that he was a health-insured patient at St. Vincent's and had been undergoing chemotherapy there for some time. On Thursday of the previous week he had been told he needed a blood transfusion and that he would be admitted to the hospital within the next day or two. When that did not happen, the family contacted the hospital and the man was advised by the medical personnel to present himself at the accident and emergency unit. He arrived at accident and emergency at 3 p.m. on Monday but did not get a bed until 6 p.m. on Tuesday, and then only in an annexe rather than in a regular ward.
I submitted this man's case for discussion on the Adjournment last week but unfortunately it was not reached. His case was not the only one of which I have been made aware in the past week concerning accident and emergency services in St. Vincent's Hospital. I was told about the case of a 76-year-old woman on dialysis who spent from 8 p.m. on Saturday until 5 p.m. on Monday in the accident and emergency department of St. Vincent's waiting for a bed.
The day before yesterday I received an e-mail from another constituent who wrote:
The services for cystic fibrosis, in my opinion, are, to say the least, inconceivably inadequate and that is not doing the bad service the justice it deserves. However, now it seems that for a cystic fibrosis person to get a bed in St. Vincent's Hospital it requires a long waiting period in A&E. My sister, highly prone to infection and very sick, went to A&E on Monday and there she stayed until Thursday, at one stage on a bed in a corridor about four feet wide, with three other patients sitting alongside her and one woman sneezing on her. I heard today that the other cystic fibrosis patients who need to be in hospital will simply not go in as they are either not up to the wait in A&E or do not want to risk the wait for fear of further deterioration in their health, most likely because of the psychological distress of the ordeal.
None of these cases reflects on the excellent and committed members of staff of St. Vincent's Hospital who do their very best in difficult circumstances. Each of these cases, however, calls into question the adequacy of St. Vincent's Hospital to cater for the needs of the entire population of the east coast from Ballsbridge to Wexford.
The Hanly report, which is no longer mentioned, but which is still the Government's blueprint on hospital services, examined the hospital needs of the east coast and concluded that the solution was to make St. Vincent's the major hospital serving the area, with all the other hospitals to be defined as local hospitals. St. Vincent's clearly cannot cope with the existing demands on it, much less the demands of the increasing population of the south Dublin suburbs, as well as Wicklow and Wexford. A new hospital is needed at Loughlinstown together with the upgrading of services at St. Michael's Hospital, Dún Laoghaire, to cater for the needs of local people.
The situation in St. Vincent's Hospital where sick people sometimes wait for days in accident and emergency for the scarce available beds is not acceptable and must be addressed urgently. That is not an adequate hospital service for such a large stretch of the country. The members of staff in St. Vincent's are under enormous pressure in trying to cope with the demands upon them. The three cases I mentioned are just examples of the many cases I have heard about. They involve people who are seriously sick and have to spend long periods in the hospital's accident and emergency department while waiting for a bed.
The Government constantly tells us that the country is teeming with money and that it has risen further in the OECD league table, but that type of third world hospital service is not acceptable, particularly to those who must endure it. The Government and the Minister are directly responsible for it.
My colleagues have given good examples of the crisis that exists in accident and emergency units. It is significant that already we have such serious cases of overcrowding that patients must wait hours in accident and emergency units. I fear what will happen in the next few months because we have not yet reached the peak time for accident and emergency unit activity caused by outbreaks of various illnesses, especially among elderly people, due to poor weather conditions. The weather has not been too bad up to now.
This issue is urgent but I have not heard anything from the Government side to give the public any reassurance that something is in place to address the problems in accident and emergency units as winter approaches. I hope my prediction will not be fulfilled in the coming months but I very much fear that it will because there is no evidence that anything has changed in the year since the Tánaiste has become Minister for Health and Children.
I am concerned about this, as is the public. We have heard of appalling incidents such as those described by my colleagues Deputy Costello and Deputy Gilmore. Members of the public have described situations on the radio which nobody should have to put up with, both in terms of the impact on their health and also in terms of their personal dignity. People have a right to privacy and personal dignity from the public health service.
They are not getting it, through no fault of the people who work in those services. It is the fault of the entire structure that has not been improved since the Tánaiste became Minister. The necessary sense of urgency is lacking in dealing with this problem.
I fear the problem will only get worse in the coming months. I believe the information coming from the Irish Nurses Organisation, INO. These people work in hospitals and I consider the organisation's figures to be perfectly accurate in reflecting what is going on in them.
I am concerned at the confusion that exists regarding the implementation of the Hanly report in terms of relationships between hospitals. We do not know for sure if the Hanly report is being implemented. In my region, both Ennis and Nenagh hospitals are still unsure of the future of their accident and emergency services. In Limerick, which I represent, we are not sure about how the Midwest Regional Hospital will be affected or if it has the capacity to deal with patients who may come in from other parts of the region.
We are doing nothing to help people to move out of hospital, who are badly described as "bed-blockers". This term should not be used to describe people who need long-stay care or support in the community. No co-ordination exists on the matter. I hear regularly about people who could leave hospital if they could get, for example, a disabled person's grant, home help and other supports in the community but it is very difficult to get these co-ordinated quickly enough for a person to move out of an acute hospital bed. That must be organised on a policy basis. It is the responsibility of the Minister for Health and Children to ensure there is a nationally co-ordinated policy across Departments to ensure the necessary supports are available in the community. That is not just the responsibility of the Health Service Executive.
In the time remaining I wish to address an issue pertaining to the mid-west of which the Minister of State, Deputy Tim O'Malley, will be well aware: the provision of radiotherapy services. In the Government amendment there is a reference to the development of a national radiotherapy network to provide essential cancer services for patients in each region. People in the mid-west have raised funds themselves for radiotherapy services. They want to know if the Government will provide money for public patients to be treated on an equal basis in the radiotherapy unit that is about to open in the Midwest Regional Hospital. There is still a lack of clarity on the issue. We want a clear answer from the Minister. The Midwest Hospital trust fund should not be used to pay for provision for public patients in need of radiotherapy services in the region. That is the responsibility of Government.
There is also confusion as to whether we are still a finite region. We are supposed to be linked to Galway for radiotherapy services and we are linked to Cork for BreastCheck. We are awaiting a number of other specialties. People are not sure if the Midwest Regional Hospital is to be an adjunct of Galway. What is the situation? It is most confusing at present.
Child psychiatry inpatient beds have not been provided in the mid-west. There has also been a lack of provision in the areas of neurology and mental health care in accident and emergency units, which my colleague, Deputy Neville, has raised many times and of which the Minister of State, Deputy Tim O'Malley, is well aware. There is a litany of issues that are of concern to the public and to us as public representatives but there is no evidence that the political will exists to address these issues in a positive way.
I spoke to a relative of somebody who took ill suddenly while on holidays in another EU country. The instant care available and teams that could speak to the family and provide a full service were such a contrast to what we have here. The public had confidence that the Tánaiste would deliver. She has now had stewardship of the health system for a year and the public has been hugely disappointed. I hope that things will not get worse but I very much fear they will in the next few months.
I certainly have every confidence in the Tánaiste and the political will that was demonstrated by her appointment. I have sat through a number of these debates——
There are not too many Members on the benches behind the Tánaiste.
——not just since the Tánaiste became Minister for Health and Children but also under the stewardship of the previous Minister, Deputy Martin.
The Government benches are very bleak looking.
I will not go through the statistics but we have had a significant increase in investment in the health service and the number of personnel deployed in it.
In the entire period since I was appointed as a Minister of State at this Department in July 2002, I have never once heard a constructive idea from the Opposition benches about how to better manage the health service.
We have given many constructive ideas. Does the Minister of State want us to give some?
This is the message from the Ard-Fheis, the rubbish that nobody has any policies except the Fianna Fáil Party.
We hear the litany but we never hear one constructive idea.
There are lots of constructive ideas. The Minister of State was not listening.
Will the Minister of State listen so we can put forward a few?
Am I to be allowed proceed without interruption?
The Minister of State should be allowed to speak without interruption.
First, the Government brought forward the idea——
Will the Minister of State give way so that we can put forward a few ideas?
I did not hear any ideas from Deputy Costello. Nobody has a monopoly on compassion.
Will the Minister of State give way?
No Member in this House has a monopoly on compassion in regard to individual cases.
The Government has a monopoly on power to do something about it.
Yes, and we are doing something. The first thing we did was to set up the Health Service Executive. I note that all Opposition parties opposed that. It was clearly and transparently a sensible decision arrived at and implemented by the Government.
Even Professor Brennan does not agree with it.
Professor Drumm is an excellent man. He has already made some interesting comments about bed capacity. I wonder will the Opposition reflect on them.
He is opposed to the Minister of State's view on the matter anyway.
It contradicts every motion the Opposition put forward.
It contradicts the Minister of State's view.
It was the Minister of State's mentor, Charlie Haughey, that drove bed numbers down.
Does the Tánaiste or the Minister of State support the Hanly report?
Am I allowed to proceed? I have often listened in the House to special pleas, local bargains and hard cases. Are we going to take responsibility for managing a service?
Will the Tánaiste tell us if she supports the Hanly report?
The Minister of State should be allowed to speak without interruption.
I thought responsibility was normally handed over to somebody else.
Would the Minister of State like to tell us if he supports the Hanly report?
The Members opposite clearly do not like facts. That is the problem with Members on the other side of the House.
I am asking the Minister of State a question. Would he like to answer it?
The Minister of State obviously does not want to answer it.
There has been a major increase in investment in the health service. The Health Service Executive is implementing a consistent line of policy. I see this in my own section of the Department. Every citizen now has the same rights, irrespective of what region of the country he or she is from.
Is the private hospital system that the Tánaiste proposes for everyone?
I will address that later. I will also address Deputy Burton's extraordinary intervention later.
Like the private hospital system that is for everybody.
We are getting the private beds out of public hospitals.
It is for the Tánaiste's fat friends.
We are getting private beds out of public hospitals.
They are for the Tánaiste's rich friends.
The Tánaiste has clearly initiated a number of measures to improve the position in accident and emergency units but it will take time for them to come into effect. I accept that her initial schedule may have been over-ambitious but I have no doubt the initiatives she has taken will take effect.
Where was she over-ambitious?
I wish to refer to the national treatment purchase fund. That is another matter about which we never hear from the Opposition benches.
The Minister of State heard about it from the Comptroller and Auditor General.
No, we did not. The treatment purchase fund has been successful in treating over 35,000 persons up to the end of last September.
Let us hear about accident and emergency services, the thrust of the motion, and the Minister's commitment.
The Minister of State is not quoting the report of the Comptroller and Auditor General.
It continues to use the capacity available in hospitals to ensure that acute beds are available for emergency patients.
What about the report of the Comptroller and Auditor General?
Notwithstanding Professor Drumm's opinion, we are committed to increasing acute hospital bed capacity. This will have a significant effect on addressing the capacity of acute hospitals.
The Minister should make up his mind.
God almighty. In one speech the Minister of State has gone backwards and forwards.
I would very much like to deal with the issue of Deputy Burton's attempted sabotage of the future of the Connolly Hospital in Blanchardstown, which was truly fraudulent.
The Minister of State wanted to get rid of James Connolly's name last year.
The name is still in place, and proudly so.
This year he just wants to sell off the hospital.
The Deputy will be glad to hear that I referred to its name in my address just before the Taoiseach contributed at the Fianna Fáil Ard-Fheis. There are also admirers of James Connolly on this side of the House. Let us face the fact that public patients deserve to be treated in public hospitals.
Why does the Government not do that?
Private patients should pay for treatment in private hospitals.
Tax breaks are provided for private hospitals.
We will develop Blanchardstown as a campus for excellence. I appeal to Deputy Burton to listen——
Has the Minister of State visited units four and five recently?
I appeal to her to listen——
On a point of information, has the Minister of State——
There is no such thing as a point of information.
——visited units four and five and seen the antediluvian accommodation and conditions?
The Minister of State should be allowed make his contribution without interruption.
I appeal to Deputy Burton to listen to the views of staff at the hospital.
Has the Minister of State visited units four and five? Is he not ashamed?
It is an extraordinary appeal——
——to have to make to a Deputy in one's own constituency. The Government has invested more than €100 million in the development of a tremendous facility on-site at the hospital.
Thirty-six million euro was raised by selling the hospital land.
The accident and emergency unit is second to none. I salute the work of the staff of this unit who have done tremendous work since it opened. I also compliment the staff and management on the proposal they put to the Minister, not at her intervention but very much at their intervention and with my support. Let us not mix up ideology with what is best for the patient. The proposal has been made by the hospital community and it is very worthy of examination. It should not be dismissed out of hand because of some ideological fetish entertained by the Deputy.
My ideological fetish is that patients are entitled to treatment.
It is a solid proposal to increase bed capacity in the hospital and it seeks to ensure that public patients have access to the public beds in the hospital. It will also ensure that the private beds will also be available for public patients. It is worthy of examination. I am very concerned that the principal finance spokesperson, whom I had hoped would be eligible to be Minister of Finance in a future rainbow Government, is so dismissive of our proposal, which represents value for money to the Exchequer and the taxpayer.
The Minister of State should visit the hospital.
I visit it regularly, as the Deputy well knows.
The Minister of State without interruption.
——which the Minister of State promised as recently as last May?
I did not promise phase two last May.
The Deputy should examine the——
He issued a long press release extolling the virtues of phase two.
The Minister of State without interruption.
Is he denying he issued the press release?
I am telling the Deputy——
Is he denying his press release on phase two?
——that if she has any shred of responsibility in her body, she will realise this is an excellent proposal.
On a point of information, is the Minister of State denying that he issued a press release setting out phase two last May?
There is no such thing as a point of information.
Is that just gone with the wind?
I call on the Minister of State to conclude.
Did the Minister of State send out a press release on phase two——
I did send out a press release.
——and hold a special press conference thereon?
I did not hold any special press conference of the type referred to by the Deputy.
He issued a press release and was featured in all the local papers.
Order, please. The Minister of State is in possession for another minute.
I am most anxious to ensure that capacity is increased in the hospital and that this is done as quickly as possible.
Is the Minister of State denying the press release?
The Deputy should consult the hospital community on what it wants for the future of its hospital.
Is the Minister of State denying the press release on phase two which has been attributed to him?
This is not Question Time. On medical cards——
He is either denying it or he is not.
This is not Question Time. I appeal to the Deputy to consult the hospital community.
The Minister of State should just answer the question.
It is an easy question. Did he or did he not issue a detailed press release on phase two?
I certainly did not commit myself on phase two which would involve the exclusive decision of the Minister and the Department.
He lauded it and welcomed it and did not mention the private hospital.
What I lauded, welcomed and mentioned, and what was discussed on that occasion — the Deputy was not present at the launch——
No public representatives were invited except yourself to your own press release.
On the occasion in question, it was openly discussed whether we could improve the capacity of the hospital and by what method this could be achieved.
Is that what it was about?
We on this side of the House — I refer to the Fianna Fáil Party, with all due respect to the Tánaiste——
At the end of August the Minister wrote to me to state there was no money for phase two.
——have never been guilty of dogmatism on these projects.
It is going into the private hospital tax breaks.
That is an interesting distinction.
On medical cards and services in the community, not just services in hospitals, I will take full responsibility for the future of Blanchardstown Hospital.
Will that be for phase two of Blanchardstown hospital?
I do not want to listen to further ideological guff from the Deputy which is totally at odds with what the hospital community wants.
It is what the community of patients wants rather than the consultants.
Let us put the patients first.
Not the consultants but the patients.
The Minister's only concern is for the consultants.
The Minister of State's time is up.
Ours at least is for the patients.
The Minister of State should conclude.
The Minister of State is too provocative.
He should stick to his brief.
He was told his time is up.
He should give us a break.
He should give us a break and shut up.
On community services, the medical cards issue has been resolved, which I welcome.
I wish to share time with Deputy McManus, whom I thank for introducing this motion to enable the House to debate the dire state of the health service in this very wealthy country. I want to address the Labour Party proposal to put in place supports at community level so that patients, particularly elderly patients, can be cared for in their own homes and communities. I want to debunk the humbug and hypocrisy of that part of the Government amendment which commends the Tánaiste and Minister for Health and Children, Deputy Harney, on having a specific focus on the needs of older people. I will demonstrate the hypocrisy of the Government's position.
Home helps are neighbours or friends who provide essential care to the elderly at home and enable older citizens to live in dignity and some degree of comfort in their own homes. They do housework, cooking and shopping. Until recently, some home helps were paid at a rate that would be expected by a Filipino hairdresser on Irish Ferries. Their trade union, however, was successful in a claim for a decent wage for them. How did Harney and this wasters' Government react? They cut the number of home help hours that could have been provided. They did this without regard to the suffering of the senior citizens involved, the knock-on effect on acute bed occupancy and the take-up of the long-stay accommodation. That is some special focus.
In reply to my parliamentary question on 28 September 2005, the Minister of State, Deputy Seán Power, stated the hours of home help provided in County Kildare between 2003 and 2005 had been cut by a massive 40%. A mere two weeks later, on 13 October, the Tánaiste blankly denied that there were any cuts in the home help service. In doing so, I believe she deliberately misled this House. Her cold-hearted and cruel actions have led to real suffering and stress on the part of every old person in Kildare who previously availed of the service. All have reduced hours and many have had the service withdrawn completely.
One couple in their early 80s, both with heart conditions and other old age related ailments, were managing fine with a home help service of one hour per day and were happy and content in their home and community, but heartless Mary and this wasters' Government targeted them and other similar people for savings. The service of the couple was terminated and consequently one is now in long-stay care and the other is in an acute hospital bed. They will have to sell their home to pay Mary Harney's friends in the private nursing home sector. Shame on her. I could give her a list of similar cases as long as my arm. Harney persists with the myth that there were no cuts in Kildare, yet home help hours were cut by 40% on her watch.
The other service which was available and which worked involved the disabled person's grant. This grant assisted old and disabled people with the provision of downstairs toilets, showers and, perhaps, bedrooms. This allowed people to remain in their homes and communities. It is now virtually impossible to obtain these grants in County Kildare as the money has not been provided. Let that sink in. The Government did not provide the authorities with the money to pay the grants or build the downstairs toilets or showers.
The disabled person's grant is provided by the local authority. The Deputy and his colleagues are controlling Kildare. The funding is provided through his local authority. He and his colleagues——
The waiting period in Kildare is now two years and is sometimes forever.
The Deputy does not like the truth.
The Department of the Environment, Heritage and Local Government——
As a direct result, people who could be in their own homes are now——
——and the Deputy's local councillors would not provide the money in their estimates.
——in acute hospital beds because they were denied the grants by the Fianna Fáil Party and the Progressive Democrats.
His estimates will have to be considered again next year. Will he include money in them for the people of Kildare——
——instead of blaming the Government for the failure of the council that he and his colleagues control in Kildare?
What stupidity, what callousness——
He should not blame the Government for his part——
——and what heartlessness will they think of?
He and his colleagues control Kildare County Council.
To top it all, they cut the home help hours as well.
He should not blame anyone else for his own inaction.
Societies are judged on how they deal with the elderly.
The Deputy should know better.
This Government will be judged on that basis very harshly.
Deputy Stagg should generate one new idea before 8.30 p.m.
Get out of it, you waster.
I welcome the opportunity to contribute to this debate. I listened intently to the Tánaiste's reply to the points made by my colleagues last night and I was flabbergasted. When I was growing up in the 1960s my family had an old record player the needle of which often stuck on one spot so we heard the same old lines coming out. Eventually we had to lift the needle to get it over the rim. The Minister for Health and Children repeated the claptrap I have heard from this Government for the past eight years.
Can the Minister explain why the people of Longford and Westmeath have waited eight years for a decent hospital, as promised in 1997? During that time the Minister allowed at least €150 million be frittered away while the taxpayers of Longford and Westmeath paid their money and she did nothing about the hospital. The Minister is in no position to tell anybody here about hypocrisy. She turned up last April for a photo opportunity with her colleagues when the doors of the 12 bed paediatric unit were opened. As soon as she left the doors closed behind her and the staff are waiting to be appointed. Is that the way to run a health service?
This Government fails to give the people what they deserve, but the people are waiting in the long grass. We will not forget. I was in Longford and Westmeath recently where I met a nurse who asked me when the 12 bed unit would open. I said it should have opened by now. She hoped it would open in November or December because she works in the Coombe Women's Hospital but would like to work 20 miles from her home, in Mullingar where she is badly needed.
Does the Minister think the electorate I represent are fools? Is it not a sad day when a hospital such as Our Lady's Hospital in Crumlin, where a close relative of mine is a patient, needs additional funding? The Minister should not say the hospital does not need funding. Why are Niall Quinn and popular musicians donating money to it?
It would shame anybody but most of all it is to the Minister's shame that her ideology is to privatise the health service. She wants to look after the interests of the property developer instead of the public provision of hospital services. This is an ideological argument in which the Minister is very much to the right.
It is a scandal. The Minister should first give €100 million to Our Lady's Hospital in Crumlin, an excellent facility with excellent nurses. I know the unbelievable work they did to save a young relative of mine. I know too, as a barrister, as should the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, that people who are handicapped as a result of accidents may have to wait to be admitted to the National Rehabilitation Hospital in Dún Laoghaire. That is not good enough. It too deserves €100 million.
That is how I would have spent the €200 million the Minister will waste on PPARS. Surely people can write with biros or whatever to ensure staff receive their wages? None of them will receive €100,000 or €1 million more than they should. The manual system always got the payroll right. The Minister should put that money into services that are needed for children and for those who are severely disabled or handicapped as a result of car or other accidents.
I would be willing to pay another cent or two in tax, a suggestion the Minister does not like to hear, to ensure the services are provided for everyone belonging to me and the people of this country, young and old. Why should nurses working in Mullingar have to deal with 135% and 140% over capacity of patients at Christmas? The Minister told Deputy Paul McGrath that the hospital is going to tender in March 2006. It will have taken 11 years by the time it is open. One third of the hospital was provided in 1997 — a lovely building destroyed now by bird droppings.
Does the Minister know what the concept of value for money means? It is value for money if it is for the private investor. There is no reference to value for money when the service is for ordinary people who pay their taxes and do not leave the country to dodge them. They are the people who count. The next election will focus on ideology and putting people's well-being before the profits and economics of the right wing classes.
We would have expected more from the republicans.
I thank everybody on this side of the House who contributed to the debate, particularly my colleagues in the Labour Party. It was significant that people concentrated on articulating the views and experiences of ordinary people in their constituencies who sometimes encounter horrific problems in accessing health care. Many speakers could have scored political points by talking about squandering resources and the wasteful habits of this Government but instead they chose to use the time effectively to bring forward the concerns of people who have no other way of being heard.
It was interesting that the Fianna Fáil contributions were about problems, such as the need for more radiotherapy services, or to deal with MRSA, or the elderly. The speakers might as well have been on this side of the House.
With some regret I say the Minister made a most unworthy speech, the worst I have ever heard Deputy Harney or anybody in this House make. It was silly and self-serving, and trivialised serious matters in the health service.
I quoted the Deputy's remarks about Deputy Howlin.
The Minister had her time and did not even use it all.
I just quoted what the Deputy said.
It was self-serving and dishonest. It seems to us that the Minister suffers from overweening ambition. She thought she could float into the Department of Health and Children and get everybody working in new ways that would sort out the problems. She has proved only that she can make as many hollow promises as her predecessor, Deputy Martin. She promised to deliver real and measurable improvements in accident and emergency services within months.
The Deputy's medical contacts are making sure that does not happen.
The Deputy's vested interests will make sure it does not happen.
That was the promise she made and no amount of interruption will change the plain truth that we all know because we can daily see that accident and emergency services have deteriorated. People are waiting longer during this Minister's period of office. The number of people waiting in accident and emergency departments has grown. I was astonished to hear from Deputy Howlin that one night a couple of weeks ago 41 people were on trolleys and chairs in Wexford Hospital, a small hospital. We have grown used to the fact that in Tallaght Hospital there will be 40 people on trolleys and chairs and in the Mater Hospital patients are suffering horrific conditions but the problem is getting measurably worse.
We were told this new broom of a Minister would clean up the hospitals but the incidence of MRSA has grown significantly worse — five babies in the National Maternity Hospital have been affected by it. We depend most on health services at the beginning and the end of life. What legacy will this Minister leave after her next 18 months in the health services? Will more vulnerable elderly people and neonates be at risk?
That is the pattern and until we have a Government that faces up to the hard facts there will be further deterioration. That, not the individual stories, is what most concerns me. There is a blanket refusal and denial of the facts. When I heard the Taoiseach recently talking gobbledygook about the health service to the people I was chilled because I realised we will get nothing from this Government. We will get no change for the better. The Minister falls back on the Health Service Executive at every turn but it is a bureaucratic nightmare that does not work. It is a very expensive experiment with which not even Niamh Brennan agreed. Let us get real. There is no longer any accountability in the system. The people who have now been in charge for eight years are becoming less accountable, and that goes right through the health service. Ordinary patients do not have access to influence and power, and God knows there was limited access in the time of the health boards. Now there is none.
For the Minister to say that the national treatment purchase fund did not deny access to private hospitals for care is simply not true. Let her say that to my 70-year-old constituent who was told by her specialist at the Blackrock Clinic that the NTPS was not providing the money, so that the operation could not take place. That also happened in the case of an elderly woman from Dunboyne trying to get a heart operation in the Mater Hospital. She was told the same thing.
I asked the Deputy for the details last week. She should give them to me. She should also give me details about the person paying a taxi fare of €600.
There is one thing the Minister cannot take from me. When I raise issues such as these, it is because people have asked me to do so and because I have the evidence.
The Deputy should give me the details.
The great misfortune now is that a person who had a reputation for being an honest, straight talker comes to this House and gives us the kind of nonsense we have heard today.
I asked for those details two weeks ago and the Deputy still has not given them to me.
Elderly people are waiting on chairs for days on end and babies are becoming infected in hospitals which should have been protecting their health and which are now causing risks for them.
The Deputy should give me the facts.
Amendment put.
The Dáil divided: Tá, 67; Níl, 54.
Tá
- Ahern, Dermot.
- Ahern, Noel.
- Andrews, Barry.
- Ardagh, Seán.
- Blaney, Niall.
- Brady, Johnny.
- Brady, Martin.
- Brennan, Seamus.
- Browne, John.
- Callanan, Joe.
- Carey, Pat.
- Carty, John.
- Cassidy, Donie.
- Collins, Michael.
- Cregan, John.
- Curran, John.
- Davern, Noel.
- de Valera, Síle.
- Dempsey, Tony.
- Dennehy, John.
- Devins, Jimmy.
- Ellis, John.
- Fahey, Frank.
- Finneran, Michael.
- Fitzpatrick, Dermot.
- Fleming, Seán.
- Gallagher, Pat The Cope.
- Glennon, Jim.
- Hanafin, Mary.
- Haughey, Seán.
- Hoctor, Máire.
- Jacob, Joe.
- Keaveney, Cecilia.
- Kelleher, Billy.
- Kelly, Peter.
- Kirk, Seamus.
- Kitt, Tom.
- Lenihan, Brian.
- Lenihan, Conor.
- McDowell, Michael.
- McGuinness, John.
- Moloney, John.
- Moynihan, Donal.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M. J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Donnell, Liz.
- O’Donovan, Denis.
- O’Flynn, Noel.
- O’Keeffe, Ned.
- O’Malley, Fiona.
- O’Malley, Tim.
- Parlon, Tom.
- Power, Peter.
- Roche, Dick.
- Sexton, Mae.
- Smith, Brendan.
- Smith, Michael.
- Treacy, Noel.
- Wallace, Dan.
- Wilkinson, Ollie.
- Woods, Michael.
- Wright, G.V.
Níl
- Boyle, Dan.
- Breen, James.
- Breen, Pat.
- Broughan, Thomas P.
- Burton, Joan.
- Connaughton, Paul.
- Connolly, Paudge.
- Costello, Joe.
- Crawford, Seymour.
- Crowe, Seán.
- Cuffe, Ciarán.
- Deasy, John.
- Deenihan, Jimmy.
- Durkan, Bernard J.
- English, Damien.
- Enright, Olwyn.
- Ferris, Martin.
- Gilmore, Eamon.
- Gormley, John.
- Gregory, Tony.
- Healy, Seamus.
- Higgins, Joe.
- Higgins, Michael D.
- Howlin, Brendan.
- Kenny, Enda.
- Lynch, Kathleen.
- McGinley, Dinny.
- McGrath, Finian.
- McGrath, Paul.
- McHugh, Paddy.
- McManus, Liz.
- Mitchell, Olivia.
- Murphy, Catherine.
- Murphy, Gerard.
- Neville, Dan.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- O’Dowd, Fergus.
- O’Shea, Brian.
- O’Sullivan, Jan.
- Pattison, Seamus.
- Penrose, Willie.
- Perry, John.
- Rabbitte, Pat.
- Ring, Michael.
- Ryan, Eamon.
- Ryan, Seán.
- Sherlock, Joe.
- Shortall, Róisín.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Twomey, Liam.
- Upton, Mary.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Stagg and Neville.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 66; Níl, 54.
Tá
- Ahern, Dermot.
- Ahern, Noel.
- Andrews, Barry.
- Ardagh, Seán.
- Blaney, Niall.
- Brady, Johnny.
- Brady, Martin.
- Brennan, Seamus.
- Browne, John.
- Callanan, Joe.
- Carey, Pat.
- Carty, John.
- Cassidy, Donie.
- Collins, Michael.
- Cregan, John.
- Curran, John.
- Davern, Noel.
- de Valera, Síle.
- Dempsey, Tony.
- Dennehy, John.
- Devins, Jimmy.
- Ellis, John.
- Fahey, Frank.
- Finneran, Michael.
- Fitzpatrick, Dermot.
- Fleming, Seán.
- Gallagher, Pat The Cope.
- Glennon, Jim.
- Hanafin, Mary.
- Haughey, Seán.
- Hoctor, Máire.
- Jacob, Joe.
- Keaveney, Cecilia.
- Kelleher, Billy.
- Kelly, Peter.
- Kirk, Seamus.
- Kitt, Tom.
- Lenihan, Conor.
- McDowell, Michael.
- McGuinness, John.
- Moloney, John.
- Moynihan, Donal.
- Moynihan, Michael.
- Mulcahy, Michael.
- Nolan, M.J.
- Ó Cuív, Éamon.
- Ó Fearghaíl, Seán.
- O’Connor, Charlie.
- O’Dea, Willie.
- O’Donnell, Liz.
- O’Donovan, Denis.
- O’Flynn, Noel.
- O’Keeffe, Ned.
- O’Malley, Fiona.
- O’Malley, Tim.
- Parlon, Tom.
- Power, Peter.
- Roche, Dick.
- Sexton, Mae.
- Smith, Brendan.
- Smith, Michael.
- Treacy, Noel.
- Wallace, Dan.
- Wilkinson, Ollie.
- Woods, Michael.
- Wright, G.V.
Níl
- Boyle, Dan.
- Breen, James.
- Breen, Pat.
- Broughan, Thomas P.
- Burton, Joan.
- Connaughton, Paul.
- Connolly, Paudge.
- Costello, Joe.
- Crawford, Seymour.
- Crowe, Seán.
- Cuffe, Ciarán.
- Deasy, John.
- Deenihan, Jimmy.
- Durkan, Bernard J.
- English, Damien.
- Enright, Olwyn.
- Ferris, Martin.
- Gilmore, Eamon.
- Gormley, John.
- Gregory, Tony.
- Healy, Seamus.
- Higgins, Joe.
- Higgins, Michael D.
- Howlin, Brendan.
- Kenny, Enda.
- Lynch, Kathleen.
- McGinley, Dinny.
- McGrath, Finian.
- McGrath, Paul.
- McHugh, Paddy.
- McManus, Liz.
- Mitchell, Olivia.
- Murphy, Catherine.
- Murphy, Gerard.
- Neville, Dan.
- Ó Caoláin, Caoimhghín.
- Ó Snodaigh, Aengus.
- O’Dowd, Fergus.
- O’Shea, Brian.
- O’Sullivan, Jan.
- Pattison, Seamus.
- Penrose, Willie.
- Perry, John.
- Rabbitte, Pat.
- Ring, Michael.
- Ryan, Eamon.
- Ryan, Seán.
- Sherlock, Joe.
- Shortall, Róisín.
- Stagg, Emmet.
- Stanton, David.
- Timmins, Billy.
- Twomey, Liam.
- Upton, Mary.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Stagg and Neville.
Question declared carried.
