Health Service Reform: Motion (Resumed).

The following motion was moved by Deputy Twomey on Tuesday, 6 February 2007:
That Dáil Éireann,
aware of:
the fall in the number of acute hospital beds in Ireland up to 2001;
the fact that over 40,000 elective operations have been cancelled in the past two and a half years;
the cancellation of emergency surgery due to lack of ICU and HDU bed capacity at St. James's Hospital;
the fall in the percentage of people eligible for medical cards;
the shortage of consultant, specialist and general practice doctors; and
deploring the Government's failure to reform the health service to enhance the quality of services and achieve better value for money;
calls on the Government to commit to excellence in the quality of care, fair access on the basis of medical need, and efficient use of resources byinter alia:
beginning immediate planning for an additional 2,300 hospital beds;
scrapping the Ministers plan to build private hospitals on public land;
extending medical card coverage to 40% of the population; extending GP-only cards to all children under five, who are not covered by a medical card;
introducing health insurance for all children up to the age of 16 — including an element of free GP care for children from 5 years upwards;
beginning reform of health funding so that the money follows the patient;
making progress on the appointment of 1,500 new consultants, with a corresponding reduction in the number of junior doctors in general specialties, until a better balance is achieved;
implementing the Fottrell report on medical training to expand the number of doctors in training;
expanding community support services for elderly people to live independent lives as far as is practicable;
providing at least 1,500 additional convalescence, rehabilitation and long stay community beds to meet current and future needs with 600 of these beds based in Dublin; and
increasing the number of home help hours.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann and substitute the following:
welcomes the increase of 1,200 in the number of inpatient beds and day treatment places since the publication of the Health Strategy in 2001 and the plans to open new acute hospital units;
welcomes the unprecedented rate of expansion of acute hospital bed capacity since 1997;
notes the national review of acute hospital bed needs currently underway which will identify the number of acute hospital beds needed up to 2020;
notes the annual increase in acute hospital activity with the result that in excess of 1 million patients receive treatment in public hospitals each year;
supports management actions to improve the efficiency of use of acute hospital beds in order to shorten lengths of stay for patients and bring average length of stay closer to international norms;
regrets that some patients have their operations postponed when priority is necessarily given to emergency cases; recognises that postponements cause upset and inconvenience for patients and their families; and supports all management actions to free up hospital beds and keep postponements to a minimum;
notes the significant increase in intensive care and general bed capacity at St. James's Hospital;
supports the success of the National Treatment Purchase Fund in providing treatment for 55,000 patients, achieving major reductions in waiting times for public patients and providing a service that is directly responsive to patients;
supports the initiative to encourage private investment in new facilities on the campuses of public hospitals with the central purpose of freeing 1,000 beds currently reserved for private patients for use by public patients in a most cost effective way;
commends the Minister for:
the fact that there are now more medical cards in issue than in 1997;
the fact that substantially more people can now visit their GP free of charge than in 1997 due to the introduction of the GP visit card;
the substantial increases in the medical card and GP visit card assessment guidelines;
the considerable easing in the means test income assessment now based on disposable income after tax and certain living expenses;
the investment in the development of GP out of hours services and the recent commencement in GP out of hours service in north Dublin city; and
funding additional GP vocational training places;
commends the Government on the funding of €44 million provided to date for the establishment of Primary Care Teams and Networks and acknowledges the commitment in the Towards 2016 Partnership Agreement to the further expansion of the primary care system;
strongly commends the Government for the largest expansion in services for older people over the two recent Budgets, with additional funding of €400 million provided, bringing in major expansions in home help packages, home help hours, palliative care and nursing home subventions;
commends the Government and the Health Service Executive for securing 1,000 new long-term care beds in 2006 and for the planned addition of 800 long-term beds this year, the majority in the public sector;
commends the Government on publishing and accepting the broad thrust of the recommendations from the Working Group on Undergraduate Medical Education and Training (Fottrell) and the Postgraduate Medical Education and Training Group (Buttimer);
acknowledges the measures taken by the Government to provide funding and support for the integrated implementation of the reforms in medical education and training across the health and education sectors from undergraduate through to specialist training;
supports the Government's proposals to increase the numbers of EU student places in medicine at undergraduate level; introduce a graduate entry stream into medical education; reform the entry mechanisms into medical education; strengthen governance and accountability, improve graduate retention and phase out Non-Consultant Hospital Doctor (NCHD) posts of limited training value;
acknowledges the significant increase of 66 per cent in both the number of consultants and junior hospital doctors over the last 10 years; and
supports the Minister in the conduct of negotiations with medical consultants on a new contract within a specific, urgent timeframe, to allow for the beginning of the recruitment of 1,500 new consultants on new contractual terms and a corresponding reduction in NCHD numbers.
— (Minister for Health and Children).

I wish to share time with Deputies O'Connor, Devins, Cooper-Flynn, Fiona O'Malley and Callanan.

Is that agreed? Agreed.

I welcome the opportunity to speak on this motion, especially on primary care. This is one area where substantial savings can be made, but not that alone. In dealing with health matters we should not think purely in terms of cost. A positive and good service can be provided for the community through the development of primary care teams. The development of a primary care service is an essential component of the health service reform process which has been spoken about by the Minister for Health and Children over a considerable period of time.

In a developed primary care system, more than 90% of day to day health requirements and social care needs can be met. It is important that we deal with patients in a home setting in so far as this is possible and this can be accomplished by the provision of a proper primary care service. The emphasis is on keeping people in good health and supporting them so that they may live in the community rather than in institutional care. We know that the cost of institutional care far exceeds that of keeping people in the home setting. The key objective is to give them direct access to integrated multidisciplinary teams of general practitioners, nurses, physiotherapists, occupational therapists, home help carers and others. Such teams will be able to provide integrated comprehensive services to meet health and social care needs at community level. This has been characterised as providing the right care in the right place at the right time. Where it is happening, it is, indeed, very successful.

With the introduction of additional resources, which are being funded, the HSE will be working on reorganising existing professional resources in the community so that people's needs may be met in a generalist rather than a specialist manner in so far as this is possible. The Government has provided significant new funding — €44 million in total — to enable primary care teams to be rolled out. In 2005 an additional €5 million in revenue was provided, bringing the total ongoing funding to €12 million in support of the primary care strategy. Funding of €10 million was provided in 2006 to enable the establishment of up to 100 primary care teams, involving the appointments of 300 additional frontline professionals. These core teams can be further developed in the future as restructuring takes place within the HSE and as resources permit. It is money well spent. Indeed, with the ongoing increase in costs for keeping high support beds in general hospitals, it is to be encouraged that the HSE, the Minister and all involved in managing the health system should ensure that individuals, particularly the elderly, are kept in their own homes as far as possible.

Another €22 million is being provided in 2007 to meet the full year costs of the 2006 developments and to enable a further 100 primary care teams to be established. The 2006 funding was targeted by the HSE to establish up to three primary care teams in each of the 32 local health offices, which were formally known as community care areas. To achieve this objective, the HSE has identified the preferred locations for the first group of teams. There are currently 90 teams in development. This also involves placing 450 general practitioners in teams during the 2006 phase, with a further 700 GPs to join the teams in 2007. The HSE also proposes to run a recruitment competition seeking a further 300 additional front-line professionals for these primary care teams. Approximately 235 additional personnel are being offered appointments, including 77 physiotherapists, 52 occupational therapists and 80 nurses. The HSE is also exploring alternative means to provide staff when it has not been possible to recruit them.

I welcome these developments and I wish the Minister and the HSE every success in promoting this particular scheme.

I welcome the opportunity to make a contribution to this important debate and I compliment the Opposition on giving us this opportunity. I always take an interest in health matters and this goes back to the founding of the then planning board under the chairmanship of Deputy Woods, which set the tone for Tallaght Hospital. I was proud to be involved all the way through the planning process and to be on the MANCH board which founded the hospital in 1988. I am proud of the hospital which is within sight of where I live. There will always be challenges and difficulties, but I want to acknowledge that point.

I took the opportunity last week, when speaking on a similar motion, to talk about cancer services in Tallaght. I will not repeat everything I said, but as evidence of the Government's commitment, it will be expected that Tallaght Hospital will be designated as one of the eight major cancer centres when the cancer report is finalised.

I was interested to hear what my colleagues said about developments in primary care. We have been very proud of the development of primary care centres in Tallaght, such as the health centres in Jobstown and the GP centres in Brookfield and Killinarden. I highlight these developments because they are making a tremendous contribution to primary care needs in the Tallaght area. However, there is one problem at the Millbrook Lawns health centre, which was damaged in a fire several years ago. We have been campaigning to have the development programme started. I would like the Minister of State to convey my disappointment to the Minister that the builders are not yet on site. I will continue to press this with the Minister, departmental officials and the HSE. It is important that my local community gets that particular centre. I have pursued these issues for four and a half years and I will continue to do so.

I strongly support the concept of primary care in the community. There should be a seamless connection between primary care and the local hospital. We should stress that to HSE management at every possible opportunity. People are very proud of the development of GP services in north County Dublin and I welcome that move. However, we also need centres in Dublin south west, especially in Tallaght. I hope that the Minister's officials will look at that issue and develop it as much as possible.

I come from a health board background. I was on the Eastern Health Board from 1994. I was the founder chairman of the south-west area health board and I was committed to that particular concept. Many of us in this House are frustrated that we still must fight with officials to get information. We table Dáil questions but we do not get proper answers. We are brought to briefing sessions but we do not get the information we want. I will go to the briefing session next week, under the chairmanship of Deputy Sexton, and I look forward to it. However, the HSE is still not doing simple things. Why are we not given phone numbers of local officials so that we can get information from them? We would not have to table Dáil questions if that was the case.

Whatever about the Mater Hospital site — I do not want to excite Deputy Twomey — I have been——

I am listening.

——very consistent in my views on this subject. The excellent services which have been in Tallaght since 1998 must be retained. That is my bottom line.

I am delighted to have the opportunity to speak on this very important issue. I commend the Opposition for putting forward another Private Members' motion on health.

I wish to discuss one aspect of the wide-ranging motion and the amendment, which is the provision of health care at the primary care or general practitioner level. Since I was first elected to the Dáil five years ago, almost all debate has centred on hospitals, while little has been said about care at primary level. However, the fact remains that more than 95% of all encounters that take place occur at GP level. It is patently obvious that a good, well resourced multi-disciplinary general practice would take much of the pressure off our hospitals. Most patients can be dealt with at primary care level and do not need either referral or admission to hospital.

General practice must be well resourced for the system to work at maximum efficiency. For far too long, it has been the Cinderella of medical care, with virtually no resources supplied. Thankfully, that has changed in the recent past and I welcome the recognition that the Minister has given to the vital role of primary care by substantially increasing the funding available. This is manifested in the establishment of over 100 primary care teams throughout the country. These teams are the key to the future. By having a range of services available under one roof in the community, the public can avail of a comprehensive service. Not only is a general practitioner available, but a practice nurse, a physiotherapist, an occupational therapist and other support services can be co-ordinated and centred around the patient, who is the most important person in the health service.

Having worked as a GP in Sligo, I know the benefits that can accrue to a patient when a multi-disciplinary team is available to him or her. There are three primary care teams in Sligo and Leitrim, one in north Sligo, one in south Sligo and one in Leitrim. However, there is an urgent need for more. I welcome the fact that €22 million will be provided this year to continue funding the 100 teams and establish a further 100 teams throughout 2007. Some 450 general practitioners are currently involved in the teams and a further 700 will join the teams this year. In addition, 77 physiotherapists, 52 occupational therapists and 80 nurses will be recruited. I ask the HSE to establish some of the extra teams in the Sligo-Leitrim area, as the benefits to patients are increasingly obvious. Primary care can and must play a more pivotal role in health care provision, not only at disease treatment level but also at disease prevention level. More resources must be made available to screen the population for illnesses such as high blood pressure, diabetes and cervical and prostatic cancer. I am delighted the Government recently decided to roll out the cervical screening programme to the entire country. I look forward to that happening before the end of the year. Prevention is better than cure. Money spent on screening for such diseases is well spent. The full resourcing of general practice so it can achieve its full potential is essential. I ask the Minister to continue to make available the moneys which have been made available this year. I commend the amendment to the House.

I also welcome the opportunity to speak during this important debate on the health services.

I accept that the number of hospital beds has increased by 1,200 since 2001. While the number of beds in acute hospitals in County Mayo has increased by 60, there has been a greater reduction in the number of beds available in public long-stay facilities, unfortunately. That reduction has contributed significantly to the problems which have been encountered in the accident and emergency department of Mayo General Hospital over recent years. The Government made a commitment in recent times to develop community nursing homes so people can be looked after within the community. Some of those who served with me on the former Western Health Board will be familiar with the campaign, which has been ongoing for over 20 years, to develop a community nursing home in Ballinrobe. Now that a site is available, all we need is a commitment from the Government to spend the money that is needed to ensure the proposed community nursing home becomes a reality. Such a development would make a significant difference in that community. I ask the Minister of State, Deputy Seán Power, to contact the HSE to ascertain the current status of the proposed development in the list of priorities. The nursing home should have been built and opened in the Ballinrobe community long before now.

I do not think all the contract beds which are available in my local area are being utilised. The provision whereby beds can be contracted out to nursing homes is not being availed of. I do not know whether the hospital authorities are trying to save money for other areas within the hospital budget. This matter should be examined because there is plenty of availability in many private nursing homes in the area.

Like many of my colleagues, I have made the case over many years for a fairer subvention rate to be made available to older people in the west. I have pointed out that there is a significant gap between the subventions paid in the western and eastern regions. While there has been an increase in the rate over recent times, there continues to be a gap of over €400 between what one receives as a subvention in County Mayo and what one receives on the east coast. We will not accept minor increases if we are expected to think they will solve the problem. The discrimination that has existed in respect of subventions — the fact they have been so low in the west — has meant many people who would have liked to take up beds in private nursing homes have been denied the right to do so.

I welcome the increase in home care packages over recent years. Just five packages were awarded in my local area in 2005, at a time when the home care package system did not represent a realistic option for older people who want to live in their own homes, which is something the Government supports. I welcome the significant improvements in that regard over the last year.

I would like to speak about the transport of people by ambulance to hospitals. I am concerned about the limits on the availability of ambulances to bring people to hospitals in my local area. County Mayo is a huge geographical mass — it has a diameter of 140 miles — with some very remote areas. Many people in the county, who rely on social welfare payments, do not have the money to pay for taxis to bring them to visit people in hospital. Perhaps we should demonstrate a little more leniency in the provision of transport to and from hospitals

I support the Minister's position on consultants' contracts. I agree with the proposals to provide for public-only contracts; to arrange for the provision of services by consultants 24 hours a day, seven days a week; and to move from a service that is led by consultants to a service that is provided by consultants. I commend the Minister on the manner in which she is pushing that agenda. Mayo General Hospital has been waiting for a number of years for a rheumatology consultant to be appointed. People who are in severe pain have to travel to Galway. Some of them have been waiting for seven years or more to be seen by a consultant. I brought this matter to the attention of Professor Brendan Drumm at a meeting of the Joint Committee on Health and Children and I am bringing it to the attention of the Minister of State now. I understood that funding would be provided in 2007 to alleviate this problem, but it does not appear at this stage that it will happen. I am particularly disappointed about that. I ask that something be done about this matter, which is a priority in the Mayo area.

I would like to mention the plight of nurses, who have balloted for strike action, in the context of the debate on consultants' contracts. I supported a motion on this matter at a meeting of the Joint Committee on Health and Children. I agree that nurses should get a fairer deal in our hospitals. I support their call for a shorter working week, for example. The Labour Court indicated 26 years ago that the working week of nurses should be reduced from 39 hours on a phased basis. This proposal should be considered by the Government. Hospital administrators have a 33-hour working week, whereas nurses have a 39-hour working week. Nurses who complete four years of education as part of the degree course should receive fairer pay. We are discussing consultants but we should not forget nurses, who are the backbone of the health service. I ask the House to support their claim.

I acknowledge the work that has been done on medical cards. There has been a significant increase in the number of people who qualify for medical cards. It is noticeable that many more people have been getting medical cards over the last two years, in particular. I welcome the considerable improvements which have resulted in recent months from the changes to the guidelines for GP cards, because by November 2004 we had witnessed a situation over the previous few years whereby many people had lost their entitlement to a medical card.

I also support the investment of money by the Minister for Health and Children and her Department in primary care teams, which constitute an essential component of health service reform. I look forward to the Government meeting its commitment to increase the number of primary care teams throughout the country over the next number of years, so that there will be 300 such teams by 2008, 400 by 2009 and 500 by 2011. This component of the health system will be of great assistance in our communities in the years to come. I ask the Minister of State to bring the points I have made to the attention of the Minister.

I thank the Opposition for giving me this opportunity to speak about the challenging circumstances we are facing in the health care system. It is challenging because reform was needed. The Department of Health and Children is lucky to have the Minister, Deputy Harney, at the helm because she is courageous, determined and brave.

Those are brave words.

The Department has waited for a long time to have a Minister like her. She has taken to her task with the reforming zeal one would expect from a Progressive Democrats Minister. I would like to discuss two aspects of the Government's amendment to this motion. I refer firstly to what I call the "restoration programme", whereby 1,000 beds in public hospitals which are currently designated for private use will be redesignated for public use. I cannot understand why some Deputies in this House are so opposed to the programme. Deputy Joe Higgins disparaged the proposal this morning, even though it involves the restoration of public beds to the public service for its exclusive use. I fail to understand how it can be referred to as an example of the privatisation of the health service. It is something one would expect the Labour Party to support because it emphatically demonstrates that public beds in public hospitals will only be available for public use.

If an independent or private hospital chooses or is given the go-ahead to lease publicly owned lands and to provide additional services, the pressure is again reduced on the public service. What is wrong with that? It should not be penalised. I fail to understand the criticism that this is the privatisation of the health service. The opposite is the case. This initiative will provide an additional 1,000 public beds. Anybody who has an interest in the Irish health service should applaud it.

Deputy Joe O'Higgins this morning spoke about how private developers would rape and pillage public lands, as it were. He can be assured that a stringent cost benefit analysis will be carried out. In many cases the land will be leased at the going commercial rate so he has nothing to fear in that regard.

Another issue that deserves attention is the extraordinary success of the National Treatment Purchase Fund. It is one of the hallmarks of the Irish health service. The National Treatment Purchase Fund recently published figures from the national patient register which show that patients waiting for the 20 most common operations are now treated within two to five months.

It is wrong.

This is phenomenal. I can hear the Deputy giving out about it but he cannot argue with the facts.

It is wrong.

How can the Deputy say that? It is not wrong.

I refer some of those patients and they are not seen within two to five months.

In 2002 there were waiting lists of between two and five years. Whatever else one can say, nobody wishes to see a patient waiting longer than necessary. The way the National Treatment Purchase Fund has operated has been phenomenally successful. It provides choice for patients and, more importantly, it means the patient is relieved of the painful symptoms they had to endure.

It is telling that the new patient treatment register recently wrote to 11,397 patients and that 8,042 of that number did not respond. That is extraordinary. I am glad the National Treatment Purchase Fund will examine this. One would expect people on waiting lists to grasp the opportunity to have their ailment treated. I commend the amendment to the House.

I welcome the debate. I served on a health board from 1985 to 2002 and I have seen huge improvements in services. A total of 95% of patients who attend hospital are very satisfied with the care and services they receive. Waiting lists for many operations, especially hip operations, have been greatly reduced. If one is on a waiting list for a hip operation for six months, the National Treatment Purchase Fund will find a bed for the patient in a private hospital. I remember when one might wait up to four years for an appointment.

Our hospitals have more nurses, consultants and care staff than ever. I congratulate the hospitals in my locality, University College Hospital, Galway, Merlin Park Hospital and Portiuncula Hospital, which are providing a great service to a greatly increased population. I look forward to the provision of a new accident and emergency department in Portiuncula Hospital, Ballinasloe. This will provide far better facilities for the workers and patients. The unit is at present extremely restricted for space.

With regard to services for the elderly in east Galway, I welcome the proposal to build an 80-bed community nursing home at St. Brendan's Hospital, Loughrea, to replace the old buildings there. I compliment the nurses and care staff of St. Brendan's for the excellent care they give to the patients. I also welcome the proposal for a 60-bed community nursing home in Ballinasloe to cater for the needs of the elderly in that area and in St. Brigid's Hospital. I compliment the nurses and staff of St. Brigid's psychiatric hospital in Ballinasloe who give great care to their patients. Numbers in the hospital have been greatly reduced. A great deal of work has been done to move most of the patients into the community, which is most welcome.

I urge the Minister to proceed with the proposal to build a psychiatric unit in Portiuncula Hospital as planned. It is now accepted that psychiatric patients should be treated on the same site as the main general hospital. I welcome the proposed new hospital campus for Tuam. This will take pressure off the Galway hospitals and will cater for less severe cases in the Tuam catchment area.

I welcome the increase in the number of people with medical cards and doctor-only cards. Owing to substantial increases in the income thresholds to qualify for doctor-only cards, approximately 30% of the population will qualify for them. These people will also qualify for the drug repayment scheme, whereby no family unit need pay more than €85 per month for drugs. Holders of full medical cards are entitled to free treatment in hospitals as outpatients and as inpatients in public beds. People who opt to take a public bed in a hospital pay less than €100 per night for ten days and the bed is free for any time after that. This is a great service as patients who find themselves in hospital for long periods need not pay after ten days. In all the debate on the health services, these services are not highlighted enough. Most countries do not provide such a free health service and if people get sick, they are faced with huge medical bills.

I welcome the increase in nursing home subvention from €190 to €300. It is still not enough but the increase is particularly welcome in the west, where nursing home subvention was far too low compared to other parts of the country. In community care, I welcome the increase in the income disregard whereby a married couple can have an income of up to €640 and qualify for carer's allowance. Furthermore, a widow can qualify for carer's allowance of €105 in addition to her widow's pension if she is caring for somebody. I also welcome the increase in the respite care grant.

I wish to share time with Deputies Ó Caoláin, Gregory, McHugh, Cowley, Catherine Murphy and James Breen.

Deputy Callanan said we have a good health system in that people in other countries must pay for care. Perhaps the Deputy will point out where that applies in Europe. Ireland is unusual in the European context in having a peculiar hybrid system. Essentially, the public sector pays for the private sector. Only 10% of the funding comes from health insurance; the rest is publicly funded. There is a huge imbalance in our society that is unjust and unacceptable. Those who have money are attended to first, get better treatment and are privileged, while those who do not have money are discriminated against. There can be no argument about that.

The starting point of any debate on health must be about reforming the inherent injustice in that system. There must be an even playing field so I strongly support the proposal in the motion for the introduction of universal health insurance. There are a number of ways to even the playing field. There could be an NHS type system or universal health insurance, and there are different models for that. A common waiting list could be introduced. However, it is clear that the Government is not interested in any of these measures and is happy to continue with this strange public-private system. We are heading towards a private system. The term "yellow pack" has been used increasingly with reference to the public system. There may be more beds in the public system but the type of treatment will be inferior and this is the difficulty.

Deputy Fiona O'Malley talks about the so-called success of the National Treatment Purchase Fund, but it can only be regarded as a stopgap measure. I accept that certain people are now better off because of it but if we continue with it, we will entrench a system which is inherently unjust.

I met a woman last night who needs a basic operation. She has a kidney failure problem but she does not have insurance. One hears about this situation in the United States but this woman has to save up her money to go to the Blackrock Clinic. This is an appalling indictment of our society and such situations are becoming more commonplace.

One of the elements missing from the motion is preventative care. I would have liked some reference to the implementation of the recommendations of the task force on obesity and the task force on alcohol. Alcohol abuse costs this country €2.65 billion every year. It creates a burden on accident and emergency units where injuries caused by anti-social behaviour are treated. It is an appalling drain on the country's resources, yet the Government chooses to ignore it. The alcohol products Bill, which was due to be introduced, was shelved at the behest of the alcohol industry and this will become an issue in the general election. While people acknowledge the drink culture which exists and which is sometimes celebrated——

The monitoring group will have reported by then.

We need more than monitoring; we need action.

It is an independent group.

This voluntary agreement was put in at the behest of the alcohol industry——

It was not at the behest of the alcohol industry. The Deputy should not spoil a good story by telling the truth.

The alcohol industry tells us not to put health warnings on bottles——

The Deputy should not spoil a good story by telling the truth.

——because they say it does not work. The industry recommendation on every bottle is to drink sensibly. If it does not work, why do they put it on bottles?

I will conclude by saying that the privatisation agenda must end.

On behalf of the Sinn Féin Members I support the motion in the name of the Fine Gael and Labour Deputies and I reject the Government's amendment.

I welcome the fact that last night the Minister for Health and Children, Deputy Harney, set aside her script and replied to the points made by Members in the debate. I read her remarks with interest. If she really believes half of what she said, then we are in more trouble than I thought.

Her amendment to the motion proposes that her plan to allocate land at public hospital sites to the developers of private for-profit hospitals will free up 1,000 beds currently reserved for private patients for use by public patients "in the most cost-effective way". Given that we have no costing at all for the Minister's madcap co-location plan, it is breathtaking that she can describe it as the most cost-effective way to provide additional public beds. This is nonsense. In the face of growing opposition to the co-location plan, "1,000 beds" has now become the mantra. It is near time the Minister told us where the figure of 1,000 beds comes from and where exactly these beds will be located.

The Government and its predecessors have all defended the two-tier public-private system which put private beds in public hospitals in the first place. The Minister still defends it, yet expects to be taken seriously when she says that her hospital privatisation plan is designed for the benefit of the public patient. This again is nonsense. She cannot get away from the fact that in 2001 the Government's own health strategy estimated that an additional 3,000 beds were required to replace beds taken out of the system in the 1980s and 1990s and to cater for our growing and ageing population. In a most dishonest way, the Government amendment states that they have provided 1,200 "inpatient beds and day treatment places", thus using the day treatment figures to bump up the hospital bed figures.

The Minister appears to be talking tough when it comes to hospital consultants. However, as far back as 2001 in the health strategy, the Government promised that it would re-negotiate the contract with hospital consultants to ensure greater equity for public hospital patients and that this would be done by 2002. However, in 2007, an elite of hospital consultants is still allowed to draw massive salaries from the public purse while spending much of their time treating private patients in private for-profit hospitals and clinics. I ask the House to guess who gets more time and better treatment. The consultants have delayed negotiations for over five years in order to defend this indefensible contract. The Minister tried to appear outraged at this last night, but where was she and the Government for the past decade? They and their predecessors negotiated and maintained this privileged position for consultants to the detriment of the public patient.

The Minister, Deputy Harney, now claims to be standing up to the consultants but she has totally undermined the Government's position because while she "talks tough" about the consultants' private work, she is driving forward with her disgraceful privatisation co-location plan. In reply to a Dáil question from me last week, the Minister said tendering for these private hospitals will begin in March. If this goes ahead, the State will be tied into legal contracts and the privatisation plan will be implemented with no mandate and within weeks of a general election. The plan should be scrapped now.

The latest embarrassment for the Health Service Executive is the fact revealed by a citizen who contacted my office yesterday. The HSE has confirmed that supplies of the BCG vaccine have run out, leaving a gap of several weeks in the vaccination programme and causing worry to parents of newborn children. The HSE blames the suppliers but how was the stock allowed to run out?

Members of the Irish Nurses Organisation and the Psychiatric Nurses Association of Ireland have voted for industrial action which will take place unless the Fianna Fáil-Progressive Democrats Government changes its stonewalling attitude to the nurses' just demand for a 35-hour week and the resolution of serious pay anomalies. The IMPACT trade union, which represents thousands of workers in the health services, has also threatened industrial action because of the treatment of its members. It has highlighted the Government's ceiling on recruitment and its obsession with privatisation.

The health crisis requires a radical response. The public health system must be defended against privatisation. The two-tier system must be challenged. There is no halfway house between where we are now and a fully public system based on the right to health care for all. This is what the people of this State deserve and demand.

I support this motion because it is a commitment to fair access to the health service on the basis of medical need. I do not believe this principle of equality is possible under the current two-tier system. What is required is a real change to a more egalitarian social health care insurance scheme along with free primary care. Under the existing unequal, two-tier system, there is no doubt but that people are dying on waiting lists because they are not being treated equally.

The case of Rosie, the cancer patient, is just the tip of the iceberg. Many public patients with serious health problems can only access treatment after their condition has deteriorated and is at an advanced stage where full recovery is more difficult to achieve. This is a scandal that cries out to be addressed.

Last year, a constituent began to lose her sight. Using her medical card, she attended her GP who advised her to see a specialist as quickly as possible. She was then informed there was a long waiting list and she might not be reached until the end of 2007. This alarmed her greatly as her eyesight was deteriorating rapidly. She contacted my office and I tried to assist her. As the lady in question was on a low income and had a medical card, she was obliged to wait irrespective of the urgency of her condition. She waited for a number of months to no avail before arranging to borrow money. She was then able to make an immediate appointment when she contacted the Mater Private Hospital. The consultant confirmed the seriousness of her condition and made arrangements for the necessary treatment with his team.

The moral of the story is that if one is on low pay and has a medical card, under the Government's two-tier health service one can go blind or worse while waiting for treatment, but if one has money, one can receive treatment immediately. This constitutes inequality Progressive Democrats style which can only be addressed by political change.

I wish to place on record the circumstances surrounding a disgraceful development in my constituency of Galway East where the Health Service Executive, through its inaction, is putting at risk the lives of people in the north east of the county. In May 2006, €1.8 million was provided under the capital plan for the provision of an ambulance base in Tuam, County Galway, to serve the entire north-east Galway region. Since then, the HSE has done nothing to improve the lot of members of the public in the area. This disgraceful scandal is further illuminated by the fact that the building in question, the old Grove Hospital, is available and suitable to house an ambulance base. A planning application, site purchase or design are not required. The only requirement is that the base be established in an existing building with a parking area and all other services.

In medicine the term "the golden hour" is used to describe the hour after a person suffers a major trauma, such as a heart attack, and during which he or she must reach a coronary care unit to have a reasonable chance of survival. The golden hour criterion cannot be met in present circumstances given that ambulances based in Galway city must travel 35 miles in each direction to collect and take a patient in north-east Galway into care. This journey of 70 miles, which must be undertaken before a patient arrives in hospital, cannot be completed in one hour. The HSE, by its inaction, is behaving disgracefully and placing at risk the lives of people in north-east Galway. My requests to the HSE on this issue have fallen on deaf ears. I demand that the Minister for Health and Children, Deputy Harney, take action to force it to act.

When the Taoiseach or Minister for Health and Children, Deputy Harney, are asked about deficiencies in the health service they cite statistics to show the amount of money supposedly being spent on health. Despite this expenditure, the two-tier health service is alive and well. For example, Mayo General Hospital holds ear, nose and throat clinics on two days each week. Those attending the morning clinics who try to arrange an appointment with a consultant must wait five to six years to be seen. A very urgent appointment takes two weeks, while those scheduled to see a consultant "soon" must wait for one and a half years. Deputies will get no marks for guessing that these waiting times apply to public patients, towards whom the Government has a duty of care.

Those who attend the afternoon clinic in the same hospital will sit in the same seats in the same outpatient department and be seen by the same consultant on the same couch. The only difference is that this group consists of private patients who must only wait a week for an appointment. This is not the consultants' fault as they are entitled under their contracts to see private patients in their own time. If a consultant wants to obtain a place in University College Hospital, Galway, for a public or private patient, even one with cancer, it will take approximately a month to secure a bed. Why is this the case? In the case of the latter group, it is due to a bed capacity problem in University College Hospital, Galway, whereas in the former case, it is because Mayo General Hospital does not have an ENT consultant. Patients in County Galway are not required to wait as long as patients in County Mayo. Moreover, there are too few ENT consultants in the region despite the large amount of money supposedly being spent.

Comhairle na nOspidéal, the expert State body which decides on the number of hospital consultants required, has indicated that the number of ENT consultants in the HSE west area should increase from three to six. Is the failure to appoint three additional consultants related to money? We learned almost five years ago that a fourth ENT consultant, a head and neck cancer specialist, was to be appointed in the region as a priority. The appointment has been a long time in the pipeline. However, as it is an academic post, the consultant will be based full time in Galway, with the result that the ENT clinics in Mayo General Hospital will be held on just one day each week. This will lead to public ENT patients in County Mayo being forced to wait for ten to 12 years for an appointment. That is disgraceful.

I will focus on one aspect of the motion, namely, the issue of health insurance. A decade ago, it was inconceivable that a healthy 20 year old or 30 year old would have private health insurance. This is no longer the case and this sends out the message that people in this group need insurance because they cannot afford to queue and experience delays.

The debate on reforming the health service is characterised by opposing visions. The United States model, which has been much studied by the Government, restricts public coverage to elderly and disabled people and certain groups living in poverty. According to the OECD, 71% of the US population has some form of health insurance. The alternative vision demands the establishment of a properly funded universal health service. Key to delivering this demand is the delivery of the thousands of beds called for in the motion.

Health has become a commodity discussed within the parameters of the marketplace as if it were a replacement part for a washing machine or fridge. In many ways the debate on private health insurance is the wrong discussion. While 43% of the population has private health insurance, according to the OECD, private health insurance contributes just 7.6% to the cost of health provision. We need to address the reasons for increasing reliance on private health insurance.

A review carried out in 2004 by the OECD — the same organisation which will receive €400,000 this year to review the general public service — noted that private health insurance has given rise to equality concerns and raises cost-related challenges. For example, the report points out that providers face incentives to offer preferential treatment and quicker access to private patients in public hospitals because these patients are largely treated in public hospitals where the cost of treatment is subsidised. We need a decent public service and we must end reliance on private health insurance.

Week in, week out the appalling state of the health service is debated in the House. The Government's only defence is to inundate Deputies with statistics, hoping that the real truth will be lost among the dross. Every week the Taoiseach comes to the House and waffles about all the money being spent on the health service. If he referred to large sums of money being squandered on the health service, people would believe him.

Where is money being squandered?

Does the Deputy believe there are no waiting lists for operations or beds, or that operations are not being cancelled? Is no one waiting for a consultant's appointment? Last week, a constituent of mine who suffers from severe diabetes was sent to Limerick Regional Hospital to see a neurologist before being sent home without being seen. Limerick Regional Hospital does not have a neurologist which means one must come from County Kerry two days every month to serve the mid-west region. Is this the health service of which we are proud?

We have endured a long saga with Ennis General Hospital. Before the 2002 general election, the then Minister for Health and Children, Deputy Martin, stated on a visit to my constituency that an upgraded hospital was so far advanced in the planning and design stages that it would shortly be advertised for tender in the European journal. The four Oireachtas Members from the Government side met the Taoiseach about 18 months ago without asking me or my namesake, Deputy Pat Breen, to accompany them because they wanted to deliver an upgraded hospital in Ennis on their own. What happened after the meeting? The Members hurried home because the Taoiseach instilled in them such confidence about the project that they were afraid it would commence before they arrived in Ennis, with the result that they would not have an opportunity to announce it on Clare FM or in The Clare Champion. Nothing has happened since.

We were informed by a Senator that the Minister assured him the team would proceed to the tender and planning stages in July 2006. The date was changed first to late October 2006. It is now early spring of 2007. When will Ennis General Hospital be upgraded? The election will be long over but I am hopeful I will be here to see the project delivered.

We do not want any more waffle from the Minister or the Taoiseach. The truth is not being told in the House. The Government has tried to hoodwink people. East Clare does not have a 24-hour accident and emergency service and Loop Head, 60 miles from Ennis, does not have an air helicopter service. We have been promised both services. While this is grand on paper when will we see them in reality? Is it surprising that the people of County Clare have lost confidence in the Government? When will Ennis General Hospital be upgraded? Will the Hanly report be implemented? Will Ennis retain its 24-hour doctor-led accident and emergency service? I doubt it. The Government has failed the people, including the people of County Clare. They will continue to fail while in power but, hopefully, we will be on the Government benches after the election and we will bang them out of the place.

I wish to share time with Deputies Hayes and Connaughton.

Is that agreed? Agreed.

I want to deal with the issue of mental health, which has been ignored as the Cinderella of the general health service. The Minister of State, Deputy Tim O'Malley, said I am always speaking about this matter so I wish to introduce an independent view of the Government's performance since the publication in January 2006 of A Vision for Change, the policy report accepted by the Government. The Irish Psychiatric Association has produced a one-year progress report on the initial report, entitled A Vision in Hindsight. The latter report was launched on 24 January 2007 and the Minister of State should reflect on the views of one of the key groups which delivers psychiatric services. Dr. Siobhán Barry, the public relations officer for the Irish Psychiatric Association has stated that the experience at the coalface over the past 12 months was disappointing. She said the degree of enthusiasm felt by service providers has not been responded to, so there is a feeling of betrayal and disappointment.

After the first year, the Minister should have some structures in place but there is disappointment and dismay at what has occurred. The Government is not serious about doing anything about the health services or introducing the recommendations in A Vision for Change. Dr. Éamonn Moloney has pointed out that one third of community-based psychiatric teams have less than 50% of the staff recommended. At last year's rate of appointments, which amounted to 24 posts, it will take 25 years to introduce the full recommendations of A Vision for Change.

Dr. Barry has said the Government's response to capital development requirements is shameful, shabby and shoddy. The national mental health directive has not been introduced, although it is cost neutral. That indicates the Government's lack of interest in introducing any reform in mental health services. The Government is not serious about change.

The report of the Irish Psychiatric Association says there is little evidence that the task of implementing A Vision for Change has been tackled seriously to date. The HSE implementation and expert advisory groups took almost six months to be established and each met just three times. No formal mapping exercise has yet been conducted by the HSE, although such a task is fundamental in the association's view. Insufficient funding has been provided, according to the Irish Psychiatric Association which states that although €26 million was committed nationally to the development of new mental health services in 2006 at the commencement of A Vision for Change, the level of funding received by individual services has been small with none receiving more than €500,000. This has been insufficient to create the new multidisciplinary teams recommended. In fact, the introduction of such teams was first mooted 22 years ago in a report entitled "Planning for the Future", which was accepted by Government but not implemented.

Last year, I tabled a parliamentary question asking how much was being invested in the psychiatric services as a percentage of the total health service. I was told the figure was 7.3%. That compares to 12% in England and 18% in Scotland. On 1 February, I asked the Minister for the percentage of the budget allocation for psychiatric services compared to the total health budget, but the Minister did not know. She told me the Revised Estimates volume for 2007, which will give a breakdown of spending across these areas, including mental health services, is being compiled. We will not know the answer until 22 February when it is due to be released. While the Minister does not know the relevant figure, the Irish Psychiatric Association could calculate it, and stated:

An unprecedented increase of €1.1bn in the health spend was announced in the 2007 budget — bringing the total to €14 billion. Of that, €800m is allocated to mental health as revenue funding and €25m to new service developments. A Vision for Change advised that implementing their recommendations would require the mental health percentage of the health budget to increase from its previous 6.9% to 8.24% — the meagre increased funding for mental health in 2007 brings that percentage down to below 6%, indicating clearly that we are moving in the opposite direction.

The Irish Psychiatric Association concludes that one year after its publication, A Vision for Change remains a plan. At the most senior organisational level, little thought appears to have been given to organisational development, financial or otherwise, to enable its implementation. The funding issue, if it is being debated at all, is being discussed in the abstract. The financial targets outlined in A Vision for Change will clearly not be met. The Irish Psychiatric Association's latest report states:

We can say with some confidence that on the first anniversary of the publication of the document, and also the year in which our budgetary giveaways have been at a historical high, the relative decrease of the mental health budget is a very bleak indicator for the future.

At its press conference, the Irish Psychiatric Association's representatives stated, "The vision is vanishing and with it the opportunity and goodwill to make it possible. Those affected by mental ill health are close to yet another political betrayal." This is a missed opportunity for the Minister of State, Deputy Tim O'Malley, who is the first incumbent in the newly created junior ministry, to make a credible and enduring contribution to those his office is meant to serve. The public, service users and carers are angered and disappointed. They cannot accept this lack of progress. The IPA, together with service users and providers, is demanding urgent political and administrative action or, failing that, it will seek electoral accountability.

On the first anniversary of the launch of A Vision for Change, the Irish Psychiatric Association published a review of the progress in its implementation but, as I have outlined, no progress is being made.

The Minister of State's colleagues sometimes tell me this is not a political issue and there are no votes in it. I probably agree with that. While getting re-elected is important in order to deliver one's views, politics is also about leadership. It is about taking on major issues of deep public concern, which may not be overtly expressed. The stigma surrounding psychiatric services prevents open debate about their provision. We have asked repeatedly for investment to reduce this stigma. For example, the National Suicide Prevention Office will receive a budget of €1.6 million this year. The National Safety Office, which promotes road safety, has a budget of over €30 million, yet there are more suicides than road deaths. I adhere to the view that investment in promoting road safety is not adequate. Young people in crisis need help. They need to understand that they are suffering from depression. They see no way out of their pain other than to take their lives, but there is no investment or interest in this.

There is a need for leadership in this area. We in Fine Gael and the Labour Party have shown leadership in our first published policy document which, initially, one senior Minister moved to rubbish but then quickly pulled back and accepted it was a good document. Fine Gael and Labour have shown leadership. If there is a change of Government, the parties will have committed themselves to producing a costed policy to change the situation.

I am delighted to contribute on this important topic. When I listened to the "One O'Clock News" with Sean O'Rourke today, the opinion poll under discussion showed a huge turn in favour of the Opposition, which would enable it to form a Government. A major issue in the featured constituency was that of health, in particular equipment purchased with public funds but left lying idle because the HSE and those responsible for putting it in place did not carry out the work. That situation will be replicated in constituencies, towns and cities throughout the country. There is no greater concern in the public mind than health and the situation of friends and family when they get sick.

Members of the public visit many public representatives every week seeking to have hospital beds provided. They know that the huge amount of money spent on the health service by the Government is delivering a poor service. Nobody will condemn it for spending the money but when a poor service is being delivered, somebody must be held accountable. That is the real concern. Some weeks ago the HSE and the Department of Health and Children came before the Joint Committee on Health and Children, where several of the issues raised concerned the waste of money. Following the contributions of the officials of the HSE and the Department on management of the health services, I have major concerns.

My constituency has seen one of the longest and most bitter struggles between two towns on the amalgamation of services and the location of a hospital. The transfer of surgical services from Cashel to Clonmel took place after Christmas but there is serious concern in the constituency about the need for reassurance that standards will remain high. Major resources have been invested and people have had to give up much in the context of the transfer of services. This is the first time the matter has been discussed in the House, despite an agreement over ten years ago to the transfer. I want an assurance that high standards will be maintained for the people of south Tipperary.

St. Patrick's Hospital in Cashel is one of the finest geriatric hospitals in the country. I am very much in favour of the future development of the hospital, which serves the needs of a wide community in south Tipperary. No matter what happens, if funds are not invested in services for older people, we are going nowhere as a country and as a people. I commend the work of the staff and all involved in St. Patrick's Hospital and support the submission the hospital has put before the Department. The Minister of State, Deputy Brian Lenihan, should remind those in power in the HSE that there is a role for St. Patrick's Hospital in Cashel. He should bring this matter to the attention of the Minister.

I listened attentively to the Taoiseach when he answered on Leaders' Questions yesterday with regard to the number of patients on trolleys in accident and emergency units last month when compared with the figures for the previous 12 months. The figures he provided were fascinating. He told us there had been reductions of 20%, 30% and 50%. However, I have great doubts about the method of calculation of the number of patients on trolleys throughout the country.

For example, it has been brought to my attention that at University College Hospital, as in many other hospitals in recent months, five wards were closed due to the incidence of the winter vomiting bug. Two weeks ago, while those wards were closed, 16 patients were on accident and emergency trolleys. Lo and behold, at a certain time during the morning, one of the wards was opened and the 16 patients were wheeled off to it. However, I understand they were wheeled back again later in the day.

I would like to know if those 16 patients were added to the day's statistics for persons on trolleys. Many operations were cancelled at that hospital while the wards were closed, but it was remarkable that one ward could be opened that morning. The Minister and the HSE should explain how the figures are calculated because people are suspicious, as I am, given that the method of calculation seems unusual. I hope the explanation is to the contrary.

No matter what way the Government massages the message on health, the electorate are fed up to the teeth with the services they must put up with. In east Galway, like every other rural area, many elderly people have no car and have no one to drive them to hospital appointments. Until last year, they were used to having the health boards organise transport from their homes to the hospital and back. Apart from patients with cancer or needing dialysis treatment, that service has been stopped. Does anybody suggest this is a good service? Will the Taoiseach or his Ministers tell me it is the right way to do business?

I carried out a survey in east Galway of 25 matters relating to normal health problems which people experience. Some 1,400 people across the constituency saw fit to answer the questions and send back the survey with their comments. I guarantee that if the people in every other constituency are as fed up with the service as the people in my constituency, as demonstrated in this survey, the Government is in for a bigger shock than it expects.

For example, 84% of those who responded claimed the public dental service was either poor or average. Just 16% believed the public dental service in County Galway was a good one. The response was similar with regard to accident and emergency and other services. If there was ever an issue on which the Government faced criticism, it is the health issue. I hope the day will come soon when the Government will be in opposition because of what it did not do.

The Government, in accordance with the wishes and votes of the House, has invested almost €15 billion in health services this year. In 1997, we spent €3.6 billion. Normally when we have debates on the business of different Departments, some word of praise is uttered on all sides for those involved in the provision of the service.

Hear, hear.

For the tremendous work that is done within the health services, the social services and the associated primary care services, I have nothing but unqualified admiration.

In the tenor of this debate, there is no recognition of that from the Opposition. Instead, there is constant identification and isolation of problems which inevitably arise in any system involving the administration of health and social services.

Hear, hear.

Perhaps we should not talk about the problems.

The Opposition did not say one good word.

There is no good word to say.

There may be no good word in the document the Deputy is brandishing, but there is the good word of the many who have a good experience of what happens in our health care service. There is the good word of many who have had their physical and mental infirmities, difficulties and incapacities addressed by our health service and who have had good outcomes because of our outstanding medical profession, because of our outstanding and caring nursing profession and because of all the other allied support services that go together to provide an excellent health service.

Our capital investment in health is among the highest of all OECD countries, including Norway, which is often cited as a particular exemplar in the provision of such services. Let us look at where the money is being spent and what we are getting. First, let us look at the hospitals. Much of the focus of public debate and discussion has been on hospitals which provide more and better services than ever as evidenced by activity levels.

Some patients cannot even get hot water in a hospital in the Minister of State's constituency.

This year 1.2 million patients will be admitted to hospital, the HSE proposes to carry out more than 2.75 million procedures in outpatient departments and we expect 1.3 million visitors to accident and emergency departments. We also have care for the 65,000 births that take place in the State.

Things could not be better.

I am not saying that, but I am saying that if we examine the volume of the statistics, particularly those on activity levels relating to outpatient procedures, we can see an enormous increase in the number of outpatient procedures carried out in the past decade. This increase in volume reflects the amount of assistance medical science now provides for individuals and the corresponding investment by the State to ensure that many people benefit.

It is inevitable in a system which involves such substantial investment and such an enormous number and range of operations, procedures, assessments and tests that there will be complaints from time to time about the system.

From time to time — the Minister of State must not have been canvassing recently. It is a torrent of complaint.

Allow the Minister of State to continue without interruption.

The Deputy will be glad to hear I have intensified my efforts in the area of visiting constituents since the summer months and have heard complaints and comments about many different public services.

Would the Minister of State like to repeat them here?

It would not be normal for a Deputy to hear no complaints. The Taoiseach has always been assiduous in visiting constituents, but I confess that I have always belonged to the class which, like leaving certificate students, only prepares for the exam in the last year or two. I accept I am fully into the senior cycle phase of the election at this stage and am aware that the exam is drawing near. I assure Deputy Stagg that I am very active in visiting my constituents and I hear their many complaints about public administration and the different public services.

The Minister of State has passed all his exams so far.

There are many good stories to be heard in our health and social services. There are many successes, but it is the job of the Opposition to focus on the failures and difficulties. A significant volume of investment is going into the system. Much of the public debate has focused on how we can get value for money and how we can invest to the best benefit of the patient.

I am delighted to have the opportunity to speak on this issue. It is a bit disingenuous of the Minister to say that we never compliment those in the health service as we do so at every opportunity. However, today the staff of the HSE came out to say that they have lost confidence in the system. Therefore, it is not only the Opposition that is saying it has no confidence in the system. The Government has a big problem on its hands and sticking its head in the sand will not solve it.

The first issue I want to address is the new home care package lauded by the Minister for Health and Children whenever we raised the issue of people leaving hospital without having somebody to look after them if they are not going into nursing homes. A constituent of mine who lives alone in a very rural area recently came out of hospital. His family got a letter from the HSE to say he was granted a home care package valued at approximately €60 per week and there was no problem with that. The letter was approximately four or five pages long and informed the family that it would have to make the arrangements for the people involved in the care package. The grant of €60 per week was to cover an initial period of six weeks. The letter provided a list of private providers who would provide care, but when the family rang the two companies in Cork, it was told they only cover urban areas. What will happen to this man who lives in a rural area and has no home care? This amounts to privatisation of the home help service.

I will read a paragraph from the letter which I find interesting:

A list of private companies providing Home Care in the Health Service Executive South is attached for your convenience. The Health Service Executive makes no recommendation with regard to the suitability of any supplier and you or your representatives must satisfy yourselves that the provider selected by you can provide the care that is needed and to the standard you desire.

The HSE will pay for the service and provide a list of companies, but it does not want to have anything to do with standards. Have we learned anything from the nursing home debacle? We are going backwards. The HSE is more or less privatising the system and telling elderly people they must decide what standards they require and satisfy themselves as to that standard. The HSE wants to wash its hands of the problem, which is not acceptable. The Minister must take another look at this area. A system that asks an individual living almost 100 miles from Cork to ring up and arrange private home care with a company in the city, for him to be told care is only provided in urban areas, will not work.

This system was lauded by Government and we were told it was the answer to all the problems of elderly people coming out of hospital. It may work in the cities, but it definitely does not work in rural areas. I have serious reservations about the standard of care provided. I do not suggest there is anything wrong with the companies, but it is not right that patients must decide what is a satisfactory standard. The HSE is paying the money and it should decide on standards. There will be more investigations if this is what is happening.

Another issue I want to deal with is that of orthodontic waiting lists in Cork and Kerry. The senior public orthodontist for Cork and Kerry has announced that he has closed the waiting list for public orthodontic patients because there are more than 1,000 patients on the waiting list. Two dentists who left to continue their studies have not been replaced. The average wait for an orthodontic patient in Kerry is now four to five years, which is too long for a child in need. This is another stark failure on the part of the Government. I have been raising the issue in the House for the past ten years with no improvement.

When working as a full-time GP, I had between 12,000 and 15,000 consultations with patients every year, just like any other GP across the country. When I was on call, for example, going out at 12 midnight to see a sick child, admitting someone to hospital, ringing a local accident and emergency department or consultant, or chatting with an ambulance crew outside a patient's house, no one thought that patients should bow or scrape before us. We were doing what we were paid to do, and it was our duty and privilege to help people in that way.

If we are in Government after the next general election, it will be our job to look after the health services. Although people in this House do not refer to it directly, those working in the health services know what a good job they are doing. However, they are disgusted at the way in which the Government has used their good work and serious commitment to the health services to cover up its gross inadequacies and failures. The Minister of State is part of a Government that has been making an absolute mess of things, and that is among the reasons that Fine Gael and Labour issued a joint policy paper on a patient safety authority.

Patients lack an independent authority to protect them. An authority would last a great deal longer than the Minister of State or I and allow patients to feel that someone was looking after their interests. It would contradict the notion that every patient across the country must bow and scrape to Fianna Fáil for the great privilege that it has accorded them through providing a health service. That is the sort of disgusting arrogance creeping into the Government, which is responsible for what is going wrong with the health services and for addressing what is going wrong.

At a time when the consultants' contract has not yet been negotiated and the Minister is going around playing spin-doctors with patients' welfare, why does the Taoiseach or the Minister for Health and Children, Deputy Harney, not take control of those talks? Why does the Taoiseach, who does not know whether he is for or against the consultants and nurses, not take them in hand? He could show that great commitment to labour relations of former years, chair the talks himself, and secure a resolution.

On the fifth floor of this building, Fianna Fáil backbenchers scream all night at the Taoiseach about how the poor nurses in their constituencies might not vote for them. They do not give a damn about nurses; they are worried about nurses' votes. Why does the Taoiseach not come out and say what he wants to give the nurses who keep the service alive? They are very much its backbone, and he should not embarrass them or others working in the health service by forcing them to go on strike before an election. He should show us what he can do for health service workers rather than drag matters out with press releases detailing what he might do. He has let patients down desperately.

Dr. Neary was suspended from practice in Our Lady of Lourdes Hospital in 1998, yet we have the most faulty Medical Practitioners Bill that might possibly be introduced to the House to stop such events recurring. The Bill might have to be withdrawn so the Government can issue a new version. There is no quality assurance to get bad doctors out of the system. The vast majority of doctors and nurses in the health care system are fantastic. They are dedicated, well trained and totally committed, but the Government has done nothing to remove bad doctors from the system or protect patients. That is why we need a strong, robust Medical Practitioners Act and why we need a patient safety authority rather than another commission, which is the Minister for Health and Children's solution. There is no clear commitment to protecting patients.

The Minister of State should suggest at next Tuesday's Cabinet meeting that the Taoiseach or the Minister for Health and Children chair the consultant contract talks. The Taoiseach should make a commitment regarding nurses rather than send them out on the picket line. He should make clear his intentions. When he is there talking to them, instead of paying the lip service that I have heard from so many Fianna Fáil backbenchers regarding their concern for primary care or elderly people at home, he should ask why children with disabilities and those elderly people who want to stay at home cannot get an occupational therapist. Such therapists are necessary to assess an older person's house or whether a child with a disability requires additional services. It is used to restrict services, and the Minister of State supports that.

We have many physiotherapists, but they are not being employed by the HSE to care for elderly people in the community. There is no commitment to such care in the sort of lip service that Fianna Fáil pays in this Chamber. The hospitals are a disgrace because they have no clear commitment to looking after them. MRSA is rampant, and what has the Government done to deal with it? It is absolutely everywhere and getting worse each year. Some 29,000 people are waiting to see a hospital consultant, while 40,000 have had procedures cancelled. The Minister, Deputy Harney, told the House the bare-faced lie that people must wait only three months.

I ask the Deputy to withdraw that comment.

I will say that it was at variance with the truth.

That is what is happening, and a recent report from the Irish College of General Practitioners — and the Irish Cancer Society in case the Minister of State thinks there is a vested interest — showed that 41% of public patients wait more than 12 weeks for a colonoscopy, which is what the patient known as Rosie required. In her case, it was delayed significantly, and she was handed down a death sentence from bowel cancer. When I hear Deputy Fiona O'Malley or the Minister tell the House that patients are being seen within three months, I recognise it as a misstatement of the truth trotted out by Government representatives. That is why they have lost people's trust. They have deliberately tried to mislead them, and that is the sort of misleading information that they supply daily.

The Minister of State is part of a Government that will soon have been in power for a decade without having any strategy for the cancer services for which he is responsible. Those services are being run in accordance with a cancer strategy written in 1996. The strategy that the Government published last year awaits an implementation report that will not come until next year. They will have had a decade in power with no direct input into policy on cancer services.

But there have been great improvements in outcomes.

On the basis of the cancer strategy written by Deputy Noonan and presented to the Dáil.

We funded it.

It was funded by the Irish people. Fianna Fáil should not fool itself into thinking it did it. The economy was built on the backs of Irish people.

The Government must identify weaknesses in services and improve them. It must protect patients by whatever means necessary. Our favoured means, the way forward, is a patient safety authority rather than a commission to examine the issue. Deputy Martin puts everything off for four years, and Deputy Harney has also come down with a dose of "Micheál-itis". It is the Minister's job to look into the matter.

We know the health services work fairly well if one has access to them owing to the dedication of those who work in them. However, the Minister of State's job, like that of all those in the Government, is not to squeal from the fifth floor of this building about what he would love to see done. He must instead locate those problems and address them. He must not play politics, in this case with nurses but every day with patients' lives. That is what is so despicable about current events and what he is supposed to change.

We have formulated policies on mental health and screening programmes and decided that we need more beds. I cannot understand the Government's problem with that contention. Our hospitals are working at 100% occupancy all the time. The Minister, Deputy Harney, attended the House last night. There was a clear problem, since she stated that Ireland's bed occupancy exceeded 100%. However, the average length of stay here, according to the OECD, is among the shortest.

The Minister stated the average length of stay to be one of the longest.

Deputy Kenny raised the issue of BreastCheck and the Taoiseach tried to rubbish his statements about the ten dedicated beds for breast cancer patients in the Mater Hospital. The BreastCheck programme is supposed to identify people with breast cancer who are then supposed to be treated. There is not much point diagnosing breast cancer unless there is an ability to treat it. The Taoiseach's mumbling, fumbling and warbling on about something he does not understand just shows how disconnected the Government is with what is happening on the ground.

Amendment put.
The Dáil divided: Tá, 69; Níl, 54.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Ardagh, Seán.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Brennan, Seamus.
  • Browne, John.
  • Callanan, Joe.
  • Callely, Ivor.
  • Carey, Pat.
  • Carty, John.
  • Collins, Michael.
  • Cooper-Flynn, Beverley.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Curran, John.
  • Dempsey, Noel.
  • Dennehy, John.
  • Devins, Jimmy.
  • Ellis, John.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Haughey, Seán.
  • Hoctor, Máire.
  • Jacob, Joe.
  • Keaveney, Cecilia.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McEllistrim, Thomas.
  • Martin, Micheál.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael
  • Nolan, M.J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Connor, Charlie.
  • O’Donnell, Liz.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Batt.
  • O’Keeffe, Ned
  • O’Malley, Fiona.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Roche, Dick.
  • Sexton, Mae.
  • Smith, Brendan.
  • Treacy, Noel.
  • Walsh, Joe.
  • Wilkinson, Ollie.
  • Woods, Michael.
  • Wright, G.V.

Níl

  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burton, Joan.
  • Connaughton, Paul.
  • Connolly, Paudge.
  • Costello, Joe.
  • Cowley, Jerry.
  • Crawford, Seymour.
  • Crowe, Seán.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Durkan, Bernard J..
  • Enright, Olwyn.
  • Gilmore, Eamon.
  • Gogarty, Paul.
  • Gormley, John.
  • Gregory, Tony.
  • Hayes, Tom.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Kenny, Enda.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McGrath, Paul.
  • McHugh, Paddy.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Moynihan-Cronin, Breeda.
  • Murphy, Catherine.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Penrose, Willie.
  • Quinn, Ruairí.
  • Ring, Michael.
  • Sherlock, Joe.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Upton, Mary.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 69; Níl, 56.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Ardagh, Seán.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Brennan, Seamus.
  • Browne, John.
  • Callanan, Joe.
  • Callely, Ivor.
  • Carey, Pat.
  • Carty, John.
  • Collins, Michael.
  • Cooper-Flynn, Beverley.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Curran, John.
  • Dempsey, Noel.
  • Dennehy, John.
  • Devins, Jimmy.
  • Ellis, John.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Haughey, Seán.
  • Hoctor, Máire.
  • Jacob, Joe.
  • Keaveney, Cecilia.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Killeen, Tony.
  • Kirk, Seamus.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McEllistrim, Thomas.
  • Martin, Micheál.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, 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, Batt.
  • O’Malley, Fiona.
  • O’Malley, Tim.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Roche, Dick.
  • Sexton, Mae.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • Walsh, Joe.
  • Wilkinson, Ollie.
  • Woods, Michael.
  • Wright, G.V.

Níl

  • Boyle, Dan.
  • Breen, James.
  • Breen, Pat.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burton, Joan.
  • Connaughton, Paul.
  • Connolly, Paudge.
  • Costello, Joe.
  • Cowley, Jerry.
  • Crawford, Seymour.
  • Crowe, Seán.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Durkan, Bernard J.
  • Enright, Olwyn.
  • Gilmore, Eamon.
  • Gogarty, Paul.
  • Gormley, John.
  • Gregory, Tony.
  • Hayes, Tom.
  • Healy, Seamus.
  • Higgins, Joe.
  • Higgins, Michael D.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Kenny, Enda.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McGinley, Dinny.
  • McGrath, Paul.
  • McHugh, Paddy.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Moynihan-Cronin, Breeda.
  • Murphy, Catherine.
  • Murphy, Gerard.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Dowd, Fergus.
  • O’Keeffe, Jim.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Penrose, Willie.
  • Perry, John.
  • Quinn, Ruairí.
  • Ring, Michael.
  • Sherlock, Joe.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Twomey, Liam.
  • Upton, Mary.
Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.
Question declared carried.