Senator Fallon has indicated that he would like to wait for the Minister.
Health Services Cutbacks: Motion.
An Leas-Chathaoirleach
I understand the Minister for Health is engaged in the Dáil at the moment.
He was here a moment ago.
An Leas-Chathaoirleach
I think the Minister for Health is in the other House at the moment but the Minister for the Public Service, Deputy Boland, will sit in for him. Would Senator Fallon like to proceed?
Certainly. I move:
That Seanad Éireann condemns the cutbacks in the Health Services and calls upon the Minister for Health to ensure that there will be no reduction in the level and quality of general health care.
The reasons for this motion are very obvious indeed. It seems to me that there is a deliberate policy on the part of the Government who have been in office for a period of two years to drastically reduce health services in every way possible. The unfortunate point in this regard is that the very people whom the Labour Party and the Government say they want to protect, namely the poor, the deprived, the less well-off and those who are on very low incomes, are the people who will suffer most and who are suffering greatly at this point in time. Indeed we have a group who have become known as the new poor, people who are just above the medical card guidelines. They are heavily committed to mortgages, to taxes, to new levies of all kinds for planning, for water, for refuse and so on. I must repeat that in the joint programme for Government those were the very people the two parties concerned indicated they would protect most.
The Minister for Health himself, urged passionately that these very people should not suffer in any way. It is a sorry situation for Labour people in Government that they should be reneging on all their promises and all their beliefs. I find that all over the country Labour members of health boards and county councils are hanging their heads in shame at the savagery of the present cutbacks. From Donegal to Cork it is the same story, and what I intend to say here this evening will be in many ways a factual illustration of what is happening.
Throughout the country the story is similar. Wards in hospitals, in maternity units and other units are being closed. There are cutbacks in expenditure on maintenance and transport. The statements of many health board members are emotional. They are saying that people will die because of the cutbacks. These are very serious words. I hope that does not prove to be the situation. The Minister will have to be working extremely hard when he replies next week to prove to me and to my colleagues that it is not. We are told that by 1985 there will be further drastic cutbacks, further staff reductions, further wards and units being closed. There will be vacancies in hospitals next year. The public sector rule of filling one in three vacancies will apply to health boards. There is a ban on overtime. There will even be a ban on sick leave, if that is possible. The Chairman of the Dublin Skin and Cancer Hospital has said that the amount of money being made available by the State and by voluntary donations makes it difficult to maintain existing health services and developments. He further stated that both the quality and the quantity of services will be reduced.
In Galway a maternity unit is not in use because of lack of funds. Throughout the country there are buildings vacant because of a lack of money to fit and staff them. At the moment 14 buildings for the mentally handicapped are idle. In Cork knee joint and hip replacement operations are being discontinued. Here in Dublin wards are being closed in the Meath, Mater and Adelaide Hospitals.
In the Midland Health Board area, extreme difficulty is being experienced. The cutback there for 1984 has been £2.025 million. The board feel that to implement this cutback, if that is the right word, there will be no replacement of staff, no locums, no transfer of staff, that there will be juggling here and there and redeployment all over the place. That is on the pay side, while on the non-pay side there will be no painting, no maintenance, no renewal of machinery, of ambulances or of other vital equipment.
We know too, of what I consider to be an all-time low, a cutback on food. There is evidence of this in hospitals and institutions throughout the country. In St. James's Hospital tinned fruit and ice cream are no longer on the menu. In a certain west of Ireland hospital, not far from Athlone, I know of a visiting consultant who has been denied a cup of tea and a biscuit during a break. He has to go out now to his hotel. That takes about an hour whereas in the hospital he could have a cup of tea in a period of ten minutes and then continue his work. That is a very sorry state of affairs.
The shortfall for 1985 in the Midland Health Board area will create more and more problems. A shortfall of £2 million would be the equivalent of sacking 200 members of staff at approximately £10,000 per annum each or, if you like, closing for six months Portlaoise or Mullingar hospitals. It costs £3.8 million per annum to run Portlaoise hospital and £3.9 million per annum to run Mullingar hospital. I am trying to highlight the magnitude of this cutback, the severity of it and what it means. One could say that Birr, Edenderry, Athlone or Longford hospitals might be closed by way of equating the cutbacks. I want to assure the House that that is not the way the problem is being handled, but it is an indication of how serious the whole matter is.
Recently in the Athlone area there was a very serious accident. Because of the cutbacks, because of redeployment of ambulance drivers to other duties, what happened in regard to that accident led to massive public concern. Unfortunately, a young woman and her child were killed and a number of passengers were seriously injured. A gruesome scene, one might say, just outside Athlone but there was no ambulance available. The bodies of those who died and those who were injured were brought to a hospital in Ballinasloe by a passing van driver. He put the injured and the bodies of the dead in the back of his van and took them to hospital. Surely in this day and age that should not happen.
Again in Athlone — I am sorry to be so parochial about this — the Minister for Health last year came to the town and announced publicly a commitment to an orthopaedic unit and a casualty unit for our hospital. He has reneged on that promise. We congratulated him at the time. We thought it was the best move possible. We had been fighting for it for years. The Minister may say that planning is going ahead, which I believe it is, and that the project may well be ready next year for tendering stage, but that will not happen because members of the health board in their wisdom saw fit to travel to, Dublin to make a submission for extra staff for this important orthopaedic unit and also for the casualty unit. They were told that they must fund the units in some other way, that there must be redeployment, that they must fund them through some saving scheme or whatever. That is practically saying to our people in Athlone, "sorry, the hospital is not on, the orthopaedic unit is not on" because there is no way that the health board can transfer funds in this way for this particular important unit.
I make the point that in the national plan there is provision for, as it were, specialist, separate, important facilities, that they would come automatically without having the juggling of funds within the health boards' scheme. However, I must confess that I am not happy to read the contribution of Deputy Ormonde in the Dáil in which he said that in dealing with the Athlone situation, he had bad news for the Midland Health Board. He went on to explain that when the South-Eastern Health Board managed to provide additional funds from their allocations for the provision of two casualty officers and a radiographer, they were told by the Department of Health that because they would have a deficit for 1982 these funds would have to go to correcting this deficit. Therefore even if a health board manage to find the funds from within their allocations they are losing out.
I make the point also that I believe we are the only health board area where there are no paediatricians or orthopaedic surgeons.
The area of medical cards is one that has to be mentioned also. Entitlement in this regard is being reviewed and they are being taken back at an almost unprecedented rate. Shortly after coming to office the very first people to be hit by the Minister were the old age pensioners. The previous Minister for Health, Deputy Woods, issued medical cards automatically to old age pensioners. Then we had the students: their medical cards were withdrawn from them as quickly as they got them. We were promised a review of the famous 900 items that were removed from the list by Deputy Woods as Minister. There was a storm of protest at the time but we were promised a review of this area. The review did come about, but an extra 200 items were added to the list. Simple items like aspirin and Anadin which would have been prescribed in the past are now being replaced by far more expensive and more powerful painkillers costing the taxpayer and the health boards in question much more money than previously.
One might ask if the whole operation was a waste of time. The national plan, at paragraph 5.38 refers to coronary by-pass surgery. It makes the point that there has been an expansion in the capacity of the health services to provide effective diagnostic treatment services for conditions which previously were beyond the scope of active care. We are told that these include coronary by-pass surgery, renal transplant programmes and total hip replacements. The paragraph continues:
The community expects that these life-saving and life-enhancing techniques should be available to all those for whom they are effective. While health policy will aim to reduce the need for such services by preventing the associated illnesses, it will continue to be policy to make necessary care available to all.
It has been strongly suggested to me that in this area the people with medical cards perhaps are not receiving the same help as are people who are VHI members. I would like to think that that was not the case, that if a person had a serious coronory ailment he would have coronary by-pass surgery and would get the same treatment as anyone else. I should like to pay tribute to those people in the Mater Hospital for the great work they are doing in this area of coronary by-pass surgery. It has saved many lives. The team at the Mater are recognised the world over as being first class. They should be congratulated heartily.
I read in the Evening Herald that the Minister indicated that 70,000 Irish people are drunks, that they greatly abuse drink and that many of them die much earlier than they should. He said also that half of the 5,000 or 6,000 people injured in car accidents were injured as a result of the abuse of drink. At paragraph 5.34 of the national plan we read that it will be a major concern for future health policy to reduce avoidable expenditure on alleviating the consequences of unhealthy lifestyles. I would agree with all this. I would have to refer to the recent report of An Foras Forbartha and agree with the Minister about so many car accidents resulting from the abuse of alcohol. I am of the opinion that the Health Education Bureau by their TV and newspaper advertisements are doing great work in highlighting these problems and telling the people to drink only in moderation. But in the national plan we read of a proposal to extend drinking hours, for which there is absolutely no demand from either publicans, public house staff, trade unions or even the heaviest of boozers. Nobody wants this extension. I would have to accuse the Government of positive double standards in this area. They are undermining the work, the morale and the confidence of the Health Education Bureau. Clearly this is a major retrograde step.
The Minister is seeking an extra £1.5 million from consultants. This money is to be collected through health boards. The consultants naturally will turn to their patients for this extra money. They will charge higher fees and in turn the VHI who are presently losing many customers because of the high costs will apply further high costs. Consequently, more and more patients will be turning to the public sector which is already heavily burdened. The VHI are to be congratulated. They are playing a major role in providing finance for major operations and for sickness generally but they are losing 60,000 customers a year because of the costs being so great. This move on the part of the Minister will further take people away from the VHI schemes. The Minister has been suggesting that we should aim for five-day beds as it were, in other words, that one should arrange to become ill on a Monday only and to be able to leave hospital on a Friday evening. That is not realistic. It is absolutely ludicrous, but again it indicates how low we tend to go. I could go on at length giving, as I said, factual situations. We know that the dental schemes including the schools dental scheme, are in a chaotic situation. This is a national disgrace.
Orthodontic treatment is a thing of the past so far as the dental services are concerned. We cannot say that we are making progress in the area of health. The Minister may ask if we cannot agree with something. We are not opposed to a reasonable review of the health services and their cost. But it is an area where we have to be very careful. It is the most sensitive area of Government in my opinion. Certainly, greater efficiency can be achieved, but it can be done with far more compassion and with a far more human touch than is the case. This Government, and this might be acceptable in certain areas of Government, are taken up very much with the question of financial rectitude, but the problem is that in this area we are ignoring the unfortunate sick, the geriatrics, people who are physically handicapped and those who suffer from serious illnesses. These are the very people that the Government promised to-support to a greater extent. The Government are insensitive to the tragic problems they are creating.
I have a note taken on a question which seems to have hit the headlines recently, that is the question of whether contraceptives should be made available to people at 18 or at 16. I am sure everyone here would agree with me that this is not a vital issue today. Compared with the problems I have outlined and to those which other Members on this side of the House have highlighted, it is not a problem at all. I am not saying that it should not be discussed but I am suggesting that it does not deserve the amount of publicity it has got. Throwing the question out to the media is purely a diversionary tactic; keep the attention of the people away from the real issues in the area of health.
Every Government should be judged on how they proceed to help those who cannot help themselves. If this Government do not provide very soon sufficient capital to the health boards to run the health services we will have a total collapse of these services that are so vital to other people. The Minister for Health, whom I regret is not here, will have to accept total responsibility for this terrible situation.
On the question of cost generally, as a member of an advisory committee of the Southern Health Board and also as a member of a voluntary hospital group in Cork city, I would have to ask why there should not be priorities as regards the health services. I agree that the question of the cutting of health services is an emotional question. Should we say that health services in themselves are being cut or that health in itself is being given proper priority? I differ and I see a situation where we are not using our moneys to the best advantage.
I would have to put the question as to whether we have created a situation where we allowed groups within the health services to make their own demands. That trend started in 1979. I do not want to give the impression that I am knocking one Government or another, but when we are spending in the region of about £1,200 million of taxpayers' money, we must ask whether we are getting the best from that expenditure. In respect of health we must ask again what is enough or what is the priority. The impression is given that many people are suffering because of the cutbacks. Certain points can be made in that regard, but I would like to give a few examples to indicate whether we should question expenditure on health.
A patient in a Southern Health Board bed this week would cost in the region of about £750 a week to keep. I appreciate that we are talking about the total services and the total commitment of the consultants and other specialists involved in the Southern Health Board area. I must speak of the area that I represent because I can see the problems there. I cannot say that the same situation prevails in many other areas but I understand that it prevails in particular in Dublin and in the other cities and big towns. I cannot understand why some people would say that we should not question why it is costing so much to keep a patient in a Southern Health Board hospital and costing much less to have him in a voluntary hospital which would be funded by way of voluntary contributions as well by contributions from the health board and from central Government.
To give an example of the difference in costs as between both types of hospital, a patient in the Southern Health Board area costs £750 per week to maintain while the cost in a smaller hospital, a hospital of between 200 and 600 beds, is in the region of £380 to £390 per week. I agree that in the latter case the patient would not get the specialist services but all the people within the Southern Health Board region are not looking for specialist services.
I must then point out that maybe we have brought about a situation where we have created massive specialist areas and not enough caring areas. That costs a lot more. Senator Fallon put his finger on the problem when he said that not enough consideration is being given to geriatrics and psychiatrics. That is just an example.
We imagined in the early seventies and right up to the early eighties that big was good, and that big was good in our health services. I do not agree with this. It has been proven now that we can give the very same service and, in fact, a more personal service — I emphasise this point as I have seen it personally — to people who are sick in a smaller hospital. Why is it that we are not reconsidering this and admitting our mistakes?
We must admit that the cost of running health boards and the enlargement of them is not working out to the good of all the people. We now have the situation in which certain people who were under the impression that they were entitled to certain services are not able to get them. I do not deny that there are campaigns by groups within these marvellous enlarged health boards who only look for their own betterment. For far too long we gave that priority; we should not have done it. The first priority must be given to patients. The administration staff of health boards are now recommending and have considered the closing of wards. To think that people in health boards are prepared to say that they will close wards and not allow patients in just so as to intimidate central or local government is a crime and a moral disgrace. I resent this. There is no reason why priority should be given to the closing of wards. In my local city we can cater for patients and make them well at much lesser cost. This is appalling. Are we not allowed to question this?
We are all aware that there are areas within health boards and within the health system generally — not alone in hospitals or within health care, but also in the social welfare system — that are being blackguarded. This should not be allowed. The responsibility for this lies with the administration staff of the enlarged health boards throughout the country. People get the impression that they cannot and will not be got at. We as public representatives should be seen to be questioning this.
The people who pay money every week through various schemes, PAYE and so on should be getting the best value for this money. As other Senators have said, there are areas in which we have people in hovels, in diabolical conditions. These are long term patients. I have seen it in Cork. The long-term patient is not seen as often as the person who goes into hospital for one week or ten days. He can get a menu in front of him of four different types of meals. The priority should be to make him better. At the same time, the daily newspaper has been cut from long term patients. Is the priority right? In my eyes it is not. I do not think that one person should have a choice between four different meals and that a paper should be taken from a person who cannot go outside the door from one end of the year to the other except for perhaps a bus ride to a local beach once or twice a year. I question whether that administration has got its priorities right. I resent that.
We have questioned locally, in our own committees with the administration staff of the Southern Health Board and voluntary hospital groups boards together, the difference in costs. We do not get a proper or sincere explanation. We must give the first priority to the patient. We all know what it is like to be sick and to be sent to hospital and we expect the best care possible.
The Senator has two minutes to finish.
We must demand rights. If the spending of £1,200 million per year cannot cater for our people properly as regards health, we must seriously question why this is so. This is being done, and rightly so. What are the priorities in this area? The Opposition spokesman on health says that he also will have to question this. It must be emphasised that the cuts are being made by the administration staff of the relevant health boards differently in different areas. There are differences between the Southern Health Board, the South Eastern Health Board and the Western Health Board.
People are not worried about the health cuts in particular areas yet there are big worries in other areas because an impression is coming across from the administration staff. We have a right to question these staff. We have a moral responsibility to the people whom we represent, particularly to the sick people who need our assistance. As Senator Fallon has pointed out, we have a responsibility to geriatric and mentally ill people. We see them living in hovels, in big institutions. We must bring these people to smaller institutions where they can get more personal care at a lesser cost. This has been proven. If we work things properly we can make these people more comfortable. I have seen this in my area. People are being kept more comfortable and more happy within themselves, at a lesser cost as compared with health board hospitals. Why should this not be questioned?
There is understandable public concern about the immediate and long term consequences of the failure of the Minister for Health to understand that you cannot at all times cut in every area of health.
I have listened with care to my colleagues. We all realise that health is costing the taxpayer an enormous sum today. I have always said that we made a mistake in our stance on the regionalisation of health. I have said that from the beginning, because of the costing. I worry sincerely about the Minister's approach to general health policy, in particular to staffing. I nevertheless welcome this debate here this evening because it is typical of the Fianna Fáil Party whether we are in Opposition which we dislike intensely, or in Government, that at all times we try to deal with human problems. Our present Leader's record as Minister for Health was far superior to that of the present man. The present man, with all due respect, is extraordinary. I cannot track him down. He even sees fit not to be present here this evening to hear this debate. I suppose he will read it and comment on it.
There is widespread upset in the nation today at the cuts in health, because there are savage cutbacks. My sincerely held worry here in this Chamber this evening is that we might eventually have a total breakdown in the health service. That would be dreadful because we have at the moment a very, very good health service. With all the cutbacks, there is no way that we can continue to have the health service to which the people have become accustomed.
We have financial rectitude a la Minister Dukes. He may not be remembered for being a Minister for Finance but he will be remembered for generations to come for the hardship and sadness and misery which his actions as Minister for Finance have brought in the field of health through the cutbacks which the Minister for Health and Social Welfare has had to implement. The cutbacks are ill timed and ill judged, because the morale of the people out there this evening with the generally low standard of living and no jobs available is very low. It is crazy for any Minister, a Labour Minister in particular, to hammer a good health service in the way he has done.
I agree with Senator Cregan: there were ways of cutting costs. In fact yesterday evening if he was listening to the debate on the Dentists Bill he was given one very positive way in which he could have made a cut in the health field instead of the awful and inhuman ways in which he is doing it. His novel idea of people getting sick for five days — this is it. You get sick on a Monday and you go home on a Friday and you are better Saturday and Sunday but you can go back into hospital on Monday morning. My God, for any Minister for Health to get that idea is ridiculous. How could any hospital be run? How would the nurses in Ennis run the general hospital on a five day week with staff cuts at weekends, with no doctor that you can call? If a doctor is there he has to work a 24 hour day. It is crazy. What are we to do? Wrap up all the patients? Then there are no ambulances — because he is making cuts in the transport area — to take them home and back in again on Monday when they can get sick again because Minister Desmond says it is all right and the bed will be there again for them.
He also in this magnificent document, this grey piece that will go down in history, stated that there are no cuts. Yet they are not replacing staff. You have three nurses. If a nurse leaves or if a nurse is out sick she is not replaced. You could have one nurse being asked to do three nurses' duty. That is the reality of what may happen in that case. Here you have the nurses who are to me probably the greatest profession serving this nation this evening, and I will have more to say on that when we come to the Nurses Bill, and they cannot give the level of service they have been used to giving if they are cut from a three nurse situation to a one nurse situation. I really do not know how they are going to cope.
No matter what the cutbacks are I would never accept that the standard of patient care should be reduced. This is the main worry of the nurses and the doctors. How are they going to give the same professional nursing and medical attention to the patient with the cut-backs?
The black bound, grey covered fairy tale would make an ideal Christmas gift. I beg the Minister — I hope he will read what I have said — to leave the nation the essential services and leave the hospitals with their nurses and doctors and the ambulances. He has this lovely way, when there is a major problem in a constituency or in a health board area, of passing it to the board or to the members of the board. It does not make any difference what party they belong to, he passes the problems and he expects them to come up with the solutions to the major problems in health. A famous American politician said: "The buck stops here". It is not their responsibility. It is their responsibility to make recommendations and to speak and to suggest options and so on, but it is his responsibility to have the proper health service given to the people of this nation.
The Minister certainly does not know rural Ireland. People with bad arthritis now find that they cannot keep appointments with doctors or surgeons. Young and old sick people are being asked to use public transport and when they reach Dublin they are supposed to get to the hospitals. Dublin may be well known to the people of Dublin and to the people who have spent a long time around Dublin, but it is a great worry to arrive at Heuston Station if you are not well or if you are not accompanied and facing what you might be told to have to find your way to hospital. Such people are being told by the present Minister to use public transport. He just does not know rural Ireland. After the next election he will not know any of it because the few he has down there will be gone after the next election.
I ask the Minister to tell me, when he is replying, how the Mid-Western Health Board, which is my own area, can save nearly £6 million next year and give a service to the people of the mid-western region. That is the figure, so there will be cuts in staff, cuts in community care, no replacement of locums. Regardless of what the media say about us, I intensely dislike dishonesty. In his grey book, which he had as much to do with as the Fine Gael Members had, he makes no reference whatsoever on page 95 of 533 to health cuts. There is no mention of any cut on page 10 of the smaller version which they got out. He said there have been improvements in the efficiency with which health services have been provided in the last few years. Of course he was talking about the days when we were in power. I do not know what is in the black version with the gold print on the cover that the present cabinet are bringing round the country giving to their supporters. That must be something else. There are certainly no cuts in that, I am sure.
We have a problem in Ennis, and indeed it is one that the Mid-Western Health Board have had on their plate for quite some time. The Minister passed the buck, as he thought, to the members of the health board and they made responsible decisions and then because pressure was put on him from some place he did not fulfil his part of the bargain. In 1983 there were 1,687 Clare babies born. There were 719 babies born in Clare and 968 of the mothers had to go outside Clare for a service. We built, at a cost of £800,000 or £900,000, Cahercalla, and what did the Minister do then? He came along and told the members of the Mid-Western Health Board, and I am sure Senator Smith, who is a member of it, will speak further on this: "You can have Cahercalla but you must close down the hospital for the old people". That was the choice he gave and that was the job he gave to the members of the Mid-Western Health Board.
Thank you, a Chathaoirligh, and I thank the Minister of State, Deputy Donnellan for listening to me. It is rather tragic. I agree that health is costing an enormous amount of money. I understand and admit that there should be cuts. I worry at times about too much money being spent on administration, but to cut in the areas that the Minister for Health has done certainly is unforgiveable.
As a member of the medical profession and as somebody who has worked for five years as a consultant in a central teaching hospital and ten years in one of the smallest viable peripheral hospitals in Ireland, some of the points I would like to make may be relevant to this debate.
The first thing I would say is that it does not follow that money poured into the health service will result in healthier people. Almost 20 years ago Lord Platt, who was a distinguished English physician, when delivering the Harvean lecture at the Royal College of Physicians in London made the point that at a time in the United States when federal expenditure on biomedical research had increased from one million dollars to 1,000 million dollars, infant mortality had failed to improve and the expectation of life had remained almost stationary. I will quote from that lecture. He said:
The demands of a clinical scientist for ever more expensive and sophisticated apparatus are justifiable if the things to be measured by the apparatus are relevant and important to the study of human health and disease and if they cannot be equally well assessed by simple methods.
In other words, he asks whether a lot of the research, a lot of the gadgetry, is relevant to the needs of health. He then puts the question: do we make a distinction between the curing and prevention of disease on the one hand and the promotion of health on the other? It is my opinion, and I think the opinion of an increasing number of people, both in the profession and outside it, that we have a disease service, disease centres and that we have barely started to consider the implications of a real health service.
I might say waste not, want not. There are tons of disposable material thrown out in Irish hospitals every day. You touch a precious gown that you could use in a garage locally and because it is no longer sterile it is put into the bin. Take the syringes that are used. I can use 40 or 50 syringes in a varicose vein clinic and they are never used again because I am caught up in this whole preconditioning that these things can be used and abused. It may make short term economic sense but it spells long term disaster. The question then is, should we not be looking for safe Morris Minors that 90 per cent of the people using them can understand in smaller hospitals rather than looking for Rolls Royce which only 10 per cent can understand? Technological imperialism — and that is a term I would like to get into the thinking of people concerned with health — technological imperialism has become part of the armoury of institutional imperialists, people who are determining what our needs shall be rather than going to the people to find out, as Senator Cregan said earlier, what their priorities are and meeting them.
The allocation of priorities is the central issue in this whole business. We have limited resources, we have limited talents, we have limited finances. A surgeon wanting the latest endoscope at £2,000 for which he is told there is no money is not impressed by the fresh tarmac being spread across the extended car park. The sick person wanting an extra nurse at night is not impressed by an argument for an extra gardener, and the trade union movement, concerned about the implications for health of employment, is unlikely to be pleased on hearing that the doctor's salary is to go up while the outside labour force in the hospital is being reduced.
The question then is, how do we get our priorities right? I suggest that the medical, nursing and para-medical professions, the consumer and all interested in health at local community level, should in order to promote good feeling and heightened awareness for better health, participate in the tripartite concept of management. We need to get the operatives in our institutions together as one leg, and I emphasised this before in this House. We need to get the institutional input such as the clergy, the profession, the trade union movement and so on as another leg but, most important, we need to involve the consumer, the person for whom the service has been created, the person who is never consulted or rarely consulted and the person who pays our salaries.
Having dealt with the structure which might help us to decide on priorities at local level and at area and regional level I then go on to the point about how you allocate scarce resources and how you spread our talent. It is vital to appreciate that only 1 per cent to 2 per cent of ill health or 10 per cent to 15 per cent of hospitalised ill health needs super specialists and super technology care. Yet the power to decide how undergraduates will be taught, conditioned, the power to determine how postgraduates will be trained to meet needs dictated, by and large, by professional organisations is held to a great degree in the hands of those who are chiefly concerned with the super specialist line in the spectrum of total care. Therefore, I think we need to challenge the institutional power that is held inside the professions and indeed even inside the centrally controlled movements throughout the country to try to get a better allocation.
Briefly, then, what I have tried to say is that we need to look at the priorities and to determine how we are going to achieve them. The best way I can see is to bring together the three legs of the service — the consumer, the operative and the institution. We need to look at that at local community level. We should be considering whether at local level we should not have a community health guild that would bring together those three legs from the day centre to social services, the health centre, the family doctor service and the hospital, to have a debate and to promote at a local community forum a genuine discussion about the allocation of priorities.
Let me give you one story. I remember that in Coleraine hospital shortly after I went there there was a problem which has been alluded to here tonight of the elderly, the people who were not labelled geriatric because they were long term stay patients. The terrible Nissen hut was always pointed at. Yet the Nissen hut did not leak. It just looked ghastly. It did not look part of the 20th century. In that hut there was one nurse at night who had to call the main hospital for help. I suggested, as a means of coping with this, that all the relatives should come together and send up one volunteer per night from each of the families separately, that the churches which were always saying they were so concerned might out of all the churches in this town send one representative from the lot, and that the community groups, tenants' associations, should send one, not from each but from the lot. You would quadruple the staff overnight, but you would have only started, because as soon as those people arrive at the front gates of the hospital they would be met by our profession and the nursing profession who would say, "No, you do not hold the right certificate" and the administration would be saying, "No, we cannot insure you because of legislation and liability." The whole of society needs to be shaken by the neck if we are going to be able to make use of the money we have got, the talent that is bottled up and is fossilised because it is so structured. We must also have the ability to share equipment in accordance with the relevance in the use of that equipment to meet needs determined by the people and not to go on meeting needs dictated by professionals such as myself.
The consumer will give the clues if you let him, but the institutions are so housebound that they will not allow the consumer to enter the debate freely at local level and local institutional level. Do that and relate it to an overall scheme of priorities in relation to super specialist need and decentralised need and we will be able to go somewhere.
That brings me to my last point. You could evolve a system of finance which would be based on the assumption that the central hospital serves the central city but they should also receive finance in relation to that 10 per cent from other districts which cannot deal locally with the super special, super technology needs. We must question for instance; are Ballymoney and Coleraine with 100,000 people getting a quarter or slightly less than a quarter of the finance to manage their health services compared with Belfast with its 450,000 people? Certainly they are not, because in the city, as in Dublin, there are numerous hospitals with all sorts of hierarchies of staff systems, all sorts of expensive equipment which is duplicated, triplicated, quadruplicated and yet we can be told in our neck of the woods that you cannot have a piece of equipment because eight miles down the road another hospital has it and it cannot be duplicated. I say, fair enough, at a time of financial constraint we should listen to that argument, but let us start rationalising where it would be most effective first in the centre and then rationalise the weak, the peripheral and the small. When I can see rationalisation taking place in the cities in terms of staff, equipment and finance, then I will be the first to say we will rationalise our two small hospitals in our little district in North Antrim.
At a time when public disquiet in relation to the health services was never more rampant, Seanad Éireann has been treated in a most shabby and disgraceful way by the Government, almost akin to the way this Government are treating geriatric homes. It is the Government that order the business of the Seanad, and yet tonight for the first time in a long time in public life we have witnessed a situation where the Minister for Health has not seen fit to come to this House on this motion. Apparently also he did not inform the Minister of State that this debate was going ahead. He is now here belatedly without even the normal assistance of personnel from the Civil Service and from the Department of Health.
He knows I will not need them.
I am sorry that the Minister of State would want to interrupt me at this stage, because I am not personally condemning him. I think he would have to agree with me that on a matter of such importance it is less than fair to Seanad Éireann that it should be treated in that way. I would expect that there would have been at least some apology to the House long before this. Perhaps it was an oversight, but I feel it is a most shabby and most disgraceful way to treat a motion of such importance which has been on the Order Paper for a considerable time. Since we do not have the control on this side of the House as to what business is taken and since it is arranged by agreement the least we could expect is that the Government side would be presented in the way that anybody would expect in a situation like that.
Over the past couple of years members of health boards have been concerned with developments that have taken place. It is important that we should constantly review our services at all levels and see that they are cost-effective and any inefficiency and any waste in our services should be eradicated. This would have the support of people of all political shades. There has been a marked deterioration in the standard of service available to many sectors in the community, but particularly to the old and the poor. It is because of the biting effect the services are now having on these groups that this matter has to be highlighted until such time as firm Government action is taken. Most of these groups are unable to fend for themselves. There was a time in this country when there would be mass public meetings and considerable publicity because of this kind of problem.
In recent times there has been a marked restraint because everybody knows that the economic situation is difficult and nobody wants to be unreasonable. We have to be judged ultimately as politicians, and members of the present Government will be judged by what they do for those in society who are not in a position to fend for themselves. Whether it is long lists, queues of people unable to gain access to ophthalmic services, dental services, waiting lists for admission to orthopaedic hospitals or wherever the problems are, they should be highlighted here and we should try to get across to the Minister of State the necessity to ensure that whatever the economic strictures are — I am not saying that the overall budget has to be increased: perhaps it has; but even if it has it is crucial that the money available is diverted and used to cater for the poorest sections in our community.
Many of our services have been discontinued; others are collapsing. Our hospital wards are packed. I went in to visit a patient in the county hospital in Nenagh and I virtually had to shift a bed out of my way to get out of the ward as other visitors were coming in. Nursing services are stretched to the last and there is a limit as to how far we can go down that road. Perhaps we have travelled down too far already.
As I am anxious to give the Minister of State some time to reply, I should like to refer briefly to the general medical services scheme. A few years ago about 900 items were removed from the general medical register. These are the items provided under our choice-of-doctor scheme. When this Government came into office they added, as our spokesman on health, Senator Fallon, said earlier, an additional 200 items. I should like to make a few points in relation to some of the items that have been excluded. The antacids, Aludrox, Mucaine, have been taken off the list with the result that now doctors are prescribing much more powerful drugs like Tagamet. If one looks at the report for the general medical services for 1982 one will see that Tagamet which is a preparation for ulcers cost £1,404,635. Yet, one year later that same drug was costing our health boards £1,880,660. Panadol, paracetamol and preparations for pain killers were taken off and they, again, are replaced by much more powerful drugs where the doctor, in the knowledge that his patient cannot afford the normal drug, prescribes the only drug that is on the list. This ultimately leads to the situation where the actual removal of items from the register inevitably costs the State substantially more. Ponstan which is used instead of Panadol and paracetamol, in 1982 cost the GMS £496,000 and one year later it had doubled to £900,586. The number of prescriptions for that very powerful drug had increased in the order of 62 per cent. A cheap effective cough bottle like Benylin has been taken off and replaced by Pulmoclase and other expensive preparations.
I have already demonstrated that the actual decision to take off some of these items has led to increased costs. I am not saying that they should all be replaced; I am suggesting replacing the ones that seem to be needed particularly by old people, by people suffering from chest ailments and people in need of the normal pain-killing drugs. It is not just a question of the cost factor which I have amply demonstrated, where the overall cost is doubling for particular strong drugs, but also there is the fact that where more powerful drugs are used they may not have the same beneficial medical effects when they are more needed by the patient. We have also removed all the vitamins, and so old people are unable to get tonics which would cater for their problems and probably ultimately help them to remain out of hospital.
When a patient leaves hospital the doctor in the hospital will give that patient a prescription. I understand, as far as our public patients are concerned, that patient has to go back to his or her own doctor before that prescription can be put into effect. In other words, when the doctor in the hospital prescribes for the patient when he is being discharged, that prescription cannot be taken to a chemist's shop; it has first to be taken to the general practitioner, renewed as it were, and then the person has to queue somewhere else to get what is needed. That is an unnecessary procedure and probably adds additional costs to the service.
I note that the Minister set up a committee to report on the general medical services. I am told that one of the proposals which emanated from that committee where the medical profession were seeking to have a proper pension scheme was that any saving which they would make in the general medical services, in the discharge of their duties, would be the way by which they could contribute to their pensions. I should like to give an example to the Minister and I would like him to reply. Some doctors have abused the general medical services scheme. I take it for granted that some of them did not but some of them definitely have. So, therefore, somebody who abused the scheme has room for cutting back where he can demonstrate that this is for pension purposes but a doctor who played it fair and did not put in unnecessary visits cannot make the same contribution. That kind of scheme is unworthy of the Minister and certainly will not contribute to improving the services as a whole.
We hear the Minister for Health constantly telling us that the area to improve is the community care area, and that we have to take people out of institutions, that it is less expensive and that this is the way to go. At the same time as that is happening we dismantle the ophthalmic scheme, we discontinue the dental scheme and we are unable to develop these services. If the Minister wants a development to take place in that area — and he has the support of everybody in it — how can it be done when the existing services in the community care area are collapsing? Time has caught up on me at this stage and I am anxious to give a small proportion of my time to the Minister for his reply. Overall, we on this side of the House want to emphasise the critical aspects of the administration of the present health services and the need to ensure that whatever funds are made available it will not be the poor and the needy sections of society who suffer as they certainly do today.
One of the valuable things that emerged from this debate this evening was for me to be in a position to listen to the excellent contribution of Senator Robb. We had the opportunity of listening to a man who has first-hand experience in this field. With the benefit of that experience behind him, he was able to say to us what he felt were the necessary ingredients for a better health service in general terms.
I may not be paraphrasing him correctly, but I gather that one point which he made earlier was that millions of pounds could be poured into a health service but that does not guarantee that people will be more healthy. Coming from a man of Senator Robb's experience and stature in the medical field, that is a comment that should be borne in mind.
Having listened to the contributions from the other side of the House, I have no doubt that whatever motivation was behind this motion, a substantial part of that motivation — I am not prepared to say all of it — was political. As far as I am concerned, the greatest share of that motivation was political, and therefore I will respond to a certain degree in political terms.
I would hope you will keep to the motion.
I certainly will and if I do not, I can depend on you to draw me back. On reading the motion, there is a very clear implication that there will be serious and savage cutbacks in the health service and that the blame and responsibility for that rests entirely on the Minister for Health and the Government. There was an attempt to copperfasten that implication by pointing out that the Minister for some reason, refused to come into the House this evening. Apart from the fact that the Minister is well represented by the Minister of State, I reject also the contention that the Government in some way connived in that situation because they have responsibility for arranging the business. Of course that is not correct. This is a motion being taken in Private Members' Time. It was the turn of the Fianna Fáil Party and it was their privilege to select whatever motion they wanted. They selected this particular motion.
I have listened to — among others — my colleague from County Clare talking about savage cut-backs and talking about "a little grey book" which I understand is her description of the National Plan. If you look at what the national plant says about expenditure by the State in relation to health services over the period of that plan — the next three years — starting off from a base in 1984 of £986 million, the amount allocated for next year has increased by about £33 million to £1,019 million. Where is the savage, serious and dangerous cut-back in that allocation? It simply is not there. The reverse is true. For 1986 the allocation will be increased by a further £60 million, to £1,078 million. In 1987 it will increase still further. to £1,123 million.
Perhaps we might look back to what the situation was, for example, ten years ago. In view of the fact that Senator Smith used some statistics, I will perhaps be permitted to use them also. Senator Smith, in keeping with his usual contributions, was not political all the time. He made some worth-while comments. In 1974 the total allocation by the State for health services was £143 million. There has been an eight-fold increase in terms of finance in that period. If you want to express it in terms of GNP, 5.2 per cent of GNP was allocated in 1974. Ten years later that allocation has increased to 7.5 per cent of GNP. For that 50 per cent increase in terms of GNP or the eight-fold increase in terms of actual finance, have we that greater measure of sickness in the State today? To put it another way, has that substantial increase both in terms of money and as a proportion of GNP reflected itself in an improved and much better health service? Have we a 50 per cent improvement? In 1975-76 the number of personnel employed in the health services was approximately 40,000. At present it is substantially over 60,000. Let us examine, for the benefit of the people who put down this motion, how this substantial increase came about. It was brought into being in the great days that succeeded 1977, when the sky was the limit, where money could be borrowed and when sources could be scattered. Every health board in the country were told that they could recruit x number of extra staff. When it appeared that in certain health boards extra staff were not being taken on, reminders were sent to them inquiring as to why it had not happened. When the reply came back from the health boards that they did not have work for extra people, the response from the Minister of the day was: "Take them on whether there is work for them or not". Resources are scarce. That has been admitted by a number of speakers from the other side.
Acting Chairman
You have two minutes.
I want to put that on record. There is evidence in my own county of the ruthless tactics that can be employed by health boards to extract sums that would perhaps be beyond their genuine needs. Senator Honan referred to hospitals in my county. It was not the Minister for Health who said if you want to work in Cahercalla you will certainly shut Edendale. It was the health board that said that. I am glad that the Minister for Health, having being apprised of the facts of the case, informed the health board that they had better have a re-think on that situation. That was simply a case of using a new maternity hospital as a measure of blackmail to ensure the closure of an essential geriatric hospital. That was carried out by the health board and not by the Minister.
Acting Chairman
You have one minute.
I want to put that on record. The effect of the situation that has now emerged will have, among other positive results at least this one: it will encourage health boards to have a radical re-think of their priorities. It will encourage them to have a radical re-think of the best use to which they can put the resources available to them. Even in the contributions from the other side there is evidence, in addition to these contributions, that resources are not always utilised to the best advantage. I move the adjournment of the debate.
Debate adjourned.
Acting Chairman
Before I call on Senator Brendan Ryan will the Leader of the House indicate when it is proposed to sit again?
It is proposed to adjourn the House until 10.30 tomorrow morning.