Seanad Éireann debate -
Wednesday, 27 May 1987

Vol. 116 No. 4

Health Services: Motion (Resumed).

Debate resumed on the following motion:

That Seanad Éireann calls on the Government to reconsider their budgetary proposals in relation to Health Services because of their serious implications for the well-being of the general public.

—(Senator Fennell.)

Mr. Kennedy

I should like to support this motion that the Government should reconsider their budgetary proposals for the funding of the health services because of the serious implications for the well-being of our community and, indeed, the lives and safety of patients. I do so, because I am a member of the Mid-Western Health Board, a board, who, over the past five years, have trimmed and pruned their budget estimates while at the same time providing a high level of patient care. Over these years we have achieved the necessary economies and savings of the order of £10 million. We have done this without any savage closure of hospitals and institutions and without drastic and dangerous reductions in staffing levels of our hospitals and institutions. For these achievements we have been commended by Ministers and Ministers of State and, indeed, by senior personnel in the Department of Health.

It is in this context — the context of good and efficient management of our affairs — that the budget allocation to our board for 1987 makes it impossible for us to provide a reasonable and safe level of patient care. This can be seen from the fact that in 1986 our approved gross expenditure was £84.391 million, whereas our approved gross expenditure for 1987 is only £82.256 million. This represents a reduction of £2.135 million, or 2½ per cent, in our allocation for 1987 as compared with 1986. Yet the Minister for Health states categorically that health boards are receiving an increase of 1 per cent in 1987 over the 1986 allocation. It is for this reason that the Mid-Western Health Board, at their meeting on 1 May 1987, unanimously passed a resolution rejecting the cutbacks and closures as proposed by the chief executive officer. These cuts, as proposed by the CEO under the direction of the Minister for Health, would represent the closure of 36 per cent of the beds in our board area — 400 beds out of 1,120 — and drastic and dangerous reductions in the essential levels of staffing.

The serious situation which now exists can be seen from the fact that on yesterday's front page of the Limerick Chronicle there was a heading from a senior nurse in the hospital “Wards of St. Joseph's Psychiatric Hospital left with no nurses.” The senior personnel in that hospital indicated that, because of these cutbacks, large wards in that psychiatric hospital will be left without any nurse over weekend periods. As a member of the Mid-Western Health Board and as a Member of this House, I am totally behind the people and the patients and our health personnel in their demands for a re-adjustment of the budgetary allocation so that we can provide, as we have done over these past years, an adequate and safe level of patient care.

I also believe that our citizens, deprived as they are now under these savage cuts of a basic level of patient care, would be justified in seeking an interlocutory injunction in the High Court to prevent the Minister for Health and indeed, the health boards, from carrying out such savage and drastic cuts. We are told by our consultants and by our medical and nursing personnel that without an increase in the allocation lives will be lost and patients will die. I do not say that lightly. These are the experts. I am not saying so as a politician. The right of people to a proper level of patient care was vindicated by Margaret Rose McMeel and the people of Monaghan when in that famous case in 1984, in McMeel v the Minister for Health, the Supreme Court unanimously held that under section 38 of the Health Act, 1970, the Minister for Health could not close Monaghan Hospital without first holding a public inquiry.

I believe, therefore, that our demands for an adequate level of funding to finance our vital health services are reasonable when we consider that the previous Government and, indeed, the previous Minister for Health, were consistently castigated and berated in respect of the health cuts by a series of senior Fianna Fáil spokesmen. On 2 June 1983, Deputy O'Hanlon had this to say:

Our responsibility here is to ensure we provide proper health services. Because of their strict monetarism, this Government are not in a position to do that and it is not enough to hide under the umbrella of what the WHO prophesy may happen by the year 2000.

On 1 March 1984, Deputy O'Hanlon told the Dáil:

Our concern is to ensure that an adequate health service will be provided. In view of the massive cutbacks for which the Minister is responsible this is not possible in 1984.

On 19 November 1981, another member of the present Government had this to say:

I believe this is a tight-fisted, Scrooge-like, heartless Coalition who will stop at nothing to meet the requirements of the economists who are quite disinterested in the realities on the ground.

That was, of course, Deputy Woods, the present Minister for Social Welfare. On 4 December 1986, again the present Minister for Health, Deputy O'Hanlon had this to say:

Has anybody looked at the cost, first of all, in human terms, to the patient of those long delays of, say, 13 weeks waiting for a hospital appointment...

Then, of course, we had the Fianna Fáil election promises vividly depicted on election posters and in election material all over the country entitled "There is a better way". All these promises ring hollow as our health services are reduced to a state of crisis and shambles. The position is well summed up in The Irish Times editorial of 21 May 1987. It is headed “There must be a better way” and says:

The cuts in the health services have provoked more hostility, inspired more rumours and raised more fears than almost any other action taken by a Government in recent years.

The editorial concludes:

"Dr. O'Hanlon has the opportunity today to dispel some of the rumours, ease some of the worries, eliminate some of the fears. He can do this by saying clearly what he and the health boards are about. That has to be a political, not merely an administrative decision. The Government may need to be reminded of its election campaign and the premise on which its platform was based —"There must be a better way".

It is clear from what I have said that these savage cuts and closures will place the lives and safety of our patients at risk. Therefore, I support this motion for additional funding to finance our health services. I believe the right to life is one of the fundamental personal rights enshrined in Article 40 of the Constitution. The right to a decent level of patient care is a corollory to that fundamental right as enshrined in the Constitution. I support this motion.

Mr. Fallon

Listening to the Opposition spokespeople one would think that if they were in Government we would have no cuts at all. It is a well-known fact that they had planned harsh cuts. Senator Kennedy referred to a comment by Deputy Michael Woods about being Scrooge-like in 1986, but I believe the opposition would be equally Scrooge-like in 1987. He asks now for extra funding when he knows in his heart and soul that his party had planned, and were about to introduce, excessive cuts. It is very interesting to refer briefly to last Wednesday night's debate in the Dáil when on Private Members' Business there was a motion from the Progressive Democrats which said: "Dáil Eireann wishing to remain within the 1987 Revised Estimates ...", while the amendment from Fine Gael stated: "Dáil Éireann wishing to remain within the 1987 Revised Estimates for Health...".

It is unfair to suggest that there would not be cuts if the people now in Opposition were in Government. The fact is that there would. We would be having much the same problems we now have throughout the country in regard to the health services. It is well known that spending in the health area is in many ways a reflection of national spending, how we should tighten our belt and how we should prepare for the future of our nation. In 1981 we were spending 8½ per cent of our gross national product on health. Now it is something less than 7 per cent. Compared with Europe, excluding Portugal, Spain and Greece, we are spending far more than other countries.

There has been criticism of health boards. Members of health boards are easy targets. Perhaps health boards in the past have been negligent. They could have sought the moneys outstanding in a very positive way. I know that they are considering employing debt collection agencies to collect the money outstanding. It is a move which is unprecedented, but it has to come.

The Minister has been unfairly criticised. He is endeavouring to protect the health services for the future. Last week he gave a very detailed reply concerning what was happening. One of his comments appealed to me and concerned me. I felt that I should comment on it in some detail. The Minister said:

Starting next week, officers of the hospital services division of my Department, with the assistance of Comhairle na nOspidéal, will commence consultations in each health board area — They will meet with management of health boards and voluntary hospitals. The staff interests involved are to devise a plan for each area. When that is done the results will be considered globally in the Department to ensure that they are integrated at regional and national levels.

As a health board member I welcome the exercise that has been announced by the Minister. I know the chief executive officer of my board will welcome it also. In the past he has spoken to us on the need to rationalise the hospital network in the State. He played an important part in the rationalisation of hospital services in the Midland Health Board area which has been taking place over the past two years. It is well known that in the Midland Health Board, because we adopted policies which were probably more correct at the time, we have set an example for the other health boards.

Putting myself in the position of a chief executive officer, I believe I would welcome a hard look being taken at our hospital system. I would be anxious to see that our general hospitals are of a very high standard and that investment in hospitals in my area and in other areas is such as to provide the very best care. I would be very anxious to keep on side with my board. I would have to bear in mind that a rationalised system based on what we can afford may be less than what the current policies of my board envisage. If I were in the role of a chief executive officer, I would have to be mindful of the policy making role of my board. I would be anxious, therefore, to consult with them or with a committee of the board as the exercise progressed. It would be important to know how much money was likely to be provided for health services in the years ahead and how much of that was to be spent on hospital services. There is, quite rightly, much emphasis on health promotion and on the whole area of prevention in the years ahead, but it is less clear what role the general hospitals will play as these policies meet with success.

Many people say that the FitzGerald report was perhaps 20 years ahead of its time and that one of the reasons it did not succeed was that members did not consult adequately. I am just querying — and again it is something for the Minister and for his civil servants to respond to — whether the Government had a preference for a FitzGerald-type hospital network concentrating on a very high standard in a small number of modern, well-equipped hospitals, or is there a preference for what might be described as a watered-down version, which became known as the Corish plan? If the FitzGerald type plan is favoured, as a CEO or as a health board member, I would like to know the views of my board. Knowing them I would like to know the attitude of a particular health board to that approach. Again, if I were a chief executive officer, I would be keen not to view the needs of general hospitals in isolation from the type of supports that would be required in the form of community care services or in long stay beds.

Since 1981 the health services have suffered from not being part of a long term plan. We cannot go on removing an increment each year and trusting the quality will not suffer. We need a plan for a service we can accept and agree we can afford. We need a plan soon. Therefore I support the type and the degree of urgency the Minister is attaching to it. I accept that the issue of cuts in the health area generally is an emotive one. It is unfortunate. We are all sad that health cuts must come, whether it be a Minister or a Minister of State, the health board members or the public at large. It is a fact of life that if we do not proceed cautiously and have cuts in health, education, local government, and so on, we will be told by other people that they will run the show. That is a fact of life. We are living, unfortunately, in an era of cuts. Unless and until the Governments get their economic and financial houses in order, this will be the order of the day. I regret that happens to be the way it is. That is the reality of life today and, unfortunately, health cuts are part and parcel of that reality.

Mr. Ferris

The previous speaker put the whole subject in context. As I am the first Labour Party speaker to this Private Members' Motion, I want to remind all sides of the House that because of this very discussion that is taking place here an election was held. The Labour Party, as part of a previous Government, were not prepared to agree to the decimation of our health services which were handed over intact to health boards and to the Minister for Health by local authorities in the Seventies. As a member of a local authority and as a member of a previous health board I want to say that they have sold the county councils down the drain in regard to their attitudes to hospitals. We handed over a service which was in good shape. It has since been neglected because of varying degrees of incompetence. It is also very difficult to put one's contribution in context when one reads what Senator O'Connell said last week. I could not believe that a man who had professed himself to be a socialist at one stage——

Dr. O'Connell

A social democrat.

Mr. Ferris

——could have said some of the things which he had said last week in this debate. It is appropriate that when the Senator puts something on the record he should be quoted. First of all — and I object to his reference to our health board — he said:

In the health boards there are some chief executive officers who are rather dictatorial in their approach, who have unilaterally — I mention in particular the South Eastern Health Board and the Western Health Board — brought in cutbacks without consulting the members and that is very dangerous.

For the record, in defence of a person who is not present here although I might not necessarily always agree with his actions may I mention the chief executive officer of the South Eastern Health Board who brought these measures to a full board meeting and they were rejected. Unfortunately, the whip was brought out. The meeting was reconvened and they were whipped into place to put the cuts into operation. They were proposed by the Senator's good colleague, Deputy McCarthy, who is now a Minister for State in my constituency. Do not tell me that the CEO effected cuts without consulting the members. The members proposed them and voted in favour of them. Dr. O'Connell condemned people for arranging marches and protests. It is inevitable with the level of cutbacks that there would be protests. The Senator created an impression here last week that this is hyped up hysteria created by the media and that the patients were not uppermost in the minds of the people who were objecting. I reminded Dr. O'Connell that he was pretty good at this last year.

An Leas-Chathaoirleach

Would the Senator please address the Chair?

Mr. Ferris

I will address the Chair. I am sure you will be pleased to hear this, a Leas-Chathaoirligh. Senator O'Connell said that he never said any such thing. He said: "Anyone may read my speeches in the Dáil. Never once did I say this. I said you could have a very good health service without necessarily spending extra money". Could I put the record straight again? Dr. O'Connell in the Dáil last year said:

The Minister, Deputy Barry Desmond...

— a pet hate of his obviously——

...is four years in the Department of Health and in those four years he has done more to undermine the health services and to cause anxiety and distress to poor unfortunate patients than any other Minister in the history of the State. The Minister is the most hated and despised Minister in the eyes of the public. Everywhere I go I see distress and old people waiting in queues for attention...

I was right last week when I reminded the Senator that he was good last year at hyping up an attitude in people's minds that created problems. Unfortunately for Senator O'Connell, Deputy Barry Desmond was so specific about what he wanted to do in the Department that he did it in a rational way. We did not lose one bed or one job in the health service while he was in charge of it.

Dr. O'Connell

I never mentioned money.

Mr. Ferris

I would hate to quote some of the things that were said by Deputy McCarthy but they are on the record for anybody who wants to read them. I have a lot of regard for the present——

(Interruptions.)

An Leas-Chathaoirleach

Senator Ferris must be allowed to continue his speech without interruption.

Dr. O'Connell

False charges made should not go unanswered.

Mr. Ferris

The record stands for itself, Senator O'Connell. I have put on the record what I wanted to say here. The record was misquoted last week and a lot of disservice was done. I am sorry if Senator O'Connell's new-found political allies are the ones who are effecting cuts in health boards. I have regard and respect for the new Minister for Health, Deputy O'Hanlon. I know that he is a caring Minister. As he said last year in the Dáil, he represented a caring party. I know he has problems in trying to fulfil his brief in this particular instance without doing harm. I am faced, as a public representative in my area, with decisions arrived at by a health board supported by all the Fianna Fáil members, proposed by them and voted on by them. The decision closes a hospital in my own town in Tipperary — St. Vincent's — which was run efficiently as a sub-acute hospital. It was a district hospital with 42 beds, running within the budget allocated by the health board. It was doing so efficiently and there is no other sub-acute medical hospital within 26 miles of the location of that hospital, and within 50 and 60 miles of some areas of west Tipperary which are dependent on it totally. They say they are closing it on economic grounds.

We have produced figures to the health board to prove that the cost of a patient's care in that hospital is approximately half of the cost of care which will now be available in the nearest acute medical hospital. If that is economics I would like any Minister, politician or doctor who knows anything about medical care to explain to me the economics of changing people from one bed to another one which is twice as expensive. There is also the trauma for the patients and their relatives of visiting. A health service can be damaged. We have all contributed to the health service over a long number of years as taxpayers, paying PRSI and health contributions. This year the charges are increased for a lesser service which is no longer available in some areas in which it was available until this Government took office.

It transpires that the health board were convened illegally. The High Court decided last Monday that the hospital in Lismore — which my colleague Senator O'Shea will speak about — was closed by an illegally convened meeting. My hospital committee in Tipperary town are faced tomorrow with the dilemma of having to take another High Court injunction on the CEO and on the members of the board for the decision they arrived at, at an ill-conceived and illegally convened meeting. People were brought back from Brussels to vote for the package to close hospitals. We have lost acute beds, sub-acute beds, maternity beds, regional hospital beds, specialised ENT beds, surgical beds and psychiatric beds. Can anybody, who knows anything about the health service, tell me that that is a contribution to the health of the nation?

I am not creating any hysteria. Fifteen thousand people walked up here to hand in a protest letter. Is that hysteria? That is the response of people on the ground to their very genuine concern. I have experienced it in my own area. Every week there is a mass protest by ordinary people — not nurses or doctors, although they are included, but people involved in the community; bishops, priests, nuns, and representatives of chambers of commerce. I say to Senator O'Connell, through the Chair, that they are out there and they are not subject normally to mass hysteria. This Government have reneged on their responsibility to provide the basic health care to which people are entitled. They could have done it. They will get the support of the Labour Party parliamentary group in either House to bring in a scale of economics and new funding which will make it possible for the Minister to carry out his plans. He could collect the VAT that is outstanding, or he could rescind his stupid decision about the abolition of land tax. He could insist that health contributions which are legally due are paid; he could tap some of the resources from the national lottery. Instead we have a crisis which will mean that by the end of the year at least 20 hospitals and other institutions will be closed. A minimum of 800 acute hospital beds will be permanently closed, and 1,000 long-stay beds, mainly catering for the elderly, are also being withdrawn from the hospital service; 300 beds for psychiatric patients will go and no planned community alternatives are available.

The Minister in his direction to the health boards told them — I cannot quote it because I have not a copy of the letter but I have seen one — to carry out these economies without interfering with or touching the community care service. I am afraid the Minister did not touch the community care service either; he made no additional funds available. He made no additional funds for public health nursing available in the community although this service will be under stress and strain because people will no longer be kept in hospital. They will be sent home and there will not be professional help from community care nurses for them. In my region that service does not have sufficient nurses and people do not have regular visits by GPs. The health boards, and the Minister, through the GMS service, will have to pay more money for travelling expenses by doctors because people who should be in hospital will be sent home. I have never defended people being in hospital for no reason but I cannot understand statements by economists and doctors who are members of political parties that there are too many people in hospital.

May I ask one question? Who recommends that people go into hospital? Who calls people back to outpatient clinics? Who asks people to get transport to clinics and hospital beds? It is the medical profession, not politicians, not the public, and certainly not the patients because no patient wants to be subjected to the trauma of being hospitalised unless they need it, who make those requests. Let us not fool ourselves into thinking there are people in hospital who want to be there because they love it. If the medical profession have a case to make let them make it. Doctors in my area have said, since our hospital was debarred from admitting further patients, that they are now faced with the dilemma of sending patients further afield to another hospital at the general medical hospital in Clonmel the number of beds has been reduced. The acute surgical hospital in Cashel has lost 20 beds and we have had staff losses throughout the country. In our area alone there are massive staff losses and throughout the country it is reckoned that between the health board areas and voluntary hospitals, 3,700 people have lost their jobs because of the cutbacks.

I am not suggesting for a moment that the Minister for Health does not have a budgetary problem. I know he has, but that is a matter for the Cabinet. It depends on where one's priorities are, whether one feels that people should have this service and whether one should save their lives. Senator O'Connell felt last week the price was too high, that we cannot save these lives because it is too expensive. I could not believe my ears when I heard a doctor say that. He is a politician and he is expected to say certain things which may be unpopular but to say that it is too expensive now to provide life saving supports is a different matter.

I respect the view of the Minister of State who has made his own stand about the hospital in his constituency and I admire him for that. He should not worry about the little slap on the hand; those things come right. He is well able to take the knock on the chin and fair dues to him. I am suggesting that all of us have a responsibility to deliver a health service in our own constituencies. We do not have to answer to the Government or anybody else. While I was a member of a health board I never answered to the Government. I always answered to the people in my electoral area who elected me to the county council. I am sorry that is not the case now because people are whipped into place, forced into voting for schemes they know are fundamentally wrong and against the interests of their constituents. That can lead to all sorts of problems on the ground, problems I do not welcome and which will be dangerous for democracy.

I am warning the Minister, through the Chair, that it is a dangerous road to go down. If he needs support to collect additional funds he will get it from the Labour Party because we always felt people were entitled to a basic health care, delivered as close to them as possible, without duplication and without waste. We will follow that line for as long as we are Members of this House.

Mr. Farrell

Everybody is in agreement that we have to keep within a budget in regard to the health services. The row seems to be how best to divide the cake as it were. Everybody can say how it should be divided but I think the Minister was very wise when he said to every health board: "There is the money and it is up to you to run the service". Local authorities for years have been criticising Ministers for directing us as to how much to spend on roads and housing. We felt that if we got the lump sum we could run the local authority much better. That is exactly what the Minister for Health has done. I applaud him for doing that. I will not be political about health cuts because we have had them since 1981. Our health board has had to cope with a 50 per cent cut over the years. My big complaint last year, although I was the one who seconded our budget, was that we did not get our allocation for the year until the middle of April when four months had gone by. That meant our cutbacks had to be much more severe because we had to spread an eight month allocation over 12 months. We could have had better management and less hardship for all concerned if we got the allocation at the beginning of the year. Health boards will have to realise that we are not an employment agency but a health agency.

A lot of emphasis has been laid on the number of people losing jobs. I am sorry to see anybody losing a job. Almost 31 years ago while I was a temporary worker with the ESB I had an unfortunate accident out poaching one Sunday. I was told when I was better that the ESB could not take me back because I was not capable of doing the job I had. I got the chop many years ago and I know what it is to be a temporary worker and to be told: "You have to leave your job and you cannot get it back". We have to realise that the health boards cannot be employment agencies.

I welcome the Minister's decision to send out a team to review the boards. The board of which I am a member has the highest percentage of population over 65 years of any health board. We have also the highest dependency ratio of any health board, the lowest average weekly household income, the highest number of medical card holders and the lowest population density per square kilometre. Yet — and here is where the Minister can make changes that will improve the health service without spending more money — we in the North-Western Health Board region are down three-and-a-half beds per 1,000 of the people in our area. In America and in Europe at present the criterion is four beds per 1,000 people. I am sure I can say we are giving as good a health service as is given anywhere in Ireland.

We had an unfortunate tragedy down there some time ago. I will not say what it was because Senators all know, and we were complimented on having one of the finest hospitals and emergency services in the country. It was a terrible accident down in Mullaghmore — a deliberate accident. Our health services are in no way curtailed. Some health boards have seven beds per 1,000 of the population within the area. If every health board had three and a half beds per 1,000 of the population — that is acute beds — we would be saving money and still providing a good health service. The review body should examine where we can provide the services without hardship. Since 1981 I have heard a lot said at health board meetings, in the House and here and I remarked to someone recently that the players have changed but the scripts remain the same. I have heard it all on both sides but I supported the board's budget when their own Government men would not support it. I seconded it and I am on record for doing that.

Mr. G. Reynolds

The Senator is the only one.

Mr. Farrell

It is in writing, and it is there to be proven. During those years in our health area, since 1980 — despite all the cuts, and this is where I say work can be done — we had major developments in Letterkenny General Hospital. We had a major extension. We have an orthopaedic service added to Sligo General Hospital. We have community nursing units at Falcarragh, Ramelton and Buncrana and a residential unit for mentally handicapped at Stranorlar. All the cuts were supposed to inhibit progress. We set up new services, the life skills programme in second level schools, the Renal Dialysis Services, programmes for addiction, behaviour modification services, new health centre services at Letterkenny, Arranmore, Annagry, Gurteen, Riverstown, Dromahair, Drumkeerin, Easkey, Enniscrone and Sligo, all at a time when people were shouting that this could not be done. We have extended or developed our home help services, day hospitals and day centres, community psychiatric nursing, services for the mentally handicapped at Dungloe, Buncrana, Stranorlar, Donegal, Sligo and Carrick-on-Shannon. We have extra dental surgeries and clinics at Ballyshannon, Sligo, Killybegs, Dungloe, Creeslough, Letterkenny, Easkey and Enniscrone at a time when people were saying our health boards were dying on their feet with cutbacks.

Those are the achievements and they are there for anyone to see. In his review I appeal to the Minister to have a look at our health board. My only complaint to the health board last year was about the administration of the allocation although we did not get it until the middle of April, four months after the date. As a result we ran over by £900,000 which was small compared with others. Had we got our allocation at the beginning of the year we would have had no overrun. What is crippling us this year in the health service is the fact that too many boards had overruns. The Minister, in all sincerity probably, tried to wrestle more money from the Cabinet. I am sure he did it with the highest motives, but he delayed our budget and he gave some of the health boards the bad habit of spending from what we used to term in the country long ago "a fool's purse". There were overdrafts and he allowed this to go on. That is why we are suffering some of the cutbacks this year.

We have to be realistic and realise that at present the Health Service is costing £370 per head of the population. I wonder if the Minister said in the morning that parents with four children would be given £2,210 to look after their own health, would they go for the cheques or would they opt for the health service. I have a funny feeling they would grab the cheque of £2,210 because that is what it is costing this country to provide health services for such a family at present. It is almost 7 per cent of our gross national product. We will have to have a good look at things. I believe that within our budget we can provide a good health service. Over the years I heard about all the people who would die; there are people dying one way or another anyway. I have heard of nobody dying for lack of care or because of neglect.

I would like it to go out loud and clear from here that I am quite certain that, despite all the cutbacks, nobody will be neglected in the health service anywhere in Ireland. It is possible to do it and it can be done. We are all jumping on the band wagon and there is a lot of Rúille Búille at present about the cutbacks and what have you. The greatest physician ever in this world — He cured the sick; He raised the dead to life; but the mobs followed Him and what did they say? Crucify Him. He was crucified. This thing of mob law and mob running is as old as Christianity.

(Interruptions.)

Mr. Farrell

I would not interrupt the Senator but if she wants to interrupt me, fair enough. I will have her on, lady and all as she is. There is fair play in this House for all.

Mrs. Bulbulia

I wondered if the Minister was Christ-like.

Mr. Farrell

What the Minister is doing, in my opinion, needs to be done. It had to be done. I am not going into political arguments about it. In my 20 years in public life I have always avoided getting into political wrangles because, as I have said, the script is the same but the players are changing. I do not believe in that type of ideology but I do believe that the review body should examine the ratio of acute beds per head of population within the boards. If they look there, I believe they will find savings. Again in the community care area much could be done if we provided more nursing beds within the community. Our community care and the social services are quite good but they lack something. We have not got sufficient nursing care. Perhaps two hours nursing care a day for patients could keep them at home, whereas if we send them to hospital they have to get nursing care for 24 hours a day. If this area was looked at and examined and we provided more nursing units and nursing care many of our health problems could be solved. We can give a good service within our present budget. It was passed without any problem. All parties voted for it.

When we try to house an itinerant family everyone says it should be done, but not beside me. Now everyone says we should have the health cuts, that too much is being spent on health, that the service is robbing the country. No matter how it is done, it is not done right. I believe that it can be done right. With community nursing and acute beds per head of the population within the health board areas, savings can be made and a good health service can and will be provided.

Mrs. Robinson

This motion calls on the Government to reconsider their budgetary proposals in relation to the health services. I find it very difficult to know what consideration was given in the first place to the budgetary proposals. There is clearly an element of panic and of fire brigade measures in what is taking place now because, as I think everybody who has participated in this debate has emphasised, we are facing a major crisis as a result of the reality of the health cuts striking in every constituency and striking locally. When decisions are taken and when the effect happens in this way, the cuts hurt the most vulnerable and the cuts affect those most in need and we have acute unfairness and acute problems. I am not making a party political point on this because I agree to some extent with Senator Farrell. Listening to this debate is just listening to the sides changing and to one side saying what the other side were saying comparatively recently.

I agree substantially with a number of the points Senator Ferris made in his contribution and my priorities would be very similar to those that he put forward. There will have to be more honesty and more data if we are to have a sensible debate on this. The motion is a very general one. It allows everybody to deal with the crisis as it affects their local area but that does not advance the situation very far. If we are to achieve the objective of ensuring that our health service, although trimmed to our financial reality, is a good, fair and adequate health service, we will need a great deal more factual data and a much clearer sense of the Government's priorities in relation to the health services.

The Minister, in his contribution, was singularly short on providing the House with that factual material. He referred to the letters of allocation to health boards for 1987 and said that those letters of allocation to health boards and voluntary hospitals gave clear and specific guidelines to the agencies on how they should frame their budgets. Could Members of the House have copies of those letters of allocations to health boards? Surely this is the kind of material Members of the House need in order to know the position. The Minister referred to the departmental team which had discussions and prepared findings which the Minister is considering. If we are to address this crisis with the urgency and the concentration it deserves, surely Members should be made aware of the preliminary findings of this team. Surely at this stage the House should be made aware of the priorities envisaged by the Departmental team in their discussions with health board officials so that we would know what approach is being adopted. That would at least serve to lower the feeling of cynicism and despair which is widely prevalent at the moment. People no longer have much faith in what individual politicians say because they change sides on this issue depending on whether they are in Government or in Opposition.

The crisis in our public finances, and particularly in our health services, is so urgent and so serious that we must have an agreed data base, an agreed order of priorities which we can address if we are to have a fair and equitable system. In relation to priorities, I want to address one specific area to which the Minister referred, that is, the question of the sexual assault unit in the Rotunda Hospital in Dublin. This has become a small political football. The Minister has very publicly criticised the Master of the Rotunda and Dr. Maura Woods who is on the staff of the sexual assault unit. That is a highly undesirable development. My understanding of the position is that the decision by the then Minister for Health, Deputy Desmond, to locate the sexual assault unit in the Rotunda Hospital was a Government decision made at the time because it was felt that the Rotunda Hospital was not necessarily the only place or the best place, but was a suitable location for a Government resource, namely, the sexual assault unit. Government funding was provided, staff were gathered and the unit started its work.

I visited the unit on a number of occasions and I know that the pressure on the staff grew dramatically because it provided the first real opportunity for those in contact with children who were sexually assaulted to have a unit which could deal with their problems. The unit was overwhelmed with referrals of children to it. The appointments book in the sexual assault unit is an indictment of our society for other reasons which I will not deal with here. There is a very serious crisis in the area of sexual assaults on children. The unit was inundated with complaints about the need for care of children brought along by their parents or referred by health boards, other agencies, or doctors.

The position for this year was that, instead of the Government making another specific allocation for the sexual assault unit, as had been the basis on which it was located in the Rotunda Hospital, the Rotunda Hospital was expected to fund the sexual assault unit out of its general funding. That is a complete change in the manner of allocating funds for the sexual assault unit. The Rotunda Hospital is a maternity hospital and, like all hospitals, had a crisis in its general funding. It was not the Rotunda Hospital's business to find the allocation out of its own funding for the sexual assault unit. This was a Government project and the Government identified the need to establish the unit. It has been a very dishonest creation of a climate of acrimony for the Minister for Health to go public on this in the way he did. It is no answer to say there were discussions about the possibility of this unit being moved elsewhere. That is not the issue.

The need for the sexual assault unit is unarguable. We need to devote more resources in this area and the funding of it must be allocated at Government level. That is an example of an established priority and an established need that must be addressed and yet the issue is being dealt with as a kind of political football with personalities entering into it and the Minister seeking to undermine the criticisms being made by the medical staff of the Rotunda Hospital by suggesting that they are being found in a contradiction. There is no contradiction. Whether the sexual assault unit is located in the Rotunda Hospital is not the question. At the moment it is located in the Rotunda Hospital. It must be continued and it must be funded but it cannot be funded out of the already diminished allocation for the maternity hospital which is having the same crisis in meeting its on-going needs as any other hospital.

This is an indication of the kind of debate that is developing. We need, therefore, to establish the priorities, and to do that we must be better informed. The Minister in his response could give an undertaking to the House to provide copies of the letters of allocations to the health boards and voluntary hospitals so that we will know the extent of the crisis. He could also provide the preliminary findings of the departmental team so that the Senators can assess them. We could have a more informed debate at a later stage if we had that data, or at least individual Members of the House could have a better basis on which to approach it.

There are two aspects to the crisis. The first is how to establish fairness and equity within stringent financial realities and how to do it in a way which ensures that the priorities which are perceived are advanced. I support the emphasis which is put on community health services. This was a strong priority of Deputy Desmond as Minister for Health and I do not think he received the degree of support from individual health boards which was warranted. I do not think there was a willingness at that stage to face the seriousness of the problem. There was a great deal of politicking and we all know exactly what was going on. We know that there was a lack of honesty and a lack of real concern in a great deal of the debate and, in some instances, an aggravation of the debate for political opportunism.

The grim reality now is that we can no longer play politics with this; it is too serious. How are we to address the much more difficult task of actually defining and constructing a health service which provides the fairest, the best and the most comprehensive service which we can provide within our financial circumstances? Apart from trimming where it can be trimmed — and I do not think there can be a great deal of trimming in the existing services — there must also be a concentration on ensuring that funds are gathered.

I agree with Senator Ferris that it does not look well that there is a sum in outstanding health contributions which is not being collected. There is the possibility of ensuring that the taxation system in this country is both fair and more comprehensive with a view to ensuring that we can support the services which must be available in a young, growing and highly dependent population. Therefore, if we are to determine the priorities, and determine the structure and approach of a health service which will respond to the exigencies in which we find ourselves, we must do so from the basis of having the necessary information.

I am not satisfied that there has been an adequate consideration in the first place of the budgetary proposals. In general terms I support the motion in that it is looking for that kind of consideration, but I do not think an open ended debate of this kind addresses the problem. We need the Minister to come forward with a report on the existing health services which includes any documentation which has been furnished by him, any letters to health boards or voluntary hospitals, any reports of his departmental team, so that we can have open Government on this urgent problem and so we can address priorities in the health service and try to cope together with ensuring that it is as fair, as equitable and as comprehensive a service as our resources will allow.

Mr. Connor

As I have been allowed only 15 minutes to contribute I will confine my remarks to the effects of the health cuts in the Western Health Board area where I live and also the particularly acute effects on County Roscommon. Roscommon is to sustain the greatest single casualty in the whole country with the early and inevitable closure of Roscommon County Hospital. The shortfall in the budget notified to the Western Health Board is £8.4 million and that is the largest cutback in real terms in any of the eight health boards. The argument is made that the Western Health Board have an allocation per capita which is greater than most of the other health boards. While the amount of money spent per head might suggest this, the Western Health Board have built in characteristics and special problems that do not exist elsewhere or, if they do, not to the same acute degree. I will be at cross purposes with my colleague Senator Farrell who spoke about the north western region, but I have studied the census and statistics issued by the Department of Health. The western region, according to my research and the research of others, has the worst demographic structure in the country in relation to the average age of the population. The counties of Mayo and Roscommon, taken as separate counties, have the largest number of older people as a percentage of the total population in comparison with all other counties.

An Cathaoirleach

Senator Connor, I am going to make an appeal to you. I did not notice that Senator Lanigan was offering. Fine Gael have to come in to conclude because it is your motion. Could we have a break up of the time that is left? Senator O'Shea indicated also that he wanted to——

Mr. Connor

I will do my best. I came in expecting to speak for 15 minutes and I do not want to delay the discussion. I have prepared some very germane points that will take me probably 15 minutes to make, so bear with me and I will do my best.

Mr. Ferris

In the absence of the Leader of the House, perhaps the House could agree to extend the debate for 15 minutes to allow those who have indicated that they wish to contribute to speak. We would have no objection to that.

Mr. Connor

I propose that, if it is order.

An Cathaoirleach

Senator Bulbulia will you still conclude the debate?

Mrs. Bulbulia

To facilitate people who wish to contribute I will waive that right and allow the debate to continue so that everybody who wishes to make a contribution can do so. We can extend it for 15 minutes.

An Cathaoirleach

Is it agreed to extend the debate for 15 minutes? Agreed.

Mr. Connor

I was making the point about the peculiar and particular demographic structure in the counties making up the Western Health Board region, that is, Counties Mayo, Roscommon and Galway. The figures for older people as a percentage of the total population in Counties Mayo, Galway and Roscommon show that there is a much higher percentage of older people in comparison with all other counties. County Galway, outside of Galway city and its greater urban area, falls into this category also. Implicit in the older population phenomenon is a very high degree of dependency and consequently a greater incidence of illness and hospitalisation and longer than average stay in hospitals.

The community medical card services, that is, the work of the rural general practitioner and the community nurse, carry the same problem. They are dealing with a very high percentage of elderly people living in very remote areas, remote from any central point. A very high percentage of them live alone and need more frequent visits. Naturally it costs more to service this set of circumstances than it does where the population is more urbanised and less scattered, or where the population in general on average is much younger and has a much lower propensity to illness.

It is nothing short of shameful and outrageous that this health board, with a total budget of £117 million, are left with an £8½ million shortfall in 1987 to finance their services at 1986 levels. The effect of this on individual centres is that almost £1 million is slashed from the budget of the Galway Regional Hospital, the major flagship hospital in the region, which also has to absorb the transfer of patients from the closed or to be closed Merlin Park Hospital. There is a £350,000 cut in the allocation to the county hospital at Castlebar, the second largest hospital in the region. The worst blow of all is a £1.6 million cut to the Roscommon County Hospital which I will deal with later.

There is another really nasty little detail that we might examine and that is the role of the community nurse. Under the new arrangements and decisions the community nurse must service 3,700 head of population instead of 2,700 people as heretofore. Because of the older age structure, the community nurse was always extremely hard pushed to deal with 2,700 people, but with 3,700 people to service his or her position becomes just impossible. The net effect has to be the complete withdrawal of service from hundreds of elderly or infirm people living alone or elderly couples who live in the most remote off centre locations. It all points to a total lack of any central planning that is sensitive to special or the unusual circumstances such as exist in this health board area. All we have is a cruel wielding of the sledgehammer and that is more an attack on and a destruction of the essential fabric of the existing service than an equitable or balanced examination and pruning. We must prune because it is absolutely necessary but not pruning that seems to affect only the indigent, the elderly, or essential child care.

I will come to the more specific case of Roscommon County Hospital. If the decisions that have been taken come into effect — I sincerely hope they will not — the Roscommon County Hospital, to my knowledge, will be the only county hospital closed or so badly decimated in this particular round of health cuts that it will be the greatest single casualty, taken as an institution, in the whole country. Roscommon has been the victim of this disastrous decision. It also has been the victim of a chain of betrayal. Last Friday the Western Health Board decided effectively on the destruction of the hospital which has been in existence for almost 45 years. Yes, there has been a managed media whitewash orchestrated by Deputy Seán Doherty, in particular, to suggest that the Roscommon County Hospital has been "saved". Nothing could be more false.

This hospital as it stands has about 137 or 140 beds. The board's decision last week reduces the bed complement to 49. The board's decision last week reduces the nursing posts in the hospital from 83 to about 20 with pro-rata reductions in staff under all the other headings, doctors, porters, domestic staff, etc. The budget of the hospital goes down from £3.992 million, which is what would be needed to keep it at 1986 levels, to £2.04 million, with the promise of an additional £600,000 from what I would call an uncollectable source, that is, uncollected farmers' contributions throughout the western region. In the opinion of most people barely £60,000 will be collected, if they are lucky, which is about one tenth of the amount outstanding.

Much of this money has been outstanding for ten years at least and it is levied against people who are no longer there. It is also uncollectable because it is levied against farmers because of an incorrect compilation of their ratable valuation. It is utter nonsense to assume, even for one moment, that anything but the smallest fraction will come in in 1987, notwithstanding the board's decision to sent out 8,000 solicitors' letters this year. Even if they sent out 80,000 solicitors' letters they would not get a single pound more because, as I suggest, most of it is uncollectable. It is an insult in the extreme to say to Roscommon: "Take a budget cut by half and, of the half we give you, almost half of that again is subject to the collection of moneys that are effectively uncollectable".

Since economy is at the root of recent cutbacks there is no economic reason to jettison or to close this hospital. According to the last set figures made available by the Department of Health, the cost per week per occupied bed in Roscommon was £671. That is against £734 for Castlebar. The cost per week per occupied bed in Galway Regional Hospital is £838. I concede that because it is a regional hospital it is not a true like with like comparison between a county hospital and a regional hospital. Nevertheless the comparison with Castlebar is a very valid one.

Upward of 5,000 patients were discharged from Roscommon County Hospital in 1986, that is, using its 140 bed complement. With the reduction to 49 beds the maximum throughput has to be much less than 2,000 patients.

An Cathaoirleach

The Senator has two minutes to conclude.

Mr. Connor

I suggest that we lost about five minutes while we debated——

An Cathaoirleach

I am in the Chair.

Mr. Connor

Where are the overspill of 3,000 people to be treated or accommodated? Financial cutbacks will not mean a drop in the number of people falling ill or needing hospitalisation. They can hardly be accommodated in Galway which is already bursting at the seams. They can hardly be accommodated in Castlebar because it too is overburdened. Is the answer to that question: "Sorry; there is no hospital space for you; you can recover if you can, at home". It is also noteworthy that the county hospital in Roscommon has a larger throughput than Mullingar — which incidentally is getting a new hospital — Tullamore, Portlaoise, Navan, Bantry and Mallow, to mention but a few. None of them is threatened.

The average distance for any resident in County Roscommon from Galway or Castlebar is approximately 60 miles. It is further for some and a little nearer for others. Roscommon has no other hospital institution to soften the blow or absorb some of the effects of losing its major hospital institution. Take County Galway, for instance; it has district or private hospitals in Clifden, Ballinasloe and in Tuam. This complements the Galway Regional Hospital and Merlin Park Hospital. Mayo has district hospitals in Belmullet, Ballina and Swinford. Roscommon has no such additional private or district hospitals, and to close its single hospital would be an utter injustice——

An Cathaoirleach

The Senator's time is up.

Mr. Connor

——an injustice sharply focused by the fact that no district or private hospital will be closed in County Mayo or County Galway. While the flagship hospitals in Galway and Castlebar have been badly hit, they remain in existence. I want to make a few other small points.

An Cathaoirleach

Your time is up.

Mr. Lanigan

I will not delay the House very long on this motion. My experience as a member of the South Eastern Health Board since 1985 has not been a very happy one. From the time I joined the board in 1985 we have been discussing the problems of financing. The very first meeting I attended was an emergency meeting called because it was said at that stage that the 1985 finances were not sufficient to carry the health board through that year. The first meeting did not take place until July and there had been an enormous amount of overspending in the first six months of that year. If the health board had stuck to the amount allocated to them in that year, they would have been able to maintain a reasonable level of services. Nobody shouted stop and overspending went on right throughout the year. Suddenly in October there was no money left in the kitty to pay the salaries or the suppliers for the remaining two months of that year. The end result was that an extra allocation in terms of an overdraft facility was given. I am not suggesting that was the start of the problems of the health board, but in 1985 £2.1 million of overspending took place and nobody even queried the fact.

In 1986 we had a series of emergency meetings. We got an allocation of £91 million and throughout the year the chief executive of the health board indicated to us that we could not manage the services on a budget of £91 million. Overspending took place and the Minister allowed an increase in the overdraft. As a result at the end of 1986 the overspending amounted to £4.9 million. In the two years 1985-86 there was an overspending of £7.1 million. Half way through 1987 the allocations were announced and there was an slight increase over last year's allocation to the health board but the Minister said we had to cut back in order to claw back the overspending which was done illegally in the previous two years. He could have gone back further and looked for repayment of the overspending that had taken place in the previous number of years.

I do not think anybody could condone the fact that, in 1986, £91 million was allocated to the health board in Kilkenny and, at the end of the year, over £100 million had been spent. When I say the health board in Kilkenny I am talking about the South Eastern Health Board area. This overspending was against the background of economic depression throughout every part of the Irish economy except, possibly, certain elements in the export business and high technology industry who export a great deal and have the benefits of a low tax regime. We had to try to indicate where further cuts could be made. The Minister sent down a document saying that the cutbacks were not to take place at the sword edge, that they were to take place where they would involve the least disruption of service to the elderly and the poor.

It was a crisis, but the crisis was of a different magnitude from the crisis in every boardroom and every business in this country throughout the past 12 months to two years. There is no business operating which has not had to cut back on its operations and make sacrifices. Sometimes, unfortunately, the sacrifices. were in terms of job losses. Many individuals and companies have gone out of business. Many individuals have lost jobs because of the fact that financial institutions would not give extra accommodation to businesses which were in trouble. Why should we expect the national Exchequer to give extra funds to boards who were overspending? The continuing overspending in the South Eastern Health Board area of the enormous figure of just over £200,000 per week could not be sustained. There is no doubt that that could not continue. There is no doubt that people will have to make sacrifices as a result of the necessary cuts made this year.

I do not think it is beyond the bounds of possibility that an executive of the South-Eastern Health Board or the Western Health Board could come up in the short term with solutions which will not hit the old and the elderly. In a health board area with an employment content of 4,438 people, there should surely be areas where cutbacks can take place without hitting the very basis of the health services. Some executive took the soft option which would garner the most sympathy for the cutbacks and this was to try to hit areas where maximum publicity could be afforded. Unfortunately the sick are very vulnerable to the suggestion that they will die because of cutbacks. People lying in hospital beds are vulnerable to any suggestion that their situation will worsen because of any change in the organisation of the hospital which they are in and, of course, when people are vulnerable they pass on their vulnerability to their relatives and their friends and it is easy to get a snowball effect.

We have had highly paid and highly skilled people in medicine coming out with scare headlines, using the plight of patients to bolster up their own case to have their own position maintained. I saw this in the Kilkenny People last week. A certain surgeon who pretends to be caring of his patients suggested that cancer patients will die because of these cutbacks and that the health services cannot be maintained. That same surgeon was not thinking of his patients when he headed off to Iraq for two years on leave of absence so that he could benefit from the enormous salaries that are being paid by the PARC organisation. He was not thinking too much about his patients here and I guarantee that it was not for the sake of the patients in Iraq that he was going. The same surgeon and others like him do not think too much about the plight of their patients when they head off to hospitals run by the PARC organisation where they run a series of operations on a short term basis, for which enormous fees can be earned. Therefore, the plight of patients is not always foremost in the minds of medical people when they speak in terms of cutbacks.

The cutbacks are necessary. It is up to the health boards where the cuts should take place. There is an opinion being expressed by everybody around the country that health boards have become top heavy in administrative and clerical areas and I have no doubt that that is a fact, and I have no doubt that particular area will be addressed fully by the review committees that have been set up by the Ministers and who are now examining the running of the health board services. I am sure that as a result of these reviews we will get a comprehensive, properly organised and planned health service.

There have been many calls for the abolition of the health boards. Many people are of that opinion. They say the health boards are not useful in the sense that they are too close to the problems and that the make up of the health boards ensures that the professionals will look after their own interests, that the politicians will look after their own interests and that people put on the boards by courtesy of the Minister for Health will look after their own interests. I must say that is not the situation I have seen on the ground. The health boards play an essential part in the orderly running of a regional health service. I would not like to see the health boards being abandoned and control going back to the Department of Health because, if that happened, I can assure Senators that the situation on the ground would deteriorate very fast.

Mention has been made of the amount of money owed to health boards by farmers, in particular, and indeed by local authorities. I am glad that at least the nettle has been grasped. Unfortunately the nettle was not grasped by the previous Government. It was suggested to the local authorities that they could repay the money owed to the health board over a five year period. It was ludicrous to think that, at a time when health boards were coming under extreme pressure and running into trouble with their banks, agreements with local authorities could be reached whereby a five year repayment period could be allowed for moneys which were due in the short term.

I disagree totally with Senator Connor who said that sending out solicitors' letters to farmers is a wasteful exercise. In the South Eastern Health Board area shortly after the solicitors' letters were sent out the money that was due, and admittedly due irrespective of what Senator Connor said, started to come in. Once they were pressured to pay farmers paid. Farmers, like everyone else, will pay only when they have to pay. The first person who calls for money, generally speaking is the person who gets it. If nobody goes after you for money you will not pay it.

The over expenditure in the health service areas has not contributed to a better health service. It has padded the health services. If we were getting an increasingly better health service from over expenditure I would say that over expenditure could have been justified, but there is absolutely no doubt in my mind that the over padding that took place at all levels in the health services could not be justified and did not give greater patient care. It is unfortunate to have to sit on a health board and use a sledgehammer when, if the nettle had been grasped two or three years ago, a smaller hammer could have done a similar job.

The health services will not be run down. It has been suggested by many people not alone in politics but in the professional areas in the health services that we are going to have a Third World type of health services here. We have a health service of which we are proud and the moneys allocated should be sufficient to give us that service. That does not mean there are not areas where I, and every other member of the health boards, have had to make decisions which were harsh and politically detrimental to us. There was no way in which as health board members we could do the job we were elected to do on the health boards if we did not grasp the nettle. Now that the nettle is grasped, when the information starts to flow back to the Department of Health I hope proper, sustained planning will take place.

Mr. O'Shea

As a new Senator I should like to see this House taken seriously. I submit that about half an hour ago the credibility of the House was stretched to the limit when we had the Minister being compared to Christ. That type of nonsense does not help the serious debate in which we are all taking part.

An Cathaoirleach

I was not in the Chair when that remark was made.

Mr. O'Shea

I regret that. It was said in your absence. One of the placards outside Leinster House last Thursday said it all: "Being in Government damages your memory." The Minister, who was compared to Christ, spent four years sneering and jeering at Deputy Desmond, the then Minister for Health, who, in my view, will go down as the best Minister for Health that we have had.

I should like to refer to what is happening nationally. At the end of this year at least 20 hospitals or other institutions will be closed. In Clonmel last year Deputy Desmond gave an undertaking — and the secretary of the Department was also present — that no support hospitals would close in the south-eastern region. We now have five support hospitals going and a voluntary hospital in my own city is under severe threat. A minimum of 1,000 long-stay beds, catering mainly for the elderly, are being withdrawn from the service. Senator Ferris referred earlier to Lismore District Hospital and the fact that an injunction is being sought regarding the constitutionality of the health board meeting held concerning the closure. This hospital has 21 beds. I remember visiting it in November 1985 and three of the patients there were over 100 years old. The last of those patients died recently. It seems that a new philosophy regarding our senior citizens in abroad; that is, if you do not hospitalise them they will die sooner and will be less of a financial burden on the State. In the south-eastern region the chiropody service has been withdrawn from medical card holders. Senior citizens who cannot provide the service for themselves are left to hobble around in pain. Fianna Fáil made very big play of the right to life in the 1983 referendum campaign but now the right to life of our senior citizens is under attack. A figure of 800 acute hospital beds are being permanently closed nationally.

I should like to refer the Minister specifically to the situation which has arisen in Waterford. Waterford city has two acute hospitals: Ardkeen Regional Hospital and the County and City Infirmary. There is a joint department of surgery between the two hospitals and there are 86 acute surgical beds; 12 of the acute surgical beds are being withdrawn by decision of the South Eastern Health Board and, following a reduction of 24 per cent in the allocation to the County and City Infirmary, this could well result in the closure of the Infirmary. This would mean that 55 per cent of the acute surgical beds in Waterford could be closed. I should like to ask the Minister — and I would like him to respond — why has Waterford been singled out for particularly harsh treatment?

The Minister, Deputy O'Hanlon, in this House last week referred to the fact that there are particular problems vis-a-vis the voluntary hospitals in the urban areas and he said there were particular problems in Cork and in Dublin. In Cork we have five voluntary hospitals which are backing up the modern regional hospital. The Cork Victoria Infirmary would be comparable with the Waterford County and City Infirmary and yet in Cork, where we are told that there is a particular problem, the Victoria Infirmary has a cut back of 8 per cent as against 24 per cent for the Waterford County and City Infirmary. Where did these percentages that have been applied to the voluntary hospitals come from? What yardstick and criterion were used? To us in Waterford this is daft, harsh and totally beyond explanation.

I should also like to put it to the Minister that the average cut back for voluntary hospitals is 7.5 per cent. There is also the aspect to the voluntary hospital in the Infirmary that there are permanent pensionable staff in that hospital who are direct employees of the Department of Health and not employees of the South Eastern Health Board. They are not entitled to redundancy payments because they do not pay the relevant PRSI contribution. What is their future? Will there be redeployment? With cut backs in the South Eastern Health Board, where can you have redeployment? What is the position of the student nurses? Even if there is a partial closure, student nurses will go, permanent staff will go. What happens to these nurses? What is the exact position? There is no answer coming back regarding permanent pensionable staff if they are let go from the hospital. This begs a further question, a more important one in some ways: are this Government maintaining the commitment to a 430 bed regional hospital in Waterford? With the reduction in staff and the reduction in services can the Minister tell the House that this Government are committed to the project launched by Deputy Desmond last year?

Finally, I should like to refer to psychiatric beds; 103 psychiatric beds are closing in Waterford. The same philosophy that I allege is being applied to the elderly is being applied here: do not hospitalise your psychiatric patients; leave them out in the community and they will die quicker and again you reduce the burden on the State. Small issues have come to my notice. For instance, in the town where I live — Tramore — because of maternity leave no replacement for the public health nurse is being provided. The nurses from Waterford give one day each in Tramore but only to extreme cases. For four months quite a number of elderly patients will have no service. This problem will be compounded when holiday leave comes on the scene.

I put it to the Minister that Waterford has been singled out for the harshest treatment regarding its voluntary hospital in the most inexplicable way. The Minister owes the House and the people of Waterford an explanation as to how that figure was arrived at.

Question put.

The Seanad divided: Tá, 18; Níl, 28.

Tá

• Bulbulia, Katharine.
• Connor, John.
• Cregan, Denis.
• Daly, Jack.
• Hogan, Philip.
• Kelleher, Peter.
• Kennedy, Patrick.
• McCormack, Padraic.
• McDonald, Charlie.
• Doyle, Joe.
• Fennell, Nuala.
• Ferris, Michael.
• Harte, John.
• McMahon, Larry.
• Manning, Maurice.
• O'Shea, Brian.
• O'Toole, Joe.
• Reynolds, Gerry.

Níl

• Bohan, Edward Joseph.
• Byrne, Sean.
• Cullimore, Seamus.
• Doherty, Michael.
• Eogan, George.
• Fallon, Sean.
• Farrell, Willie.
• Fitzgerald, Tom.
• Fitzsimons, Jack.
• Haughey, Seán F.
• Hillery, Brian.
• Kiely, Dan.
• Kiely, Rory.
• Lanigan, Mick.
• Lydon, Donal.
• McEllistrim, Tom.
• McGowan, Patrick.
• McKenna, Tony.
• Mooney, Paschal.
• Mullooly, Brian.
• Mulroy, Jimmy.
• O'Callaghan, Vivian.
• O'Connell, John.
• O'Connor, Nicholas.
• O'Toole, Martin J.
• Ross, Shane P. N.
• Ryan, William.
• Wallace, Mary.

Tellers: Tá, Senators Daly and Hogan; Níl, Senators W. Ryan, and S. Haughey.

Question declared lost.