Seanad Éireann debate -
Wednesday, 27 Apr 1988

Vol. 119 No. 6

Non-Government Business. - Hospital Closures: Motion

Mr. Ferris

I move:

That Seanad Éireann——

having regard to the crisis and chaos in the health services, which is causing widespread and unnecessary suffering to people in need of treatment and hospitalisation and leading to a two-tier health care system, which will result in loss of life, calls on the Government to provide the necessary funds to re-open the following hospitals:—

Auxiliary District Hospital, Kilkenny,

Bagenalstown District Hospital, Co. Carlow,

Brownswood Hospital, Enniscorthy,

County and City Infirmary, Waterford,

Kilrush District Hospital,

Lismore District Hospital, County Waterford,

Monkstown Hospital,

North Infirmary, Cork (In-Patient Services),

St. Laurence's Hospital,

St. John of God Hospital's Maternity Unit, Cahercalla,

St. Vincent's District Hospital, Tipperary,

Thurles District Hospital,

Barringtons Hospital, Limerick,

with their full quota of 1,036 working beds in service at the time of closure, and further opposes the decision of the Minister for Health to close St. Mary's Geriatric Hospital, Drogheda.

It does not give me or the Labour Party any joy to move a motion couched in these terms which deals specifically with all the hospitals which have been closed by the Government to date. We have listed them and they are included in the motion. I will not repeat them because they will appear in the Official Report. We lodged this motion because we are acutely concerned about the widespread hardship and unnecessary suffering that have been created for people who are in need of hospitalisation, who are sick, old and unable to provide hospitalisation for themselves. As result of the closures of all these hospitals which total 1,036 beds, we are satisfied that our concern in this regard is justified. Under the 1970 Act, as the Minister of State will confirm, most of the decisions to close these hospitals were not taken by the Minister but were as a result of resolutions passed by health boards which were afterwards agreed by the Minister.

This was particularly true in the five hospitals in the south east region which is my own health board region and deals with St. Vincent's District Hospital, Tipperary, the Auxiliary District Hospital, Kilkenny, Bagenalstown District Hospital, County Carlow, Brownswood Hospital, Enniscorthy and Lismore District Hospital, County Waterford. Those hospitals were never identified by the Minister as being eligible for closure. His predecessor, Deputy Desmond, publicly stated that he had no intention of closing sub-acute hospitals in the hospital structure. They were cost effective; they were a necessary part of the structure; they were cheaper to provide the sub-acute care that was needed rather than the acute hospital beds to which people are now forced to go to if a bed is available. In nine cases out of ten acute beds are very scarce. They are not available on demand as they should be in a society that purports to have an interest in its people. The cost of these beds usually runs at three or four times the daily cost of a sub-acute bed in the past. Deputy Desmond, when he was Minister for Health, publicly stated that he had no desire to close district hospitals in the sub-acute structure.

A document was published on the psychiatric services which dealt with a possible future structure for psychiatric care and stated that it would be advisable and worthy of consideration that people should be looked after as far as possible in the community. That document was adopted by the then Minister as a working document in principle and was recommended to him by various experts in the field, but the structures in the community were not put in place. Therefore, there was no question of putting that documentation into action until the community was ready to take psychiatric patients. My colleague, Senator O'Shea will develop that point further in regard to the implications today. One of the reasons the health boards made these decisions — not that they wanted to make them but they were forced to make them — was the inadequacy of the funding given to them by central Government and approved by the Dáil for the various health boards in the Health Estimate each year.

That is why it amazes me when I see an amendment from Fine Gael which clouds the whole issue and requests the Government to examine the financing of the health services. This from a party who voted in the Dáil in favour of the Health Estimate which has created the problem for the health boards that they are unable to provide the same level of health care and bed numbers as they did in the past. I have heard the arguments from the professionals, from doctors in particular, and doctors in the Fianna Fáil party, that vis-à-vis the European standard and the number of beds per head of the population, Ireland has too many hospital beds. I ask: who sends a patient into a hospital? It certainly is not a politician — not a Member of the Dáil or Seanad. It is not a county councillor. It is a doctor. If there is a query about beds being occupied by people who do not need hospitalisation, we should ask the medical profession if they are over-recommending people for hospitalisation. If that is the case, that is a whole new debate.

What the Labour Party and I are suggesting is that where there is a need, seen and perceived and proven, for hospitalisation which the health boards cannot provide, there is a fault in the system. People who are sick, who are in need of hospitalisation, are referred to hospitals. When a sub-acute hospital like a district hospital is closed, the only place left for that type of patient if they need hospitalisation is either an acute hospital bed at four times the cost or a geriatric bed. That is what happened in the southeast. I was told recently by a medic in charge of the assessment unit of a geriatric hospital: "Michael, you will have to wait for somebody to die in this hospital before there is a vacant bed."

That is a pity. It is a tragedy that you have to wait for an inmate to die before a vacancy is created. We would all appreciate it if they could be looked after in the community, in the welfare home structure and all these other structures of private nursing homes which are admirable and give an excellent service in the community. The two-tier health system we are talking about which is being created by the lack of response from the statutory powers is that people who have medical cards are being pressurised into going into private nursing homes and sending for their GP. They are unable to be supported by beds subvented by the health boards because of the cost factor. They are now paying £20 or £30 a week more than their old age pensions to keep them in some sort of frugal comfort in some institutions where they can have medical care, limited as it may be.

Our old people do not deserve that kind of treatment. I am sorry the Government in all their planning and all their fiscal rectitude had no priorities whatsoever when they decided that the Health Estimates would be cut to such an extent that health boards would be forced, and they are being forced, to make decisions they do not like.

In my constituency we had to go to the High Court about the closure of our district hospital. We won the case in part, but we had to pay half the costs. The community had to pay £8,000 to prove that the health board convened a meeting that was not in accordance with standing orders. They still decided to close our hospital. The Minister rightly said to me that he did not want to close the hospital but the health board decided, and he accepted. The same thing is happening now with the two acute hospitals in Cashel and Clonmel. I have been told by the health board members that they are being forced to amalgamate. The Minister has stated publicly that he had no intention of closing or amalgamating these two hospitals. Still the health board are going to close them. They have no funds. It is giving the health board an excuse to run down the one that loses the vote. That is not the way to deal with health care. That is not the way to deal with the kind of problems we have.

Of course, we are prepared to sit down and discuss — we offered to do so in the past — how this could be done in a structured way, with priorities. If that were the case, we certainly would not have closed the hospitals first and then talked about a structure and a hospital plan, which the Minister has been accused of not having. He does not have an overall plan except to give the health boards less money, let them close as many hospitals as possible, and then we will talk about it.

This afternoon on the Order of Business there was a query about the validity of this motion. It was queried by Senators who had an interest in one hospital. I have an interest in all the hospitals. There was a suggestion that there was something incorrect about this. The reason I included as an addendum the fact that it was not included in the closed group is that I am aware of the Minister's intention to close St. Mary's Geriatric Hospital in Drogheda. I give that information on the following basis. A question was put to the Minister for Health in the other House by Deputy Bell. He asked him if he proposed to give sanction for the closure of St. Mary's Hospital in Drogheda, County Louth; the outcome of discussions between his officials, the North Eastern Health Board and the Board of Drogheda Cottage Hospital; if there will be a reduction in geriatric beds in Drogheda; and if there will be any job losses. The Minister for Health gave a written answer on Tuesday, 1 March 1988. He said:

My Department, the North-Eastern Health Board and the authorities of Drogheda Cottage Hospital are currently engaged in discussions as to the future role of the Cottage Hospital. The intention is that Drogheda Cottage Hospital——

——which is a private hospital——

——would take on the role of providing long-stay geriatric accommodation for the area which would facilitate the closure of St. Mary's which is the existing long stay hospital in Drogheda.

That is what the Minister said on 1 March. That was not enough — to say in a House of the Oireachtas that by keeping one hospital open it would facilitate the closure of the other. A meeting was held in the Custom House on 13 April, chaired by the Minister for Health, Deputy O'Hanlon, at which the following people were present: Mr. Farrell of the health board, Mr. Clarke and Mr. Scully, Dr. Irwin, Dr. Carney, Mr. Orr and Miss Fallon from the Drogheda Cottage Hospital; and from the Department: Mr. O'Dwyer, Mr. Mooney and Mr. Edwards. These people discussed the closure of St. Mary's. The first item on this minute, which has been circulated to members of the health board, stated that, "it was agreed in principle that Drogheda Cottage Hospital would become the long-stay geriatric unit for Drogheda and that St. Mary's Hospital should be closed". That is why we have included St. Mary's Geriatric Hospital in the motion.

Two former Ministers, the present Taoiseach, when he was Minister for Health and Deputy Barry Desmond, committed themselves not only to the cottage hospital, to which Deputy Desmond said he would give £1 million towards refurbishing, said they would build a new geriatric hospital in Drogheda. This was said by two former Ministers for Health about the cottage hospital and the need for a geriatric hospital. That is why the motion is valid. That is why we want to be specific. That is why we do not want this motion to be affected by amendments from anybody else. We want to talk about how we should plan the hospital services and about the acute drop in morale in health board workers.

That is why we cannot understand why this amendment was put in. We wanted to argue with the Government that they had agreed to proposals from health boards to close various hospitals throughout the country and had given inadequate funding to allow some of these institutions to remain open, forcing hospital boards to make the same decisions. We are suggesting that that should not have happened without a proper plan.

Now that they have been closed, the only way to address this is to commit ourselves as a priority to this area. We are asking the Government to have priorities in the area of acute beds which are an essential part of our health structure, our health requirements and our health entitlements for people who are paying PRSI and PAYE. These people are paying for the costs. This Government brought in further legislation to charge them for their already existing entitlements. That was not enough. They reduced the funding to health boards to make it impossible for them to continue in this area of health care. I request the Fine Gael Party to withdraw the amendment and let us see what the Government have to say about these individual institutions throughout the country.

Mr. O'Shea

I second the motion. First, I would like to deal again with what has arisen regarding St. Mary's Hospital in Drogheda. I would like to emphasise the word "morale", the morale among staff who operate within the health service. It was only last week, after a sit-in in the matron's office at St. Mary's, that a senior health board official was sent over and read the minute of the meeting, which Senator Ferris alluded to, held under the chairmanship of the Minister for Health in the Custom House on 13 April. The staff were not consulted at any stage about what was being discussed or what was likely to come. This was the first indication they got of what was happening. Now we are facing the situation when the only public hospital in Drogheda is about to be closed.

Senator Ferris referred to the commitment given by Deputy Desmond regarding the provision of an extra £1 million for the reconstruction of the Cottage Hospital in Drogheda and the provision of a new geriatric hospital. Indeed, the present Minister for Health, Deputy O'Hanlon, when he was a member of the health board, was one of those promoting such an undertaking and commitment, which incidentally was given by Deputy Haughey, the present Taoiseach, when he was Minister for Health.

The people in Drogheda have been very badly treated. We in the Labour Party are very concerned that, the trades unions and the staff until they sat in and demanded information, that information did not come, in spite of the fact that a meeting had already taken place at which it was decided to close the hospital.

In the motion proposed by Senator Ferris we refer to the closure of hospitals. Since Fianna Fáil came to power in March 1987 15 hospitals have been closed and a total of 1,470 beds all over the country have been lost. In addition, three more hospitals are likely to be closed in the future. Drogheda, Dublin and Cork are the others. A grave threat stands over other hospitals all around the country.

This is only part of the story because no fewer than 3,617 beds have been closed in hospitals in the country. No branch of the services has been spared: 2,659 acute beds have gone, 3,349 geriatric beds and 609 psychiatric beds have been closed. As well, 2,000 staff have gone from the service. We cannot over-emphasise this point of morale when we talk about 2,000 people gone, when in the minutes Senator Ferris referred of the meeting in the Custom House it is stated that a voluntary redundancy package will be offered in Drogheda Cottage Hospital and St. Mary's Hospitals. People in the service are uncertain of their future. They do not know what is coming. They are overworked. The whole system is in chaos and obviously the people working in these conditions cannot function at the level they would like.

Another point I would like to stress is the fact that it costs £36,000 to educate a consultant and £23,000 of that comes from our taxes. We are heading down the road to a two-tier health system and those who are paying taxes for the education of these consultants are now being denied services because there is absolutely no doubt that there is a very solid pattern abroad in which the numbers of public beds are being diminished.

I shall refer to the South-Eastern Health Board region which is the region I know best; it is the region where I live. The South Eastern-Health Board suffered a £6 million cut back in 1987 and there will be a cut back of a further £6.2 million in 1988. This is where I find a lot of difficulty with the Fine Gael amendment. If you take money out you lose services and staff and it is about time we cut out the codology. There is no use saying that we can now come up with a plan after the money has been taken out and get our health services back to where they were before the present Government came to power. The stable door has been left open because Fine Gael did not oppose the Government when the Health Estimates came before the Dáil. On that basis I say it is hypocritical to come up with something like this now which gives the impression that vastly reduced money can provide the services that are required.

Looking at the South-Eastern Health Board region and in particular the new regional hospital which is under construction at Ardkeen, I am very concerned about whether this Government are serious about continuing that project. I asked the Minister of State the same question before the recess at Easter and he said it was a matter for another day. Let me give some figures which illustrate why I am concerned. In 1984 we were informed by the then Minister for Health, Deputy Desmond, who gave the go ahead for this hospital, that the hospital would cost £40 million to construct. It would cost a further £10 million to equip and would cost a further £26 million per year to staff and run.

Let us examine the South-Eastern Health Board budget as it is. The budget for general hospitals in the South-Eastern Health Board region in 1987 was £34 million. That has been reduced to £31.5 million in 1988. Something like £11 million went to Ardkeen, according to the estimated out-turn from the South-Eastern Health Board in 1987. Where are the £26 million plus the additions which must be put on for inflation since 1984 to come from? I am very suspicious that this Government are not serious about completing that project at Ardkeen.

Local Deputies have been saying: "Your health services are being cut back in the Waterford area but in five or six years everything will be grand." That is a lot of consolation for the people who need health care and in particular the public patients who need health care at the moment. More worrying and something that concerns many people in the south-eastern region is the fact that the Minister for Health, Deputy O'Hanlon, stated in the Dáil that the national norm for surgical beds is 0.06 per thousand — in other words six beds per 10,000 people. Ardkeen, the Waterford Regional Hospital, caters for not alone the Waterford city and Waterford county area but also for south Kilkenny and the New Ross area. There is a total population of 137,000 people in that catchment area. On the Minister's own figures this would require 82.2 surgical beds. At present there are 67, and with cutbacks already in hand that is to be reduced to 52 surgical beds, fewer than two-thirds of the norm the Minister spoke of in the Dáil.

When this Government came to power there were 84 acute surgical beds in the Waterford area. There are now 67 which is to be reduced to 52 and, on the Minister's own admission, this is reducing things to a very dangerous level. Either he believes in the figures he presented to the Dáil or he did not. Certainly he has left the Waterford area in a catastrophic position because only emergency procedures are being carried out. I do not want to go into specific cases but old people, for instance, who need surgery, though not urgently in the sense of an emergency or of their lives being in danger, but who are suffering greatly, are being told that in 12 or 18 months they may get health care.

Fianna Fáil in their much spoken of programme for the last general election complained that health cuts were hurting the old, the sick and the handicapped. I will refer for a moment to the handicapped. I believe that, because psychiatric beds have been reduced, psychiatric patients are being discharged into the community without being ready for it and I ask the Minister to investigate the suicide rate because I have reason to be worried about this problem.

Dr. O'Connell

This motion is the Labour Party's most interesting one as, indeed, is the amendment from Fine Gael. The difference between the two is that Fine Gael are adopting a very responsible role in this. To put it in any other way would show a degree of irresponsibility because what they are saying is "When we were in Government this is what we planned." The trouble with the Labour Party is that they try to forget they were in Government and this is the big problem they face. They cannot get away from it. They were in Government and they carried out a programme of hospital cutbacks and closures. They did that and they cannot deny it; they cannot run away from it or suddenly say they are all pure now and want to forget they were in Government. They were in Government with Fine Gael. They carried out the policy on cutbacks and they must accept responsibility for it.

This was on the cards while Deputy Desmond was Minister. There is no denying this. To be fair to Fine Gael, they were responsible. They looked at this and they knew they would be seen to be hypocrites if they were to support this motion. They put down an amendment. They recognised that there was chaos, that perhaps some of the decisions were on an ad hoc basis and they looked at it that way. They are not unaware of the problems facing the country and how they are to be tackled.

We are spending £1,300 million on our health services, a very large sum by any standard. Fianna Fáil came into power in March and had to prepare a budget, a far from pleasant one. They were in a dilemma. Unless they took effective action the country would be in serious trouble and we would have had the International Monetary Fund moving in to decide our affairs. When Mr. James Callaghan was Prime Minister in Britain the IMF came in and took over there. The option open to this Government was whether they should allow the IMF to move in and engage in radical revision of our social services resulting in the abolition of, say, the unmarried mother's allowance, the deserted wife's allowance, disability allowances and so on. The Government had to weigh all of those issues. They were faced with an unenviable problem. They had to effect cutbacks in our services and within a very short time. I am not saying they were perfect but they had to carry out emergency surgery in our health services. It did not call for great deliberation.

You do not sit in an office and work things out while the place is on fire. You must take emergency action and that is what they did. They were faced with the prospect of having to take hard, very courageous decisions, with many of which I did not agree. That does not take from the fact that I had to admire their courage in so doing. I must pay tribute to the Minister with whom I disagreed. He was very courageous; he stuck to his guns in saying that was what he had to do. We all know that, on occasion, he was chased from some hospitals. He was given a very rough time, but he took on the task. He did it and we are seeing now the results in the public response. The opinion polls are showing that he did the right thing. They testify to the fact that what this Government did was met by a positive response on the part of the public.

We should put matters into perspective. Sitting on the Opposition benches, as I have done for years, it is very easy to attack and criticise. The bible of a former Minister for Health, Brendan Corish, and his staff of Labour advisers was entitled Health Care Rationing By Coupon. It was a very interesting booklet. There are many copies in the Labour Party offices. It was the bible of the Labour Party and of former Minister, Brendan Corish and his advisers, ex-Senator Flor O'Mahony and others, who used it over and over again to illustrate to us why the health services were getting out of control in terms of cost and how we must contain them. I might quote from it——

Mr. Ferris

They must have taken them away with them. I did not see any.

Dr. O'Connell

In that book it is contended that the more you supply the greater will be the demand. That is the whole tenet of the booklet. If we provide £2,000 million for health services there will be a demand for £2,100 million. The demand has continued like that. More money does not necessarily mean more health. We should bear that in mind.

Some of the hospitals listed in this motion are very dear to Senators in the south-eastern region, politically very dear to them. District hospitals are an anachronism; one wonders should they exist at all. Let us be honest; if we are talking about a proper health service for our people, do district hospitals constitute the answer? Can we say honestly in our hearts that district hospitals are the answer? Take the example of Monkstown Hospital. It should have been closed many years ago. I have maintained for years that it should have been closed. I was amazed it was kept open because it had been serving no purpose. It may have been serving the purpose of the vested interests running it, with prestige for those in charge, but that is all. Monkstown Hospital should have been closed years ago. I advocated many years ago that it should be closed.

It is interesting to see St. Laurence's Hospital listed in the motion. The former Minister, Deputy Desmond, wanted St. Laurence's Hospital closed. He worked feverishly to have Beaumont Hospital officially opened. Part of that aim was to close St. Laurence's Hospital. Do we want to re-open St. Laurence's Hospital. Should we close Beaumont and re-open St. Laurence's Hospital? Where does Jervis Street Hospital feature in all of this? There is not a word about Jervis Street. What are we doing about that?

Acting Chairman (Mr. Doyle)

The Senator has one minute remaining.

Dr. O'Connell

In terms of hospitals generally we must streamline our health services if we are to serve our people properly. Many hospitals are a danger to patients because they do not have adequate services. I went to Athlone many years ago for the Labour Party to talk to them in terms of providing a proper hospital. Having a one surgeon hospital was a danger because the man was over-worked and could not provide a proper service. My instructions were to go and explain that. We must put the matter in perspective and ask ourselves: are these hospitals serving a purpose? We would all like to see hospitals in every corner of the country. When the economic position is favourable, when we have the GNP that will enable us to do so, then I hope we will have more hospitals.

Mrs. Fennell

I move amendment No. 1:

To delete all words after "Seanad Éireann" and substitute—

"aware of the chaos in the health services brought about by ad hoc decision making and crisis management with a consequent dislocation of services, loss of bed numbers, drop in the morale of health care workers calls on the Government to examine the financing of the health services and to publish a plan to indicate how, in the light of moneys available it intends to provide an equitable, comprehensive and cost-effective public health service which is a basic right of all citizens and to indicate the specific changes in the system of administration it intends to implement to achieve these purposes.”

In moving this amendment I might say that this party are being consistent in their approach to health and other policies. What we recognise we do not have is a consistent policy and programme to effect the cuts or savings we accept are necessary. I do not need to remind Senators or anybody else of the classic signposts erected by Fianna Fáil prior to the last election. I am sure people in the Fianna Fáil Party hated those signposts and the message they carried being quoted back at them. We saw time and again: Health cuts hurt the old, the sick and the lonely. A number of people who saw those signposts looked at them and said: "At least Fianna Fáil care. They are a caring party. They are saying they are not going to effect cuts. They will not hurt the old or the sick." I am quite sure they had some influence on voting in the last election.

I would like to say to Senator O'Connell that it is all right if you are young and healthy — you do not think you will ever be sick — or if you are sick and rich. Such people will not be bothered. Probably much debate in which others indulge goes over their heads. You tend not to consider your needs in the health care area — a lot of people do not — until ill health affects you or your family.

In this House we have an obligation seriously to consider what is happening. With all due respect to Senator O'Connell and his perception of this party the last Coalition Government and so on, we should remember that we are now one year down the road. In that year we have seen considerable chaos, agitation, distress, a terrible mish-mash of health services. I suggest we are witnessing the total abandonment of a good health service, built up over the years and which served our people well. We have watched as hospitals were closed in a brutal, thoughtless manner, nursing staffs cut back, out-patients departments restricted all leading to an inability on the part of people who are ill, in stress or worried to get hospital beds. Hardly a day goes by without a chronicle of despair by someone suffering because of the hamfisted manner in which our health system is being administered. We read stories in the newspapers. We heard a story today about the Adelaide Hospital. We hear reports on radio. Indeed it must be said that the people we hear of or read of are those who are sufficiently assertive to complain. They bring their problem or deprivation, or somebody belonging to them, brings them to the attention of a newspaper or radio reporter. What about all the others who have not got that power, who do not have those contacts? What happens to them? They are the lonely, unseen, suffering people.

We are spending £1,300 million on our health services. The public are not getting good value for money. They are paying very dearly for those services. We are seeing the emergence of a two-tier system of health care. It is beginning to resemble health care as it has obtained for years in the United States. We have always wondered how social status determines the health care of people in America where the poor can be abandoned to indifferent treatment. That is what we are moving toward here — indifferent health treatment and worse for the majority of people. That is not the whole story. Old people or parents of families are now living in dread of there being illnesses in their families. They worry about how they will cope with it. Many are neglecting other needs. Many people are now joining the VHI who would not otherwise have spent money on health insurance. This is an indication of their concern about health care and their anxiety about becoming ill.

Of course health cuts could be effected. Some savings are capable of being effected on expenditure on health issues but, in effecting savings, clear thinking and planning are needed. It should not be done on a regional or local basis but rather from a national prospective taking account, on the one hand, of resources, skills, personnel and, on the other, people's needs impartially and fairly determined. This has not happened. We have watched the Government lurch from one crisis to another, patching up here and making do there. There is just no public confidence in the Government, in their ability to care for our health needs. We have seen an agenda of calamities from the abolition of the Health Education Bureau to the débacle in regard to Barrington's Hospital in Limerick. Government policy on cutbacks is hamfisted and clumsy.

What do people want? They want to be reassured that the health service to which they had become accustomed will not be permanently scarred by Government policies. They want equity and fair play. Many people can point to cutbacks and staff rationalisation in general hospitals staffs. In other words, personnel in the lower grades are being cut, or rationalised, virtually leaving alone the staff hierarchies of consultants and specialists.

Savings should be made across the board. No one group should be excluded. All should carry a fair amount of the savings implemented. What is happening in the health area was brought home to me recently when my husband was ill and needed an appointment with an orthopaedic specialist. My general practitioner said he would have to be listed three months hence for an appointment. When I expressed surprise my general practitioner told me how lucky my husband was, that public patients must wait 16 to 18 months for an appointment.

In the present climate there are some groups more vulnerable than others. Among them I would give priority to the old, men and women who are ill and deserve good care at the end of their lives. They are not getting such care. This is what probably influenced me and others most — the number of old people who are ill, who are being sent home from hospital to die because this Government do not care that we do not have a developed system of community care. In another country if would be possible to send old people home into the care of their family or a relative because there would be a sophisticated community care system, a network of nurses and caring personnel. Such community care has been a casualty of the cuts effected here. There is no vestige of community care, in a real sense — like having day care centres, or public health nurses. There had been a development in that direction, something with which most of us would agree.

There are the areas affected — such as maternity, child care but particularly the old, the people who need homes. In this context I might quote from a contribution in this House by Senator O'Connell on 23 March, 1988, at column 112 of the Official Report:

We have a growing population over the age of 65 for whom it is impossible to get a bed, it is absolutely impossible. This is happening not just in the past year but it has been going on for the past three or four years. We are not making provision in any way for these people who are over the age of 65. Because of the way the services and health in general over the years have improved due to developments in technology and medicine many people will live longer. They become a burden on the community.... This is something that we have to look at. This is an opportunity for another look at this whole matter.

We need to revise what has been done. We need to look at what is ahead because we cannot continue tolerating the cuts we have seen in the last year.

Mrs. Bulbulia

I have pleasure in seconding the Fine Gael amendment. I notice that it seems to have upset the Members of the Labour Party who put down the motion in Private Members' time. I would just like to remind them that we have a right, an entitlement as a political grouping, in the Seanad, to put down an amendment. We do not apologise for that at all. In fact it is a rational, sensible and intelligent amendment. While I understand the tremendous distress an anxiety caused by the closure of the hospitals, quite frankly, when I saw these hospitals listed I felt that to suddenly, tomorrow morning, turn around and open all these hospitals would cause crisis upon crisis. Consequently, I thought the Labour Party motion an absolutely extraordinarily simplistic motion to put down, really one that showed no evidence of evaluation, planning, reasoning or an awareness of the financial realities within which we must all operate. In this list of hospitals I, too, queried where was Jervis Street in all of this, where is Baggot Street, where is Sir Patrick Dun's? If one is going to list all the hospitals that have been closed why not do it comprehensively, which is the very least those other hospitals that have been closed deserved?

I have a horror of politics intervening in the whole health care area. Nevertheless we live in a very real, practical world and I suppose it must be the case. To me, the provision of health care is just far too important for cheap political shots, for the sort of shroud politics that we see. That is not my term, that is only used, I think, by the former Minister for Health, Deputy Barry Desmond. I would regard that as a very low form of politics, that frightens the vulnerable, causing upset and distress, all in the name of gaining political points and point scoring. In fact it undermines the very people for whom health care is so vitally important. I would hate to think that anything I would say in the context of this debate would have an upsetting or undermining effect on any of those vulerable people.

Senator Ferris spoke about the Fine Gael amendments clouding the issue. Then, in the course of his contribution, he queried the Government's priorities. I would put it to Senator Ferris that that is precisely what the Fine Gael amendment is designed to do; it is designed to query the Government's priorities.

Senator Ferris spoke in relation to Cashel and Clonmel, contending that the whole question was being raised again in the south east region. Of course both he and I served on the South-Eastern Health Board. We are well aware of what is happening. I gather there has been a special committee established to look into the Cashel versus Clonmel hospital and come forward with recommendations. There is a very real fear that if the vote is won in one direction the other hospital that loses will be run down. I do not think that is any way to plan a health care service — on the basis of a vote taken at health board level. That is not good enough. There has to be an overview, an evaluation and then a democratic input. Something should not be decided merely on the basis of an argument at local level. It should be put in a national context and be related to available resources.

I am somewhat sick of the Government lecturing the public on their voracious need for more and more health care. It is not on to do that. You have to recognise the fact that it is important to have logic underpinning health care provisions, recognising that there is an inexorable rise but also planning for that rise. Senator Ferris said he resented — I think it is not too strong a term to use — the presence of the Fine Gael amendment because he wanted to argue with the Government. I would much prefer to reason with the Government and to appeal to their good instincts — I am sure there must be some in the Government — in relation to health care services. I would regard mere arguing about health care as a very sterile activity, indeed. By logic and by reason I would hope to persuade them that the absence of a plan, or overview is something that is distorting the delivery of health care on the ground to our people and that that is not good enough.

The Government must have recognised that fact at some stage. They set up a commission on health funding with specific terms of reference. The terms of reference come into the Fine Gael amendment. The commission on health care funding were asked to bring forward a plan to provide an equitable, comprehensive and cost effective public health service. In the course of his reply I should like the Minister to let us know how many times the commission on health funding have met, how far along the road they are in their deliberations, when they are expected to report and when action will be taken on foot of their report? I think I am correct in saying that an undertaking was given to the leader of my party that the commission on health funding report would be laid before the Houses of the Oireachtas and that there would be a debate on such a report.

That kind of debate and report on the health care services is long overdue. In the absence of a debate, in the absence of the possibility of consensus about the delivery of health care, what is happening out there is ad hoc planning, crisis management, quite frankly, chaos. Much of it is hitting the headlines and much is not. A lot of it is quiet and sorrowful. It is ending up very badly indeed. It is unacceptable. Because of that people like myself and others who speak today wish to debate the health care services. There is no point in having a callous, simplistic philosophy that the books must be balanced no matter who suffers. That is just not good enough. I do not believe that that could possibly be Government policy.

Senator O'Shea in his contribution spoke about the morale of health care staff. I am glad he did because that is contained in the Fine Gael amendment. I take it he would agree that morale among health care workers is at an all time low precisely because of the absence of planning, because they do not know where they are going, because they see the patients — for whom they care and for whom they are powerful advocates — suffering as a consequence of the absence of Government planning. I am pleased to note that Senator O'Shea recognised that aspect of the Fine Gael amendment.

We want a humane, rational and planned approach. I want to reiterate the right to health care of every citizen in a civilised community as not being open to question. The question is: how do we plan this? I am fearful of what lies ahead. We read in the papers that some additional £400 million cuts will be effected in the autumn. It is unthinkable that these would bite at the health care services without a careful evaluation and study and the bringing forward of, at the very least, the report of the commission on health care funding, a White Paper on health care services, or a full debate and, hopefully, the possibility of some consensus on what it is possible to do in relation to the delivery of health care.

In an ideal world it ought to mean that every one of our citizens is entitled to the best health care service available. In the Ireland of today, I am not so sure that it can absolutley mean that.

We must remember that there has been a huge expansion in medical technology, what is called high-tech medicine. We have to take decisions on what proportion of our scarce money is to be spent in this area, what proportion will be spent on acute beds, on long-stay beds, on psychiatric care and on so many elements of health care. I appeal to the Labour Party to adopt a mature, rational approach, to stop this shroud politics, this panicking of people, this symplistic, naive and pathetic approach to the whole issue of health care. Blazoned on their banners is: health care is a basic right. I do not disagree with that. I accept that the Government do not disagree with that, but it has to be done on the basis of a plan, an evaluation, on the basis of a realisation of the amount of money available to us to spend on health care.

For that reason I second the Fine Gael amendment. It is sensible. It meets the position obtaining. It recognises the crisis and chaos caused by the absence of planning and appeals, one hopes, to what are the better instincts of the Government.

An Cathaoirleach

I understand that Senator Farrell is sharing his ten minutes with Senator Mulroy.

Mr. Farrell

That is correct. I cannot agree with the motion or the amendment. Both use a very sensational kind of lauguage, such as crisis and chaos. I do not notice at all that crisis or chaos in the health services. Certainly, as chairman of the Association of Health Boards of Ireland, I have not come across that at any of our meetings. In the north west there have been no hospital closures for the simple reason that our hospitals were closed 15 years ago. We adopted a proper regional system. What too many regions tried to do was to retain their county system, at the same time maintaining a regional system. You cannot have both. With good management those hospitals which did provide acute services could be used for other purposes without causing any hardship or problems. That is what we did in the north west.

I should also like to remind the proposers and seconders of the motion and the amendment that you would have the impression that they were never in power at all themselves. Indeed I might remind them that on 10 December in the Dáil the previous Government told us that, in their four years in office, there had been a national cut of 3.8 per cent in funding of the health services. Indeed in that period the allocation to our health board was cut, in 1983, by £3.4 million, in 1984 by £1.7 million, in 1986 by £2.2 million. I heard much of that same scare mongering at health board meetings. I must say that I did not agree with those cuts although some of my party were making them. At the same time, it was agreed within our health board that we would live within our means, that we would adopt a budget and estimates and work within them. For that reason we were able to manage our affairs with no hardship being occasioned.

I do not agree at all that there is any hardship being suffered even at present. I should like to pay tribute to the various health boards on the great job they are doing. Indeed I might congratulate the Minister on the way in which he is managing to keep the health boards in check. It should be remembered that a previous Minister had intended to abolish them, leaving local representatives with absolutely no say. It was his proposal to have one board only — Bord Sláinte — located in Dublin which would dictate the services for the entire country.

What is happening now is a far cry from the attitude that was displayed then. One would think that during the time of the last Government no hospitals were closed. Many hospitals were closed and, indeed, the hospital in Longford, which I pass on my way home, was closed and there was no big hullabaloo about it. It was accepted by the Fianna Fáil Party, by the Fianna Fáil politicians in Longford and by the health board.

There was, and is, no crisis. The health boards are being run very ably and efficiently. Over the past number of years they were run on shoestring budgets but there was no hardship as a result. There still is no hardship and there will be no hardship. It is grossly unfair for healthy, able-bodied people to try to promote this type of attitude and make it tougher for people who may be ill or seeking hospitalisation who now believe they will not be able to get into hospital. I have spoken to many people who have been in hospital and they thought the services in the hospital were great. They thought before they went in that there would be no places for them. The services in hospitals are good and I want to pay tribute to the hospital boards, the staff and those who are administering the health services in a very fair and sincere manner.

It is grossly unfair to suggest that there is chaos in the health service. There is no chaos. It is a good service and it is being properly and democratically implemented through the health boards. We are all proud and delighted about that. The motion and the amendment are nothing more than an attempt to sensationalise the situation. A hospital that is not facing closure has been listed in the motion as facing closure. I am amazed that people put forward those type of motions without first doing proper research. It is grossly unfair.

Mr. Ferris

Which hospital is that?

Mr. Farrell

I will leave it to my good friend to speak about it later on.

Mr. Ferris

He heard me.

Mr. Farrell

It is listed in the motion, St. Mary's Geriatric Hospital in Drogheda. How can this House claim to have credibility when we are not prepared to put honest motions before it for debate. We should get our facts right.

An Cathaoirleach

Senator Farrell, are you giving time to Senator Mulroy?

Mr. Farrell

Yes, I cannot agree with either the motion or the amendment.

Mr. Mulroy

I consider this motion to be regrettable because it has been put on the Order Paper purely to highlight the position in certain constituencies. As I said earlier today on the Order of Business, I have no doubt that the footnote — which I believe was added at a late stage — about the hospital in Drogheda is inaccurate. The Minister has taken no decision to close St. Mary's Hospital. A Labour Senator said earlier that he was aware of a proposal——

Mr. O'Shea

An agreement.

Mr. Mulroy

It is a proposal; there is no agreement. The situation at present in relation to the hospital in Drogheda is that discussions are on-going between the North Eastern Health Board, the Department of Health and the Cottage Hospital to transfer 20 patients from the old fever hospital, Fatima Hospital, which is attached to St. Mary's Hospital, and to accommodate them in the Cottage Hospital. That is phase one of the operation. Phase two of the operation is down the road and it is for consideration by the North Eastern Health Board. I should like to remind Senators that Deputy Desmond issued an instruction to close Monaghan Hospital in 1982-83. He said at that time that he would not give the go ahead for Cavan Hospital unless the North Eastern Health Board closed Monaghan Hospital. Monaghan Hospital is still open.

I am aware of the difficult financial constraints on the Minister. Nobody likes it when hospitals are closed but I should like to remind the Labour Party that they were part of a Government who over four years, spent £12 billion. There is not much evidence that any of that money was spent in my constituency. If we even had the interest that is being used to service that £12 billion, I am sure we would not be debating this motion here today. The publicity being generated by the Labour Party in Drogheda and the publicity they can command in the town is causing anxiety to patients and their relatives and it is affecting the morale of all the staff in all the hospitals in Drogheda. This is wrong, I have no doubt that it is being done for party political reasons only and I believe the vast majority of the people in Drogheda are aware of this also. I resent the leaflets that are being handed out by the trades councils which state that if St. Mary's Hospital is allowed to close, sick and elderly people will be sent home or moved to hospitals in Dundalk, Ardee or Navan——

Mr. Doyle

The Senator should look at the leaflets which were issued by his party before the last election.

Mr. Mulroy

——when I have an assurance that the level of geriatric services in Drogheda will be maintained and we will lose no geriatric beds.

I am aware that there is a need for a complete re-assessment of the medical services in this country. I am confident that the Minister for Health will not alone maintain the service in Drogheda but improve it. There is a need for a geriatric assessment unit in the town and I hope that the site of St. Mary's Hospital will be retained so that, when the economy improves, we will be in a position to build a geriatric hospital there in the long term. However, in the short term we have got to realise that phase one is being discussed and no decision has been taken to close St. Mary's Hospital. I hope when things improve this hospital will be maintained.

Minister of State at the Department of Health (Mr. Leyden)

The Labour motion and the Fine Gael amendment seek to give the impression that the changes which are taking place in the health services are unnecessary and are being implemented without insight on an unplanned basis. As I will explain to the House, this is a distortion of the true position. There is a clear and justifiable rationale underlying the major changes which have occurred.

Mr. Ferris

Can we get a copy of the Minister's speech?

Mr. Leyden

I am sorry but I only have speaking notes.

Mr. Ferris

I will need time to reply.

Mr. Leyden

If there are some transitional problems, they arise from the rate of change rather than from any lack of soundness in the objectives which are being pursued with both firmness and care. I want to start by putting the changes in the appropriate financial and policy context.

Arising from measures outlined by the Minister for Finance in his Budget Statement, total spending on the health services in 1988 will amount to just below £1.3 billion. This amount takes account of the continuing funding of the community drugs scheme, the transfer of the disabled drivers assistance scheme from the Revenue Commissioners to my Department and an increase of 3 per cent from next July in the rates of allowances to disabled drivers. The provision of almost £1.3 billion is only slightly less than the 1987 figures. Having regard to the financial effect of the savings made in 1987 and carried through the year I am satisfied that the amount will allow for the provision of an adequate service, particularly to those most in need.

From my assessment during 1987 of the unavoidable difficulties encountered by the health agencies because of late notification of their allocations I ensured that, in respect of 1988, agencies will know well in advance of their 1988 allocation. The Minister for Health, Deputy O'Hanlon was, therefore, glad to be able to notify agencies in October 1987 of their allocations which enabled health boards, voluntary hospitals and other bodies to plan their service delivery in good time. This also allowed agencies to plan in such a manner which would ensure that resources would be spread over the year and that agencies would adopt a strategy of service delivery consistent with their financial resources.

Therefore, I have to reject suggestions that agencies are necessarily engaged in crisis management in 1988. Those who took a positive approach to their task and exercised good management skills have been able to adjust to the priorities in services in line with their budgets. If, for whatever reason, some agencies failed to act in this manner, there may well have been difficulties but these were not primarily due to a shortage of resources. I would suggest that it is wrong to attribute to the whole system problems which occur only in parts of it and which are often the result of inability or unwillingness to manage change.

I wish to outline briefly some of the main elements of change now taking place in the health services in line with Government policy. I have to say that some of the areas which require change were clearly identified before this Government came into office; yet very little positive action was taken to implement these changes. I put it to the Senators from the two parties who formed the last Government that they had aspirations to rationalise the acute hospital system, develop primary health care services, develop health promotion and preventive services and improve the managerial arrangements at all levels of the system. The achievement of these objectives is what I am about, as is clear from the changes taking place in the service. In accordance with Fianna Fáil policies, I am also, conducting a review of health service funding arrangements. I am rather surprised that Senators should object to and seek to set aside the achievement of many of the objectives to which they and their parties subscribe. Perhaps they are disappointed that action has been substituted for words.

I think all of us would agree that we must continue to make available to the people of the country a health service that is effective, efficient and equitably distributed. We have developed a first class health service with very wide political and public support for these aspirations. In recent years we have had difficulty in maintaining the required level of public funding and it seems only prudent to take a good look at how we are using available resources and how well we will continue to fund services in the future. The point made by Senator O'Connell is quite correct. Irrespective of the funding available to the health services, there will continue to be a demand for the money that will be provided. I believe that the £1,300 million provided from the public purse is a considerable investment in the health services and one which, at the end of the day, the taxpayer has to pay for. That basically is the situation. If we had unlimited funds available to us, that would have to be taken into account, but that is not the case.

It is because of these considerations that I have appointed a commission on health funding who are currently examining in detail the question of funding the health services with a view to providing the best possible advice to me and the Government. The terms of reference of the commission are very broad and range well beyond any narrow consideration of funding mechanisms. I have specifically requested the commission to make recommendations not only on the extent and sources of the future funding required, but also on any changes in administration required to ensure an equitable, comprehensive and cost effective public health service. The linking of the funding in question with such considerations as equity, comprehension and efficiency was deliberate. The funding issue is not being considered in a vacuum.

While I will refer later in my response to other initiatives which are relevant, it appears that the Fine Gael amendment seeks to pre-empt the commission's report and recommendations. I was glad to hear Senator Bulbulia clarify her party's position on these matters and I accept that the commission's report should provide the basis for a full debate on many key issues of our future policy on health services. I expect to have the commission's report later in the year. In addition, I expect, as a result of the work being undertaken in my Department that, in advance of next year's allocation to health agencies, I will be in a position to introduce improvements in the existing resource allocation mechanisms. I believe it is particularly important to ensure that all agencies can be assured that they have been given a fair share of the available resources having regard to well known and easily understood criteria.

I am glad to have the opportunity this evening to outline the policy in relation to acute general hospitals which seems to have given rise to the motion put down by the Labour Party members. My objective at all times is to provide an efficient, effective and caring health service within the limits of the funds allocated for that purpose by Dáil Éireann. I have to say, however, that there can be no question of providing additional funds to reopen the hospitals listed in the motion. This is not only because of the difficult budgetary situation but also because it would not be in the best interests of an effective, integrated hospital service to reopen them. I am amazed at the list of hospitals outlined by the Labour Party which is totally unrealistic.

With regard to the seven district hospitals listed in the motion, I should first of all say that these hospitals were owned and managed by the health boards who have statutory responsibility for providing hospital services in their functional areas. In my view the health boards, as the bodies involved at local level, are in the best position to determine what the local needs are and I do not intend to interfere with their decisions to close these hospitals. I do not feel I have any reason to do so, for the action of the health boards is in line with the policy that the number of hospitals and hospital beds should be reduced to a level which we can afford.

I am sure this House is aware that the general hospitals consume over 50 per cent of all health spending. It is imperative that hospital costs be controlled if we are to make any progress in achieving the budgetary targets and yet ensure that adequate funds are available for the other necessary and desirable services. This has been the principle of health policy for well over 20 years. It remained merely a principle until the advent of this Government who have taken steps to convert it into reality.

The first step in this regard was the establishment last year of a review of the acute hospitals system so that the rationalisation and development of hospital services could proceed on a planned basis. The review established, yet again, that the number of beds in the system was well in excess of the number required by reference to the Department's planning guidelines and the level of provision elsewhere. Between them, the seven district hospitals listed had a total budget of £2.724 million and these funds can now be used to develop community care services in the areas concerned. Indeed, the district hospitals closed in many areas have already been replaced by community care services for the elderly.

I have encouraged and assisted this process through the provision of funds where necessary from the national lottery. We have provided £45,000 and £40,000 respectively from the national lottery to assist in the establishment, on a local community support basis, of nursing facilities in the buildings which previously accommodated Kilrush and Lismore district hospitals. In that regard I believe the Labour Party are not well informed in relation to the developments which are taking place. If they were aware of the situation, they would not have listed Kilrush District Hospital which has actually been reopened as a community base. I am sure the Cathaoirleach will confirm that.

An Cathaoirleach

The Cathaoirleach knows all about it.

Mr. Leyden

These beds will be able to provide a crisis intervention service for those elderly people who cannot continue to live in their own homes. Similarly, I have provided £40,000 towards the establishment of geriatric day care services in the Geriatric Hospital of the Assumption in Thurles, in St. Vincent's Hospital, Tipperary and in Bagenalstown. A notable aspect of these developments which I greatly admire is the involvement of the local community groups in the new community care services. These are models of community involvement and a credit to the local people concerned. It is an initiative which I hope to foster and develop.

There can be no question of providing funding for the reopening of those hospitals listed in the motion which are not district hospitals. The financial imperative has again merely acted as a catalyst to bring forward the implementation of agreed policy. In these cases the principle in question is that hospital services should be provided in a smaller number of larger centres. This principle was advocated over 20 years ago in 1968. It is not possible to provide hospital services of the highest medical standard in the existing multiplicity of small centres. Time does not allow me to go into greater detail with regard to each of the hospitals but I would like to highlight a few points.

The acute hospital review group found that there was a surplus of beds in the Mid-Western Health Board area and that hospital services were fragmented between the three hospitals in Limerick City. This did not make for economic or medical sense and it was clear that one of the voluntary hospitals had to close. The Department and the Minister decided that Barringtons Hospital should close and their budget of £1.6 million is now being used to greater effect in providing services in the remaining hospitals in Limerick — St. John's and Limerick Regional Hospital. In that whole episode I cannot help recalling the enthusiasm with which the Labour Party supported the privatisation of St. John's Hospital in an effort to reverse the decision on the closure of Barringtons Hospital. That was an unbelievable decision on the part of the Labour Party who, in theory and in public, are opposed to private medicine and yet in practice they were prepared to vote for private medicine in relation to St. John's Hospital in Limerick. In fact, under a Labour Minister, more private beds were opened in this country than under any other previous Government. This was certainly an indication of a policy reversal or U-turn on the part of the Labour Party in Dáil Éireann when this matter was debated last year.

The same rationale lies behind the closure of the North Infirmary in Cork, where there are four hospitals within a small area, and in Monkstown which serves an area of Dublin already admirably served by several hospitals, among them St. Vincents, Elm Park, one of the major hospitals in the country. Similarly, the acute beds in Drogheda Cottage Hospital cannot be regarded as indispensable, given the presence of the large nearby 360 bed hospital of Our Lady of Lourdes. It makes sense in terms of efficiency to combine long stay institutional services, currently provided by the Cottage Hospital and St. Marys' Hospital, in one site. The Cottage Hospital was chosen for attention because of the much higher physical standard of its buildings.

Beaumont Hospital has replaced the old St. Laurence's and Jervis Street hospitals with a facility which can provide an excellent service. I am not sure why St. Laurence's Hospital is listed in the motion. Do the Senators wish me to close Beaumont Hospital and transfer the services back to the old unsafe St. Laurence's Hospital? Seriously, it seems like a totally unrealistic motion. From what I have said it is clear that hospital closures have not been necessary merely for the reduction of public expenditure but also for the development and implementation of the integrated hospital policy. The Department and the Minister are fully committed to ensuring that this country receives, and continues to receive, an exellent hospital service.

The present financial constraints, necessary and generally accepted though they are, do not diminish the difficult management decisions which have to be taken in order to continue to provide a range and standard of services which are acceptable and affordable. It is the essence of good management that workable and balanced choices are made and carried out. These choices must represent a clear commitment to the maintenance of priority services across all programmes which protect, in particular, those who are dependent on the provision of care service and are unable to provide for themselves.

Senators will be aware that the reorganisation of health board structures is one of my priorities in improving and developing our health delivery system. I use the word "reorganisation" deliberately. The question of the abolition of the health boards is not on my agenda. I accept that changes need to be made in relation to the framework of health boards. The relationship between boards and their management, the role of the boards and the role of managers in achieving agreed objectives. There is also a clear need for a more positive and supportive approach to the development of managers and managements system. A similar agenda is appropriate in relation to major non-statutory bodies responsible for the delivery of services. The most effective approach to health board reorganisation is to identify the failings and shortfalls in the existing structures, to test different delivery systems to establish their values and general application and then to make the necessary adjustments in structures, management and responsibility.

Initiatives I have taken in all of these areas will be evaluated as soon as the pilot phase is complete. At that stage I will be in a position in the spirit of consultation with the relevant and professional and staff interests concerned to make the necessary structural changes. In addition my Department, in conjunction with health board management, are reviewing the co-operative and managerial functions of boards to identify the factors in the existing framework which hinder a more effective and efficient management of services. The existing health board management structure is divided between different care programmes — hospital, special hospital and community care.

There is general agreement that this is an artificial divide and, given the nature of health and social services and the interrelationship of all such services, a different structure, perhaps geographic rather than programme-based, would seem to be far more appropriate to meet present day demands. A geographic service manager would be clearly identifiable within the community, would be responsible for meeting local health needs and would be held accountable for the effective delivery of local services. I intend to further assess the strength and weaknesses of this approach. I am satisfied that the approach I have outlined will achieve the improvements necessary.

I wish also to refer to a pilot project in the North Western Health Board area which I have identified as suitable for testing and developing innovative options and approaches in relation to the organisation, management and delivery of health services. The pilot project will encompass a range of services, including community medicine, mental handicap and some social services. The basic objective of those involved in this project is to establish what changes are required in the existing organisation of services to ensure that they are appropriate and responsive to the needs of the population and that the working relationship of the personnel involved is fully productive. It is in all our interests to ensure that the delivery system is properly structured, responsive to change both now and in the future and can deliver a quality service.

Since taking office the Minister for Health, Deputy O'Hanlon, has expressed the need on several occasions to develop a strategic plan for the future development of health services. We must produce a plan which concentrates on the achievement of progress in a small number of critical areas and which ensures that these priorities will be fully reflected in the resource allocation process. Considerable preparatory work on the development of such plans has already taken place. The major conference of my Department's discussion document Health—the Wider Dimensions was very successful and focused attention on the future direction of health policy and the factors which should determine how best to proceed. The removal of identified health inequalities in line with the Government's stated object of protecting the vulnerable and less well off in our community will be a major factor underlying my approach to health policy and resource allocation. It is my intention to have a developmental plan prepared as soon as the findings of the commission on health funding are available.

I have outlined the rationale which underpins the changes which are taking place in the health services. A planned approach is being taken to the implementation of the many changes which are necessary. I ask the House to support the Government in the policy which they are pursuing to ensure that an effective and efficient health service is available to all who need it. In this context I must say that the work undertaken by the Minister for Health, Deputy O'Hanlon over the past 12 months is attributed to his capacity to handle the particular brief.

Mr. Ferris

I welcome the opportunity to conclude but I must express my regret that I did not have a copy of the Minister's speech. I realise that he was restricted in time and had to literally gallop through it. I believe there was bad news in that script for Senator Mulroy. The Minister of State confirmed what the Minister for Health had said about St. Mary's Hospital. I am sorry about that because I believe St. Mary's Hospital played a useful role in Drogheda. I note from the final minute of that meeting — and I am alerting Senator Mulroy to this — that a meeting to finalise all these arrangements will be held in the Drogheda Cottage Hospital at 5 p.m. on 12 May. The Senator should sit up and take notice because the Minister is agreed that this hospital should be closed. This was stated at a meeting chaired by the Minister and has been confirmed by the Minister of State in his speech.

Mr. Mulroy

On a point of information, that meeting is being held to discuss phase one of the operation, the proposal to transfer patients from Fatima Hospital.

Mr. Ferris

It is regrettable that I have to put on the record the position within the Department in relation to this hospital. The only reason I dealt with this is that today I was called a liar, a statement which was withdrawn afterwards.

People including the Assistant Whip of the Government Party questioned the validity of this motion because there were inaccuracies in it. Thankfully this debate on the motion was allowed to take place because this is where you can decide whether or not something is valid. A meeting of the Star Chamber group in Drogheda to put the pressure on not to allow this motion to be taken can create political problems. That is what happens when decisions like this are made by a Government who have no plans. I have no objection whatsoever to the Fine Gael amendment but it was put down two years too late.

Mrs. Bulbulia

There are cuts of £400 million more pending.

Mr. Ferris

I know and appreciate that. There is nothing wrong with the amendment but it should have been put down before all these hospitals were closed. This is a very relevant point and Senator O'Connell referred to it. During Deputy Desmond's period in office it was said that hospitals were being closed and if said often enough people will believe it. The Deputy did not close any hospitals which were not recommended for closure by health boards. The only hospitals recommended for closure by the health boards were the ones that were being replaced by better hospitals. The Deputy highlighted the Monkstown Hospital and admitted that that hospital was being kept open by somebody who had a vested interest in it. I mentioned earlier that there may be medical vested interests who want to keep hospitals open but that is for another debate.

The Minister said — and it is difficult to quote from a speech delivered like that — that there were unavoidable difficulties in this Health Estimate and in the allocations of funding. He said also that money creates demand. That immediately raises the question: who is creating the demand for these health services? It is not the people. People do not want to go into hospital unless they are sent there or told by medics that they need to go there. I am defending their right to get a bed when they are told they should have one. If the Government feel that medical people are over-prescribing they should deal with those people directly and not deal with them indirectly through the poor who are not able to make these judgments for themselves. This is what we are faced with.

I accept that Senator Farrell was being absolutely legitimate when he said there is no crisis in his health board area, but he confirmed there was no closure in the health board area. That is why there is no crisis. There is an availability of beds. That is how it should be done. The Senator incorrectly stated that, over the period in which Deputy Desmond was Minister for Health, the health boards were short of money every year. I wish to put this in context because I want to be absolutely specific about what I am talking about. I was a member of a health board for ten years and each year we determined at health board level what we needed and we sent the estimates to the Department. The Department allocated what they thought was the correct amount. The difference between what they gave you and what you had looked for was the cutback.

More money was always allocated than in the previous year. This is the first year, following on last year's cuts, that less money has been given to the health services than in the previous year, irrespective of what was asked for. It was irrelevant what you asked for. The Department allocated the amount in plenty of time but health boards were told that was all they were getting. This is a real cutback because it is less than what the health boards got the year before. That is what we are talking about here. It is a great thing to have a community service in a hospital and the Minister has complimented the community.

Sub-acute district hospitals have been closed down without a replacement service being provided in the community. A community hospital has not been opened in place of St. Vincent's District Hospital in Tipperary. We have asked for it. We do not even have a community structure agreeable and willing to do it. Are we talking about day care centres, meals on wheels? I am talking about sub-acute hospital services which are an economic service. The Minister of State, the Minister and the Government have replaced cost-effective sub-acute hospitals with specialised acute beds, costing the taxpayers four times as much money as they would have cost in a district hospital. Do not tell me what you want to do with community services. What have we in Lismore? The Minister said we have not researched the matter. We know what is in Lismore. The Minister should ask the Fianna Fáil people in Lismore what is there. Some people resigned from the party because of what happened there.

An Cathaoirleach

The Senator has one minute to conclude.

Mr. Ferris

I could go on forever but I want to be absolutely fair to the Members who considered this motion was worth amending. I accept that the amendment would have been valid at the time of the health board estimates or at the time of the Health Estimate in the Dáil, when we knew and Fine Gael knew that there was not enough money to run the health services. They had to be rationalised. We saved £15 million over ten years, but we did not lose a bed. We did not lose any jobs and we did not lose a patient.

Mr. McKenna

You did lose beds.

Mr. Ferris

We did not lose any of those things and we saved money. The trouble with people like the Senator is that people like Deputy Desmond can do it without losing beds or jobs while they do not know how to do it. Now we have lost beds, we have lost jobs and the unfortunate thing is that the Government have lost credibility.

Amendment put.

The Seanad divided: Tá, 11; Níl, 32.

Tá

• Bulbulia, Katharine.
• Connor, John.
• Cregan, Denis.
• Daly, Jack.
• Doyle, Joe.
• Fennell, Nuala.
• Hogan, Philip.
• Loughrey, Joachim.
• McMahon, Larry.
• Manning, Maurice.
• Robb, John D. A.

Níl

• Bohan, Edward Joseph.
• Byrne, Sean.
• Cassidy, Donie.
• Cullimore, Seamus.
• Doherty, Michael.
• Eogan, George.
• Fallon, Sean.
• Farrell, Willie.
• Ferris, Michael.
• McGowan, Patrick.
• McKenna, Tony.
• Mullooly, Brian.
• Mulroy, Jimmy.
• O'Callaghan, Vivian.
• O'Connell, John.
• Fitzgerald, Tom.
• Fitzsimons, Jack.
• Hanafin, Des.
• Harte, John.
• Haughey, Seán F.
• Hillery, Brian.
• Hussey, Thomas.
• Kiely, Dan.
• Kiely, Rory.
• McEllistrim, Tom.
• Ó Conchubhair, Nioclás.
• O'Shea, Brian.
• O'Toole, Joe.
• O'Toole, Martin J.
• Ross, Shane P. N.
• Ryan, William.
• Wallace, Mary.

Tellers: Tá, Senators J. Daly and Fennell; Níl, Senators Ferris and O'Shea.

Amendment declared lost.

Question put: "That the motion be agreed to."

Senators

Votáil.

An Cathaoirleach

The question is: "That the motion be agreed to." On that question a division has been challenged. Will those Senators calling for a division please rise in their places?

Senators Ferris, Harte, O'Shea, Ross and O'Toole stood.

An Cathaoirleach

The division will now proceed.

The Seanad divided: Tá, 4; Níl, 28.

Tá

• Ferris, Michael.
• Harte, John
• O'Shea, Brian.
• O'Toole, Joe.

Níl

• Byrne, Sean.
• Cassidy, Donie.
• Cullimore, Seamus.
• Doherty, Michael.
• Eogan, George.
• Fallon, Sean.
• Farrell, Willie.
• Fitzgerald, Tom.
• Fitzsimons, Jack.
• Hanafin, Des.
• Haughey, Seán F.
• Hillery, Brian.
• Hussey, Thomas.
• Kiely, Dan.
• Kiely, Rory.
• McEllistrim, Tom.
• McGowan, Patrick.
• McKenna, Tony.
• Mullooly, Brian.
• Mulroy, Jimmy.
• O'Callaghan, Vivian.
• O'Connell, John.
• Ó' Conchubhair, Nioclás.
• O'Toole, Martin J.
• Robb, John D. A.
• Ross, Shane P. N.
• Ryan, William.
• Wallace, Mary.

Tellers: Tá, Senators Harte and O'Shea; Níl, Senators W. Ryan and S. Haughey.

Question declared lost.

An Cathaoirleach

When is it proposed to sit again?

Mr. Fallon

At 10.30 a.m. tomorrow.