Before I continue, I would like to welcome the Czechoslovak delegation. I, on behalf of many, many people, would like them to remember that we are not happy with the denial of human rights in Czechoslovakia and we would like them to do something about it.
Health Services: Motion (Resumed).
Debate resumed on the following motion:
That Seanad Éireann, bearing in mind that this Government since coming into office has reduced health spending from 7 per cent to 6 per cent of G.N.P., calls upon the Government as a matter of the gravest urgency to provide an extra £70 million immediately, as an emergency injection into the health services, to remedy situations such as the following:—
(a) enormous waiting lists for hospital admissions,
(b) the totally inadequate level of community care services,
(c) the derisory level of services for the handicapped,
(d) the intolerable delays being encountered by out-patients even when they have hospital appointments.
(e) the low morale and stress that staff in the health areas are increasingly subject to,
(f) the decimation of the psychiatric services and the consequent social problems,
(g) the accelerating movement towards a two tiered health service where the ability to pay rather than need dictates who receives the service.
—(Senator O'Shea.)
We will get back to the motion.
Yes. Britain spends 6.5 per cent on the health services and we spend 6 per cent. Britain is a far wealthier country than Ireland, but they do not spend very much more on their health services. What I see wrong is not that we do not spend enough money on the health services but that we do not use it wisely.
There has been a tremendous waste and inefficiency in the health services, and having worked in the health and hospital services for many years I saw tremendous waste. The X-ray departments closed at 5 p.m. each day. People would be taken into hospital on a Friday and tests would not commence until Monday or Tuesday. That is inefficiency. In the United States, we would admit a patient at 5 p.m. and all the tests would be done and the patient discharged the next day at 10.30 a.m. Inefficiency is the biggest problem in our health services. That is the first thing we have got to look at. We must streamline our health services. Many hospitals which have been closed recently should have been closed many years ago. They were inefficient, they were not doing the job and in my view should have been closed long ago.
The next problem I would like the House to consider is that in recent years we have had some major technological breakthroughs and advances in medicine which we never contemplated, and these are very costly operations. The public have not come to terms with these costs. It is a new burden on the health services that we have got to look at. We must consider this. Hip operations, heart and kidney transplants, coronary by-pass surgery cost many thousands of pounds and we were not geared for that. We are a small country and we do not have the finances for this, considering that we had to borrow £800 million this year to pay for our services and we are paying £2 billion a year in interest alone on the national debt. That is a lot of money for a small country to have to pay. I am not saying who caused it: we have this debt on our hands and we have got to pay it. The public must have a debate on this, on the costs, who is going to pay it, and what our priorities are, because I believe many of these breakthroughs are eroding the other services which are urgently needed — the geriatric and psychiatric services. I believe the maldistribution of the funds across the spectrum of health care is causing the problem. I would like to see this area improved. More money will not necessarily mean better health. I can understand the demands that are being made and there are a lot of pressures from different areas, such as hospitals, telling Senators what is happening and asking us to get things done. I honestly believe inefficiency is the root cause of our problem.
We are told there are very long waiting lists. I had occasion to study some of these waiting lists recently. A woman told me she had to have fusion of the spine. That is a major operation and is not without great risk to the patient. When I talked to her about her condition I advised her to please get off the waiting list because it would be very dangerous to have this operation. I told her it was a hazardous operation and should not be done except in serious cases. This woman's symptoms did not warrant it. We need to have a monthly review of these waiting lists to see what is wrong. Another woman had a hammer toe and she felt it needed treatment urgently. When I investigated I found it did not necessarily need an operation and a little chiropractic treatment or perhaps some other work would have been better.
People complain that they are discharged from hospital early and others say they were discharged after two days. I say it is in their interests to get them home after two days. Lying in bed is very dangerous for patients. Sending patients home at weekends is a very good idea. That is not a callous approach. It is a very humane approach. I do not think hospital beds are the answer. If I had my way I would want to see the prescribed relatives allowance being doubled or trebled so that elderly people could be kept at home. It is wrong to send them to homes and geriatric places. We must adopt a more humane attitude towards them.
When I worked in out-patients and accident departments, I found many of these cases should not have been there. There is also a disorderly arrangement about appointments and so on. I came back from America to work in the Mater Hospital as a registrar. The out-patients department would start at 9 a.m. and it would not be finished until 3 p.m. I got it finished at 11 a.m. with a little efficiency. That is what we need. I am trying to highlight efficiency as the real solution to our problem. Two Labour Ministers Brendan Corish and Deputy Barry Desmond — emphasised this over and over again. The bible of the Labour Party at the time was Cooper's "Rationing of Health Care." Brendan Corish said the answer was a proper efficient approach to the health services. I did not complain when Deputy Barry Desmond as Minister for Health, cut back. I said it was the right approach. I believe if we should have a more efficient health service, but the one we have at the moment, I agree that there are problems but it all depends on the way it is handled.
The Senator has one minute left.
I am not finished. I have another three minutes. There was an interruption.
Acting Chairman
The Senator has not three minutes. He has one minute.
I was interrupted. The interruption of thought takes longer than the one minute. The Chair has got to appreciate that. When I was interrupted in my line of thinking, it took me a little while to get back on the track again and because of that I thought I should get more than one minute.
Acting Chairman
I appreciate that.
We have got to consider what is using up the total funds of the health services, and give priority to the areas to which Senator O'Shea referred. I agree with him that there are problems because of this, but the answer is not necessarily to throw £70 million at the health services and expect it to solve the problem. The problem is to make sure that those areas which are in need of attention get the finance.
Having listened to the two speakers before me I think the remedy to our problems lies somewhere between the two. I do not necessarily think that it is a case of throwing more money into the health services, nor do I agree with the rationalisation that Senator O'Connell has engaged in. I believe it is a question, perhaps of inefficiency, but at the end of the day it is a question of management, and the management of the health services is the responsibility of the Minister and the Department.
This debate is taking place against the background of confusion, criticism and of disaffection about the health services as delivered to thousands of consumers here. Our voices will join those of others here in the Oireachtas, in the local authorities, in the health boards and in the community, all saying the same thing. There is something desperately wrong with our health care, it is on the verge of crisis and it is the very vulnerable people, the old and the handicapped, who are its victims. I have no doubt that the Minister for Health, Deputy O'Hanlon, and his Minister of State, who is here with us, and Department officials mean well and have the best of intentions in the job they are doing, but this is not enough. Good intent will not sort out the present dilemma. Accepting that there is an all-time crisis and setting out to take practical measures to rectify matters will work.
We are talking about a Department with one of the biggest, if not the biggest, budget of all in the region of £1.3 billion. It is an awesome amount of money for health care and does not even include the £120 million that 34 per cent of the population pay for VHI for separate cover. We spend £22.50per capita whereas Britain spends £23 per head of the population. The difference is that for 50p more the British health consumer gets much more than his Irish counterpart. They get free GP care, free hospital care, free consultant care and free drugs. That is for everyone in the UK, 100 per cent of the population. Here, we give only 40 per cent of the population, those on medical cards, something remotely like the British give.
It means that, indeed, if somebody like Margaret Thatcher, Neil Kinnock or anyone else in a high earning capacity wanted to avail of public health services, they could do so. Of course, people like this who are at the top end of the income bracket prefer not to take up their national health entitlements, they have private insurance, but that is their option. The big question that should be addressed is, why is there such a lack of proportion, why is the Irish taxpayer getting such bad value and how soon can the system be reformed to make it responsive and satisfactory?
It would take much longer time than I have here tonight to adequately address the problems being experienced at present. To be done accurately and geographically it would take a day and sound like a journey of distress and hardship around the country. Hospitals all over the country are hardpressed, under-funded and understaffed. We saw the almost total breakdown of one system with the disgraceful events in the Southern Health Board region last month and the distress caused to the employees in Tralee General Hospital. We witnessed the unseemly public row between the Minister and a Southern Health Board official.
We can add a situation of one scapegoat after another being offered up on the alter of inefficiency, poor planning and bad communications, but at the end of the day the responsibility for the delivery of health care comes back to the Minister. If the health boards are not fulfilling their obligations or by their structure are unable to fulfil their obligations as well now in the eighties and going into the nineties as they did when they were first set up let us admit it and propose a change. Let us look at, maybe, the proposal from Fine Gael for a new structure, An Bord Slán. Perhaps that is the direction in which we need to go.
In reading the Minister's speeches in the Dáil and here and his answers to parliamentary questions, I was struck by the sort of new speak he indulges in. It is a substitute vocabulary, we see words like "rationalisation" when what is meant is "cutback" or "reduce", "restructured" or "reorganised" which really means "the service is gone" or as close to as makes no matter. It is an unhelpful way to deal with issues as is the current trend in the Department of Health of setting up committees, commissions and working parties. On one count recently, it was discovered that something like 50 working parties of one kind or another are operating. These are all delaying tactics, delaying action and delaying decisions on action, as I well know.
To deal with a few specifics, one group most severely pressed — there can be no dispute about this from anybody — are old age pensioners. Although there is an excellent report on the Minister's desk, The Years Ahead: A Policy for the Elderly, there are, as far as I am concerned, no plans being put forward to implement any of its excellent proposals, the most pressing being the need for geriatric hospital care and community support services. A phased programme of action over five years is badly needed and no group are more deserving. The last speaker dealt with the joy of going home. I agree it can be a joy to go home at the weekend from hospital if you are going home to a well supported home and you have enough money to be able to look after yourself. Of course, it is an ideal thing that our old people should spend their last years in their own homes or with their relatives, but this is an ideal, it is not the reality. The reality is that many old people need some domiciliary care or residential home. These are very scarce and very expensive, so you have a situation where thousands of old people are making second best arrangements. That is not good enough.
I am sure others will have mentioned the lack of facilities for bone marrow transplants. Again, this is something that comes up. It is a reality, not a myth. There are serious hold-ups here in making this procedure available in St. James's Hospital. It is a remarkable treatment and a life saver for many, particularly children, with chronic blood disease. When can we hope to cope with all the cases needing treatment here at home?
On 15 March, when the Minister for Health was asked about the number of people awaiting hip replacements — this is something the last speaker dealt with — he gave the figure of 2,000 in a reply to a parliamentary question in the Dáil. You cannot rationalise away that figure. If one needs a hip replacement, one needs it badly. It is not something that cures itself or that can be left for one year, two years or three years. Among the waiting numbers are old people with arthritis, possibly in pain, as well as some people I know very closely who are young haemophiliacs, in early middle age, who are handicapped and have restricted mobility because of damage to joints through bleeding. I believe there should be a special programme to reduce that number of 2,000.
An area I have spoken about previously is that of health education. Unfortunately, the health promotion unit continues to decline. It plays a very poor role in preventative medicine or in promoting positive health and is limited by getting only 1.7 per cent of the Health Estimate. Because of low morale and no true commitment to the work it needs to do, staff are leaving, people with experience and commitment to health education. This is very serious in view of the fact that there is unanimous agreement that there are long-term gains and benefits to proper health promotion and health education.
I mention one group particularly who were involved in the health promotion unit, the Irish National Council on Alcoholism. They did excellent work but they got into financial difficulties. Their grant was either reduced or terminated. They could no longer continue and so were subsumed into the Department. With the serious problems we have in this country of alcohol abuse and the extent to which it affects family life, health and employment, there is a need for a meaningful body on alcohol prevention such as the Irish National Council on Alcoholism. Because of a lack of commitment there and official inaction, since then this organisation has died. This is very regrettable. Now there is no planning, no public education, no monitoring group specifically committed to public education on alcoholism. This is another sign of the way priorities are decided in the health services. Regardless of long term gain there is no thought given to the needless ending of an organisation like this.
There are many examples of what is happening but of which people generally may not be aware. People like us hear of the chronic cases, those who are under great stress, people who phone you up or write to you. There are a lot of areas we do not see. Again, I come back to the mismanagement of the total budget and the lack of action where there are bad procedures or bad practices in health boards throughout the country. It is a very fundamental problem. I do not necessarily believe it needs the kind of funds that are being proposed in this motion. For that reason we will be abstaining on this issue.
The motion before the House tonight seems to come from a different world, as if the last few years never happened. In fact, it seems, with respect to Senator Ferris, to be more related to a forthcoming election with the list of institutions in the Munster area particularly, than to the reality of the situation. It also seems to ignore the factual situation where there was an overspending of £50 million by the former Labour Minister, Deputy Barry Desmond, who was then Minister for Health. Is this funding in addition to the £50 million that was overspent at the time? It seems that the Labour philosophy seems to be to throw money at a problem, not to work out the situation.
The motion ignores the lesson that we cannot resolve the problems of the health services by throwing more money at them, particularly when that money is untargeted and non-specific in purpose nor is it clear as to how it is quantified and calculated. The motion also ignores the lessons of the last two years, when the Government pulled the country back from the brink of financial disaster and, in the process, set out on the transformation of the health services into the new, streamlined and efficient system that is now emerging.
The general thrust of this Government's policy on the public finances enjoys overwhelming support throughout the country. The benefits of this policy are beginning to be seen in the economy and there is a new air of national confidence. We have, however, made it clear that there is still a long way to go. We will still be borrowing over £800 million this year to meet day to day spending. We will still be paying over £2 billion to meet the cost of servicing our accumulated national debt.
I should like to remind the House that from 1982 until 1987 our national debt rose by £12 billion under a Coalition Government which included the Labour Party. The same amount was borrowed from the foundation of the State to 1982 as was borrowed from 1982 until 1987. Despite this, the Government have increased this year's provision for health, as a percentage of net non-capital supply services, to 19.7 per cent, as compared with last year's provision of 18.8 per cent.
Against this background how can we talk about injecting an extra £70 million into the health services? Where would the money come from? What, precisely, would it set out to achieve? What would be the consequences for the hard won turnaround in the public finances? Would it entail increasing our tax, our PAYE contributions or other forms of taxation? No mention is made in the motion as to where this money will come from.
I want to make it absolutely clear that I accept without question that there are areas in which the health services need improvement. The demands on the health services are increasing all the time. New technology is constantly becoming available, often at very high cost. Indeed, I must say that I appreciate the contribution made by Senator John O'Connell, a man who has the practical experience of the health services. In fact, his constituency clinic is a real clinic, according to the information given to this House. His experience in the service is very much appreciated here in this debate.
At any time one can point to gaps in the service. This is true of any country, no matter how affluent. It is widely recognised that if one set out to meet every demand in the health services, no conceivable budget would ever be enough. The challenge, therefore, is to ensure that the service is constantly being streamlined and adapted to meet ever-changing needs as efficiently as possible. Priorities must be set and must constantly be updated as technology changes, as society changes and as our demands on the health services change. This means that new developments and new servcies are constantly needed. However, it also means that other facilities and services become outdated and have to give way to the new priorities.
The problem we faced on coming to office was that this nettle had not been grasped. Much had been promised about streamlining the health services and increasing their efficiency, but very little had been delivered. The Government, on the other hand, did not shirk from the challenge and the necessary streamlining has been taking place.
We have excellent health services and we should be proud of them. The facilities available and the skills and commitment of our health care personnel are unparalleled in any country at our level of economic development and wealth. That is not to say that there are no problems in the delivery of services, no unnecessary delays, no shortfalls in the provision of important services of certain types. Of course there are. They were there before we came into office and they cannot be removed overnight. Throwing money at the health services willy-nilly is not the answer. Not only is it a short-term measure but it worsens the long-term position by reinforcing the very inefficiencies we need to remove.
The only way that services can be developed and improved to meet the acknowledged gaps and shortfalls is to identify and remove inefficiencies, outdated facilities and services which no longer merit the priority once attached to them. The health services must constantly change and be renewed, but it is only since this Government came into office that this basic truth has been recognised, accepted and implemented.
In the last two years we have closed facilities that were surplus to requirements. We have also seen many new developments in both institutional and community based care. We have greatly increased the productivity of the services, thanks in particular to the efforts of our medical and nursing staff. Indeed, I would like to pay tribute to the dedication and commitment of those working in the health services. Their performance over the last two years is evidence of anything but the low morale suggested in the motion.
It is worth while looking in detail at the progress we have made in relation to specific services in order to give the lie to the charge made in the text of tonight's motion. Our rationalisation of the acute hospital system must be put in perspective. From the mid-sixties on there has been a very large measure of consensus among all political parties that this country should endeavour to maintain its position as one of the countries with an advanced modern health system. In the hospital field that entailed a commitment to consultant medicine, with increasing specialisation and a very high level of diagnostic capacity.
It was quite clear as early as the mid-sixties that the increased capacity for better patient care, brought about by the new technology, and the cost of supporting such technology meant, by definition, a reduction in the number of centres at which a first class acute diagnostic and treatment service could be maintained.
In the intervening period a major building programme got under way. New technology came on stream rapidly, medical practices changed so that fewer beds but more support facilities were required. Expectations of successful diagnosis and treatment increased as new techniques and procedures became available. All of these developments have been reflected in the closure of hospitals which are to be replaced and are, therefore, surplus to requirement; the reduction in the number of beds; and the increasing reliance on the quicker throughput of patients through the development of short stay facilities.
The commitment to maintaining a very high level of diagnostic capacity is reflected in, for example, the fact that there are now 12 "cat scanners" in the country and eight of these are in our public hospital service. Radiological equipment today is extremely sophisticated. For example, the suite brought into operation recently at St. James's Hospital is among the best in the world. Priority will continue to be given to the replacement of high technology equipment in hospitals.
Despite the restrictions on staffing and finance, we have maintained the number of consultants in the hospital system. That should be said loud and clear because that is the factual position. We have maintained the number of consultants in our hospital system but this is ignored in the motion and by its movers.
We now have a clear picture of what we want to achieve in the organisation of acute services. The changes which have been made will result in a much more efficient health service which will be more responsive to the needs of our community over the coming years.
There has been steady progress in equipping and opening new units. This year alone, new facilities have come on stream at St. James's, the Mater, Cavan, Mullingar and Castlebar. Each of these represents a significant improvement in the range and quality of services available to patients. Each unit is part of a plan which will be the basis for further development right through the next decade. A good start has been made in a number of hospitals, and new facilities will continue to come on stream in the coming years, including Ardkeen, Sligo and Wexford and, of course, the new hospital which is being planned for Tallaght.
The motion refers to waiting lists for hospital admissions. Waiting lists did not come into being with the arrival of this Government in office. They have always existed here and elsewhere. However, waiting list numbers are a very unreliable measure of the availability of hospital services. Patients may be on more than one doctor's waiting list for the same treatment. In some cases, patients are added to waiting lists when doctors expect that they will require treatment in the future but do not, at that point, need admission to hospital. Also, crude waiting list statistics do not distinguish between patients presenting for first time treatment and those receiving continuing care. The cruicial point to be understood in relation to waiting lists is that they must always be put in the context of the actual throughput of hospitals. For example, there has been much uninformed comment in the media and elsewhere recently concerning the fact that there were over 22,000 patients awaiting admission to hospital in 1988. However, that figure is set in proper context when one considers that over 500,000 patients are admitted every year to our acute public hospitals out of a population of 3,500,000 people. Similarly, the number on the orthopaedic in-patient waiting list on 30 June 1988, was 5,170 — but a total of 31,542 orthopaedic patients were admitted in 1987.
This point is even more strikingly made when one looks at figures for outpatient departments. In December 1987 there were around 67,000 awaiting outpatient treatment, while over 1.5 million such patients were treated that year. Again, the orthopaedic outpatient waiting list numbered 9,205 patients, while over 188,000 such patients were treated. These figures show the real achievements of the health service in meeting the demands placed upon it. It has responded very quickly indeed to a rapid expansion in demand for certain elective procedures such as hip replacements, cataract operations and ENT surgery.
We inherited a massive waiting list when we came into office in 1987. It is our ambition to work to achieve a situation where people can get service on demand. It has not been achieved anywhere in the world but it is something to which we would aspire. It has to be done in relation to the cost of the health services and our ability to pay.
While some problems do exist in specific areas, we are addressing these situations with a view to having them resolved as soon as possible. The Minister for Health is keeping waiting lists constantly monitored to ensure that no intractable situations develop.
The motion also refers to outpatient delays in our public hospitals. It is not widely realised just how significant the workload of our outpatient departments actually is. During 1988 there were 1.5 million attendances at outpatient departments in general hospitals in this country. This is an indication of the excellence of the health service which responds effectively to the needs of the community. Some delays at outpatient departments are inevitable when such huge numbers call on the service.
One must understand that patients must always get adequate consultation time even if it means that those waiting their turn must suffer a delay. Diagnostic tests may have to be performed. There may have to be close monitoring of a patient's condition. In fact, hospitals are to be complimented for handling such large numbers with as little inconvenience to the patient as is humanly possible.
I would now like to turn to our community care services. The Government are committed to reorientating the focus of health care towards primary care in the community. Even in the difficult financial climate of the last few years, there has been a steady and orderly shift to the provision of services in the community rather than in institutions. This can be clearly seen across the range of services — psychiatric services, childcare, and services for the mentally and physically handicapped.
A central element of primary health care is an emphasis on the promotion of good health, and the prevention of illness and handicap. A significant amount of work has been carried out in establishing appropriate structures for health promotion at all levels. The major issues are being tackled to ensure that our society is well informed and aware of the measures that each of us, as individuals, can take to combat ill health.
A range of measures to tackle the new problem of AIDS in the community has been put in place and is being constantly monitored and refined.
The measles, mumps and rubella immunisation programme introduced last year is another example of the ongoing development of measures to tackle illness before it arises rather than afterwards.
The general practitioner must, of course, play the pivotal role in primary health care. The successful negotiation of the new contract for the General Medical Service has been one of the major achievements of my colleague, Deputy Rory O'Hanlon. I wish to take this opportunity to offer him my congratulations and to the Secretary of the Department, Mr. Flanagan, and all the staff involved, I am sure the Labour Members of this House will join with me in congratulating the Government, the Minister and the Department in concluding those very sensitive negotiations. This contract establishes a sound basis for the development of general practice to meet the health needs of the population.
I fully accept that it would be highly desirable to be in a position to apply increased resources, particularly to the further development of a primary health care system, but, as I said at the outset, we must operate within the realities of our current financial constraints. There are priority areas in community care which need strengthening — particularly oral health, ophthalmic services and community nursing. These services can, and will, be strengthened as part of our overall strategy of redirecting the available resources to the areas of greatest priority. The motion refers to the level of services for the handicapped as "derisory", I cannot accept that. The Government are committed to protecting services for the disadvantaged sectors, including the handicapped. There has been a clear direction to health agencies that measures which are taken to live within their budgets must not be such as to cause hardship to these sectors. My Department spend some £120 million on the care of people with a mental handicap. This excludes further expenditure by the Department of Education on special schools and classes. In my Department's allocation of funds, services for the mentally handicapped have received priority status since this Government took office. It is our intention that they will continue to be protected. In every health board area, developments have been taking place steadily, particularly in regard to providing community based services for people who have, until now, been placed inappropriately in large residential centres.
These developments are being achieved through redeployment, rationalisation and the investment of capital funding from the State. For example, the Eastern Health Board has detailed plans for the provision of 200 community based residential places this year to be provided by the board itself and by the voluntary agencies involved in the provision of care in its area. In fact, every health board, with the co-operation of voluntary agencies, is at present identifying the future need for all services for the mentally handicapped in their regions, so as to ensure that available resources are used to the best advantage.
The Government have also supplemented the Exchequer funding by making £1.3 million available from the proceeds of the national lottery to enable some important new developments for the mentally handicapped to take place. The services for other categories of the handicapped are similarly under continuing review. Indeed, I believe that contributors to the national lottery are pleased with the expenditure of funds in the health area. They have been extremely well directed to people in need.
Despite the financial constraints, over £5 million has been provided to enable the two deaf schools in Cabra to open new residential facilities.
The Multiple Sclerosis Care Foundation has been given £250,000 to open a new short-term residential centre. The launching of these new services attracts further funds from the State for their running costs. For example, an additional £60,000 is being paid through the Eastern Health Board towards the running cost of the Multiple Sclerosis Centre. A further allocation totalling £85,000 was paid from the national lottery to assist with the launch of this centre. Special grants of £225,000 and £150,000, respectively, were also made from the national lottery to the Irish Wheelchair Association and the National Association for Cerebral Palsy to enable them to enhance their services.
The motion refers to the "decimation" of the psychiatric services. The psychiatric services are not being decimated. On the contrary, the Government are implementing the policy outlined in the report Planning for the Future which was published over four years ago and was accepted by the Government at that time and the then Minister, Deputy Desmond.
This report provides a planning framework for the development of a comprehensive community oriented psychiatric service. I might point out that it was first adopted as public policy by the previous Minister for Health and the Coalition Government.
The main recommendations of Planning for the Future were that a service should be established which would be capable of dealing with all the psychiatric problems of the community in a caring and professional manner and, secondly, that every effort should be made to rehabilitate to a normal community environment, persons who are long-term residents in psychiatric hospitals. We, on coming to office, adopted this policy and we should be complimented by the Opposition for the continuity of this policy decision. This policy involves a major change from a centralised, hospital service to a community-based one. The overall aim is to provide a better service. The motion which we are now discussing seems to imply that the policy being pursued in relation to the management of our psychiatric services has more to do with cutbacks than with service development.
I would strongly refute this, and I would suggest that Senators might reflect on what has been happening in the practice of psychiatry over the past 30 years. I pointed earlier to the considerable advances which have been made in medicine. The same is true of the practice of psychiatry. This has resulted in a reduced need for hospitalisation for the treatment of psychiatric disorders. We should all be delighted with the progress in this particular area.
We can see this development reflected in the reduction in the number of in-patients in our psychiatric hospitals from a peak of 20,000 patients in 1958 to some 9,000 patients at the end of 1988. For far too long, patients were being put into institutions when they should have been in the community. We are now ensuring that this happens. In recent years, and particularly since the publication of Planning for the Future, there has been a considerable expansion of community based facilities such as day hospitals, day centres, hostels and community residences. For example, at the end of 1988 there were 47 day centres and 32 day hospitals catering for some 7,500 attenders. There were also 272 hostels and community residences, with some 1,800 places. I would recommend Senators to visit those patients in their new hostels and homes and they will see people who have been brought back to a new life within the community.
These are examples of the alternative facilities being put in place so that patients no longer have to rely on outdated institutional facilities for treatment. We are all aware of the stigma attached to the psychiatric service which has not been helped by the concentration in the past on the institutional approach to the delivery of care.
The main beneficiary of the developments which I have outlined has been the patient who can, in many instances, receive appropriate treatment, close to where he or she lives, and with the minimum of disruption to normal life.
The Government are determined to pursue the policy outlined in Planning for the Future which has been widely accepted by all those associated with the psychiatric services as a realistic approach to the provision of a caring and professional service for people with psychiatric problems.
It should be clear from the examples which I have given that all areas of the health services are at present experiencing development and change. If one wishes to be negative, it is easy to point to shortfalls and gaps in services. As needs and priorities constantly change, there will always be new gaps to be filled, new services to be developed.
The Government, unlike their predecessor, are rationalising the health services so that the resources will be available to meet these needs and priorities. The result will be an efficient and equitable health service which enables our skilled and dedicated professionals to provide services of the highest quality in the most cost effective setting. I do not accept the suggestion that we are moving towards a two-tiered system of health care. We have always had a balanced mix of public and private services but medical need was, is and always will be the essential criterion for getting services.
Even if the public finances did not present so great a constraint, the present process of planned development and renewal would surely be preferable to the old approach of indiscriminately channelling extra funding to each agency which demanded it, without regard to the country's ability to pay. For two years, this country has experienced a new realism in relation to what we can afford and the careful husbandry of our available resources.
Tonight's motion is a throwback to the earlier, carefree days for which so heavy a price eventually had to be paid. When we came into office, I would remind the House again, we had to pick up the tab, we had to pick up the debt of the £50 million overspending on the health services, we had to take the action to resolve the issue, because if we did not we would not be in a position to pay our debts and the services would suffer as a result. We have taken the hard action, we have taken the responsibility and I believe the people of this country will respond in an appropriate way at an appropriate time, their first opportunity being on 15 June during the European elections. I am confident they will endorse the policy which has been effected over the last two years.
If we had surplus funds at our disposal, of course, things would be much easier. It is difficult being in Government and being in the Department when we had to take action. Future Governments and future Ministers will look back to the end of the term of this present Government as one of the most enlightening periods in the Department of Health where realism came in, where we tackled the problems. At the end of the day I believe we are delivering a better health service than has been delivered heretofore.
I reject the motion and I request Senators to reject it for the reasons I have outlined in the statement I have made.
I had better remind the House that the Minister who is present is the one who coined the immortal phrase: "We said there was a better way but we did not say that it would be any easier." I am still trying to work out what he meant by it, but it is definitely a phrase that deserves to go on the record.
I visited an old lady in Saint James's Hospital recently who needs physiotherapy five times a week. She can only get it once a week. There is no residential child psychiatric service in the whole of Munster anymore. They are now charging people for ambulances when they are moved from one hospital to another for necessary treatment. They are ripping off old people's pensions in many hospitals now.
My youngest son needed an ear operation. I have the good fortune to be able to afford to pay for private care. We were told that if he had to do it through the public service he would have to wait for two to three years by which time his hearing would be permanently damaged. I have a family relation who has a very severely mentally handicapped child and who has just been told that the child, who is in residential care, will be sent home shortly. Because of the cutbacks they cannot afford to keep the child in residential care anymore. There are community nurses in the Munster region who get no travelling expenses for part of the year.
I say those things because they are the most eloquent refutation of what the Minister has said. The health services are in chaos. Community care is not a substitute for psychiatric services. My wife is a psychiatrist and she knows the mess the psychiatric services are in. When she was working at the coal face, as far as I am concerned she was a far better authority on the quality of the psychiatric services than either the Department of Health or the Minister for Health. We have had a mess. The only thing I cannot stomach in this debate is the fact the Fine Gael Senators sit in front of me here and pretend that it is all somebody else's fault. One would think that they resigned from Government in 1987 over cutbacks in the health services instead of the Labour Party.
I am glad the Labour Party put down this motion. It is time we put ourselves on the record. The poor have been victimised; they have been ripped off to satisfy the needs of the bankers and the financial institutions. The poor have been sacrificed to satisfy the greed of the rich and the powerful in our society. The poor have suffered the pain, the agony, the health cuts, the poverty and so on and there is no way of getting around it. The Minister can produce all the figures he likes but it is still a fact that the poor pay the price for his alleged economic success.
The Minister said in summing up that he believes the policies of the Government will be endorsed in the Euro elections. The Minister and his party are in for a rude awakening and the rather inappropriate comment to my colleague, Senator Ferris, that the list of hospitals which he mentioned in his speech was something to do with a Euro election campaign was uncalled for. The Minister is missing the point of what is happening. Senator Ferris is canvassing in an election, he is meeting people and getting their reaction. The people know, for example, that seven hospitals have been closed by this Government in the South Eastern Health Board area of which three are in my constituency. What are people saying to us at the doors? They are talking to us about the very essence of this motion.
I want to put on the record that my colleague, Senator Ferris, would be in dereliction of his duty as a Member of this House if he did not put on record exactly what he put on record when he was making his speech. It was inappropriate for the Minister to say that. It was trite but his party will learn when the votes are counted after the Euro elections that what the electorate have conveyed to Senator Ferris and what he in this House has conveyed to the Minister is where it is really at.
I would like to deal with one specific area. The Minister made great play and there was much rhetoric about mental handicap and service for people with mental handicap but the only area in the health services where staff has been increased between 1984 and 1987 is in the mentally handicapped area and all of that increase occurred between the years 1984 and 1986. Between 1986 and 1987 there was a reduction in staffing in this vital area of 143 people nationally. The Minister knows as well as I do that services that are provided for psychiatric patients and for mentally handicapped patients are labour intensive. That is the essence of these services. The support service is in the community. From the date this Government took office until the end of 1987 there has been a reduction of 143 staff in this area.
There has been a lot of high-falutin, rhetoric from the Government side tonight. Those I deal with, whose problems I listen to and for whom I make representaitons where I can, are real people with real problems. There has been talk about efficiencies and inefficiencies and so on since this Government came to power but — I am not going to go over the statistics I gave earlier — there is a chronic deterioration in the health services. We are at, and may be beyond, crisis point. The Minister asked me to specify where the money should go. He knows that 6,000 people have been taken out of the health services by this Government. He knows that health services are labour intensive. We must put people back to work to provide the full services. Also, in dealing with efficiency and utilisation of services, the area of in-patients for surgical procedures is suffering very badly because of the lack of beds and the under-utilisation of theatre staff. The people who do not have their operations carried out because of the lack of beds are going onto out-patient lists which are already over-crowded. Therefore, the problem is compounded.
I am sick and tired listening to meaningless rhetoric about efficiencies and inefficiencies. This Government have used, and continue to use, a blunt instrument approach — you take out money and you let the health boards find their own level, you do the Pontius Pilate, you wash your hands and when a specific problem comes up you say it is a matter for the health board. Seventy million pounds does not go anywhere near solving the critical urgent problems that are there now but it is badly needed to deal with all those problems. Is the Minister trying to tell me that the community care area is properly serviced and that with those niggardly cutbacks on the travelling expenses of public health nurses, particularly in rural areas where some old person is discharged from hospital on the day after the public health nurse makes a visit to that area and may not be back there again for one week, that he can save money? Where does it to and what is achieved by it?
The Minister says he rejects the motion but at the same time he says that there is merit in what we say. There have been meaningless proposals such as the one from Senator O'Connell who said that instead of having senior citizens in geriatric hospitals they should remain in an effective and comfortable family setting. I agree with that. But then he said that he would like to see the prescribed relatives allowance increased two or threefold. Has he put that forward to his parliamentary party? Has he made representations to the Minister about that? It is easy to make statements that are based on nothing more than justifying what is a strategy that is about correcting the country's finances. I do not have to say once again that we in the Labour Party accept that there is a need to deal with them but as Senator Ryan has just said, not on the backs of the poor, of the sick, the old or the handicapped.
The Minister slid beautifully away from the recklessness of his party in the Oireachtas, the recklessness of Fianna Fáil people on health boards throughout the country who helped run up the very debts he talked about by a deliberate reckless and destructive policy that was motivated by one thing and that was to return to power. There was no care or concern about the people the Labour Party care for, the poor, the sick and the handicapped. It was about what the soul of Fianna Fáil has become, a quest for power and a quest for holding on to that power.
The Minister asked us to withdraw the motion we put down following his speech. I would like to say, respectfully, to the Minister that there was nothing in his speech. It rambles around the place with sometimes a history, sometimes pulling out statistics that applied here and there. The statistics that matter are those that apply now at this very moment and far from withdrawing the motion, we are going to press it because the Labour Party — the only real Opposition party in this Oireachtas — are not going to stand idly by and see the hypocritical Fianna Fáil Party, who traded on the slogan that health cuts hurt the old, the sick and the handicapped, completely aboutface and then tell us they are working some kind of miracle.
Acting Chairman
I am putting the question, "That the motion be agreed to". I think the question is lost.
Senators
Vótáil.
Will Senators who are claiming a division on the motion please rise?
Five or more Senators stood.
The division will proceed.
Question put.
The Seanad divided: Tá, 7, Níl, 21.
Tá
- Ferris, Michael.
- Harte, John.
- Murphy, John A.
- O'Shea, Brian.
- O'Toole, Joe.
- Ross, Shane P.N.
- Ryan, Brendan.
Níl
- Bromell, John A. (Tony)
- Cassidy, Donie.
- Cullimore, Seamus.
- Eogan, George.
- Fallon, Seán.
- Fitzgerald, Tom.
- Fitzsimons, Jack.
- Haughey, Seán F.
- Hussey, Thomas.
- Kiely, Rory.
- Lydon, Donal.
- McEllistrim, Tom.
- McGowan, Patrick.
- Mullooly, Brian.
- Mulroy, Jimmy.
- O'Callaghan, Vivian.
- O'Connell, John.
- O'Conchubhair, Nioclás.
- O'Toole, Martin J.
- Ryan, William.
- Wallace, Mary.
Tellers: Tá, Senators O'Shea and Harte; Níl, Senators S. Haughey and Hussey.
Question declared lost.