Senator Brian O'Shea, the mover of the motion, has 20 minutes. So that there will be no confusion, each Senator has ten minutes. At 7.50 p.m. Senator Ferris will conclude.
Health Services: Motion.
I move:
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 GNP, 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.
The Labour Party, in bringing this motion before the Seanad, is in no way suggesting that there is not a problem with the national finances. What we are saying, and saying very emphatically, is that the measures taken by this Government in the health area go beyond what is acceptable. There is a worsening crisis in the health services that is nothing short of a national scandal, and which requires the immediate injection of emergency funds.
Health expenditure in this country was, until 1986, higher than the OECD average but now it is substantially below that. During Deputy Barry Desmond's term as Minister for Health, Exchequer expenditure on the health services was at 7 per cent of GNP. It is now at 6 per cent. This motion is seeking an immediate injection of £70 million to deal with the present shambles that causes suffering and death. Let me say that the £70 million is about ½ per cent of GNP. We are not seeking in this motion to restore the spending to 7 per cent of GNP. Rather we are looking for an immediate £70 million to deal with problems which I intend outlining later in my speech.
The Labour Party salutes those who are employed in the health services. They are working under deteriorating conditions and they have responded magnificently, but with the pressure they are encountering there is only so much that they can do.
This Government and their Minister have sacked 6,000 health workers and closed 4,000 hospital beds. They have also bankrupted the Voluntary Health Insurance Board. The Blackrock Clinic and the Mater Private Hospital have drained funds from the VHI, which it was not meant to provide to them. The Minister responded to this situation, but not before enormous damage was done. A two-tiered health service is evolving and this has been roundly condemned not alone by the Labour Party but by the Churches. "Love thy neighbour" in terms of the health services has become a hollow phrase when we examine the services available to the poor.
This occasion should not be allowed pass without putting on record the destructive and reckless approach Fianna Fáil public representatives at all levels, both in the Oireachtas and throughout the country, to the previous Minister for Health, Deputy Barry Desmond, when he retained and streamlined the service. The cynical U-turn which Fianna Fáil is guilty of since coming to office cannot be condemned or exposed often enough. They viciously attacked the marvellous achievement of Deputy Desmond in very difficult circumstances. They promised the electorate an unattainable level of health services in a totally dishonourable and dishonest quest for power, and then on coming to power progressively destroyed those same services. I believe that this dishonesty and deceit will never be forgiven.
We must deal with the here and now, and Fianna Fáil have the opportunity of redeeming in part their credibility in the health services. Admittedly, all of the blame is not Fianna Fáil's because the right wing consensus in Dáil Éireann was necessary to allow the Government to carry out the cruel decimation of the health services. The horror stories regarding our hospitals grow and grow. Geriatric and acute and surgical medical in-patients are those most affected. Waiting lists continue to rise at an alarming rate. Health boards have been forced to close beds and wards in hospitals. There is a chronic shortage of beds, and patients who are on in-patient waiting lists are being forced on to already excessively long out-patient waiting lists. The system is choking itself and the casualties are overworked staff and neglected patients. This totally unacceptable situation is to be condemned but more importantly rectified as a matter of the gravest urgency.
In the South Eastern Health Board region there are very long in-patient and out-patient waiting lists. There have been appalling increases in the numbers on the waiting lists in the first three months of this year. The in-patient waiting list has increased from 907 to 977 in that period. The out-patient list has increased from 2,797 to 3,055 during the same period. Let no one tell this House that this is not a gravely worsening crisis. The total waiting lists in South Eastern Health Board hospitals for the first three months of this year showed that in-patient numbers on the waiting lists have increased from 2,655 to 2,754 and out-patient numbers have increased from 3,891 to 4,236. These are not just statistics but people, and in many cases they are in grave need. In addition, patients are being discharged from hospitals earlier to make way for acute admissions. The effect of this is that an intolerable burden is being placed on GPs and on public health nurses in the community care area.
Rationalisation of community nursing services is deepening the problem because of the non-replacement of posts and the curtailment of nurses' travelling expenses. This was always an excellent service but now it is being progressively reduced to a shambles. Again those at risk are the old, the sick and the handicapped. Out-patient waiting lists are a national scandal. They are causing death and great suffering. People are spending days in hospitals after being given appointments and go home without meeting a consultant. The system is not reacting quickly enough to the needs of people who require urgent attention. When we talk of community care services we must look at how they relate to psychiatric patients.
This Government's commitment to the Minister's Department's plan Planning for the Future, is as hollow as the posters that littered the country before the last general election stating that: “Health cuts hurt the old, the sick and the handicapped.” Patients are being sent out into the community — and I will deal with this more specifically later on — without adequate back-up services. The whole rationale of Planning the Future was to get people out of institutional care, but it is a meaningless and may I say dangerous exercise to put psychiatric patients into the community without appropriate back-up. In the south-eastern region, 570 beds were closed at the end of last year, 200 of which were in St. Otteran's Psychiatric Hospital, Waterford. There is a chronic under-provision of medium-term care in the psychiatric services.
Alarming rates of suicide among psychiatric patients have been reported in newspapers in my area. Any society with pretensions to being called a caring society should be judged on how it cares for those who in the material and human sense are the least among us. There is another national scandal relating to the handicapped which needs to be addressed and improved dramatically and urgently. There are 20,000 mentally handicapped adults and children who need speech therapy services. Throughout this country we have the equivalent of 27 speech therapists attending them. In my own area mentally handicapped children receive something between seven and nine minutes speech therapy per week. This service continues to worsen and is pathetically inadequate even as it stands.
Indeed, I have personal experience of this problem. I have a daughter with Down's Syndrome. Thankfully, she has no real problem with her speech, but I encounter other children who understand speech but because of the lack of the professional assistance of speech therapists they cannot reproduce it. It is a heart-rending experience to observe these children. They understand what is being said to them. There is a peculiar difficulty with regard to Down's Syndrome children because the tongue is a little large for the mouth cavity. In many of these cases to progress towards adequate speech they need a great deal of attention from speech therapists in their early years. When you observe them you know they understand speech. In their minds they can reproduce it but the final act of sending the message from the brain to the tongue does not happen because they have not been guided on how to do it.
Some of these children become bold and less adjusted. As they move towards maturity they are less adjusted individuals because of the damage that is done at an early stage. They become a greater problem for their parents. Indeed, in many cases they become more of a burden on the State. This could all be rectified if there was an injection of funds, if we got our act together in providing speech therapists nationally. What is happening at present is shameful. I know that a special interest group of speech therapists presented a report to the Minister recently and that the Minister has some dealings with them. We need a solution. These children are suffering from the lack of something which is vital. As human beings we have, above all other forms of creation, our ability to communicate with one another. If for no other reason the Minister should accept this motion and provide extra funds.
I should like to refer again to the appalling situation in our hospitals. I have given the number of people on our dramatically increasing in-patient and out-patient lists. I should like to read a letter from Mr. Gordon Watson, a surgeon at Ardkeen Hospital, Waterford, which was published in The Irish Times last Saturday. He was referring to an RTE programme regarding the emergency and accident services in Dublin. He said:
Being in absolute agreement with Professor Thomas Hennessy and his associates regarding the recent failure of accident and emergency services in Dublin, I wish to emphasise that the problems they discussed on RTE recently may be a countrywide phenomenon.
On the same day as St. James's Hospital, Dublin, reported to be one of the largest hospital complexes in Europe, ground to administrative chaos, having received 15 surgical admissions from a total of 38 emergency patients, the general surgical department at Waterford Regional Hospital (48 beds) received 10 acute admissions and over the past week 42 acute general surgical emergencies were admitted and treated on site. Unlike St. James's on "supertake" every third night, Waterford Regional Hospital is on call for 24 hours every day. With such an emergency load resulting in a bed occupancy of 107 per cent last year, there is little chance that out-patients and elective surgical waiting lists can be managed effectively.
Hence, if a commission is established to examine emergency hospital services in Dublin, as Professor Hennessy advised, might I recommended that its terms of reference be expanded to include the country nationwide.
It gives me no pleasure to say to the Minister here tonight that, in my considered view from my experience as a public representative, the cutbacks which have been implemented by this Government have resulted in the most awful suffering and in some instances in deaths. Who is suffering? We talk in terms of getting the country's finances in order. There is no one in this House who does not agree that the country's finances have to be put in order. The real question is: who pays? Unfortunately — and in a sense this is a terrible indictment against this Oireachtas — it is the very people on whose behalf this Government festooned the country with posters before the last election. The Government has broken faith totally with them. They are the ones who are suffering.
I belong to the only real Opposition party in this House, the only party who are proud to speak for these people, who make no apologies for speaking on their behalf and who will continue to speak for them. The geriatric patient who cannot get into a geriatric hospital; the child or adult who requires speech therapy services, the person who is referred by a GP and who, because of inordinate delays in seeing a consultant at the initial stages, may well have a terminal condition by the time he or she is dealt with and examined.
Our society has become very mercenary in many ways. The consensus in the Dáil leads to an accountancy mentality. We must get the finances of the country in order — but the caring attitude has been lost. The whole ethos of that right wing consensus is that we will brush all these problems into the background somewhere, forget about them for the time being and, when everything comes right with our finances, the poor can be looked after. We are seeking nothing less than the level of service Deputy Desmond provided during his term as Minister for Health. At that time a reckless and power hungry Opposition came in here day after day and vilified the Minister. They pilloried him but when they came to power they reduced the funding of the health services by 1 per cent of GNP. In effective terms they took between £140 million and £150 million out of the service.
The Senator has one minute.
The hyprocrisy displayed by this Government is unbelievable. I feel sick when I recall those posters with which the Minister's party festooned this country. Once Fianna Fáil came to power, admittedly needing the help of a right wing consensus to keep them there, they kept on attacking the poor, the sick and the handicapped. It is not too late to redeem something of the real Fianna Fáil, the Fianna Fáil of the thirties who were a caring party. I believe that caring element is gone in this party today. Whatever, the Minister and the people in those benches say the poor, the sick and the handicapped are suffering. The services which are so necessary for them have been attacked viciously by this Government on a day to day basis.
I ask the Minister to accept this motion or, failing that, to show some sensitivity for the terrible crisis which exists in the health services at present.
I second the motion on behalf of the Labour Party group in the Seanad. As Senator O'Shea said, it gives us no joy whatsoever to have to return to this subject which we discussed in this House last year. Last year we were looking for the re-opening of institutions and hospitals which were closed by this Government. We received no support for our efforts to redress the damage caused to our health services by a loss of beds. We are forced to bring to the attention of the Minister, in response to requests from people throughout the country, that unless additional funding is made available by a minority Fianna Fáil Government the health services will collapse around us like a pack of cards.
I have travelled throughout the Munster region over the last three months campaigning door to door for the European election. I found that people have a cardinal interest in the health services. Once you knock on the door and try to discuss the importance of the European Parliament election, their first concern is for the health services. This is repeated on doorsteps throughout Munster, the region I am contesting.
I want to sound a word of warning to the Taoiseach through the Minister that if the Government decide to call a general election, they will find there is widespread anger because of the way the poor and the sick have been treated and the lack of health services. This surpasses all other considerations: unemployment, emigration, social welfare, etc. Everybody I have spoken to accepts that the Government have been trying to address the financial problems in this country but they have not made health care a priority. That is true in the Cathaoirleach's Clare constituency, I visited on Monday. In Ennis County Hospital they are at sixes and sevens as to how long they can continue.
Limerick is devastated following the closure of Barrington's Hospital, which was a politically inopportune thing to do at the time. Now demands and pressures are on the Regional Hospital. In North Tipperary the concept of an acute surgical hospital in Nenagh is under threat. If vacancies occur at consultant level, the likelihood of being able to employ anybody is slight.
In my own constituency, South Tipperary, the record is dreadful. We have closed acute hospital beds. We have closed sub-acute hospitals like St. Vincent's in Tipperary town which preceded the foundation of this state and it took a Fianna Fáil Government to close it. We have closed beds in Cashel County Hospital. We have closed beds in St. Joseph's County Hospital and we have closed beds in St. Luke's Psychiatric Hospital after tremendous improvements had been carried out by previous Governments of all political hues. They have shown complete disregard for the views of the professionals involved in the service and the views of public representatives.
Irrespective of the fact that Deputy Desmond managed to commission a new psychiatric unit in St. Luke's, this Government closed the same number of beds in a different part of the hospital the following year. That is not progress in my opinion because we would not have built a new unit if there was not a need for it.
I have canvassed extensively throughout Cork and Kerry, the Southern Health Board area. The sacking of a deputy CEO is not the answer to the acute financial problem of the Southern Health Board. There has been a court decision requesting that Mallow Hospital should be restored to its former level as an acute hospital serving a vast rural region. The closure of hospitals in Cork city have put an extraordinary demand on the services being provided at the Wilton Regional Hospital. There have been bed losses in the new hospital in Tralee together with the loss of nurses. No ENT service is available for anybody in Kerry and people and are now required to travel to Cork for treatment. This has created crisis management and is a crisis for patients in need.
We now have a new régime in the Southern Health Board area which requires that there will be no further admissions to geriatric hospitals, welfare homes, etc. People are being discharged from hospital compulsorily at weekends even if they are not medically fit, to be brought back again on Monday morning. Did we ever think we would see the day when you could not be sick at the weekend, that your sickness would be confined to a five day week? We have moved very far away from the comprehensive health service to which the people have contributed by way of their PRSI and the taxes.
In Senator O'Shea's constituency look at the chaos following the closure of the Waterford City Infirmary in Ardkeen. They are in the process of constructing a new regional hospital on that site which was approved by Deputy Desmond. There is no hope of having a hip replacement operation even if you have VHI cover. Consultants are now requesting special payments in addition to VHI fees. We have early discharges following surgery. One man aged 96 was threatened with early discharge from hospital following a hip operation and there was nobody to look after him at home. The unemployed have been forced to go to the credit unions to borrow money for a pacemaker. How far more are this Government prepared to go? In most instances there is no transport available. People with one child may be able to thumb a lift but they would not get a lift if they had two children with them.
The Minister said there will be no extra funding provided for health services. He also accused a previous Minister and a previous Government of overspending. As Senator O'Shea said week after week they continued to request additional funding and health boards dominated by Fianna Fáil members refused to meet their statutory obligations to make changes in the management structure or to make efforts to make ends meet. Now we have the sad fact that there is less money for the health services. Fianna Fáil dominate the health boards and a Fianna Fáil Minister is now refusing to meet the needs in the areas I mentioned in Munster.
It is no joy for me to have to say this. The matter is now of extreme urgency before there is a major loss of life. I do not think that is what the Minister wants. But that is inevitable if something is not done immediately.
I have read this motion and I can understand why the Labour Party wanted to raise this matter. It is a very emotive subject. I am not questioning the sincerity of Senator O'Shea. I firmly believe he wishes the Government to carry out what he has embodied in the motion. I might refer Senator O'Shea and the House to the fact that he says that health spending has dropped from 7 per cent to 6 per cent of GNP. I wonder where he got those figures, because I did a little research on it. We will take December 1986 against December 1988, because that was the last time we had Deputy Barry Desmond in power. In 1986, the percentage of GNP spent on health was 7 per cent. On 31 December 1988 the percentage of GNP spent on health was 7 per cent. We should put that in proper perspective from the beginning.
I would like to see an improvement in the health services but you have to put it in proper perspective. More money does not necessarily mean better health. I learned this a long time ago. You just cannot allocate money and expect the health of the nation to improve because that will not happen.
Debate adjourned.