Seanad Éireann debate -
Wednesday, 10 Dec 1997

Vol. 153 No. 2

Hospital Waiting Lists: Motion.

Mr. Cregan

I move:

That Seanad Éireann condemns the Minister for Health and Children for his failure to take the necessary steps to eliminate hospital waiting lists as promised.

I congratulate the Minister on his appointment and I wish him well in his portfolio, which is not an easy one. I do not wish simply to condemn because I am aware of the nature of the problem of waiting lists as a former chairman of the board of a voluntary hospital. I was involved in the merger of two hospitals in the Cork region and I was very conscious of the need to ensure that the hospitals worked better and provided a better service. I am sure the Minister supports such aims having heard him speaking in a similar vein in Cork.

There are areas of health care where people do not seem to receive an optimum service, in particular cardiology and hip replacements. With regard to cardiology services I am concerned, as a result of a report I read, that there are more consultant appointments in the Eastern Health Board region than in other regions. In the Southern Health Board area consultants do not seem to be appointed on the same ratio basis as in the eastern region. That is unfair to the people who need the services.

That said, it is a good long-term policy to have more consultants. The more quickly patients can see consultants the better because it will result in fewer people occupying public and private beds. I am aware of people who have had to wait from two to four years for cardiac surgery. I realise it is a difficult health care issue but the comparisons for the southern and western regions with the eastern region are unfavourable. In some cases public beds in a voluntary hospital were occupied for 16 to 18 weeks by patients waiting for cardiac surgery. That is a long period to have a public bed tied up unnecessarily. With the cost of a bed being occupied for such a period the patient could be sent anywhere in Europe for treatment at a saving.

The patients had to stay in hospital for such an extended period because the cardiologist could not take the responsibility of letting them go home. It is unfair that these public beds which are needed for other patients cannot be made available to them because the cardiac patients cannot be treated. I do not make the point lightly but it is a fact. In the Southern Health Board area the cardiac and hip operation services being provided are tying up beds unfairly for the hospital staff and especially for the patients who may need the beds more urgently.

Will the Minister address the issue of comparing the work of the health boards and the voluntary hospitals? We should consider whether enough money is being given to the voluntary hospitals compared to the health boards. Is too much money being spent due to health board policies which could be better spent through the voluntary hospitals? I feel strongly that this issue merits greater consideration.

With regard to the upgrading of voluntary hospitals we should be greatly encouraged by the development of St. James's Hospital in Dublin. It is a credit to all involved. Such a facility is needed in the south, west and north-west areas. St. James's Hospital is a credit but that is because of the number of consultants available. Decisions can be made and operations can be done very quickly. The 24 hour service provided at St. James's Hospital is not available in other regions and it should be. The facilities are available in other regions but they are not used to their full extent.

We have managed to tackle waiting lists in many areas. With regard to hip operations, for example, the problem was tackled to a certain degree by sending patients to Belfast for treatment. People laughed at that approach when it was suggested but it has been a great success. We should not be afraid to consider availing of services provided in other regions or countries. If such an approach works why should we keep a patient in bed for 16 to 18 weeks at a cost of about £770 a week? That patient could be treated elsewhere at less cost and money could be saved. Serious consideration should be given to eliminating waiting lists as promised.

Mrs. Jackman

I second the motion. Although the Minister has allocated an extra £12 million for waiting lists based on the post-budget figures, £9 million of which has been provided already, the total amounts are still disgracefully inadequate. Patients are dying because of an insufficiently funded health system. The figures I am using have been gleaned from newspapers, hospitals, the Minister in answers to parliamentary questions and interested personnel. More than 30,000 people are awaiting necessary medical treatment. People can be waiting up to ten years for life saving heart surgery, while cancer patients are waiting up to four months for radiotherapy. Up to 20 per cent of heart patients die before they are reached on hospital waiting lists. There are 1,600 adults and 150 children awaiting heart surgery. The problem has become so bad that heart patients from the west are being referred to Britain for surgery in an effort to alleviate the problem. It is sad that the further a patient lives from Dublin the longer they have wait for surgery.

Maurice Neligan, a leading heart surgeon, stated in an article in The Irish Times on Thursday, 4 December, that “a recent review of just 250 patients found 47 died awaiting surgery. That is 20 per cent. If you extrapolate those figures to the waiting list as a whole, well in excess of 100150 people have died awaiting treatment over the past five or six years”. I was at the funeral yesterday evening of a priest awaiting heart surgery. I am not saying he died because he was awaiting surgery, but the operation was supposed to take place on Friday. Mr. Neligan also stated that the heart unit in the Mater Hospital urgently needs the capacity to do 500 extra heart operations per year. The hospital currently carries out 15 to 16 operations per week. I cannot dispute these figures — we must believe them as they come from a leading heart surgeon.

An OECD report does not make good reading in revealing that the share of national income devoted to health services in Ireland has dropped by 5 per cent and that Irish health spending as a proportion of national income is less that the average of our EU partners and other major industrialised countries. The situation is so acute that the health services could easily absorb the country's entire budget and still require more funding. I do not expect the Minister to immediately address this but it is an extraordinary figure.

I was appalled by the numbers on waiting lists. The longest waiting list included 6,592 people waiting for ear, nose and throat procedures; 1,299 patients are on waiting lists for hip replacements, over 500 for more than one year. Other problem areas include orthopaedics, general surgery, vascular surgery, ophthalmology, gynaecology and urology. All these areas need to be targeted for additional funding.

There are 1,600 patients on the cardiac surgery public waiting lists, over 70 per cent of whom have been waiting for over one year. According to the Minister's figures, there are 902 patients on the Mater Hospital's waiting list, 502 on St. James's, 64 on Cork University Hospital's and 109 on Crumlin hospital's. Over 10,000 patients on hospital waiting lists for medical and surgical treatment have been waiting for longer than the Government's target maximum period of one year. Over 505 children are on hospital waiting lists for longer than six months, the maximum target period set by the Department of Health and Children. Those aged 85 years and over will increase by 50 per cent by 2006 and the advent of expensive, high-tech treatments will mean the problem will get worse in the future.

I question the Department's proposed policy — I wonder if the Minister is still pursuing it — to introduce changes in the funding of waiting lists by only providing funding for hospitals which show their waiting lists are caused by excess demand rather than inefficiency. This will only serve to penalise patients on the waiting lists of hospitals judged to be inefficient. They will have to wait longer for treatment or travel to another centre. I call on the Government to use the funding to identify the inefficiencies rather than compound the problem by withdrawing critical services, because the most likely result of this policy is that more patients will die. There is an urgent need for improved management structures throughout the health service in order to get the best from those working in the service in an efficient and effective manner. The Department of Health and Children must review its funding in this area. The needs of the patient's health and wellbeing must not be overshadowed. It is scandalous that so many are needlessly suffering and dying due to the lack of a coherent and proper health strategy.

I wish to draw the Minister's attention to the figures of the Mid-Western Health Board for acute hospital services and in-patient waiting lists up to 30 December 1997. There are just two patients on the cardiology waiting list because there are no cardiology services in Limerick. There are 98 patients on the dental waiting list. There is concern about people working in the orthodontic area who are not specialists while some orthodontic specialists who have the required qualifications cannot get into the system. I believe the orthodontic service of Ireland is extremely concerned.

I wish to briefly look at the figures from the regional hospital where there are 924 public patients on waiting lists for between three and 12 months and 901 on waiting lists for over 12 months. In St. John's Hospital, Limerick, there are 182 patients on waiting lists.

I would like the Minister to take a particular interest in attention deficit disorder which is common in the Limerick area — although not overly so — where up to 10 per cent of children are sufferers. Parents and support groups have been to the fore in the Limerick area in raising awareness of this issue and I hope the Minister will provide the necessary expertise and immediate funding to allow the Mid-Western Health Board to set up a pilot programme for the assessment of children suffering from it. I do not have time to discuss what the disorder means for parents. The health board is aware of a number of children showing symptoms of this disorder in the mid-west. There is an immediate need to assess four teenagers for funding which will enable them travel to the learning assessment centre in West Sussex.

The problem will not go away and I appeal to the Minister to ensure information is given to teachers which will enable them alert the health authorities and general practitioners to the problem. General practitioners and the medical profession in general need information to allow them help the parents of children who suffer from attention deficit disorder. Sufferers are known as children with a hidden handicap and there are many children who have this handicap who have not yet been diagnosed. We must investigate this issue and funding must be provided to establish an expert group in the mid-western region where some work has already been done.

I hope the Minister can make inroads into the waiting lists of the regional hospital and St. John's Hospital in Limerick, and throughout the country.

Dr. Fitzpatrick

I move amendment No. 1: To delete all words after "Seanad Éireann" and substitute the following:

"notes the recent initiatives taken by the Minister for Health and Children to reduce waiting lists and supports his policies to channel waiting list funding to best effect".

I was surprised that this motion should be tabled so early in the life of this Seanad. The Minister, hardly a wet week in Hawkin's House, is being berated for the misdeeds of his predecessors and their lack of attention to certain areas. However, it is the right of Members to table motions as they wish.

I wish to turn to some points raised by Senator Cregan, the thrust of whose argument was that health boards in the east are favoured over other health board areas. I hope I am not misinterpreting him but the majority of problems are in the east. Most of the population is there and the demand exists. I do not suggest demands are not placed on health boards in other areas, but they are not as large. Ministers must take cognisance of the facts as they are presented to them.

Senator Cregan also raised the general point that perhaps it is time to consider the work of health boards. They are in the health care delivery area and after more than 30 years, it is time to consider their operations. A review of the Eastern Health Board is taking place at present. Health boards are good at dealing with specialist and general hospital care. However, they do not have a good input when it comes to community care. They are too far removed from community care on the ground. We should consider re-establishing the old health authorities in Dublin and Cork. They would be better at delivering community care in terms of district nursing and palliative care services in homes. However, this is a matter for another day.

Senator Jackman quoted at length an eminent cardiac consultant in the Dublin area. However, as he said, people who are not on waiting lists also die. It does not change the position.

Mr. Cregan

The average is 20 per cent.

Acting Chairman (Dr. Henry)

Senator Fitzpatrick without interruption.

Dr. Fitzpatrick

We can argue about long waiting lists, but I was interested to learn that the Department of Health and Children is considering not just the lists but the waiting time. This area should be examined and followed up.

Certain areas, such as cardiac surgery, demand high support services. They are expensive and involve many staff. However, other areas involve equal skills but do not need massive funding for beds. In a recent initiative, the Royal Victoria Eye and Ear Hospital in Dublin substantially reduced its waiting list for cataract surgery by using hotel rather than hospital beds. Patients were operated on in the hospital and accommodated in adjacent hotel beds for the 24 hour follow up period. This did not involve a large capital expense but it reduced the waiting list for cataract surgery by over 100 in a week.

Mr. Cregan

That is good, and cheap.

Dr. Fitzpatrick

We must put matters in context when we discuss waiting lists. According to Department of Health and Children figures for 1947, 25 per cent of deaths were due to heart disease, 15 per cent to senility and 9 per cent to cancer. The 1995 figures show that 24 per cent of deaths were due to cancer and that heart disease still accounted for 25 per cent of deaths despite all the research and advances made over the years. A dent has not been made in the number of deaths due to cardiac disease.

Mr. Cregan

The cause is pressure.

Dr. Fitzpatrick

Many years ago I was a student of dentistry in Dublin. In those days, a dentist's job involved extractions and fitting dentures. However, the then Minister for Health, in the face of opposition in the Supreme Court, introduced fluoridation. There is now a new dental industry. Children no longer have teeth extracted and the need is for orthodontists. There were three orthodontists in Dublin 30 years ago. Now it is the major subspecialty of the profession. The point is that if one problem is solved, another is created in the future. I do not suggest that problems should not be solved; I do not want children or adults to have painful teeth. However, when a problem was eliminated through fluoridation, the science or art of orthodontics was created.

Mr. Cregan

Perhaps the answer is to eliminate teeth.

Dr. Fitzpatrick

That is another matter into which the Senator can get his teeth. The Fitzgerald report, which was issued 30 years ago, forms the basis of the structure of our hospital services. It is time to produce a new report. The Department of Health and Children should meet professionals, examine the current position and consider what problems will arise in the future. For example, people have healthier lifestyles and are living longer. There have been amazing advances in maternity services. Children weighing only two pounds or less when they are born now survive.

We must consider where pressure points will arise in the future and address them before they overtake us. As the Secretary of the Department of Health and Children said, the tolerance level for long delays in accessing services and long delays when people reach them and tolerance for anything other than appropriate care and respect will reduce steadily as the economy grows, people become better educated and an awareness of what constitutes good health care becomes widespread in the population. This is the fundamental problem facing us.

The Minister for Health and Children increased health spending this year by 11 per cent to £3.1 billion. This is 20 per cent of total Government spending. It is an amazing amount of money and will increase in the future. As another speaker said, where do we call a halt because the basic issue is the allocation of resources? On a parochial matter, I welcome the £25 million development plan for the Mater Hospital. This will be a great initiative in the area I represent. I also welcome the launch by the Minister of the Irish Hospice Foundation Palliative Care Service. One does not have to be a doctor to realise that this is a growing area of health problems.

Minister for Health and Children (Mr. Cowen)

I am pleased to have an opportunity to provide the House with details of the initiatives I have recently taken to tackle the problem of waiting lists in acute hospitals. Senators will be aware that this problem existed before I became Minister for Health and Children and that it is unlikely to be resolved easily. Successive Governments have grappled with it and none can claim to have come up with a speedy solution.

The existence of waiting lists is a serious problem for patients and their families. In addressing it, however, it is important to remember that waiting lists are not peculiar to Ireland; they are one of the major issues facing hospitals and health systems throughout the world. It is easy to look at waiting lists and criticise Governments for not reducing them more quickly. It is much more difficult to put in place a structured, carefully targeted set of initiatives which will help to address the problem rather than acting merely as a substitute for real action. This is what I have done.

When I took office at the end of June, I decided to take stock of the waiting lists area. I wanted to determine how to use the money available to the greatest possible effect. In particular, I wanted to avoid a situation where money might be allocated without any real assessment of its impact. With these factors in mind, I decided to take the following steps, which have been passed on to health boards and hospitals by my Department as part of the allocations process.

First, I made sure that hospitals would be notified immediately of the exact funding available to them during 1998 for waiting list work. This is a valuable step forward. In previous years hospitals were not informed of their waiting list funding until as late as June or July. Hospitals will now be able to plan their activity, including waiting list procedures, from the beginning of the year. Second, I instructed that the service plans to be prepared by health agencies should specify clear targets for waiting list activity during 1998. It will be the responsibility of the chief executive officer or hospital manager to ensure that these targets are achieved and to take corrective action as necessary. Third, I indicated that hospitals should pay particular attention to waiting times rather than waiting lists alone. This is vital because the rate at which the waiting list is cleared is of much more practical concern to patients than the size of the waiting list on which they appear. Fourth, I asked that where agencies have not already done so, they should now designate an individual to act as a co-ordinator of waiting list work so that the system is streamlined and resources available are used to the best possible effect.

I have also emphasised to health boards and hospitals the importance of validating their waiting lists. If this is not done, we risk not having a clear and up to date picture of the current situation. There is a danger that some patients will be incorrectly included on a waiting list due to validation problems. My Department has recently reminded hospitals of the need to exclude certain categories from their lists, such as patients who have received treatment elsewhere; patients who, on the basis of clinical judgment, no longer need treatment; and patients who have been placed on a waiting list in anticipation of their needing treatment at some future stage.

These initiatives are a practical response to the problem of waiting lists. They are based on a careful assessment of the problem and on a realistic response to it. The original motion proposed by the Fine Gael Senators sets out to condemn me for "failure to take the necessary steps to eliminate hospital waiting lists". The initiatives that I have just outlined to the House demonstrate fully that this claim is simply not true. There is no doubt that the initiatives which I have announced will take some time to make an impact on waiting lists and waiting times, but Senators on the other side of the House can hardly claim that I have failed to take the necessary steps to address the issue.

In addition to the initiatives that I have described I am happy to draw Senators' attention to the fact that I am allocating 50 per cent more to the waiting list programme in 1998 than was done by my predecessor in 1997. I have allocated £12 million for waiting list work in the coming year; £9 million has been allocated already and the balance of £3 million will be allocated in the near future when I have had an opportunity to review the situation in relation to waiting lists for cardiac surgery.

I emphasise that I am not simply throwing money at this problem in the hope that it will be solved. Not only have I substantially increased the amount of money available, I have also ensured that it is allocated on the basis of a rigorous analysis of how to achieve the best possible outcome for patients. To this end the available resources were allocated for 1998 having careful regard to waiting times rather than the length of waiting lists alone; the principles of health gain and social gain as set out in the health strategy, Shaping a Healthier Future; and the need to direct money towards a small number of selected target specialties. I am conscious that spreading the funds among too many specialties may mean that little progress is made in any area.

I have undertaken that the causes underlying waiting lists in particular areas will be assessed. It is not sufficient to allocate money where waiting lists arise — we must identify the reason for the emergence of a waiting list in the first place. With this and other factors in mind I will shortly commission an independent evaluation of the waiting list initiative to examine how it has performed since its introduction in 1993 and to identify other possible areas of improvement and development.

I assure Senators that I share their concerns about the serious problem of waiting lists. I want to alleviate the problem for patients and their families by putting a realistic and workable set of initiatives in place. The steps I have announced, and the 50 per cent extra funding in 1998, will not of course resolve the problem overnight — it would be foolish to claim that but I strongly believe that what I have done represents the correct way forward and will yield positive results in the coming months.

Regarding the Fine Gael position outlined by Senators Cregan and Jackman, I do not expect them to agree with me. However, I expect them to be consistent. Senator Jackman did not describe last year's national allocation of £8 million as disgraceful. An allocation of £12 million is now being made available. I remind the Senator that when the so-called adequate allocation was made to the Mid-Western Health Board, the then Minister for Health, Deputy Noonan, allocated £424,727 to the waiting list initiative. I will allocate £689,000. I remind Senator Cregan that the Southern Health Board was allocated £410,182; I will allocate £593,000. I confirm to midlands colleagues that last year their health board was allocated £400,713 for its waiting list initiative; this year it will be allocated £580,000. The North-Eastern Health Board was allocated £357,000 in 1997; it will be allocated £520,000 in 1998. I could go on. The figures have increased because of the significantly improved allocation.

I do not expect unanimous approval, but I expect consistency. It should be acknowledged that this is a serious attempt to seek to improve the situation. Anyone who knows anything about modern health care provision will know that we will always have waiting lists. However, I am carrying out an independent evaluation, increasing the allocation by 50 per cent and then putting practical measures in place. Those in hospitals and health boards are being put on their mettle to validate the waiting lists and to concern themselves with making real progress in the specialties required.

In relation to cardiac surgery, the previous administration proposed increasing numbers by 500. I am preparing a cardiovascular strategy emphasising waiting times so that people in time will not have to wait more than six months from the time they are diagnosed as needing heart surgery. I intend to implement a plan over a period of years to show how that will be done on the capital and revenue sides. That is a far more comprehensive way of dealing with one of the biggest causes of premature mortality in the country. My predecessor, to his credit, brought forward a national cancer strategy. My strategy relates not only to cardiac surgery but to the need to improve cardiology facilities and lifestyles. It is lifestyle which determines social and health gains.

Mr. T. Hayes

This side of the House has no problem in acknowledging that the Minister is doing something, but we are concerned that not enough is being done. We have a very serious problem with waiting lists. A man came to one of my clinics in Cashel last week who was told by his doctor 12 months ago that he needed a hip replacement operation which he has not yet had.

I was never a member of a health board, nor am I a doctor. I do not claim to be an expert in this area. However, the public is concerned that they must wait so long for operations which will give them a decent quality of life. We boast of the Celtic tiger, but no politician can boast of doing a great job when people must worry for months while waiting to enter hospital.

Last week there were increases in outpatient charges from £12 to £20. The public inpatient charge also increased by £5. There were 20 years of strife in my constituency of Tipperary South between Cashel and Clonmel about the location of a sector hospital in the county. That argument caused bitter divisions, not on political lines but between the two towns. Two years ago a decision was reached, with which I did not agree, to locate the hospital in Clonmel. Some people involved in that argument over the years, including some medical experts, made the point that smaller hospitals give a great service to the community. I wonder if we were right to close down some of those hospitals. The closure of St. Vincent's Hospital in Tipperary also caused a great deal of concern.

The Minister referred to the Fitzgerald report. I wonder if that is the best way to progress. Smaller hospitals are very homely. Perhaps the Minister might examine the argument in favour of retaining smaller hospitals.

Dr. M. Hayes

I welcome the Minister. I have heard this debate so often in my professional life that my eyes almost glaze over at the mention of it. I commend the Minister for his grasp of the issues and his reply.

In my experience, waiting lists are the most fallible measure of health services. Waiting lists are comprised of so many different elements that they tell us very little about the performance of the service. It is true that people die on waiting lists, but the question is whether they die while they are waiting or because they are waiting. The waiting time is a better measure. It is necessary to develop some sort of performance indicators for the hospitals and health services.

I sympathise with the Minister in trying to cope with infinite demand for finite resources. One of the difficulties is that people want to advance on every front at the same time. There is a feeling that the State should be able to provide the same level of care in all the services for everybody. I am afraid that is no longer possible and the Minister must prioritise. It would be better to focus resources and expertise on a small number of conditions, such as cardiology, cancer, hip joint replacement and cataracts. The Minister is wise to concentrate resources on the units which perform most efficiently.

A previous speaker asked if it would be better to have many small hospitals, to which the short answer is no. There is a move towards the concentration of resources and extremely scarce expertise. I would rather have my head opened by someone who does three such operations a week than someone who does three a year. Hospitals, surgeons, nurses and ancillary staff develop that expertise. If the Fitzgerald report had been implemented at that time, the Minister would be in a better position now.

It does not necessarily mean the death knell for the local hospital. Such hospitals have a role, but there is a great deal to be said for seeing the entire hospital structure as a system in which a few high tech medical centres are the equivalent of the intensive care ward. Technological advances mean that diagnosis and a great deal of treatment could be centralised. There is no doubt that the concentration of services and interaction of medical professionals, particularly in cancer and cardiology treatments, provide better outcomes for patients.

The Minister should examine the extent to which day procedures could be encouraged. The number of surgical procedures which can be done on this basis is increasing — it is 30 per cent in Canada but is still quite low here. I had two cataract operations last year. I went in at 12.55 p.m., came out at 1.55 p.m. and went home at 3.30 p.m.. The use of day procedures frees up beds and hospital space.

There is an argument for blitzing waiting lists for procedures such as heart operations by going outside the country. I am not sure if the Belfast hospitals have much spare capacity. A couple of years ago the western health board in Northern Ireland had its operations done in Oxford. It suited the patients, worked very well and was highly preferable to being on a waiting list for a long time.

The Minister has grasped the essentials of the issue. It might be worth his while to look, as a previous speaker suggested, at the structure of the health boards. I am involved with a hospital in Belfast where the split by the health board between purchasers and providers was extremely helpful. It sharpened up both parts and put hospitals on their toes. It also meant that the health boards were surveying the health of their populations and creating their demands accordingly.

There is no absolute answer to waiting lists, although Departments, Ministers and hospitals do their best. There is a need, however, to concentrate resources on the areas which provide a return and I commend the Minister for so doing.

Mrs. Taylor-Quinn

This motion is entirely appropriate and I welcome the fact that the Minister has come to the House to discuss it. Health care is always a priority and concerns people of every age, every family and every area. It is extremely important to provide a fair and adequate service across the country. This motion deals with the problem of waiting lists, which arise in areas of serious concern. For example, the number of outstanding heart operations in all hospitals, especially those which specialise in this area, is very serious. The list has increased dramatically and there are reports of a number of people who have died because they did not get surgery on time. That unsatisfactory situation must be addressed.

Recommendations and appeals have been made to the Department regarding the provision of a proper transplant service but it has not reacted properly, despite the fact that it impinges hugely on those directly involved — the patients and their immediate families — and causes serious suffering and disruption. This could be avoided. The Minister is in a unique position to see the personal suffering involved and to address the issue.

Some eight health boards are accountable to the Minister. There are varying practises within each, some of which are commendable and others which can be criticised. The Department should examine the discrepancies in the services provided from one health board to the next. For example, many people who have moved from Dublin to County Clare under the rural resource development scheme find huge differences between the services provided by the health boards in the Dublin area and the Mid-Western Health Board. It appears the former provides a better and wider range of services, including more specialist services. This issue must be addressed.

A recent report dealing with the women's health strategy, launched by the Minister's predecessor, Deputy Noonan, recommended that a pilot scheme be established regarding the provision of maternity services for people in isolated rural areas. The Minister should address this. He should request the Mid-Western Health Board to establish a pilot project in County Clare for a proper maternity service because there is no such service in the county. It was removed by the Minister's predecessor, Deputy O'Hanlon, in the late 1980s. Unfortunately, there are no Clare babies — they are either Limerick or Galway babies.

Mr. Cowen

The county still has good hurling teams.

Mrs. Taylor-Quinn

The members of those teams were born in Ennis and were Clare babies. People from the Loop Head peninsula who have been offered a mast have no proper health service facilities. A woman going into labour has to travel a minimum of 70 to 80 miles to a hospital that provides a maternity service. The Minister should recommend that the Mid-Western Health Board establish a pilot scheme to provide a maternity service in a small hospital to monitor its effectiveness. We might then have more Clare babies.

Mr. Cowen

Only if the waiting times exceed nine months.

Mrs. Taylor-Quinn

There is a difficulty between the private and public services regarding the provision and location of mamographic testing for women. There is a mamographic unit in the general hospital in Ennis, thanks to local voluntary funding. However, in parts of the country some women must wait three to four months to avail of the service. This can give rise to situations of life and death. It must be addressed.

Many older people are still awaiting hip replacements. The Minister's predecessor was successful in reducing the waiting lists in hospitals across the country, but it appears to be increasing again. The Minister rightly said that the reasons for waiting lists needs to be addressed. There is a need for greater scrutiny in the health services regarding day to day management between the administrative and professional staff and the various interest groups involved. When the services of a public hospital are provided to specialists for their use they should be for the benefit of public patients in the first instance. Private patients can use other private hospitals. The Minister must examine this issue.

Mr. Glynn

From 1993 to the end of 1997 a total of £58 million was provided to address the problems of waiting lists. Fair minded people must concede that the Minister is taking the correct course of action. Given the low inflation figures, which the Government is sustaining, I was amused to hear that while the provision of £8 million was sufficient in 1997, £12 million is not enough for 1998.

Reference was made to the Celtic tiger. That must have been a toothless animal when the Minister's predecessor was in Government because he could find only £8 million. In the short time he has been in office the present Minister has found an additional £4 million, an increase of 50 per cent. There is therefore no merit in this motion.

There was a waiting list of 39,423 in March 1993. Yet, despite the input of £58 million from 1993 to the end of 1997, it amounted to 29,069 in March 1997. The Minister was correct to say that it is not enough to throw money at the problem, because money alone is not resolving it.

When it becomes apparent that inroads have been made new cases tend to be added to the lists to replace those who had received a service. It is similar to digging a hole in a field with a high water table; the more that is dug out the more water seeps in. It may also be expedient for some to have waiting lists. For example, there may be a percentage for the private sector.

A sustained effort to reduce waiting lists will not address the underlying reasons for their emergence. I congratulate the Minister on his approach in this regard. Long waiting lists could be the result of inadequate staffing or equipment, poor management of hospital facilities or a combination of such factors. Providing money is only a stop gap measure unless the underlying causes are addressed. Further analysis is required in this regard. This problem can be addressed by targeting the limited available funds at a small number of selective specialties, setting specific objectives in relation to waiting times and ensuring that lists are properly validated.

Of the £8 million allocated in 1997, £1.7 million was used for cardiac surgery. The remaining £6.3 million funded 8,300 procedures. The Minister referred to the increased allocations to various hospitals. I welcome the fact that the Minister has increased the 1997 allocation of £400,713 to £580,000 for the health board in my area.

The principles which apply to the allocation of money for waiting lists must be examined. In the past money was directed towards a small number of selective specialties because little or no progress would be made if it was spread over too many areas. There was an increased focus on waiting times rather than waiting lists. Longer lists do not present as great a problem if they are created at a relatively quick rate. Patients are only concerned about how long they must wait for treatment; the number of others waiting is of little concern to them. The ultimate aim is to eliminate waiting times of longer than 12 months for adults and six months for children. Emergencies and urgent cases must be treated on a different basis.

The Minister referred to the criteria for 1998. He said agencies would be notified of the funding for waiting lists at the beginning of the year. This will allow health boards to plan their strategies. It is clear that throwing money at the problem is not the answer; the underlying causes must be tackled. There will be an increased focus on waiting times as well as waiting lists to ensure that children do not have to wait too long for treatment.

This motion is unfair. The Minister has paid attention to the problems of all health boards, including that in my area which received £580,000 this year. He gave £0.305 million to Tullamore General Hospital and £85 million to Portlaoise General Hospital for the development of additional services. The hospital in Longford-Westmeath received £25,000 for epidural services and we also got £1.5 million for the opening of phase 2A. Members in the Lower House beat drums about this but funds were not provided in 1997.

I congratulate the Minister for the great job he is doing. He may not be old with grey hair and a beard but he would give Santa Claus a run for his money in terms of his performance.

Dr. Henry

This is a fascinating debate for someone who is involved in the health service and has to deal with these waiting lists. I am sure Senator Glynn did not mean to be offensive when he said that consultants keep people on public waiting lists in the hope of transferring them to their private waiting lists.

Mr. Glynn

It is not in my nature to be offensive.

Dr. Henry

I take issue with him because consultants in the health service do not do that.

Mr. Glynn

I did not say that.

Dr. Henry

This debate is totally focused on money as if the Minister could solve the problem by firing money at it. I am glad he said we must identify the reason for the emergence of a waiting list in the first place. I have raised two issues with the Leader on numerous occasions which will result in waiting lists getting longer no matter how much money is provided. The first is the situation regarding non-EU graduates who staff a large number of our peripheral hospitals, particularly in such specialties as obstetrics, orthopaedics, psychiatry, paediatrics and accident and emergency. They are having serious problems with temporary registration in this country.

The Medical Council felt it had to bring in an English language test and certain standards for non-EU people. However, we have not faced up to what the Irish Medical Times described this week as “a looming medical manpower crisis”. It is not exaggerating because only three non-EU nationals have put their names down to sit this exam in December. I do not know what we will do when we gradually run out of such people, some of whom are in senior registrar posts and doing great work to reduce our waiting lists. I know we can bring people in from other EU countries but they may have trouble with the English language, although they would not have to sit an examination. We may have trouble with them in some specialties as well. There is an urgent need to address this matter.

The new university exam costs an entrant £475. This could rise to £1,000 when travelling expenses, accommodation, etc. are taken into account. It will cost them less to do the same exam in England. Many excellent graduates came to this country from Asia, India and Pakistan to do training courses for six years because they were not required to do this exam until recently. This was not because they were no good but because it was easier to get in. I and many other consultants believe they will vote with their feet now and go to England. This will create a serious problem as they will not be part of our health service. They have come here to do training courses but they have also done an enormous amount of work in the health service. We are seriously underestimating the problems we will have from 1 January onwards.

There may also be a problem getting them to come here because we only allow them temporary registration for five years. Many postgraduate training courses in surgery or orthopaedics are for six years. What will they do about their fellowship if they are only registered for five years? This is a serious problem which is not being addressed and which will cause us trouble in the near future. They have been the backbone of the service in the peripheral hospitals. When they are gone, the Minister can provide whatever money he wants but there will be no one to do the operations.

The Tierney report stated that we should have a consultant provided not a consultant led service. What has happened to this? We get into difficulties such as that with hepatitis C. To begin with the Blood Transfusion Service Board had too few consultants because of an embargo. At one stage it was staffed only by Dr. Walsh and Dr. Lawlor, who were present on a temporary basis to set up a bone marrow transplant unit. This led to a very serious problem in the service. There were hardly any haematologists in the country. We have eight new haematologists coming on board but it is suggested that we need 19.

Are we to have a consultant provided service or not? If we are going to go on with a consultant led service let us forget the Tierney report and go on with what we are doing. I am alarmed by the Ministers's continuous references in journals and newspapers to a sub-consultant grade. Is this going to be a career grade for non-consultant hospital doctors trying to progress to consultant grade, or is it going to be a less well-trained or experienced grade which fills in for consultants? If these doctors are as well-trained and experienced as consultants then why not make them consultants? We have to decide what sort of service we wish to have. It is not only about money. A great deal of effort, time and thought must go into this and on deciding in which direction we are going.

I agree with Senator Hayes's comments on the Fitzgerald report. It was a pity this was not implemented. A patient is better off in a place where doctors are performing an operation three times a week rather than three times a year. We have to question why there is such a different success rate for the treatment of cancer around the country. We need to look at these issues on an international as well as a national basis. The time spent waiting for treatment is not the only issue, it also involves what treatment one is waiting for.

I hope I have given the Minister some issues to think about. We need to look at the problem of the well-trained, non-EU people we are going to be without and also the number of consultants. I agree with looking to Northern Ireland to ensure that we integrate the two services. There are periods of slack from time to time. For example, we are performing liver transplants on patients from Northern Ireland and they are performing hip replacements for us. This is a good idea. However, I urge caution about going further afield, except in selected cases. This is not so much for the sake of the patient or because of the cost involved. If the illness is serious, funding may allow for only one person to go to the UK. This is hard on the rest of the family. The more we keep treatments within the island the better.

We could integrate an enormous number of specialist services. Garda Ben O'Sullivan went to Northern Ireland to have his shoulder reconstructed after being shot by the IRA in Adare. We need only one such trauma unit on the island. I hope the Minister will take on board some of the points I have made.

Mr. Cassidy

I support the amendment that Seanad Éireann "notes the recent initiatives taken by the Minister for Health and Children to reduce waiting lists and supports his policies to channel waiting list funding to best effect". The Minister listed the various allocations which have been made for 1998. These allocations speak for themselves. I was surprised that this motion came before the House as the Minister has only been in office for five months. The Estimates have only gone through most Departments during the past few days, so the timing of this motion is wrong.

The Minister has a record of hard work and a common sense approach. He will face the challenges of his portfolio. I am extremely confident with Deputy Cowan as Minister for Health and Children. I congratulate him on his appointment. We are fortunate to have such a young, energetic and enthusiastic Minister.

Senators have given examples in support of the amendment. I welcome the massive allocation of funds to the Midland Health Board. Last year the figure was £400,000, this year it will be £580,000. This is a terrific increase to assist the board to reduce waiting lists. However, I wish to mention the 1,600 who are waiting for heart bypass surgery. I am involved with the charity associated with Dr. Maurice Nelligan and his team in the Mater Hospital. Many people are alive because of the expertise of this team. If a second theatre was operational, it could take 500 people off the waiting list each year for the next three years.

As politicians we might be tempted to ask what price is a person's life worth. However, one cannot put a price on life. The second theatre might be located in Galway or elsewhere. Senator Hayes stated that investment should be directed to where experts are performing these operations on an hourly basis. That second theatre would cost approximately £10 million. The fund-raising charity has stated that it will match every pound donated by the Department. Given that 500 people could be taken off the waiting list every year, perhaps the Minister and his Department could put some of this money in place at the next budget. An extra £3 million will shortly be allocated to cardiac surgery. This is a priority for the Minister and the Department.

We do not have a lung transplant facility in Ireland even though we are technologically ahead of most countries. We have two trained lung transplant surgeons in the Mater Hospital — Dr. Maurice Nelligan and Dr. Freddie Wood. An enormous number of patients suffer from respiratory problems, much of which stems from cigarette smoking. I was more than an ordinary smoker but I kicked the habit 15 years ago. However, we must address this problem. We have the experts who can train a new generation of surgeons. This should be encouraged and we should provide a lung transplant unit.

I thank the Minister for his allocation of £1.5 million to the hospital in Longford-Westmeath in order to open parts of the new wing. I also congratulate Deputy O'Rourke, who initiated the project when she was Minister for Health. There was much discussion in the midlands about the allocation of funds for this project but no money was provided in the 1997 budget. I was astounded by that, as were two colleagues of mine who work in the media and with whom I have close contact. The credit for this must go to the Fianna Fáil Party which has shown commitment to the general hospital in Mullingar.

My final point concerns those waiting lists which relate to elderly people in rural areas. In the budget the Minister for Finance made provision for nursing homes to come under the same tax heading as the hotels sector. I welcome this development. Families or individuals who have been successful in life and are living in rural areas or villages can, in conjunction with the health boards, help to establish such nursing homes, provide employment and eliminate the waiting lists for the elderly.

Mr. Gallagher

I welcome the Minister, who lives in the same constituency as myself. I welcome the fact that he has been in attendance for a substantial part of the debate because the issues under discussion are extremely serious.

The waiting list initiative, as formulated in 1993, was intended to focus an annual share of the national health allocation on the reduction of waiting lists in respect of two targets. In the case of adults, the initiative was intended to ensure that no adult was on a waiting list for any of the defined specialties for more than 12 months, or in the case of children for more than six months. While the number of people on a waiting list varies at any particular time, the pattern of allocation since 1993 shows that while it is not enough to throw money at a problem to solve it, a problem cannot be solved without the allocation of funding. In that context I welcome the fact that the Minister has increased the allocation for the waiting lists initiative from £8 million this year to £12 million in 1998.

The initiative is extremely good and I compliment Deputy Howlin, who, as Minister for Health, was responsible for its introduction. It is a good idea to withhold part of the budget allocation and tender for bids from hospitals, health boards and health agencies to see what is the best value for money which can be obtained in tackling the waiting lists in specialised areas rather than its being absorbed into the general Health budget. I note the Minister's commitment to continuing the waiting list initiative and I welcome the process of fine tuning he hopes to undertake in the next year.

Since 1993, £58 million has been allocated to the waiting list initiative. With the £12 million allocated in 1998, this represents a special additional allocation of £70 million. It is necessary that this be sustained. The targets set are realistic and they are what the public expects. We should ensure that the money is supplied and that the system is capable of applying it to targeted areas to ensure that the 12 month provision in respect of adults and the six month provision in respect of children are achieved.

There are questions regarding whether I was a member of the Midland Health Board. Perhaps my membership was the shortest of any in the history of the State. However, I agree with colleagues on the opposite side of the House who are members of that health board that the additional allocation for our area in 1998 is welcome. That money will be put to extremely good use in the three general hospitals there.

In the same way as he secured an additional allocation in respect of this waiting list for next year, will the Minister consult the Minister for Finance to see if a Supplementary Estimate or additional funding can be provided to tackle the waiting list for mental handicap services in the midlands and other areas? An additional £7 million has been provided this year, but that is not adequate. Everyone agrees that anyone waiting for a day or residential place should be able to obtain one. Yet each Member can provide examples of cases where such places could not be provided. One of the most effective ways of providing those places is through extending the system of community residences that health boards and voluntary agencies have initiated in the past five years.

The Minister will be aware of a case which has been brought to the attention of a number of public representatives in our area during the past two months. This case involves an old age pensioner who is in very bad health and is trying desperately to find a place for their adult mentally handicapped son. To date the health board has not been able to provide that place. I would like to see all health boards secure an additional allocation and I urge the Minister to see if the Minister for Finance can provide such funding.

The Minister is fully aware of the plight of the elderly, particularly in County Offaly. I am waiting with expectation and confidence to see what allocation will be provided in this area. Work has already begun in respect of Riada House in Tullamore. The Minister has given prompt consideration to the situation in Birr and I hope that these areas will receive good news when the capital allocation is announced.

With regard to the financial allocation for Health, I have already asked the Minister to consult the Minister for Finance to see if additional money can be obtained for the mentally handicapped. Will he also discuss with the Minister for Finance the agreed imposition of extra charges for public users of the health service? A person who does not have a doctor's letter of referral will now be charged £20 instead of £12 and the charge for a public bed has been increased from £20 to £25, with an annual ceiling of £250 instead of £200. I do not believe those charges are justified.

Contributors to the system are mainly PAYE workers who are already paying a health levy of 1.2 per cent. People believe they have already made a contribution towards the public charge for health services and the Minister for Finance should be able to find the money to cancel the announced increase. He had plenty of money to distribute last week to those in our society who are well and who will never be placed on a hospital waiting list because they can afford private healthcare. It is disappointing for the ordinary taxpayer that despite their health contribution and the major money they pay into the system, they are now going to be charged more for the services provided.

The Minister for Health and Children is not a man to hang back when seeking to obtain something and I am confident that if he discusses the issues of the handicapped and the additional hospital charges with the Minister for Finance, Deputy McCreevy, he will be successful.

Ms Leonard

I welcome the Minister. It is my intention to speak in favour of the amendment to the motion. I commend the Minister for his input into last week's budget to ensure that the health services received a greater allocation of funds, £3.6 billion — 11 per cent more than they received last year under the previous Administration. The increased allocation relates particularly to people with disabilities, who have been ignored for too long.

The motion condemns the Minister for Health and Children for not eliminating hospital waiting lists. If the problem were that simple and one person could be blamed, I would support the motion. Unfortunately, things are not as simple as they appear. If we blame the Minister for the waiting lists, we should also blame him for road traffic accidents and the injuries and fatalities from them each year. We could also blame him for the number of people who develop heart disease requiring hospital beds and surgery. However, we must be realistic. As far as I am concerned, this Minister or any other Minister cannot eliminate hospital waiting lists. The bottom line is that we will always have hospital waiting lists and there are a number of reasons for this.

As soon as we take somebody off a list, another person will automatically go on it. That is a fact of life. There have been terrific advances in orthopaedic, plastic and cardiac and neurosurgery in recent years. In my health board area there has been an almost 50 per cent reduction in the waiting list for hip replacements. However, there is a down side. Because of medical advances, we are now performing knee replacement operations, so the list is endless. There will never be a reduction in waiting lists as long as that is the case.

A hospital usually has four theatres and possibly ten to 12 surgeons, but there are only five days in a week. No matter how much money is allocated, we can accommodate only a small number of surgeons. I commend the previous Fianna Fáil administration which allocated a specific amount to waiting lists in June 1993 resulting in a reduction. We can only reduce waiting lists for a short period because they will rise again as soon as the allocation is spent.

There is another reason for the extent of waiting lists. A person may be ready for surgery at 9 a.m. one morning; but if there is a road traffic accident or if a baby is born with a heart condition, those involved will automatically and rightly get priority. Are we to ask the person involved in the road traffic accident to wait because elective surgery has been scheduled?

People undergoing surgery for cardiac problems need specific and specialised nursing care. We must decide where our priorities lie. We have terrific medical and nursing staff and anybody on a waiting list for cardiology treatment is cared for. If a person is on a list, they will receive the relevant treatment while waiting for surgery.

The number on the waiting list in Crumlin Children's Hospital, in which I had a specific interest until recent months, has apparently risen by about 40 in the past year. This increase has perhaps been incorrectly explained by the media in recent months. Part of the reason for the increase in the list for cardiac surgery is that a cardiologist was temporarily assigned to Crumlin Children's Hospital which allowed the review and assessment of children to take place. That did not affect the number awaiting surgery but it meant that those on the list got the best treatment available. Patients receive better treatment if they are diagnosed.

We must reduce the number on waiting lists and that is why I support the amendment to the motion. This is the first time innovative proposals have been made and I commend the Minister in this regard. In 1987, when Fianna Fáil was in Government, tough decisions were made in relation to the health service. Those decisions were not popular at the time but they have led to the improved health service we have today. It does not surprise me that it has taken until the appointment of the Minister to deal with this issue. The Minister has shown a commitment to reducing the waiting lists by allocating £12 million in the budget.

I fully support the idea of hospitals being informed of their allocations early in the year because they can only spend when they know of their allocation. I support the Minister in relation to specialties because it is only when we have a certain amount of money that we can have a real impact. I commend the Minister on bringing forward these proposals. On a more parochial level, I thank him for increasing the allocation to the North-Eastern Health Board, in which I have an interest, from £357,000 to £520,000. I support the amendment.

Mr. O'Dowd

Nobody doubts the Minister's intention to provide a better medical service for all and to reduce waiting lists. There are waiting lists for local hospitals and waiting lists for regional hospitals. I am particularly concerned about national specialties and the cardiac waiting list. I am a member of the North-Eastern Health Board which has no cardiac speciality and, therefore, patients must go to Dublin.

Last week I called to the house of a lady in her forties who is waiting for over 12 months for major heart surgery. This lady has a serious problem with the valves in her heart — it is a rare condition. She has been on the priority waiting list in St. James's Hospital since last February, but that list has not moved. The same number of people, or even more, are on that list now as in February. The surgeon is so busy that he or she can perform only three or four operations per week on people on the public waiting list. If this woman is not on the emergency list, she will not be operated on because the surgeon is unable to perform more surgery. The local hospital is doing its best for her. This lady's mother, who lives with her, spends the night awake listening to hear if she is still breathing. I feel badly that this woman's mother must live under those conditions. There is nothing of which I am aware that the North-Eastern Health Board can do about it.

We have the best cardiac surgeons in the world and they do magnificent work. We need to hold a conference on cardiac waiting lists and meet with the specialists, the health boards and the Minister's staff to come to an arrangement to clear priority waiting lists. It is a disgrace that this waiting list has not moved since last February. At the end of the day, politics and community are about people. In the budget the Government identifies priorities, but people are still waiting for cardiac surgery — the newspapers stated one gentlemen has been waiting six years for surgery.

My comments are not meant as political criticism of the Minister. As a community, we must get together to solve these problems and provide these people with these necessary lifesaving operations now. If we cannot do so with the available resources and existing consultants, let us send the patients abroad or buy in the specialists. That is where the money must go. We must find the money to do it so that people like the lady in Drogheda to whom I referred can lead normal lives, to which they are entitled. Through no fault of her own, or of the surgeon who wants to operate on her, or indeed of the Minister, it is still not happening. That is the core point. The ordinary man in the street would not have objected if the Minister for Finance had allocated an extra £20 million to clear hospital waiting lists. I am not saying that he should not have given it to the GAA, but there would be a much louder hurrah if it went towards the waiting lists.

This is a very caring society. We work as a community, particularly on health matters. I know from the North-Eastern Health Board that this view is held across party lines. People want to arrive at a solution and I think they are entitled to one. I am happy that the Minister is present to listen to what I am saying and I hope something will come of it.

The Minister for Finance put a tax on illness in the budget. He said that people must pay more for a hospital bed and that is wrong. We should adopt different values. The taxpayer is prepared to pay more for essential medical facilities which the State is unable to provide at present. I commend the motion.

Mr. Moylan

I welcome my friend, the Minister for Health and Children, Deputy Cowen, to the House and support the amendment to the motion.

There are, and have always been, hospital waiting lists. The amount of money which would be required to clear those waiting lists would be substantial, but I welcome the way the Minister is setting about it. In his speech he outlined in great detail his proposals to tackle the existing problems.

Senator Tom Hayes referred to the increased hospital charges. Judging by the few occasions on which I had to take people to accident and emergency, I think the Minister is right to take steps to increase the charge by a small amount. It will ensure that people will take minor ailments to their GPs and not block up accident and emergency facilities in hospitals. I have seen people attend accident and emergency units with very minor ailments simply because it was the cheap way out, so I commend the Minister. If we want to address the problems in accident and emergency, people will have to go to their GPs with minor problems. If the GP thinks it is necessary, he or she will send them on to accident and emergency.

I compliment the Minister on the increased allocation to the Midland Health Board and the other health boards. In particular, I, as a member of a health board, welcome his allocation at this time of the year, because in the past we always wondered how much we would receive. At least now we know how much we have to spend; it has been spelt out by the Minister and we must live with it. In addition, we have it on 1 January, not on 1 April or 1 May, as has happened in the past when very severe steps had to be taken to try to balance the budget.

My health board always managed to balance the books in the past and we may have suffered in the long-term as a result. I hope that the Minister and the Minister for Finance might be in a position to help us out over those problems from which we suffered by living within our budget.

The increase in capital funding is necessary. One cannot increase throughput in hospitals with outdated equipment and facilities. The Minister's increased capital funding will set about solving that problem, maybe not this year but over the next couple of years. Some people who are on waiting lists are making unreal demands. People must be reasonable.

Senator Maurice Hayes commented on high tech medicine. People who are in a position to pay or who are covered by medical insurance are going to the high tech hospitals. That is why regional hospitals should have facilities so that staff can carry out these specialist procedures on a regular basis. That will improve the situation in all health board regions.

I know the Minister is well aware of the waiting lists for the aged. I welcome the Minister for Finance's commitment to enable the development and extension of private nursing homes to ensure provision for the aged who are unable to get into private nursing homes or public hospitals, who are on waiting lists or who are creating serious problems at homes where people are unable to look after them. I compliment the Minister on that.

I am in no doubt, having regard to the Minister's outlined criteria for the allocation of waiting list money, that he will ensure a reduction in the waiting lists over the next couple of years. As many speakers said, there will always be waiting lists; but I look forward to those waiting lists being reduced substantially in the future.

I wish the Minister well in his Ministry and look forward to working with him in the Seanad in the future.

Mr. Burke

I congratulate the Minister for Health and Children and wish him the very best of luck in office. No doubt he will do an excellent job and put all his energies into improving the health services for everybody.

I welcome the Minister's statement that he has put in place certain frameworks to reduce the long waiting lists. He has taken steps to ensure hospitals are notified immediately of the exact funding available to them during 1998 to reduce waiting lists. This is a good initiative as it is only right hospitals be made aware well in advance of the funding they will receive so that they can plan ahead. I welcome this. As regards the other aspects, the Minister is mainly juggling with words and is replacing waiting lists with waiting times.

The Fianna Fáil manifesto used the slogan that it would put muscle in the health service. What is needed is more meat.

Mr. Cowen

Off the bone.

Mr. Burke

I welcome the additional funding but one hospital with a long waiting list is Mayo General Hospital. The surgical area has 1,490 people on a waiting list for the past 12 months, the medical section has 480, urology has 400, dermatology has 210, orthopaedic has 2,255 and gynaecology has 215. Those are outpatients. There are 180 inpatients in surgery and 105 in gynaecology. That is only in Mayo General Hospital in Castlebar. I am sure it is the same for all hospitals throughout the country. There is a great need for additional funding and much work must be completed if the amount of time people spend on waiting lists is to be reduced to a reasonable period.

Some £24 million was put in place by the previous Government for the badly needed phase 2 of Mayo General Hospital.

Mr. Cowen

Who told the Senator that?

Mr. Burke

The then Minister for Health, Deputy Noonan.

Mr. T. Hayes

Deputy Ring.

Mr. Burke

The plans are nearly completed and I have no doubt the Minister will give it his full attention. As he is aware, Mayo is not just a county but a region and a good health service and hospital are basic requirements. I wish the Minister well in his portfolio and remind him we need more meat in the health service.

Ms Cox

The Minister is to be congratulated on his prompt action in addressing this issue. Too many people are waiting too long for hospital procedures. It is unacceptable and the Minister knows that. The Government is prepared to do something about it. Some £8 million was allocated to this area in 1997 and a further £12 million has been allocated in 1998, of which £9 million is for general procedures and £3 million is for cardiac surgery.

The Minister has also addressed a number of principles which allow the allocation of funding to make the most impact and that is what the amendment is about. The money is being directed into certain areas. The Minister has concentrated on waiting times as opposed to waiting lists and he has set a target to eliminate waiting times of longer than 12 months for adults and six months for children. This is welcome.

The Western Health Board has received its allocation of waiting list funding and it is extremely grateful for it. It received it earlier than normal and the timing has allowed it continue the work it agreed with the Department in August and to carry out additional work. It is important this precedent be continued and the Minister stated his intention of doing so.

The motion asks if recent initiatives taken by the Minister reduced waiting lists. I can state as a member of the Western Health Board that on 15 August the Minister notified the board of its increased allocation of £600,378. This has allowed it to nearly complete its target of 409 procedures: 150 ENT operations, 159 hip operations and the remainder in other procedures. A reduction of 409 is significant. The Western Health Board has also been allocated £125,000 to address the cardiac services needs in the area. This will remove 50 patients from the open heart surgery waiting lists as they will benefit from angioplasts. The £1.5 million in additional money allocated to the national waiting list means another 50 Western Health Board patients will benefit from the initiative in the open heart surgery area. The 100 patients removed from the waiting lists is another specific example of results and represents a reduction in terms of both the time individuals wait and numbers.

I do not deny this is not enough. It is never right to say to any man or woman needing open heart surgery that they must wait. The Minister knows that and we in this House also know it and we are doing something about it. The 1997 waiting list initiative is a start and the 1998 waiting list initiative is a continuation of it. Like any prudent and far-sighted Minister, Deputy Cowen is commissioning an independent study of this initiative to seek to establish if there is a better way to address this problem and I commend him for that.

Part of the difficulty with waiting lists is that we have an older population which means more people need hip and knee replacements. People are also living longer so a hip replaced 20 years ago is being replaced again and this is an additional challenge. I applaud and commend the Minister for his creative, practical and imaginative initiatives to address the challenge. It will be some time before the impact of his initiatives is felt. I also welcome the cardiac strategy and plan the Minister is putting in place and I remind him of the great and urgent need for cardiac surgery in the west.

Mrs. Jackman

The Minister referred to his predecessor, Deputy Noonan who, I remind him, put capital investment into the midwestern region, Limerick especially, to improve the plant of the regional hospital. The Minister stated we did not provide the same funding as he did, but he should remember that Deputy Noonan concentrated on plant in the first instance. One can have many lists and policies as regards waiting time but, if the plant in which to perform operations does not exist, one is going nowhere.

I suggest the Minister streamlines and uses effectively the resources within the Department to continue the cancer initiative Deputy Noonan started. When different Ministers assume office, they sometimes feel they must plough a new furrow. I have had particular experience of this in education. I hope the Minister continues with Deputy Noonan's initiative on cancer detection and treatment. I also hope he takes on board the women's health document and ensures it reaches fruition.

I would have liked the Minister to address the point that funding would only go to hospitals which showed their waiting lists were caused by excess demand rather than inefficiencies. That may not be the Minister's policy but it appears to be the Department's policy. It penalises patients who happen to be on the waiting lists of hospitals which seem to be inefficient. They would either have to wait longer for treatment or travel to another centre. It is the Government's business to identify inefficiencies rather than compound the problem by withdrawing critical services and I feel extremely strongly about that.

It is easy to make a distinction between lists and waiting times. As of last September some 924 patients have awaited surgery for between three and 12 months at the Regional Hospital, Limerick, and the orthopaedic hospital at Croom, and another 901 patients have waited for more than one year. The Minister said he would examine the lists to see who should be on them and would concentrate on reducing the waiting time. I applaud that. He had a lead-in period and we have the facts until 30 September, but I am interested in what has happened between then and now.

There is no consolation for the people of Limerick and the mid-west region who are awaiting cataract treatment. That is a small operation, not in the same league as cardiac surgery; but 284 people in the region have waited between three and 12 months for such treatment and another 185 have waited for more than a year. Reading is the only pleasure available to some elderly people and if a cataract reduces their ability to read, the problem is extraordinarily immediate because their quality of life has been severely impaired.

The same applies to hip and knee replacements, for which the numbers are also huge for a small hospital like Croom: 59 patients have been awaiting a total hip replacement and 14 a total knee replacement for between three and 12 months; 97 patients have been awaiting a total hip replacement and 32 a total knee replacement for more than a year. Many of these patients write to me to ask how long more they will have to wait.

I applaud the Minister for stating he will adopt a different strategy with health boards, but is he making an inherent criticism of how they have dealt with waiting lists? While it is the responsibility of the chief executive officer or hospital management to achieve targets, the buck stops ultimately with the Minister. What is his attitude to health boards who do not meet those targets? Does he regard that as the problem of the health board chief executive officer or the programme manager rather than his problem? I would have thought it was a co-operative system rather than there being separate health board and ministerial responsibility.

My last point is slightly beyond the context of this motion but there are waiting lists for patients with attention deficit disorder. The Minister should take immediate steps in this regard and I hope he puts in place a pilot programme as soon as possible, preferably in the Mid-Western Health Board region.

Amendment put.

The Seanad divided: Tá, 28; Níl, 16.

Tá

• Bonner, Enda.
• Callanan, Peter.
• Cassidy, Donie.
• Chambers, Frank.
• Cox, Margaret.
• Dardis, John.
• Farrell, Willie.
• Finneran, Michael.
• Fitzgerald, Liam T.
• Fitzgerald, Tom.
• Fitzpatrick, Dermot.
• Gibbons, Jim.
• Hayes, Maurice.
• Keogh, Helen.
• Kett, Tony.
• Kiely, Dan.
• Kiely, Rory.
• Lanigan, Mick.
• Leonard, Ann.
• Lydon, Don.
• McGowan, Patrick.
• Mooney, Paschal.
• Moylan, Pat.
• O'Donovan, Denis.
• Ormonde, Ann.
• Quill, Máirín.
• Ross, Shane.
• Walsh, Jim.

Níl

• Burke, Paddy.
• Caffrey, Ernie.
• Coghlan, Paul.
• Coogan, Fintan.
• Cosgrave, Liam T.
• Cregan, Denis (Dino).
• Doyle, Avril.
• Doyle, Joe.
• Hayes, Tom.
• Henry, Mary.
• Jackman, Mary.
• Manning, Maurice.
• O'Dowd, Fergus.
• O'Meara, Kathleen.
• Ridge, Thére se.
• Taylor-Quinn, Madeleine.

Tellers: Tá, Senators T. Fitzgerald and Keogh; Níl, Senators Burke and Coogan.

Amendment declared carried.

Question, "That the motion, as amended, be agreed to", put and declared carried.