Health Services: Motion.

Mr. Ryan

I move:

That Seanad Éireann, noting with alarm the deteriorating condition of the health services and the failure even to make proper provision for the Government's own health strategy, condemns

(1) the failure of the Government to provide appropriate additional funding to hospitals affected by the winter vomiting virus,

(2) the decision to increase both accident and emergency and drugs refund charges,

(3) the failure to give any real commitment to extend the BreastCheck service to the entire country and

(4) the omission from the programme for Government of the election commitment to end hospital waiting lists in two years.

When the general election was called everybody agreed the health services would probably be the single most important issue in the campaign. This was not my view. The single most important social issue in our society is housing, the lack of which will ultimately do more harm to more people than even our abysmal health service. However, in terms of popular perception and its impact on society, health is the most immediate concern. The health service, therefore, became the most important issue during the campaign.

Coming into the election, the Government was happy to boast about the sums of money it had spent on the health service. Those of us who live in Cork are well aware that the Minster for Health and Children, Deputy Martin, has a penchant for quoting large sums of money to the extent that one would think it was his only task as a Minister. I will turn to what Ministers should be doing in a moment. Perhaps the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, will have more constructive things to do and say than to quote large sums of money.

As the previous Government repeatedly told us for five years, it spent an increasing amount of money on the health service. Having done this, it proceeded to draft a health strategy. My understanding of how to run a business or organisation is that one first produces a business plan or strategy. Once the strategy or plan has been defined and one has identified where one is and where one wants to be, one begins to organise resources to achieve this objective. The approach of the previous Government, however, was entirely perverse in the sense that it constituted a reversal of all logic. Clearly the health strategy was no more than a cobbling together of every good aspiration and intention people from around the country had expressed. It said nothing about the way in which we would get from our then position, which was awful, to where we wanted to be, which was excellent. This is the fundamental problem the Government still faces.

In its amendment the Government admits it will not deliver one of the commitments it trumpeted in the health strategy and during the general election campaign, namely, that it would end waiting lists in two years. The Minister toured the nation announcing that waiting lists would be eliminated within two years of the general election, yet just a few months later the commitment on waiting lists has been dropped and replaced with the commitment in the amendment to make them "a priority".

Having debated the issue of the health services with the Minister on local radio in Cork recently, I already had an inkling of what was in store. During the programme he refused to state that the Government would eliminate waiting lists in two years, instead saying it would do its best and was working towards that objective. This was one of the very few specific, unequivocal commitments the outgoing Government made during the campaign and it dumped it within two months of election day. It is not in the programme for Government, which contains nothing more than the usual aspiration on the matter. We all aspire to have a good health service and it would be a strange politician who aspired to any other kind of health system. The health service no longer needs aspirations, it needs a strategy backed up by the necessary resources.

The topics we identify are ones which we know to be of central importance to ordinary people. The first, for instance, relates to an unforeseeable development which is causing enormous trouble and expense to hospitals around the country, namely, the winter vomiting virus. The Government has announced that no extra funding will be made available to health boards to compensate them for the unavoidable additional costs they incur as a result of the virus, which effectively means that other services will have to suffer.

Last week the Evening Echo published leaked figures which indicated that waiting lists in Cork University Hospital, the flagship hospital of the Southern Health Board, were 26% higher than six months previously. If resources are being consumed by the entirely unexpected outbreaks of the winter vomiting virus and extra resources are not provided to deal with the matter, naturally one will reach a point where hospitals have insufficient funds for treatments.

Money of itself, however, will not solve the problem, given that the management of the health service has been a failure. It is one of the ironies of life that many officials, particularly in the Department of Health and Children and the Department of Finance, constantly seek to introduce performance indicators to the health service, notably through the Health Service Employers Agency. They always start at the grassroots, trying to impose performance indicators on nurses, doctors, orderlies and so on. Good management, however, dictates that in order to transform an organisation, one introduces performance indicators and changes values and attitudes at the top first.

One must get those responsible for managing the health services to accept they are the ones who are accountable. Anybody working in a health board will tell you that when a decision is taken somewhere in its amorphous bureaucracy you can be certain that you will not know who took it. It is not a revolutionary change that every decision taken by the management of something as large and complex as a health service should identify the individual taking responsibility and the circumstances under which that decision was taken. The result of the current mode of operation is perpetual frustration with nobody knowing why some decisions were taken and others were not, while nobody knows who was responsible.

It is into this unaccountable mess that the previous Government pumped billions of euro and, inevitably, did not get what it wanted. That happened for a number of reasons, one of which is that the billions of euro were spread over an extending health service. Every time he gets the chance, the Minister for Finance wonders somewhat plaintively where all the money went and why nothing improved. It seems difficult to get him to read what the Department of Health and Children said about the increased expenditure. The Government had to provide hugely expanded services for children because of the scandalous neglect of child services previously and it had to expand services for people with disabilities, which I acknowledge it did, particularly for those suffering from intellectual disability.

The health service was out on its feet because a bad service was devastated by the cutbacks post-1987 and a huge amount of now vastly more expensive equipment had to be replaced as a matter of urgency. The Government could not understand why all the money it was spending was not doing what it wanted and it was unable to deal with the ineptitude of management in health boards which could not use resources it was given and was not prepared to identify its members as the accountable parties. The absence of a real strategy meant that money was scattered across every area.

We must remember what we know about the health service. The rural GP system is falling apart because young people will not work in single GP practices any more, while the availability of medical cards has dropped dramatically and people are suffering greatly as a result. People on quite small incomes who have to pay out €65 every month are suffering from hardship. We know, because the Minister for Health and Children told me, that the BreastCheck scheme is essentially on the long finger in terms of being extended to the rest of the country. He waffled to me of a two and a half year roll out time in Cork and could not announce when he was going to start planning for that. Presumably, we will have an announcement about the complete roll out of the BreastCheck service before the next election.

The Government has a strategy that cannot be funded, funding that cannot be accounted for and there is no sense in which the needs of the population at large are being dealt within the current health service. The fundamental problem is unwillingness to think this through, inability to manage the health service and the now critical shortage of resources, all of which are responsibilities of the Government for which it must be held accountable. It is the classic example of the deception this Government used to win the last election.

Ms O'Meara

I am proud to second the first Labour Party motion of this Seanad term. In bringing forward this debate on the health service we are, as my colleague has pointed out, attempting to raise the issue of accountability in relation to this important Government responsibility. In particular, I draw attention to the non-extension of the breast cancer screening programme to the remaining parts of the country.

The mid-western region is the one with which I am most familiar and I direct the Minister's attention to the fact that there is major concern about the lack of a breast screening service there. Recently, the mammograph machine at Nenagh General Hospital has been shut down, there are no plans by the health board to replace it and a perfectly good breast and smear clinic has come to an end, leaving the women of north Tipperary without a breast screening service. There is no better example of how not to do things. The Government announced a national screening programme and a timescale for it, then failed to meet its own deadlines and allowed local services people had confidence in to be run down without providing for replacements.

At a public meeting which I called because of the level of concern about this matter, a number of issues came up with regard to the lack of services for women. We have one of the highest rates of breast cancer in Europe, are now in the middle of breast cancer awareness month and we have a failure to roll out the screening service. It is – at the very least – ironic and insulting to switch on the radio every day and hear advertisements exhorting women to use a service which is not available. It is a disgrace and nothing short of a scandal. Speaking to women and their families who have been affected by breast cancer brings home the extent to which this Government is failing a section of women, at least in the community I represent. I do not speak lightly when I say it is a scandal.

In the context of how we are spending national resources on health, I bring to the attention of the House the issue of care for the elderly and the effect of privatisation. Once again, I use examples I am familiar with from my own area and point to the community hospital in Thurles which we were told last year, amid great fanfare, would be upgraded at a cost of several million euro while the number of beds for the elderly would be reduced. In other words, a State facility was winding down the number of beds available to families who could not otherwise manage. There are many families who have elderly parents or relatives and do not have the resources to meet the high cost of nursing home care even with a subvention. I am acquainted with an elderly couple the husband of which supports on a pension his wife who has been in a nursing home for a number of years. No other resources are available to him, the subvention does not simply meet his requirements and he is crucified.

At the same time the number of places in State run facilities is decreasing. As a result people are being forced and, effectively, told to rely on private nursing homes without any recourse to public care. That is creeping privatisation, a development with which I have a major difficulty at a time when private facilities are popping up all over the place and for which there is active Government support. They are not care based facilities but financial arrangements, in effect, financial units run by conglomerates on a commercial basis. We must seriously ask ourselves how we are managing, in particular, elderly care in the community.

I commend the motion to the House for which I ask for support. A high standard of health care and equal access to it are basic rights that currently are not available.

Mr. Glynn

I move amendment No. 1:

To delete all words after "Seanad Éireann" and substitute the following:

– commends the Government's new health strategy which is firmly grounded in the principles of equality, accountability, fairness and people-centredness,

– commends the Government for its unparalleled increases in health funding,

– commends the Government's primary care strategy,

– recognises the Government's specific commitments to expand acute hospital bed capacity,

– commends the Government's commitment to improve accident and emergency services,

– recognises the Government's commitment to enhance cancer-related services, and

– commends the Government's commitment to tackle hospital waiting lists as a priority.

Cuirim fáilte roimh an Aire. I welcome the opportunity to speak to this amendment which affords me and other Members a chance to highlight the successes of this and the previous Government during the past five years.

One can do no better in talking about a service than talk about the service in one's area. I am chairman of the Midland Health Board and I am pleased to say that under the health strategy, which highlights as one of its flagship proposals an increase in the number of beds, the Minister for Foreign Affairs, Deputy Cowen, recently lay the foundation stone for the construction of a new hospital at Tullamore. Next week or the week after a presentation will be made by the architect to the Longford-Westmeath members on the development control plan for the completion of phase 2B of the Longford-Westmeath General Hospital, now known as the Regional Hospital in Mullingar which when completed will increase its bed capacity from 203 to 311, an increase of 108 beds. The number of beds in Tullamore General Hospital will increase by 68. Substantial developments currently taking place in Portlaoise General Hospital will result in an increase in the number of beds in the new paediatric department, the new accident and emergency and new psychiatric units by five beds, respectively, while the medical unit will be refurbished and extended.

I worked as a professional for a number years in St. Loman's Hospital, Mullingar where I had the honour of officially opening a department in recent years. A unit for psychiatry of later life was opened there some months ago. These are only some of the developments taking place.

Various speakers have made points pertaining to waiting lists in recent years. In the period March 2001 to March 2002 there was a reduction of 62% in the number of adults waiting more than 12 months and a reduction of 67% in the number of children waiting more than six months for cardiac surgery. There has been a reduction of 34% in the number of adults waiting more than 12 months for ENT procedures and a reduction of 33% in the number of adults waiting more than 12 months for ophthalmology procedures in the same period. The total number of adults waiting more than 12 months for treatment in target specialties has fallen by 16% in the same period.

Regarding an area that is close to my heart, I recall that when I started to operate a constituency clinic, I shrivelled up when constituents raised the issue of orthodontic treatment. The waiting list in my health board area and other health board areas was unacceptable. However, the following is the current picture. The waiting list in County Longford was eliminated last year and patients currently receive treatment as soon as is needed. This, effectively, represents treatment on demand. The new clinic at Portlaoise General Hospital opened this month and all patients will taken off the waiting list in County Laois by the end of this year. As a result of an increased productivity incentive in place in County Offaly, all patients there will be taken off the waiting list by the end of 2002. New orthodontic clinics will be installed in County Westmeath in Athlone and Mullingar in early 2003. These facilities should enable all patients on the waiting list in the county to start treatment by September 2003, but the improvements do not end there.

We are fortunate to have David Hegarty, a consultant orthodontist who trained in the United Kingdom, who has established training institutions, as a result of which 19 dentists are training as orthodontists to work in the health boards. That is great news for many children and adults, especially those in poorer sections of the community, who could not avail of the orthodontic service due to the shortage of professionals in this field.

Regarding the accident and emergency service, I had the honour of leading a deputation to the Minister for Health and Children yesterday. Comhairle na nOspidéal has approved the appointment of 29 accident and emergency consultants, five of whom will be assigned to the Midland Health Board area. A new accident and emergency unit will be opened in Portlaoise General Hospital and new facilities will be available in the Regional Hospital in Mullingar, which represents good news.

While BreastCheck provides a screening service for members of the female community—

Ms O'Meara

Not entirely.

Mr. Glynn

—we must all be concerned about this area of health because it is everyone's concern. Out of a total of 91,906 women eligible for screening, 68,184 were screened, representing an uptake in the programme of 74%, with 544 cases of cancer detected. This level of uptake in the programme must be welcomed.

In early 2002 a multidisciplinary validation visit was carried out by the European network of reference centres for breast cancer screening charged with external validation of the screen mammography centres. Its report indicates the national breast screening programme is operating to a high level clinically, professionally and organisationally in the screening, diagnosing and treatment of breast cancer.

The Labour Party motion refers to the winter vomiting virus, which, as everyone knows, is highly contagious. The public has a major role to play in this regard. Infection control officers have been appointed in hospitals where there has been an outbreak and, in many instances, such officers were already in place. In the event of an outbreak, members of the public when visiting a hospital, irrespective of its location, should take cognisance of the instructions given by the hospital authorities and, in particular, infection control officers.

Mr. Finucane

I commend the Labour Party motion and support totally what Senator Ryan said. I have been in politics long enough to know that the Government will produce a counter-motion that congratulates throughout. The perception fostered before the election and the current reality are completely different.

While Senator Glynn eulogised the successes in his health board area, I am critical of what is happening in the mid-west. In July 2000 the Mid-Western Health Board made a submission to the Minister for Health and Children for a radiotherapy facility. I understand that Dr. Hollywood has engaged in the production of a report on radiotherapy facilities around the country. Perhaps the Minister of State could clarify if that report is with the Minister – I understand that it is. If so, are we likely to get a radiotherapy facility in the Mid-Western Health Board area? The Caiman-Hine report states that there should be two radiotherapy machines in areas with a population of 280,000 to 300,000. The population in the mid-western region comfortably exceeds that.

Regrettably 1,500 patients are diagnosed with cancer in the Mid-Western Health Board area each year, of which about 750 will need radiotherapy. These facilities are mainly provided in either Dublin or Cork. Many people from the area travel to St. Luke's in Dublin where access to the service takes, on average, seven weeks. A woman with breast cancer who may have the choice of a mastectomy or lumpectomy will, regrettably, often decide on a lumpectomy because of the travel time to Dublin and the length of the wait. That is a criticism of the health service in the mid-western region. There have been good developments in other specialisms such as urology, colorectal and other disciplines. Regrettably, the radiotherapy facility, which is very important for our area, has not been provided. Maybe the Minister will do one good thing this evening and announce that it will be provided. That would give reassurance to a lot of people there.

During the general election campaign I asked an elderly woman in a rural area if I could speak to her daughter. She told me that I could not as her daughter was in bed, suffering from cancer. She asked me to try to get radiotherapy facilities in the area. Those women did not have a car, yet she had to travel to Dublin for treatment. Having to travel 150 miles in an ambulance while already suffering from cancer is poor from a palliative perspective; in many cases it can exacerbate the cancer. A woman with five young children living five miles from the regional hospital told me that she found it a terrible nuisance to have to travel to St. Luke's when she lived so close to the regional hospital.

Radiotherapy treatment in St. Luke's is often given between 5 p.m. and 9 p.m. Not alone do people have to travel great distances but many of them have to stay overnight. If we are to talk of centres of excellence in medicine and proper facilities, rather than eulogising that which was achieved in the past – Senator Glynn lacked credibility – it is important that we have that type of facility.

The difficulty of having the elderly admitted to hospitals under health board control is known in all areas. St. Ida's hospital in Newcastle West was told six years ago that it would be given an Alzheimer's unit with 14 beds. If one has advanced Alzheimer's one cannot be admitted to category one and will not be admitted to either St. Ida's or St. Camillus's. The Taoiseach came to Newcastle West and took the de rigueur look around St. Ida's. Deputy Cowen, when he was Minister for Health and Children, visited St. Ida's, as did the current Minister. The Minister of State, Deputy Callely, visited St. Ida's on his way back from Killarney. Government Ministers need to stop looking at St. Ida's. The figures prove that the unit is needed and €1 would provide it.

Action in those areas would not cost a fortune. How many health board areas have a charity organisation in place like the Mid-Western Hospital Development Trust Limited? It is prepared to fund the installation of the radiotherapy equipment. It only requires a commitment from Government to put it in place. Planning permission has been granted in a dedicated area beside the oncology unit. That would mean more to my area than eulogies. It would demonstrate the tangible commitment of a Minister that cares.

The big, glossy report published before the election spoke of all the marvellous things that were going to happen. Although it said what we would all want, the Government knew the funding was not available. Some of it was Disneyland stuff. Senator Glynn told us that no one in Longford is waiting for orthodontic treatment – good luck to them. Anyone asking a representative from the Mid-Western Health Board region about the type of orthodontic service available would find that there are massive waiting lists. People cannot wait to be treated publicly and they borrow money to pay for private treatment.

I hope the Minister of State will clarify if the Hollywood report on radiotherapy is with the Minister and, if not, when it will be with him. Will we get a radiotherapy unit in Newcastle West? Maybe the Minister of State will come to Newcastle West and we will show him around the hospital.

Minister of State at the Department of Health and Children (Mr. B. Lenihan)

I have no plans to visit Newcastle West. The Senator will be aware that the Minister of State, Deputy Callely, has been assigned special responsibility for the elderly at the Department of Health and Children.

I take this opportunity, on behalf of my colleague the Minister for Health and Children, to set out the current position of the health services. I thank the Senators for their contributions. I welcome Senator Ryan's acknowledgement that the problems in our health service will not be solved by money alone. He also suggested that the electorate had been deceived regarding health policy.

Senator Finucane referred to perceptions created, he maintained, before the recent general election. The perception set out to the people prior to the election was the national health strategy. The Department has developed this strategy to move away from short-term approaches to planning and provide a blueprint for the whole health system that will realise ambitious and wide-ranging change over seven to ten years. That is the policy of the Government in its key priority area of health. The targets in the health strategy are ambitious and they reflect the determination of the Government to deal with this area.

In setting out such a comprehensive and large-scale plan of this nature, it is inevitable that a prioritisation of actions must take place. There is no magic overnight formula for putting right deficiencies in the system. These deficiencies are the legacy of many years of underdevelopment. The strategy represents a step-by-step approach to reducing inequalities in the system and building the necessary capacity to meet the growing needs of the population.

Equity in health care is one of the cardinal principles on which the new health strategy is based and it is also one to which the Government is committed in terms of the implementation of the strategy. The health strategy recognises that access to the health service is just one of the determinants of health status. Efforts to improve access must take place in the context of health-supporting public policies in other areas. That is why the strategy proposes the introduction of health impact assessment as part of the public policy. We will seek to ensure that the statements of strategy and business plans of all relevant Government Departments incorporate an explicit commitment to sustaining and improving health status.

As part of ensuring fair access, the strategy identifies the need to ensure equitable access to services. This is concerned with improved access to hospital services for public patients as well as recognising other barriers, which affect the ability of individuals to access services.

In recent years – I regret that I will have to place information about some of these matters on the record for Senator Ryan's benefit – health was by far the biggest beneficiary of new resources available for public services. Over the past four years, under the guidance of the previous Government, funding of the health service has doubled and the debate on health funding has now moved from resources alone to both resources and reform. The Government is committed to working to protecting Ireland's economic and fiscal position as the key prerequisite to providing the funding required to implement the strategy.

In the current year the Government has invested almost €8.2 billion – £6.4 billion – in the health services, which represents an increase of 134% since 1997. As a percentage of gross national product, health revenue expenditure now stands at 7.8%. This is the highest it has been in almost 20 years. The establishment by Government of a national development plan is the most important event in the development of the health capital infrastructure. The level of funding in 2002 represents a 33% increase on the 2001 outturn. This funding will allow for the continued progression of major projects in the health sector, such as hospitals and community facilities. Every region in the country has had a major investment programme in its health facilities and equipment.

The health strategy acknowledges the central role of primary care in the future development of the health services. A major refocus on primary care services is marked by the introduction of a new model of primary care involving a core interdisciplinary primary care team, which will work with a wider network of health and social care professionals and will offer 24 hour cover. The Government is fully committed to the implementation of the primary care strategy and this is specifically reflected in the programme for Government agreed earlier this year.

Primary Care: A New Direction represents one of the most significant developments to have been proposed for primary care in Ireland. This strategy will shape the development of primary care and policy related to it in the coming years. The key objective of the strategy is to shift the emphasis from our current over-reliance on acute services, such as hospitals, to one-stop-shops where patients will be able to access a team of general practitioners, nurses, physiotherapists, chiropodists, social workers and home helps. This strengthened primary care system will play a more central role as the first and ongoing point of contact for people with the health care system.

Earlier this year a small primary care task force, drawn from the Department and the health boards, was established. In line with the role set out for this group in the strategy, it has responsibility for driving the implementation of the changes and developments set out in the model. A national primary care steering group has also been established. All the key stakeholders are represented on this body which will give guidance on the key elements of the implementation plan. There is also scope for the steering group to have a significant input into the development of the implementation plans. Earlier this month the Minister for Health and Children gave approval to the first ten primary care implementation projects, with funding totalling €8.4 million being provided for this purpose in 2002 and 2003.

These projects will build on the services and resources already in place in the ten locations involved so as to develop a primary care team which will include general practitioners, nurses/midwives, health care assistants, home helps, an occupational therapist, physiotherapist, a social worker and administrative personnel. This is only one of the first steps along the way. The strategy takes a long-term view, looking forward over the next ten years or so. For many reasons it is appropriate that we take an incremental approach to achieving change, rather than trying to transform things overnight. This implementation period recognises that there are major structural changes which must occur in order for the new primary care model to be implemented. It is also necessary to ensure that the required numbers of health professionals are trained and retained in the system over the coming decade and beyond to meet anticipated needs.

We have not always planned in an adequate way for the future human resource needs of the health services, with the result that the number of health professionals available has not kept pace with our needs. Staff planning for the decades ahead, therefore, will be directed at meeting the human resource requirements of primary care on a planned and structured basis.

The single most important limiting factor for admission to hospital is bed availability. In this context a comprehensive review of bed capacity needs has been conducted in conjunction with the Department of Finance and in consultation with the social partners. This review, Acute Hospital Bed Capacity – A National Review, focused primarily on the need to increase bed capacity and to have a strategic framework in place in terms of the number of additional beds required in the short, medium and long term. On foot of this report the Government decided, in the context of the strategy, to provide an additional 3,000 beds in acute hospitals over the next ten years. This represents the largest ever concentrated expansion of acute hospital capacity in Ireland.

Some €65 million capital and revenue funding has been provided in 2002 to put an additional 709 acute beds in place to meet the first phase of a programme to provide a total of 3,000 new acute beds over the next ten years. The Department has been informed by the Eastern Regional Health Authority and the health boards that, to date, 258 of these beds have been commissioned under this initiative. It is expected that in excess of 600 beds will be in use by year end and that the remainder of the 709 beds will be commissioned early in the new year.

Last year, visits to accident and emergency Departments countrywide exceeded 1.2 million, which is equivalent to 3,300 visits per day for each day of the year. A number of significant initiatives have been taken to improve services in accident and emergency departments. A €40.63 million investment package was provided by the previous Government in the winter of 2000-01, aimed at alleviating service pressures and maintaining services to patients, particularly in the acute hospital sector. This investment package provided for the recruitment of an additional 29 accident and emergency consultants and for the contracting of additional private nursing home places for patients whose acute phase of treatment has been completed but who require additional care in an alternative setting.

Other initiatives have been identified in the national health strategy which are designed to improve the operation of accident and emergency departments. These include the establishment of minor injury units to ensure appropriate treatment and management of non-urgent cases; the use of chest pain clinics, respiratory clinics and in-house specialist teams to fast-track patients as appropriate; and the re-organisation of diagnostic services to ensure increased access to, and availability of, services at busy times in accident and emergency departments.

At the request of the Minister, Deputy Martin, Comhairle na nOspidéal undertook a review of the structures, operation and staffing of accident and emergency departments. The report of the review, Report of the Committee on Accident & Emergency Services, examines and makes recommendations on the provision of emergency services in public hospitals in the State. It explores factors that affect efficiency and effectiveness of hospital emergency services and links reform of accident and emergency departments with the need to look critically at hospital processes and patient flows throughout the hospitals. I am confident that its work will contribute significantly to advancing the existing and proposed policy framework for accident and emergency services as set out in the health strategy.

The Minister for Health and Children is committed to ensuring that accident and emergency departments are in a position to respond to the need for their services. I am confident that hospital management and staff in hospitals providing accident and emergency services will continue to work together to respond to any difficulties and to ensure that a high quality service continues to be provided to patients in the best conditions possible.

The statutory charge for attendance at accident and emergency departments increased from €31.70 to €40 on 1 August 2002. This charge is levied only on persons who attend at accident and emergency departments without a referral note from their general practitioner and applies only for the first visit of any episode of care. As well as providing hospitals with a source of income, the charge is important as an incentive towards the appropriate use of accident and emergency departments.

A number of persons are exempt from the accident and emergency charge, including medical card holders, women receiving services in respect of motherhood, children up to the age of six weeks and children referred for treatment from child health clinics and school health examinations. Also exempt from these charges in respect of treatment for the particular condition are children suffering from prescribed diseases, that is, mental handicap, mental illness, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, haemophilia and cerebral palsy. Where exemptions do not apply, the charge may be waived if, in the opinion of the chief executive of the appropriate health board, payment would cause undue hardship.

The drugs payment scheme significantly benefits families who regularly or occasionally are faced with large drug bills. No individual or family has to pay more than €65 per month for prescribed approved drugs and medicines. Any costs over €65 are paid by the State.

The monthly threshold for the drugs payment scheme was increased from 1 August 2002. Although the threshold had not been increased since the scheme's introduction in July 1999, the cost of the scheme had risen by 73%, up from €51.34 million for the last six months of 1999 to €177.6 million for 2001. Approximately 1.15 million persons are now using the scheme as opposed to 699,867 in 1999. The Department of Health and Children considers it reasonable that the contribution by those benefiting from the scheme should reflect that high increase in spending. It has been estimated that the increase in the drugs payment scheme threshold will provide a saving of €7 million from August to December 2002.

Where persons cannot without undue hardship arrange for the provision of medical services for themselves and their dependants they may be entitled to a medical card. Eligibility is a matter for the chief executive officer of the relevant health board to decide.

The SRSV or small round structured virus is a virus that causes gastroenteritis. It is commonly referred to as the "winter vomiting bug" as it is most prominent at that time of year. In common with Ireland, some other European countries are experiencing outbreaks of the virus. This virus can easily spread through person to person contact. It can also be spread through the air, hence it is difficult to contain. Since the illness lasts about two days and is highly infectious the assessment of its prevalence changes constantly. Where outbreaks have occurred, hospitals have put full infection control measures in place in line with best practice guidelines. Hospitals have been co-operating and supporting each other to deliver both emergency and elective services during the recent outbreak.

The national breast screening programme was established in 1998 with the aim of reducing mortality from breast cancer by 20% by screening women in the age group of 50 to 64 years of age. BreastCheck commenced screening in March 2000, with phase one of the programme covering the Eastern Regional Health Authority, Midland Health Board and the North Eastern Health Board areas. The decision to proceed on a phased basis is a reflection of the complexities involved in the screening process. It is essential that the programme is driven by international quality assurance criteria and best practice. To the end of August this year, almost 92,000 women had been called for screening and over 68,000 women had been screened, representing an uptake of 74%. BreastCheck is on target to complete phase one of the programme by December 2002.

The commitment of the Minister and the Department of Health and Children to BreastCheck is evidenced by the significant funding which has been provided for the programme. This year additional funding of €1.5 million was provided to BreastCheck for the continued development of the programme, bringing the total allocation to date to €8.7 million. In addition, the Minister has allocated approximately €6 million for the construction of a new state of the art screening unit at St. Vincent's Hospital. Work is expected to commence shortly on this development.

The Minister is fully committed to the development of quality services to achieve best health outcomes. In relation to the development of cancer services generally, this commitment can be seen in the level of funding provided. Since 1997, over €103 million has been invested in the development of services, well in excess of the £25 million initially envisaged in the cancer strategy. This investment has enabled the funding of 76 additional consultant posts in key areas such as medical oncology, radiology, palliative care, histopathology and haematology. This includes approval for nine new consultant posts with a special interest in breast disease.

In recognition of the need to further develop cancer services, the national health strategy has identified the need for the preparation by the end of this year of a revised implementation plan for the national cancer strategy. The national cancer strategy 2003-2010 is currently being prepared by the national cancer forum in conjunction with the Department of Health and Children. The new strategy will set out the key areas to be targeted for the development of cancer services over the next seven years.

The board of BreastCheck has submitted a business plan for the national expansion of BreastCheck. The total cost of the extension as calculated by BreastCheck is approximately €27 million, including capital costs of €13 million. The annual cost of the current programme is €8.7 million. The Department is in discussions with the executive of BreastCheck in relation to the expansion and especially the linkages with the existing symptomatic services. The Minister is committed to the national expansion of BreastCheck and a decision in relation to this issue will be considered in the context of the overall investment programme in cancer services for 2003.

The health strategy provides a framework for the reform of the acute hospital system and for improved access for public patients. It includes a plan covering the action required to address the issue of waiting lists, particularly waiting times. The target set out in the strategy is that by the end of 2004 no public patient will wait longer than three months for treatment. The programme for Government clearly states that this Government is committed to treating persons within the targets for maximum waiting times as set out in the national health strategy. A sum of €43.8 million has been made available to health agencies in 2002 under the waiting list initiative to support waiting list procedures.

A dedicated national treatment purchase fund has been established to target those waiting longest for treatment by purchasing treatments for public patients in private hospitals. The national treatment purchase fund expects to treat up to 1,900 patients this year. Taken together with the waiting list initiative and bed capacity funding, significant improvements in access to acute hospital care have been achieved this year.

Considerable progress has been made in reducing waiting times for public patients. The total number of persons on public hospital waiting lists at 31 March 2002, the latest date for which figures have been published, was 25,105. The comparable figure for 31 March 2001 was 26,382. This represents a decrease of 5% on the comparable figure for March 2001. The total number of adults waiting for more than 12 months for treatment in the target specialties has decreased by 20% between December 2000 and March 2002.

In the period March 2001 to March 2002 there has been a reduction of 62% in the number of adults waiting more than 12 months for cardiac surgery and a reduction of 67% in the number of children waiting more than six months for cardiac surgery. There has been a reduction of 34% in the number of adults waiting for more than 12 months for ENT procedures and a fall of 33% in the number of adults waiting more than 12 months for ophthalmology procedures in the period March 2001 to March 2002.

Hospital waiting lists must be viewed in a context of a hospital system which discharged 920,000 in-patient and day cases in 2001. That represented an overall increase of 42,000 in the number of discharges or 5% over the figure for 2000. I take this opportunity to salute our hospitals and their staff on the productivity of the system, which is evident in these figures. Day case activity has increased by 10% from 324,000 day case discharges in 2000 to 359,000 day case discharges in 2001.

There has been a rapid movement in the last few years towards day case work. A variety of routine and complex treatments, surgery and diagnostic tests can now be performed with the patient being admitted and discharged from hospital on the same day. The settings for day case work vary from traditional theatres to specially constructed day surgery units and treatment rooms. The ability to carry out day case procedures has increased the efficiency of the hospital system to the extent that half of all elective surgery is now done on a day case basis. Increased use of day case surgery will improve the efficiency of the hospital system, provide speedier access to services for the patient and reduce waiting times.

The Department has set out to regularise and standardise the reporting of waiting lists. There are a number of definitional issues surrounding day case work that need to be addressed to allow consistent and comparative analysis throughout the hospital system. The Department will continue to work closely with health agencies on these issues and hopes to be in a position to publish data on day-care waiting lists and waiting times in the near future.

The acute hospital system is under continuous pressure with regard to many aspects of service delivery. Despite these pressures, the system continues to achieve increased annual output. For example, the total number of persons treated last year in acute hospitals increased by almost 6% over 2000, and represents an extra 48,500 persons treated over last year. This is the biggest ever increase in hospital activity and represents an increase in activity of 17% over the last five years.

Senators may be interested to know that there was a total of 920,000 discharges from acute hospitals last year. This equates to some 2,500 discharges per day for every single day of the year. Comparing the current numbers on hospital in-patient waiting lists to the total number of discharges shows that waiting lists represent less than 3% of all discharges. This will give Senators some idea of the scale of activity taking place in acute hospitals.

I acknowledge the excellent work carried out by all staff in the acute hospital sector, which continues to cater for the increasing demand on its services. The knowledge and expertise of this dedicated workforce in the acute hospital system ensures the system continues to deliver the necessary services for those who need them.

The health strategy is the blueprint for the development of the health services and, especially, the acute hospital system. I do not underestimate the extent of the task ahead, but I am confident that the Government has the necessary commitment to deliver a quality and equitable health system for all.

An Leas-Chathaoirleach

As this is the Minister of State's first time in the House since his appointment, I congratulate him and wish him well in his new post.

Mr. B. Lenihan

Thank you.

Dr. Henry

While I also wish the Minister of State well, he will be hearing from me regularly. I am glad he ended his speech by congratulating those who work in the acute hospitals. Never has there been a greater throughput of activity within these hospitals. What is being done on a day-care basis is amazing, but that is not to say I agree totally with all that is being done in this respect. Many patients could do with the care and comfort of at least one night in a hospital bed, for example, when having a gall bladder removed. Unfortunately, more straightforward operations of this kind are now being done on a day-care basis.

I do not agree with Senator Ryan's statement that the electorate was fooled prior to the last general election with regard to health service expenditure. I watched the Minister for Health and Children, accompanied by the new Secretary General of his Department, as they left the Government meeting in Ballymascanlon. They had presented the new health strategy, yet one could see quite clearly from their faces that the €12 billion sought would not be forthcoming. Anyone who really believed the strategy would be implemented was only fooling himself or herself, although it is a good strategy that should be implemented.

In recent years, there has been an unparalleled level of expenditure on the health service. However, when one looks at health spending levels in other EU member states, we have come from a very low level. If we are not prepared to pay the taxes necessary to support the health service we say we want and the Government is not prepared to levy them, we can only expect what is happening now.

What worries me most is the terrible loss of morale in the health service. I was glad to see that the Minister of State used the word "retain" because one of the biggest problems in the health sector is retaining staff. Despite the fact that there have been wage increases all around, we still have great difficulty in retaining nurses and now have to hire nursing staff from abroad. Worse still, we have a terrible problem in retaining staff during their final five years of service prior to retirement. The number of consultants and senior nurses opting for early retirement is alarming. Early retirement not only represents a loss of personnel but also a loss of expertise because it takes newly appointed staff some time to build up experience.

I cannot say exactly how many who qualified from medical school with me have chosen to retire at 60 years of age rather than 65. Doctors are under appalling stress in this country, which has higher levels of litigation than anywhere else in the world. Medical personnel do not deserve this.

I am a member of the board of the Rotunda Hospital and can say Irish midwifery services are second to none. Our maternal mortality rate is among the lowest in the world, even accounting for the fact that in recent years pregnant asylum seekers and refugees, who have had no ante-natal care, have given birth shortly after their arrival here.

It costs €50,000 to insure a midwife working in a labour ward, yet what proportion of the health service's budget goes towards these major costs? I do not know what health boards have to pay to insure their personnel, but it amounts to a considerable sum. We must examine our compensation culture to see how much money is being taken out of the health service. Claims arising from medical treatment are causing great concern internationally.

We should do more to ensure health service workers are not unnecessarily tired. We know that errors occur more frequently when staff become tired. Recently, I read a worrying report by a Ms Hilary Coates at the department of health and science at the Royal College of Surgeons. She extrapolated figures from American statistics in a survey that considered clinical errors which led to patients' deaths. Ms Coates's figures indicated there could be as many as 90 Irish patient deaths due to clinical errors, the vast majority of which were made when staff were working overlong hours. We know, for example, that mistakes can be made in prescribing drugs. I cannot say whether Ms Coates's figures are correct, but they are worrying. Perhaps the Department of Health and Children could look into the report. The surveys quoted from America were carried out in Colorado and Utah. The report stated there was a 2.9% occurrence of error due to treatment, 53% of which were said to be preventable.

At the same time the 17 October issue of the New England Journal of Medicine has been addressing the issue of fatigue among clinicians and the safety of patients. I suggest to the Minister of State that this publication is well worth reading. Morale among hospital workers is low and needs to be addressed. It is not entirely the fault of the Department of Health and Children, but only the Department can ensure the position is improved upon.

I do not know if the Department is aware of the fact that it is becoming impossible to replace general practitioners in the more deprived areas of our cities. It is proving impossible to get people to take jobs from general medical service lists. It has proved impossible, for example, to find a replacement for an excellent practice run by a husband and wife team in Ballyfermot. Something will have to be done to improve eligibility levels for patients in the general medical services scheme because many who are not really in a position to pay for health care are having to do so with difficulty.

The expansion of the number of acute beds is an excellent development, but, unfortunately, people seem to gloss over the fact that while beds may be available, there are no staff to service them. This still presents a major problem. The fact there are new facilities does not mean they can be provided because it may not be possible to recruit the necessary staff.

It is a pity there is not better co-ordination within the health service to move patients who should not be in acute beds to step-down facilities. I am aware that the Department is doing something about this, but every week one reads about patients who have spent months in hospital, when they really should not be there, because there are no step-down facilities available for them.

The Minister of State devoted part of his speech to hospital accident and emergency services which have been abused by people who should have gone to their general practitioners instead. The planned one-stop-shops represent a very good idea. It will take quite an effort to promote them, however, because it has proved difficult to get them going in the United Kingdom. It may, therefore, take quite some time before we are in a position to see changes taking place due to their introduction.

A dispute has been ongoing for years with the Department of Health and Children over the recognition of those eligible to be considered as chiropodists or podiatrists. That is to be resolved. I want to point out another area where the lack of these sorts of paramedical people makes such a dent in the finances. There is no foot clinic in St. James's Hospital but there is a huge diabetic clinic. The hospital has no chiropodist at present; someone comes in occasionally. Last year they had to admit 30 patients with foot ulcers. The average stay in hospital was 30 days. Eight lost their legs. They reckon it cost €1 million. Surely one could run a foot clinic for less than €1 million.

A Leas-Chathaoirligh, you are indicating my time is up when I have many more issues to raise, but I will finish with two important points. The Minister wants to produce 29 new accident and emergency consultants. That is a very good idea, but before this comes to fruition some sort of agreement must be made with these consultants about staffing the place on longer than a nine-to-five basis.

I strongly support all those who said something must be done about radiotherapy services. Recently I wrote to a constituent in Wexford about his wife, who has breast cancer and whom I had seen in the summer when she had chemotherapy. The reply I received thanked me for my remarks about the patient. He stated that she is doing well but we must surely get a radiotherapy unit in Waterford, and that trying to get into St. Luke's is a nightmare. He stated that she was hoping to commence radiotherapy two weeks previously, but he rang, the day before he wrote this letter to which I refer, to be told there were 22 people on the waiting list before her for this treatment, and that she will be at least another two weeks waiting. What difference is that making to her survival chances?

It is all very well talking about setting up centres of excellence around the country, but it is only theoretical unless we actually put in place the physical units which are needed. There are two only and that really will not do.

Ms Feeney

I welcome the Minister of State, Deputy O'Dea, to the House.

I want to share with my colleagues in the House two reports, People Living In Tallaght And Their Health and People Living In The Dublin Docklands And Their Health, which I have had an opportunity to read over the past couple of days. They have been prepared by the Adelaide Hospital Society and by the Department of Community Health and General Practice in Trinity College. The docklands, as the House will be aware, covers the regions of Pearse Street, Ringsend and Irishtown.

I was so surprised at what I read. In the Tallaght report, there were 420 houses and 1,300 people surveyed. Of these, 49 households had one person on a waiting list and three households had two people on a waiting list. Of 699 people surveyed in the docklands report, 26 – the equivalent of about 3.7% – were on a waiting list and only two of those were on a waiting list for over 12 months. Therefore, I am not convinced, by what I have read in those excellent reports, that the magnitude of the waiting list would be as Senator Ryan stated and I would gladly allow him look at them.

The Minister of State, Deputy Lenihan, spoke about the primary care strategy and, like him, I welcome this strategy. I acknowledge the good work being done by the general practitioners, not only by those who practise today but by those who practised in years gone by at a time when there were few resources and they worked from early morning until late at night.

Everybody here will remember the general practitioner living at the end of their road or around the corner who was a friend to one and all. However, the health environment is changing and moving at a pace where general practitioners are coming into a system that will find them working as part of a multi-disciplinary team. This was also pointed out by the Minister of State, Deputy Lenihan.

The primary care strategy will be a big challenge for us all. It will involve not alone commitment from the medics, but also commitment and involvement from all the local communities. Here we will see a wide range of services, all under one roof, being brought into the communities for the first time and away from a hospital setting. We will find routine minor surgery being carried out, together with services for the elderly. All of this is being brought nearer the patient in a one-stop approach. This, in my opinion, will prove very popular with patients as they will be familiar with staff and with their settings. In many cases, it will cut out a great deal of unnecessary travelling to the hospital in the next town.

This also involves an economy of scale. Patients will make very good use of services that will be provided to them. The potential is limitless in providing these services for local people. I would hope it would expand to a point where we would see consultants like paediatricians and geriatricians coming from local hospitals. I would like to think that they would be allowed conduct out-patient clinics from the health centres.

Recently I was interested to read evidence from an international study carried out by Professor Barbara Starfield from a teaching hospital in Baltimore. She stated that if you spend on primary care, you spend less on secondary care. As we all know how expensive hospital care is, that does not need any qualification.

I welcome the conference in Galway over the next two days into the primary care strategy. Mr. Michael Kelly, the Secretary General of the Department of Health and Children, gave a very strong commitment on the primary care strategy stating, "It's the only show in town." The Government is positively committed to the primary care strategy and believes it must be rooted in the community. We must find out what the people want. They will not buy into change unless they are part of it. This can be achieved if we can bring the profession and the local community on board.

A moment ago, I welcomed the Minister of State, Deputy O'Dea, and now I welcome a fellow Offaly man, the Minister of State, Deputy Parlon, to the House.

Mr. Feighan

I also welcome the Minister of State, Deputy Parlon.

I welcome this motion noting the deteriorating health service. It is wrong to state that the Government's health strategy is a success. It has deteriorated since the general election.

I live in a small town in the west of Ireland. Last Thursday I left the Seanad to drive home, like most Senators do. I went to an arts auction, 10% of the proceeds of which were donated to the Marie Keating Foundation. I then realised that there was no BreastCheck service in the west of Ireland. The auction was a great occasion. I was very impressed that this brilliant foundation was trying to provide the much needed service. The foundation has three fully-fitted mobile information awareness units, but surely this is a service which should be provided by the Department of Health and Children, not only in the North Eastern Health Board, the Midlands Health Board and the Eastern Regional Health Authority, but nationally. Irish women, especially those living in the west, are more likely to die of breast cancer than their counterparts in the east of Ireland or, indeed, in continental Europe.

We were promised a comprehensive health strategy to end waiting lists. This promise lacks credibility. I acknowledge that the Government has tackled the problem. I was glad to hear last year that the number on the waiting lists fell from 31,000 to 26,000, but this is little consolation to someone who has been told he is No. 26,000 on the list.

The Plunkett Home in Boyle looks after elderly people very successful. However, the town went without a physiotherapist for a full year because the Western Health Board could not recruit one who was willing to locate there. As a result, many hundreds of people went without primary care and physiotherapy.

We have a two-tier health service. The poorest, who have the greatest need of health care, often get the worst deal. Morale in the health service is at an all-time low. The Government pumps millions of euro into the health service but this is merely throwing money at the problem. Preventative care and health awareness are vital, but in my town we do not even have a leisure centre. Surely leisure activity should be the responsibility of the health service and should not be left to the education and other services?

Over-indulgence in alcohol and tobacco is creating a burden on the health service and these problems must be tackled. Last year we were told that 200 jobs must be cut in the Western Health Board. This is not the way to provide the care essential to a good health service. These staff cuts have affected the processing of medical cards and other essential services in the health service of which we are all part.

Mr. Kitt

I join in welcoming the Minister of State, Deputy Parlon, to the House. It is important to have the Minister of State with responsibility for the Office of Public Works in the House when we are discussing hospital building and development.

I am glad extra funding has been provided for the health service this year. As the Minister of State, Deputy Lenihan, said, health is the biggest area of extra funding this year. The Western Health Board has been given 15% extra funding for 2002, or 20% if one includes the funding for the health board's takeover of Portiuncula Hospital in Ballinasloe. There has been considerable development in Ballinasloe. When the Franciscan sisters decided two years ago to extend the hospital, the Government provided £6 million for that project. The Government has provided a further £11 million for the purchase of the hospital. Portiuncula Hospital will now be a public hospital and will not be sold into private hands, as many people feared. The decision to purchase the hospital in Ballinasloe was a good one. It will serve the western region and much of the midlands.

The Western Health Board has also purchased the Bon Secours Hospital in Tuam and this hospital will remain in public ownership. The programme for the Tuam hospital campus has gone to Government in the last few weeks and I hope the Minister for Health will look favourably at the proposal to have a first class health campus, including a good community hospital and other services which are needed in the north Galway and south Roscommon area, in Tuam. I have a particular interest in this hospital because my brothers and sisters and I were born there, as were many of the people of north Galway.

The issue of bed availability which was raised by the Minister of State, Deputy Lenihan, is important. The Minister of State mentioned the provision of 3,000 beds in the next ten years. We have a problem in Galway regarding step-down accommodation. In County Mayo, there are several small district hospitals but Galway, the biggest county in the west and the second biggest in Ireland, is in need of more step-down accommodation. Patients who are recovering from operations are not in a position to go home and need nursing care. Small community hospitals are ideal for this type of service.

There are considerable problems in the maternity section of University College Hospital in Galway and there are similar problems in Ballinasloe. Many asylum seekers, who arrive in Ireland after horrific treatment in the countries they have left and traumatic journeys, see a doctor for the first time when they are about to give birth. Hospitals need extra resources to deal with this issue. I ask the Minister to look at the situation in Galway where there were 300 births to asylum seekers in the first nine months of this year. Extra funding is required for the maternity unit in Galway.

I commend the community care service. As recently as five or six years ago home helps were paid a miserable £1 per hour. They are now paid €9 per hour. This is an important and welcome development. The general practitioner service gives excellent value for money, often in multi-disciplinary and multi-functional units. It is difficult to replace GPs or to provide temporary locum cover in many areas and this problem must be addressed. The community care service does excellent work and gives excellent value for money.

Alcohol and drug abuse is a serious health issue. At a conference arranged by the Western Health Board which I attended last Friday, a speaker mentioned that only 6% of the population are teetotallers, the lowest ever figure in the history of the State. Reference was made to the fact that binge drinking is now the order of the day for young people. Smirnoff Ice and Bacardi Breezers are now available on draught and little concoctions, which are up to 45% proof, are added to drinks. Opening and closing times of public houses are not significant factors in the problem. Abuse of alcohol and binge drinking are dangers which must be highlighted. The Government must examine this problem, which will lead to serious health problems in the future.

I am glad the Government's health strategy is sound. It is based on equity and fairness and is people-centred. In Galway, for the first time, we now have cancer, neurosurgery and other services. I hope the people of the west will have these services in their region and will not have to travel to Cork or Dublin, as they must do at present.

Ms Tuffy

I thank the Minister of State for coming to the House for this debate. I support the comments of my Labour Party colleagues and the Fine Gael Members. I remind Members of the Labour Party proposals which were ridiculed by members of the Government parties during the general election, but which are still relevant and vital.

In light of cutbacks, increased charges and people dying on waiting lists, it is madness to put aside 1% of GNP for the pensions reserve fund. The Labour Party proposes that part of this money be invested in the delivery of health infrastructure now. This investment would benefit pensioners now and in the future because they would have a proper health service. It would also save money in the long term because, if investment in our health infrastructure is continually cut back and put off, the money to meet the burden of tackling the needs of the health service will have to come from the tax revenues of the future. This will be at a higher cost and make the pension reserve meaningless in terms of its future value.

Crisis management measures such as the treatment purchase scheme do not solve the long-term problems in the health service and perpetuate inequality. The Labour Party proposed in its health policy radical reform of the structure of the health service to ensure efficiency and eliminate injustice. The top rate of tax was cut in the last budget, benefiting the well-off most. This was insisted on by the Government, in particular by the the Progressive Democrats, the party of the Minister for State, Deputy Parlon. It was immoral, especially so in the light of the Government's failure to fully address the needs of the health service. People have died and will die on waiting lists because of this type of immorality.

Mr. Scanlon

I welcome the Minister of State to the House. Before the last general election, if one was to believe the newspapers, one would have thought that every hospital in the country was closing down. As a member of the North Western Health Board, I wish to put some facts before the House on the improvements that have taken place in the health board with which I am most familiar.

In 2001 the North Western Health Board received £283 million to run the service while in 2002 it received £322 million, an increase of £40 million in one health board area or €50 million. I recognise that there are waiting lists. However, if a person walks out of this House and is hit by a car, an ambulance will be at the scene in ten or 15 minutes. The person concerned will be taken to a hospital and looked after better than anywhere else in the world. While those with private insurance are receiving treatment, I admit that there are waiting lists.

In my health board area in 2000, 1,004 were waiting for ear, nose and throat treatment, but by July 2002 this figure had been reduced to 243. Some 76 people were waiting for gynaecological treatment, but by July 2002 this figure was down to 17. For orthopaedic treatment, the figure was 211 in December 2000 while in July 2002 it was 116. The orthodontic service is a problem all over the country because health boards cannot get orthodontists to do the work as they are not available. Some 400 people were on waiting lists in December 2001 but this figure had been reduced to 150 in July 2002. The health board has just received €282,000 under the private purchase scheme and I am told that another 100 people will be treated this year under the scheme.

Nine new consultants have been appointed in the last three years while one of the most modern oncology wards has been provided at Sligo General Hospital. I recently spoke to a man who suffers from cancer and is attending the ward, which has only been open for the past 12 months. Before that, he had to travel to Dublin to receive treatment which he can now have in Sligo. He is at home with his family and can continue to work, even though it is on a short-time basis. Two years ago this would not have been possible. It is a real improvement.

There is a new day-surgery ward at Sligo General Hospital which, as Senator Henry said, is the way forward. While I accept that not every procedure can be carried out on one day, it has led to major improvements in waiting lists. Senator O'Meara said she was not happy with health boards taking beds in private nursing homes. My father is currently in one of those beds and I have not known him to receive anything but the best treatment. Anyone suffering from cancer should not have to wait because to have the disease is traumatic enough without that. The service should be improved as quickly as possible.

Mr. Bannon

I welcome the Minister of State to the House and compliment the Labour Party on tabling this important motion. Some of my colleagues on the far side of the House are not living in the real Ireland where there is much anger vented against Government politicians for the manner in which they have made reductions in health services. Since the Government took office it has reneged on pre-election promises not to introduce health cuts. Many health board bosses are concerned that they are being forced to sacrifice jobs in order to comply with demands from the Minister for Health and Children to make savings.

The most vulnerable are being targeted, such as clerical and administrative workers whose contracts began less than 12 months ago in the run-up to the general election. In most cases, they have not acquired any employment rights. The Government is foolish to think that, at the stroke of a pen, it can take away 800 administrative jobs without an impact on services. Every health board worker is either providing a front-line service or fulfilling essential support functions. Patients will be affected because essential health care embraces a team approach.

The loss of key personnel, such as ward clerks and secretaries, will have a serious effect on patients. The people concerned are a part of teams which get patients ready for surgery by ensuring charts and x-rays arrive in the operating theatre with the patient. Will this part of the team service no longer be available? Will nurses and junior hospital doctors be diverted from direct patient care to take on secretarial work? Will doctors and nurses have to look after clerical work in busy surgical wards in acute hospitals? They are under enough stress and cope with enough demands as it is.

Earlier this year in the North Eastern Health Board area there were cases where elective surgery in the region had to be severely curtailed. I am amazed by the magic figures for waiting lists that my colleague Senator Glynn provided for counties Longford and Westmeath and wonder where he got them.

Mr. Glynn

The figures are available.

Mr. Bannon

Senator Glynn and I met a deputation which came to the House yesterday to meet the Minister for Health and Children with regard to getting extra consultants and shortening the waiting lists in the midlands.

Many people due to have hip replacements have to wait longer. This has a consequent knock-on effect on those originally earmarked for surgery later this year. Despite what has been said by the Minister of State, waiting lists are lengthening in every health board region. Where does this leave the much hyped national health strategy document? Would the money and effort that went into it not have been better spent on continuing to employ essential staff? Not in the Government's view, but it is the opinion of many that this much hyped document was only part one of the famous Fianna Fáil manifesto.

The electorate has been completely betrayed by the Government. Following the general election in May, shortly after being reappointed Minister for Health and Children, Deputy Martin approved an 18% increase in VHI charges effective from 1 September 2002, the largest rise in the history of the State which puts an extra €65 annually to the cost of a plan B scheme. The Minister then announced an increase in charges for patients attending accident and emergency units without a doctor's letter, and changes in the drug refund scheme. Research funding was withheld or curtailed for new trainees in important areas of the health service. In recent weeks – though only when he was caught out – the Minister withdrew a circular covering payments to some parents of disabled children. I am particularly concerned that orthopaedic vascular surgery and older people's services will be prime targets for the next round of cuts.

The people are very angry, and rightly so. They were lied to in the run-up to the general election when Ministers denied health cuts were being planned. The Government must rethink its cuts strategy or the health service will be in a shambles. Service plans in most health boards have been snookered by the Government. Cuts will affect services and the most vulnerable will suffer.

I call on the Minister, Deputy Martin, to re-examine his party's election manifesto and to take responsibility for a policy that is bound to damage health services throughout the country. His Government's approach flies in the face of its pre-election promises and the national health strategy. Senator Glynn referred to services and infrastructure in the Mullingar area. A building constructed over seven years ago has not yet been fitted out.

Mr. Glynn

It is sitting idle.

Mr. Bannon

I ask the chairman of the Midland Health Board to do what he can to progress this important development in Mullingar in the interests of the people of counties Longford and Westmeath.

Mr. Glynn

The Senator had full knowledge of the development.

Mr. Bannon

When he was Minister for Health, Deputy Noonan turned the sod on the building, but very little has happened since.

Mr. Glynn

He did not deliver.

Mr. Bannon

The people of counties Longford and Westmeath, who are represented by Senator Glynn and me, would appreciate immediate and serious action on Mullingar General Hospital.

Mr. Cummins

The Minister of State was not in the House when Senator Henry read a letter sent to her from a patient in County Wexford who needs radiotherapy treatment. The woman in question was told that she would have to wait 22 weeks to be seen at St. Luke's Hospital. I am from Waterford, the capital of the south east region which has a population of over 450,000. Seriously ill people in any region should not have to wait 22 weeks for radiotherapy, especially as national best practice guidelines recommend that such treatment should be given within ten weeks of an operation, as to do otherwise would diminish its effects. This Government is presiding over a health service that cannot meet national guidelines.

Before this year's election, all three Fianna Fáil candidates in Waterford gave an undertaking that Waterford Regional Hospital would have a radiotherapy unit within three years. If that is to happen, however, building work would have to start in the first quarter of 2003. I sincerely hope that this election promise will be met. The Minister for Health and Children, Deputy Martin, is hiding behind the promised publication of a consultants' report. We were told over 12 months ago that the report was imminent, but we have yet to see it.

The Labour Party's motion refers to increases in medical charges which were not flagged prior to the election. The need to extend the BreastCheck programme, at a cost of €27 million over four years, is also mentioned in the motion and I hope it will become a Government priority. The report of an expert group in this area has been received and I hope it will be acted upon as the BreastCheck programme has been proven to save lives. People will not accept "No" as an answer in this instance. The motion also refers to the election promise to end hospital waiting lists within two years, which has been omitted from the programme for Government. The Government seems to be rich on promises, but slow to deliver. Eligibility limits for medical cards have not been increased for many years. I call on the Minister to rectify the matter in the forthcoming budget as people on low incomes, many of whom are hardship cases, are ineligible. Many parents deprive themselves to be able to afford to bring their children to a doctor for much needed care. I could mention many other inequities in our health service.

Many speakers complimented the dedicated staff of hospitals and I would also like to mention the tremendous work done by nurses and doctors under difficult circumstances. I could speak about the inadequacies in the health service for a long time. I have mentioned some of them, but cancer care, particularly radiotherapy treatment, is the area the Government will have to prioritise. The Government has to deliver the regionalisation of radiotherapy services and I urge the Minister of State to bring my message to the Minister, Deputy Martin.

The Minister for Health and Children has finally agreed to meet a deputation from Waterford City Council in November to discuss the radiotherapy issue, after initially refusing on the ground that he could not find time for weeks or months. Elected representatives from Waterford had to threaten to picket this House before they were granted a meeting to discuss this important issue. This a matter of great concern not only in the south east, but in every other part of Ireland that does not have radiotherapy facilities.

Mr. Ryan

There are two approaches I could take in response to this debate. If I were to attempt to respond to the arguments from the Government side, I would have to conclude immediately as I heard nothing that I did not know already. The Government Senators seem to have become clones of the Minister, Deputy Martin, as they spout statistics in large amounts. Anyone who has followed the health service debate in the last two years is already familiar with the statistics we have heard tonight because Deputy Martin has a button on the back of his head which he presses to make them come out.

We are tired of the statistics as the real issue to be discussed is where the money is going. If so much money has been spent, why have we not seen improvements? In fairness, the Minister for Finance keeps asking this question. The first answer I would suggest is that the service is not improving because we are trying to run a health service on the cheap. Civilised countries spend 10% of GDP on their health services, but we only spend 7.8% of GNP. As our GDP is higher than our GNP, we are spending 40% less than should be the case. Let us remember that Ireland is not the béal bocht country of 50 years ago; it is the third richest country in the world and liable to become the second richest at current projected growth rates. This country has a bad health service because a political decision was taken to keep our health service bad while other priorities took over in the last five years. The first of these decisions was to have an orgy of tax cuts for those who did not need them, like myself.

Mr. Moylan

Give it back.

Mr. Ryan

Nobody in the last Government was capable of thinking in new terms. The Labour Party suggested that the country should follow the French health service model, which is the most successful in the world. The Government decided to build on our system, which was not working, so now we have a larger system that still does not work.

Fundamentally, we can afford the resources needed by the health service. Senator Tuffy spoke of the illogical idiocy of borrowing money to place it in a pension fund where its value is reducing. Special savings accounts are taking between €500 million and €600 million from the State coffers each year. I will not mention the other sources of revenue that could have been used, but which are being wasted elsewhere. This country does not have a financial crisis, it has a political crisis caused by a Government transfixed by its own obsession with cutting tax. It does not know what to do as it has never thought about what will happen. Its fundamental strategy is challenged and it is now running around bewildered.

The model is there, all over much maligned Europe – I am reminded of the Tánaiste's famous reference to Boston and Berlin. It exists in Germany, the Netherlands, Scandinavia and France; they all have decent health services. Only rich Ireland, richer than any of them, thinks it cannot afford to give its people a decent health service. The fundamental problem is that the Government is convinced that we cannot afford to do it. As a person of the European social democratic tradition, I know that we can do it, but the lack of political will is the problem.

I cannot finish without pointing out the gobbledygook thrown out by the Department of Health and Children. The Minister stated, concerning the drugs payment scheme, that "the cost of the scheme had risen by 73%, up from €51.34 million for the last six months of 1999 to €177.6 million for 2001." It is a wonderful trick in statistical manipulation to quote the expenditure for half a year and then compare it to the expenditure for a whole year, bedazzling people with figures. It represents a 70% increase year on year.

For the Department of Health and Children, the scandal is that 1.15 million people used the scheme instead of roughly 700,000 in 1999. The way this is written one would think there was something wrong with this. An otherwise very intelligent man, the Minister of State stated the Department "considers it reasonable that the contribution by those benefiting from the scheme should reflect that high increase in spending." Why? Why should the fact that it costs more mean that people should pay more for it, given that most of the increase in spending is caused by the fact that more people are using it? Why are more people using it? Because the number entitled to medical cards has been reduced by 30% in five years. The Department penalises the people concerned for being sick.

Mr. Glynn

They are employed now. Did the Senator know that? They are working men. Some should write to the Senator and tell him.

Mr. Ryan

When it came to a general election, the people in County Westmeath knew who to vote for, and it was not Senator Glynn but Deputy Willie Penrose who told the people the truth – that they were getting a bad health service.

Mr. Glynn

I did not run in the general election. I enjoyed success in another election.

Mr. Ryan

They did not listen to the Senator, they listened to Willie Penrose.

An Cathaoirleach

It is Deputy Penrose.

Mr. Ryan

I apologise. I remember the Cathaoirleach's letter and apologise.

Mr. Glynn

The Senator should not forget next time.

Mr. Ryan

I am intrigued by Senator Glynn telling me I should not forget next time. That is classic Fianna Fáil – forget the future. Fianna Fáil wants to forget its past and the promises made before the general election, all of which will be broken because it lacks the will and ideology to deliver the public services this country needs.

Amendment put.

The Seanad divided: Tá, 27; Níl, 21.

Tá

Brady, Cyprian.
Brennan, Michael.
Cox, Margaret.
Daly, Brendan.
Dooley, Timmy.
Feeney, Geraldine.
Fitzgerald, Liam.
Glynn, Camillus.
Hanafin, John.
Kenneally, Brendan.
Kitt, Michael P.
Lydon, Don.
MacSharry, Marc.
Mansergh, Martin.
Minihan, John.
Mooney, Paschal C.
Morrisey, Tom.
Moylan, Pat.
O'Brien, Francis.
Ó Murchú, Labhrás.
Ormonde, Ann.
Phelan, Kieran.
Scanlon, Eamon.
Walsh, Jim.
Walsh, Kate.
White, Mary M.
Wilson, Diarmuid.

Níl

Bannon, James.
Bradford, Paul.
Burke, Paddy.
Burke, Ulick.
Coghlan, Paul.
Coonan, Noel.
Cummins, Maurice.
Feighan, Frank.
Finucane, Michael.
Hayes, Brian.
Henry, Mary.
Higgins, Jim.
McHugh, Joe.
Norris, David.
O'Meara, Kathleen.
O'Toole, Joe.
Phelan, John.
Ross, Shane.
Ryan, Brendan.
Terry, Sheila.
Tuffy, Joanna.

Tellers: Tá, Senators Moylan and Minihan; Níl, Senators Ryan and O'Meara.

Amendment declared carried.

Motion, as amended, put and declared carried.

An Cathaoirleach

When is it proposed to sit again?

Mr. Glynn

Ar 10.30 a.m. amárach.

Seanad Éireann debate - Wednesday, 23 Oct 2002

Health Services: Motion.

An Leas-Chathaoirleach

Tá

Níl

Seanad Éireann debate -
Wednesday, 23 Oct 2002