Before Question Time I was dealing with the reduction of £26 million in the allocation to the various health boards. The South-Eastern Health Board, which serves my area, have had their allocation reduced by £3.6 million in 1984. They had major problems in 1983 trying to achieve savings, and what was the result? A further reduction of £3.6 million in 1984. The Minister has said that there will be no job losses in this exercise, but even he must know that it is impossible to achieve savings of this magnitude without job losses. We in the south-east managed to achieve a cutback of £1.5 million this year on the non-pay side by a number of sleight-of-hand exercises which the Minister saw fit to criticise on a radio programme one Sunday. I noticed that neither the Minister nor Minister of State is here and I presume that the Minister for Agriculture is standing in.
Estimates 1984. - Vote 47: Health (Revised Estimate) (Resumed).
I know as much about it as the Deputy does.
So I gather.
Were we not on the same board for years?
Let me explain to the Minister for Agriculture then what we in the south-east did eventually after he left us. We achieved savings of £1.5 million on the non-pay side by an accounting exercise which saw the board reduce their estimate of inflation from 9 per cent to 5 per cent. This allowed the board officials to reduce projected expenditure by £900,000 while a further £140,000 will be saved on building and other maintenance work. Do not forget that in 1982 and 1983 we have already cut back on maintenance work with the result that some of our buildings may be beyond the point of no return in relation to maintenance. It is a case of penny wise pound foolish because eventual maintenance costs will be so much greater as a result of this shortsighted exercise on the part of the Minister. However, the Minister need not worry about that because probably he will not be around to pick up the pieces. We hope also to save £100,000 by energy cost conservation. After all that, we still must save an additional £2 million and in spite of what the Department of Health say, this can be achieved only by job losses and redundancies. The Minister knows it, the Department know it, but they expect the South-Eastern Health Board and the other health boards to do their dirty work for them. Let me assure the Minister for Health and the Department that the south-east will not do their dirty work as long as I am a member of that board.
Let us have a look at some of the cutbacks in relation to other regions. The Midland Health Board will have to make cutbacks in excess of £2 million to stay within their reduced financial allocation for this year. Their CEO, Mr. Denis Doherty, said that, following the severe cutbacks on non-pay expenditure in recent years, the cutbacks this year are likely to be extremely difficult to achieve. The reduction represents about 4.3 per cent of that board's direct expenditure and is equivalent to a 20 per cent cut in the board's non-pay spending on their hospital programmes for 1984. He went on to say that it is unlikely that anything more than about £0.75 million can be saved on the non-pay side. Again we are talking about redundancies and job losses, and that in respect of a Labour Minister for Health.
The Mid-Western Health Board face a deficit of up to £3.2 million. Their CEO is considering hospital charges and staff lay-offs. It is a pity the Minister for Health is not here to hear that one. It must ring a bell for him. Surely it must be anathema to a Labour Minister, but in spite of all staff cuts are inevitable in that health board also. The North-Eastern Health Board face a deficit of £1.9 million this year and cutbacks on locums, week-ends and on-call facilities are being introduced there. Once again we hear of the five-day week syndrome, the week-end syndrome or the 24-hour baby factory. The next thing we expect to read in the national daily newspapers is a full page advertisement something similar to what we had in relation to the student medical card situation, stating that from now on patients can be seen in hospitals on a five-day week basis between 9 a.m. and 5 p.m.
In regard to the student medical card situation, the Minister and his Department claimed repeatedly that that exercise would achieve savings in the region of £2.5 million this year. I said when we discussed this matter under a Private Members' Motion, and I repeat, that there will be no savings from that exercise. Let me paint the scenario as to what will happen in relation to the students and the medical cards. Those wishing to avail of the services if they have not a medical card will resort to the casualty and out-patient departments of the general hospitals where they will be seen by a very junior doctor, in some cases one only two or three weeks out of medical school. They will be investigated, X-rayed, tested high up and low down, and I assure the Minister that at the end of the day the cost will be appreciably higher than the £2.5 million that he talks about saving. What bothers me about that is that it will lead to further cutbacks and in the financial allocations to the various health boards.
If I may revert to the health boards and the cutbacks, the North-Western Health Board face a deficit of £2.7 million this year. This health board will have to save in excess of £1.5 million on the pay side which is equal to 160 wholetime jobs. As I said earlier, all of that from a Labour Minister for Health. That will lead to further redundancies and while we rapidly approach the figure of 250,000 unemployed all this Minister for Health can do is add to that figure. Is it any wonder that there was no mention of the unemployed in the Minister for Finance's statement some weeks ago.
Deputy Enright referred to the fact that locums were not available in Tullamore as a result of which services had to be suspended. The same situation applies in the north west where they are also advocating the five-day week syndrome in order to reduce the costs of week-end "in patient" services. It is also proposed in that health board area that in the absence on leave of a consultant the bed numbers be reduced and planned admissions cease. Rather than employ locums, because they cannot afford them, they plan now to close sections of the hospital when consultants go on leave. Heaven help patients in Sligo and Donegal when their doctors go on holiday — the Minister will not provide the money to make replacements available. But I suppose those patients should be consoled by the fact that they will have three to four weeks only to wait for their doctor to return from vacation when everything will be all right again.
The Southern Health Board are still faced with a huge shortfall of £2.1 million after a recent board meeting accepted a cost-cutting package of £2.5 million. That health board had a total shortfall of £4.6 million, the largest of the four health boards. They plan to suspend the ad hoc ophthalmic scheme at a saving of £140,000. I understand also that the ad hoc dental scheme is also under scrutiny and probably will be axed very shortly. It is time the Minister came clean in relation to dental services because they are nonexistent.
Let us take a brief look at the Dublin scene where, as a result of the cutbacks, problems have arisen also particularly in relation to the promised £2 million expansion of the National Cardiac Surgical Department at the Mater Hospital, promised to enable extra adult open heart operations to be done next year. The Department are now reluctant to allow the hospital take on the 40 additional staff promised by them and the Minister last October. This was to form part of an interim development of the hospital, sanctioned by the Minister, after he had been told by the Irish Cardiac Society that people were dying each year because of the lack of facilities for more open heart surgery. How then can the Minister claim that there will not be any serious repercussions as a result of his actions? I repeat that he has been told by the Irish Cardiac Society that people will die unless they receive additional facilities and funds this year.
I might refer briefly to the health capital programme and the allocation of £55.5 million for capital projects. To be parochial — and I am sure the Minister for Agriculture will agree with me in this — as a Waterford Deputy I am very glad to note that Ardkeen Hospital has been included in the major capital programme once again. But I would have been much happier had we been allowed by the Department to insert a trailer advertisement in the national dailies, as we had recently requested. As the Minister is aware, the first procedure in relation to tendering for a major hospital such as that is the insertion of a trailer advertisement inviting various interested builders to tender. The planning of Ardkeen is now at its final stages; in fact I understand it should have been completed this week. The refusal of the Department to allow the insertion of this trailer advertisement worries me that perhaps they intend delaying the venture further. I might tell the Minister that we are now ready to go to tender with regard to Ardkeen and there is no reason we cannot be allowed do so. If the Minister intends standing over his capital programme I suggest that he now instruct his Department to allow this major venture for the South East and Waterford area go ahead.
Again on a somewhat parochial note I might refer to the other hospitals in our health board area, Wexford and Kilkenny. I know that Wexford County Hospital has been included in the major capital programme. I would appeal to the Minister to allow the building of its expansion proceed immediately because it is known that the theatre suite in Wexford Hospital belongs to the middle ages. I am sure the Minister for Agriculture present is as aware of the situation as I am, having visited there on occasions. All credit is due to the doctors in Wexford County Hospital for having functioned so well in such outdated conditions. Surely the patients of Wexford and the south east area generally are entitled to better facilities than those.
I note that the Minister mentioned Kilkenny Hospital in his remarks this morning. Is it not a fact that we have appealed repeatedly to the Minister and the Department to allow the controlled development plan in relation to Kilkenny to proceed. Yet we cannot get a response from the Department. We have asked that deputations be received in this respect. It must be remembered that the 14-bed gynaecological unit built recently remains unopened because the Department have refused to staff it. The Minister has seen St. Luke's Hospital in Kilkenny on a number of occasions, he has seen the overcrowding that takes place there. Yet although we are in a position to relieve that overcrowding through the use of the additional 14 beds in the gynaecological unit, the Minister and his Department refuse to staff it.
In his introductory remarks the Minister also referred to the advances made in medicine over the past two decades particularly those in relation to diagnostic techniques. I will admit that I am more than parochial, perhaps selfish, in relation to this. He referred specifically to CAT scanners and ultrasound diagnostic machines in relation to radiology. At present there is a total of five CAT scanners in the country, three based in Dublin, at St. Vincent's Hospital, The Mater and Richmond Hospitals, with one in Galway and one in Cork. The entire south-east and midland areas have been ignored. Yet the South Eastern Health Board cater for a catchment area in excess of 500,000 people. If the midlands are included in that catchment area then surely we also should be considered for such a facility. It seems a most unequal distribution to have three in Dublin for one million people and none in the south-eastern area for nearly 750,000 people. Of the nine capital projects in the major health capital programme for this year six are for Dublin, one in Sligo and two in the south-east. It is time the Minister and his Government realised there is an area outside the Pale called the rest of Ireland.
I am disappointed the Minister for Health is not present because I want to refer briefly to his statements in Cork last Sunday concerning the use of hospital equipment by private patients. I have no doubt that I will be accused of having a vested interest in this matter but let me give the Minister a few facts. I might refer to the Minister's remarks this morning under the heading of health service eligibility when he said:
The population is now divided into three categories for purposes of eligibility for health services.
Category I consists of persons with full eligibility. These are persons who are unable to afford general practitioner services for themselves and their dependants without undue hardship. Persons in this category are entitled to the full range of health services without charge and they are issued with medical cards for presentation when services are needed.
Category II are persons, other than those in Category I, whose income in the year ended 5 April 1983 was less than £11,000. Persons in this category are entitled, without charge, to hospital services as in-patients in public wards or as out-patients at public clinics and to maternity and infant welfare services. They are also entitled to avail of the drugs refund scheme, which ensures that nobody will have to meet excessive costs for prescribed medicines.
Category III consists of those persons whose income in the year ended 5 April 1983 was £11,000 or more. Persons in this category are entitled to the same hospitals services as those in Category II——
At this point I add the word "free". The Minister's speech continued:
——except that they are liable for the fees of the consultants involved in their treatment. They are also entitled to avail of the drugs refund scheme.
In effect, the £11,000 income limit is the dividing line above which persons are required to pay the fees of hospital consultants. This limit is due to be revised from 1 June 1984 and consideration is currently being given to the new limit. This limit, which will be fixed by regulations, will apply to income for the year ending 5 April 1984.
All patients are entitled to free hospital services and people with an income over £11,000 per year are liable for consultants' fees. The proposals to change the arrangement whereby consultants can use public equipment to treat patients will deprive approximately 175,000 people of the service towards which they have already paid £17 million per year in health contributions as well as funding it through income tax payments in the past few years.
A number of points must be made with regard to the consultants. On acceptance in 1981 of the common contract it was agreed by the Department of Health and the medical organisations, the Medical Union and the IMA at the time, that no change would result in the contractual agreement of consultants prior to that date except what was contained in the common contract. There was to be no change in their conditions of service.
The right to private practice for consultants was included in that contract. They had it before and it was included in the new contract. Is the Minister now unilaterally going to withdraw that right? Surely such an ardent advocate of trade unionism would see that kind of unilateral action as totally unacceptable? During the week the Medical Union stated they were most disappointed at the failure of the Minister for Health, an ex-trade union official, to consult the trade union representing the profession most directly involved.
Not only is the right to private practice included in the common contract for consultants but consultants have contributed to have the right to private practice. In my own area in the south-east, and in the Southern Health Board, consultants are paying 15 per cent of their health board salary for the right to private practice. The Minister conveniently played this down last Sunday but these are the facts. Is this to be another division in our society? Must we put public patients in conflict with private patients in the same way that we put the PAYE sector in conflict with the self-employed and the farmers? Surely we have enough turmoil in the country?
I ask the Minister to reconsider his allocation to the health boards. I ask him to make sufficient funds available to enable the services to be run properly without any job losses or the deterioration of the services.
I should like to compliment the Minister on the introduction of greater efficiencies into the health service. Everyone will agree that the elimination of waste, where this is proved, is to be welcomed. The Minister's actions have brought a sense of realism to the various health boards and this was evident from the fact that when the allocations were announced and when the officials looked at the Estimates they were able to effect some retrenchments. Notwithstanding the need for efficiency and the elimination of waste where this is proved, I hope the cutbacks will not affect the poor or the underprivileged, the people for whom the health service was introduced.
I welcome the imminent report of the working party on the general medical services. I put it to the Minister and the working party that there are certain areas in the health service that could do with keen, investigative public scrutiny. I am referring in the first instance to what is happening with regard to the purchase of drugs under the general medical services scheme where there is a rip-off by the drug companies. I ask the Minister to institute a public investigation or inquiry into this matter.
The drug companies are selling their products under their trade names instead of under a generic name at ten times the price they would be to the taxpayer if they were sold under the generic name. This is a scandal and the taxpayers are being ripped off. Somebody must cry "stop". I am asking the Minister or the board to look at this matter. His counterpart in the Tory Government in Britain a month ago made such an order and all drugs for their health service will be bought and sold under the generic rather than trade name. The drug companies can introduce the most flamboyant purchase schemes for the medical profession. They are now moving into the students' area and are making all kinds of provision for them in the medical colleges to get them involved with the scheme. Somebody is making a quick buck out of it but it is not the Irish worker or the Irish taxpayer.
I am worried that the cutbacks may affect people who should not be burdened. There is a need for the introduction of equity into the health services.
In some maternity hospitals due to lack of space, women are shifted within one day of giving birth to other hospitals in the region, simply because there is not enough space. I agree there is no danger or threat to their health involved in this and that the service they get in the other hospitals is excellent. It is a question of the kind of patients who are being thus transferred within a day of giving birth, a most traumatic time in a woman's life. I believe the vast majority of such women are not private patients and that there is a lock-in to the consultants. This needs to be looked at, again from the point of view of equity, because it is worker taxpayers who built the hospitals not private funds.
We have had a great deal of rí-rá about the entitlements of students. They have certain entitlements, but they have duties. For a number of years we have had controversy as to how third level education should be funded, whether by loan or grant, and students have had to make up their minds, but the sad unalterable fact is that very few working class people can find their way into third level education. In Limerick and other cities, children have to wait long periods for dental appointments in the public service before they can get them. If they were private patients they would not have to wait half that time. I do not want to be fobbed off by Deputy O'Hanlon's contention, and I think he is right, that no matter what happens the consultants will not be affected.
I put it to the students and to the Minister that in view of the controversy going on in the matter of third level education vis-à-vis secondary and primary levels, we should examine the feasibility of obliging medical and dental students to give a year or two of their time, post-graduate, working for the health boards as a way of paying back to the State the grants that got them into the elitist class. That would help working class children to go forward to university which now many of them cannot do. In that way they could work back their debt to the State, and they are very generously subsidised now. A rose by any other name will smell as sweet and there is an intrinsic merit, and an unanswerable case for what I have been proposing. Of course this can be extended to other professions such as engineers, etc. Incidentally, it would be a way to redistribute income and lessen the burden on the taxpayer.
Some of the retrenchments in the Estimate are too severe. In my constituency we were requested to cut back our expenditure by £3.2 million. The health board were able to cut back by about £2.4 million, leaving £800,000 to be found.
There is an inherent inequity in the public employment scheme and the terminology in the local government pension scheme has an element of upstairs-downstairs about it because one employee is an official and the other a servant. Under the law, an official cannot be made redundant but the same does not hold for the servant. I object very strongly to what is going on in Limerick whereby staff, though defined as temporary, are being laid off in the Mid-Western Health Board and private contractors brought in to do the work. I speak of the Good Shepherd in Limerick. I say that no staff should be laid off by any health board as a result of the economic constraints imposed by the Estimate until officials of the Department examine the position, before the lay-offs.
I will move from the general to the particular. We are all painfully aware of the tragedy in the last few days when a young child died on her way to Dublin from Limerick from a kidney ailment. Through nobody's fault, more than half way between Limerick and Dublin she could not be given renal dialysis treatment which would have saved her life. I have been campaigning for such a unit in the mid-west for a long time. Limerick is the third largest city with a hinterland of nearly three quarters of a million people. We need a renal dialysis unit in that area, and without seeking to make political capital I would say it is too much to expect the Mid-Western Health Board to find within their strictly pared resources, £2.5 million this year, the wherewithal to employ additional staff to service such a unit. In view of the size of the region the Minister should find the money somewhere for that.
I ask the Minister to look at the requirements of the mid-west in relation to the provision of a new general hospital in Limerick which was agreed by officials of the Department under another administration in 1978. The Minister and his officials say that that kind of hospital is not needed, but I would draw their attention to the fact that it is one of the fastest growing regions in the country with its population becoming increasingly urbanised, and that by the year 2,000, 80 per cent of our population, four out of every five people, will be living in cities and towns. That is in exact contra-distinction to the position in 1922, 60 years ago, when we got our freedom. I am not being facetious about this, but it does not matter what Minister is involved, he is in the hands of his advisers. It is amazing how selective they can be under some administrations and they might not be too choosy under others. When people are being urged to cut back, it might approach the situation in the story of the well known character in my constituency, the small farmer who trained his donkey to go without food and when he had trained him, he died. That is the danger which we might be facing because there is a bottom line in all these retrenchments. We have an expanding population and you cannot introduce an inverse ratio there. I suggest that the Health Estimates move in proportion to the development of the population and their needs. I accept fully the good intent of the Minister and his advisers when speaking about introducing prophylactic or preventive medicine rather than curative and agree with that. There is a great need for health education but you can only take that so far.
It was I who started that rí-rá about a fortnight ago by asking a parliamentary question on what the consultants were getting out of all this and the use which they were making of public resources paid for by workers whom I led through the streets on tax marches and on to tax platforms. Why was legislation changed over the last decade to take account of the capital acquisitions of some members of the medical profession? Why is it that the best houses in the country, running into hundreds of thousands of pounds, can be bought by members of the medical profession? Why is it that when they go to auctions the items will be paid for in thousands of pounds in cash rather than by cheque? I revert to what Deputy Dr. O'Hanlon said this morning, that if the consultants are forced to do something about their present position it is the taxpayer or the VHI payer — and I am one of those — who would have to foot that bill. That should be looked into. I suggest that a system be introduced, because they cannot have it both ways — what is sauce for the goose is sauce for the gander. If they are going to shove up the ante to the Minister and the Irish workers, saying "This far and no further" let us consider introducing docket receipts from the medical profession so that for every item of medicine paid for the doctor or surgeon concerned will be obliged to give a receipt which can be used by the patient for tax rebate purposes. Let us bring a bit of equity into the situation. Consultants never talk about money — that is vulgar. They talk only about principles and agreements, but at the end of the day it costs the taxpayer and it does not cost the consultants.
In the Mid-Western Health Board area there is an orthopaedic hospital in Croom which has one of the finest reputations in this country for quality of service. I do not know how the staff manage to give the quality of service and courtesy which they do. There are queues waiting to be admitted and I ask the Minister to put the promised improvements through as quickly as possible. They are badly needed.
Regarding the general hospital requirements for Limerick, Barrington's Hospital is staffed by the Blue Nuns, as we call them. They are giving a service second to none in a hospital which is almost 200 years old. The other hospital was built in the middle of the last century, nearly 150 years ago. These hospitals cannot function into the twenty-first century and that is only 16 years away. We will have to have a general hospital.
Someone should pay tribute to the work of the religious orders in the medical field. When the pseudo-intellectuals called for their withdrawal from education, health and other areas, they forgot the price which would have to be paid, and I do not just mean in value. God help us if the day ever comes when the services given by the religious orders are taken out of the health services. Their dedication and vocation to patients on a non-financial basis is unequalled throughout the world. It behoves all of us to take account of that. Some of these religious are being asked unfairly to subsidise those services at their own expense — this is in the case of orders of nuns and brothers and priests in the case of the mentally handicapped, subsidising a medical or health service. They should receive the proper resources. I take full account of what the Minister is attempting to achieve, which reflects the policy of the Labour Party that it is waste and not jobs which should be eliminated from the public services. That realism has been imposed on all of us. I ask the Minister to consider the proposals which I have made and I welcome his intentions as outlined today in his speech.
The Minister for Health in his Estimate Vote has presented his Estimate for 1984. In so doing I believe he has reneged on every form of socialist health policy which he and his colleagues in the Labour Party have advocated over the years. He attempts to suggest that there will not be curtailment of the health services to a degree which will affect patients, but I quote from the letter sent by the Minister to the various health boards, dated 14 December, 1983 — I have the copy which was sent to the Southern Regional Health Board. In this he gives the implications for the services in 1984 as follows:
The Minister accepts that health boards will face a very difficult task in managing the services during 1984. The impact on the level of services to be made available needs to be fully assessed as quickly as possible and decisions made on the overall strategy to be pursued in dealing with the problems which are identified. In examining the situation, the following guidelines should be adopted:—
(i) health boards should secure the necessary reductions in expenditure in the institutional services area to the maximum degree possible and protect, as far as possible, the non-institutional community services;
In other words the Minister here is talking about the non-pay area.
(ii) while it is accepted that the reductions required will have a significant impact on the pay element of your budget, every effort should be made, in the first instance, to—
(a) maximise other means of reducing expenditure;
(b) reduce on costs in the pay budget;
(c) fully utilise natural wastage opportunities;
(iii) priority areas and services should be identified; priority should be given to individuals and groups most at risk;
(iv) The efficient management of all your boards' resources should be actively pursued as a vital element of cost curtailment.
There we have it in a nutshell. The Minister in his Departmental circular to the health boards concedes that, even though he expects the main cutbacks should be in the non-pay areas, it will be essential to have cutbacks in the pay areas, that there will be a reduction of costs in the pay budget. By implication, he is of necessity saying that there will be a reduction in the number of people employed in each health board, that there will not be as many people available for overtime duty. As a consequence he is saying that there will be a reduction in the health services compared to what we had in 1983.
I have a document prepared by the chief executive officer of the South-Eastern Health Board, Mr. Peter McQuillan. This was circularised to all the members of the South-Eastern Health Board, giving his assessment of what was before us in that board in 1984. He states:
The Health Board estimates for 1984, to keep services at the same level as 1983, were agreed with the Department's financial staff in October last.
They were not the figures of the board. They were agreed with the Department's financial staff. He continued:
The Government has now published its 1984 Estimates and these show that the money provided for health board services in 1984 is 4½ per cent less than the figure needed. This amounts to a total shortfall nationally of £26.5 million and in the case of the South-Eastern Health Board it is £3.6 million. How serious is this? It means for the South-Eastern Health Board a reduction in expenditure of £10,000 per day in 1984.
Nationally it means a reduction in the health service costs of £71,000 per day.
The board is asked in the letter of allocation to decide on its priorities for expenditure.... There are some items of expenditure which the board cannot reduce due to legal obligations. For example, welfare allowances, loan repayments, pensions, rents, etcetera. This narrows the base on which cuts can be made and increases the percentage cut necessary to 6½ per cent or one-sixteenth of the cost of all services excluding community care and legal obligations. In terms of jobs for the South-Eastern Health Board region this could mean a reduction of anything up to 250 jobs. A reduction of £3.6 million for the South-Eastern Health Board region is roughly equal to the total cost of running all the 13 district hospitals in the region or about 150 acute hospital beds running one psychiatric hospital or running three geriatric hospitals.
These are the sort of alternatives the Minister gave to us in 1984. He has made much play about the increase of £24 million but, when we see that it is actually 4½ per cent short of what his Department agreed with the board to provide what was there last year, obviously we will have a deteriorating health service compared with last year. It will be diminished because there will be a lack of personnel. There will be a lack of people available at weekends and at night time in our hospitals because the health costs have been cut to a minimum.
The Minister sheds crocodile tears about the overall health cuts. He tries to excuse himself and absolve himself from responsibility in this area. He tries to shift the blame to the general national economic problem. He tries to suggest, by implication and innuendo, that the health services are being plundered by irresponsible people working in the health boards, mainly doctors, medical and para-medical personnel. One would think, if one did not know otherwise, that our hospitals are a form of holiday camp where many people go at regular and frequent intervals at the expense of the State and stay as in-patients for an intolerably long time in pursuit of what perhaps the Minister thinks are unnecessary investigations and treatments. This is not so.
It was a fact of life that up to 1982 there was a considerable degree of wastage in the health services, the GMS — prescribable products, for example, some shampoos and things like that — and in-hospital bed wastage. But this problem was firmly grasped and dealt with in what I would say was very prudent and skilful surgery by the former Minister for Health, Deputy Michael Woods. Virtually all unnecessary wastage that could be dealt with in the short term was got rid of without causing any reduction in the quality of health care either out of hospital or in hospital. We recognised at that time that there was some degree of wastage, that perhaps hospital administrators and consultants in hospitals were not as conscious of cost effectiveness as they should be. It was recognised at that particular time, pre-1982, that people were often admitted at weekends and they might have occupied hospital beds when the necessary investigations could not have been undertaken until the following Monday and for this reason they were unnecessarily occupying beds.
We were also conscious of the fact that many operations were being performed on an in-patient basis which could be performed on an out-patient basis. The Fianna Fáil Government and Deputy Michael Woods as Minister for Health dealt with this by prudent skilful surgery. All the hospital administrators and all the consultants in hospitals were inculcated with an awareness of the cost effectiveness of treatment and they eliminated this wastage. This was done in a very responsible fashion. There was no public outcry as a result because there was no question of a diminution in the quality of the health care which would be provided. The health boards' personnel and the medical profession accepted the need for this curtailment of this unneessary expenditure. This was pruned to an absolute minimum.
Let us contrast that with what is being done now by the Minister for Health. Let us contrast that responsible skilful approach with what the Minister now advocates. The Minister seems to have abdicated his responsibility entirely for the provision of the best possible health service to the people. Like his cabinet colleagues he seems to have become totally mesmerised with figures, he seems to have lost touch with reality and humanity and he seems to have become entranced with economic stringency. This same Minister a few weeks ago on the radio programme "This Week" suggested to the people of Ireland that they should have five day a week hospitals — they were entitled to go to hospital on any day of the week but not on a Saturday or Sunday. He was going to cut down on the staff and there might not be enough staff to deal with them. On that programme he made a frightening threat to pregnant women. He informed them that they should so organise themselves that they would be able to deliver early in the morning so they could depart from the hospital that evening and not take up bed space. I do not know what plans he had for them if they did not obey his instructions but he issued that as a vocal threat to pregnant women and people who might need hospital treatment.
What the Minister is attempting to do with the health services is a crude form of butchery. He is trying to undermine the entire health service. I am glad his colleague, Deputy Prendergast, seems to be aware that there is such a thing as the bottom line in relation to how far one can go in cutting back services but is he aware that there will be a diminished service this year compared with last year?
It ill behoves a so-called socialist, such as the Minister for Health would regard himself, a man who in the past was a leading light of a progressive Labour Party — that also is in the past — to impose these regressive, reprehensible and unacceptable curtailments in the provision of primary and secondary health care. We see now that the pious policies of compassion, concern and care expressed by the Minister when in Opposition were just empty rhetoric. They were loaded with hypocrisy to placate the Labour punters but when the opportunity arose and the ball was at his feet as Minister, what did he do? He forgot about his preachings of the past. He forgot about the poor Labour Party punters. He has forgotten his concept of an expanding and an improved health service. Most of all, he has long since forgotten the idle dreams he used to preach about of a magnificent free for all health service just as Her Majesty has across the Irish Sea.
When in Opposition, the Minister thought we had an inferior health service. Now he thinks the service we have is far too good for the people and he wants to reduce it. He has allowed himself to be enslaved by the yoke of Fine Gael. He has failed to fight for the rights of the people. He has forgotten that the right to the best available health service is a basic human right. He has decided to deny the people this right. He decided a half-baked service was good enough for them. At Cabinet level, he has obviously capitulated and thrown in the towel to the imperial supremacy of Fine Gael. The trendy leftie, as he used to be, has become a nice, gentle, accommodating, jelly-fish paralysed by the economic scroogery of the Fine Gael Party.
The present economic gurus in Government who are leading the fight against the rights of the people to progress and development, laid great emphasis on the overall cost of the health services as a percentage of general Government expenditure. They point out that one-fifth of total expenditure goes on the health service. This is supposed to be a marvellous boast. They try to confuse us by telling us that a higher percentage of GNP is spent on the health service here vis-à-vis the UK and other countries but they omit to tell us that our per capita expenditure on health is far below that of other countries including the UK.
One of our main problems is that we have far too many administrators getting in each other's way but there are too few doctors and nurses to deal with the essential purpose of the health service which is to diagnose and treat patients. In South Tipperary for a number of years we have not had an orthopaedic surgeon. If a doctor has to refer a patient for a non urgent orthopaedic opinion, for example in the case of a slipped disc, the next date they would get an appointment would be August 1985, 18 months from now. If they are lucky to be seen then — many of them die before they are seen — arrangements could be made for them to have an operation in February or March 1987. This is an appalling indictment of our health service. We have administrators falling over each other and yet we fail to provide the essential ingredients of a good service, that is the personnel who can diagnose and treat patients.
We must follow trends in progress in international health care. We must follow with interest the wide array of free standing hospital health care delivery systems now increasingly available in other countries, particularly the US. The commonest of these are ambulatory surgical centres. These are highly effective in every sense. The cost, quality and doctor and patient satisfaction rate are all excellent. In these countries there seems to be a new perception of a hospital as an impersonal, austere unit and a place of last resort, almost only a place to die in.
If we go back to the last century, at that time hospitals were only regarded as places for the poor to go into. All this changed after the Second World War with the bio-medical revolution and the developments in science. People clamoured to gain admission to hospitals. It is good to see that the tide has turned in places like America. The same technology that once dragged people to hospital is now repelling them and many patients in the US are being diagnosed and treated in ambulatory health care centres. I ask the Minister, in the interest of progress, if he would consider sending some experts in his Department and medical experts to report on the efficiency and cost-effectiveness of these units with a view to their long-term use here. Like everything else, we should be able to expand our views in relation to progress by copying ideas which are working well in other countries. It is important, in the context of future health care, that the Minister should appoint experts to examine the cost effectiveness and efficiency of these units.
Our hospital capital development programme over the past year has been quite severely curtailed. We had planned great hospital developments in Castlebar and the people were anxious for them to take place as had been promised. However, the Government decided to do it in a piecemeal fashion and the people of Mayo are confused.
The Deputy is misleading the House.
Very well, the Minister might not know too much about the west so I will move to the south-east. At a Comhairle meeting in February 1983 the Minister for Health made a long speech. He listed buildings which had been axed but said there was a major hospital development for St. Luke's in Kilkenny. When we were in Government we recognised that this was badly needed and had given a long-term commitment to it. The Minister for Health raised the hopes of Kilkenny people in 1983 but he has now backtracked on his promise and is trying to make the health boards accept half a hospital.
St. Luke's have a very fine new gynaecology unit, the building of which was arranged by the Department of Health. It cost £230,000 and was finished last November. It is as good as a first-class hotel suite but it is lying idle, a Departmental ghost and a monument to the inefficiency and inadequacy of the Government because the Minister will not allow the unit to be staffed. What sort of a philosophy is this? It was established years ago that there was a great need for a gynaecology unit, that you could not have people lying in corridors and being treated in inadequate conditions. The health board, the Department and the Minister agreed that it should be built. It was built, at enormous cost, but the Minister is so confused by economic scroogery that he cannot make an allocation for staffing the unit.
I am sorry for poor Deputy Prendergast because he does not realise the extent to which his senior Cabinet colleague has gone. He does not realise either what has happened to the Labour Party which was once looked up to by many people. The Labour Party have been consumed by Fine Gael who are paralysed and constipated and if the Labour Party ever reappear they will be unidentifiable.
There is a very serious problem in Dublin of drug addiction and abuse. Heroin addiction has been reported as being as high as 12 per cent in a north central Dublin area recently in adolescents between the ages of 15 and 19 years. Sadly, the figures for females were worse than the equivalent 1970 figures for the black ghettoes in New York. Earlier estimates had put the prevalence of hard drug dependence in Dublin as being 10 per cent in adolescents, and there can be no doubt that the city is very badly drug scarred. It is vitally important that the Department of Health in the provision of drug treatment units and preventative measures should make a more positive attempt to reduce and, if possible, to eradicate this growing disease which is the scourge of our young people.
It is also important for the Department of Justice to deal with the problem effectively and properly. When there is definite evidence that drugs are being provided to destroy the lives of others something should be done. It was with a sense of shock some time ago that we learned that a non-citizen who had been convicted of this offence was sentenced to 14 years imprisonment but, because he was a non-citizen, the judge allowed his deportation. It is only a few years since many of us watched with interest "The French Connection", a film which showed how drug smugglers could evade the law. It is sad to see some members of the Judiciary so unconcerned about the degree of this crime that they are prepared to allow someone who has been sentenced to 14 years for this hideous crime to be deported.
The Minister for Health has no responsibility for what a judge does and nothing to do with "The French Connection" either.
I am sure you would concede that drug addiction is the concern of both the Department of Health and the Department of Justice. There would be an interaction between them in trying to prevent the problem and treating those already addicted. All responsible citizens abhor drug pushing and addiction. We must ensure that the perpetrators of these crimes are adequately dealt with by the courts. It would be sad if the Judiciary took a soft line.
I am taking a hard line. The Deputy must come back to the Health Estimate. I appreciate his concern about the drug problem. We all share that concern.
The Minister for Health might help the Minister for Justice and——
I am trying to help the Deputy to stay on the right lines.
I hope the Department of Health will invest more money in trying to detect those engaged in ruining the lives of young people, thus causing terrible hardship for their families.
Deputy De Rossa.
On a point of order, is it normal procedure for two Opposition speakers to speak in succession?
I indicated the order of speakers at least three hours ago and the Deputy accepted it. He may recall the discussion with the Chair. Seven Deputies were called before Deputy De Rossa and in order to achieve a fair balance I decided to allow him to speak. I had already indicated the order in which Deputies would be called and Deputy Durkan accepted it.
I am sorry if I indicated that I accepted it. I should not have done so. I merely want to ascertain on a point of order whether it is normal practice to allow two Opposition speakers to speak consecutively.
Seven Deputies have spoken already and Deputy De Rossa offered before lunch. You will have ample opportunity next week.
It is clear from the trend of policy that the Minister for Health and the Government have decided to take the easy approach towards the health services. They have found it easier to confront the old and the sick rather than tackle the vested interests which control and make vast fortunes from our health services. The vested interests in the drug companies, the medical and pharmaceutical professions are making huge amounts of money from the provision of health services to the people.
The Minister has received considerable coverage during the past few days in relation to his statement on an RTE programme last Sunday concerning the use of certain hospital facilities by consultants. On the face of it this would give the impression that the Minister was getting tough with the consultants but this is not the reality. The Minister has suggested that consultants will have to pay for the use of facilities in public hospitals. What will happen is that the charges imposed on the consultants will be passed on to patients. People with limited eligibility for health services, of whom there are 175,000, will thus have to pay additional charges. Is the Minister suggesting that he will not allow the consultants to pass these charges on to their patients? Is he prepared to take on the consultants in relation to this issue? Unless he is prepared to do so the huge sums of money which the consultants make from using public hospital services will not be in any way reduced, nor will the health services be expanded or made more comprehensive and democratic.
It is the declared policy of the Labour Party to devise a comprehensive health service. They have in the past estimated that by reducing or eliminating subsidies to private hospitals up to £20 million could be saved. The Minister has made many speeches since he started to withdraw medical cards from young people aged between 16 and 25. I should like to emphasise that the withdrawal of medical cards was not aimed just at students but also at young, unemployed people not attending school and living at home. I have attempted to get information from the Minister about how many such young people would be affected. Despite the fact that he has been able to come up with a figure of 120,000 students holding medical cards, he has not been able to give information as to the number of young people who are not students but who hold medical cards. I find it hard to believe that the marvellous computer the Minister claims to have is not able to come up with the number of young people on unemployment assistance whose medical cards are being withdrawn.
If the Minister is serious about ending the use by consultants of public facilities for private patients he should banish private medical care totally from the public health system. People pay a health levy of 1 per cent up to a level of £11,000 per annum. Those who earn in excess of £11,000 pay only £110 and are entitled to basic hospital care and maintenance but must pay consultants' fees themselves. Everybody should pay a contribution of 1 per cent of income without any upper limit and hospital care should be offered to everyone who is in need of it. This would allow for a complete separation of the public health service and private medical care. If people want to use private facilities it is up to them to provide for themselves outside the public health system.
While the Labour Party manifesto published during the last general election called for a comprehensive national health care service, the Minister seems to be determined to reduce the extent of the health service available free to the public. That has been the emphasis of every decision he had made since coming into office. He made great play of the fact that he extended the eligibility limit for old age pensioners. It should also be noted that the money he is using for this purpose is being taken from young people between the ages of 16 and 25. It seems from the responses of the Minister in relation to eligibility for medical cards, and also from the responses of the Minister of State at the Department of Social Welfare, that the definition of socialism by the Labour Party now is the right to apply a means test to anything and everything, whether it be social welfare, health care, or whatever. That is a very narrow and unwise approach to the development of our health services. The Minister appears to be taking the line of least resistance.