I appreciate your decision on this occasion. The reason for this motion is the serious concern on the part of members of our party at the continued dismantling of the health services. The level of service has been reduced over the past three and a half years and we are particularly concerned about the situation as it exists in 1986. The health boards will have a combined deficit of approximately £35 million in the current year. The Eastern Health Board have an estimated deficit of £8.95 million; the North Eastern Health Board, £1.5 million; the North Western Health Board, £3.2 million; the Western Health Board, £4 million; the Mid-Western Health Board, £3 million; the Southern Health Board, £5.5 million; the South Eastern Health Board £6.2 million and the Midland Health Board, £2.5 million.
When I asked him on 19 February last year the real decrease to the health boards the Minister admitted that the decrease was as high as 6.6 per cent in the Western Health Board and 6.7 per cent in the North Western Health Board between 1982 and 1985. All the other health boards suffered a decrease. The Southern and Eastern Health Boards were something less but that is accounted for by the fact that they had rapidly expanding populations. Their allocations were marginally higher in those years. It is a matter of serious concern that we are now almost half way through 1986 and some of the health boards have not yet made their final decision as to how they will manage their 1986 budget. This must be unacceptable. It is a direct result of the Government's policy in enforcing these cutbacks on the health boards.
The acute hospitals in particular will suffer. For example, in Letterkenny they are closing down medical, surgical, gynaecological and ear, nose and throat wards for two months in the summer. The Limerick regional are closing wards. The cutbacks are not confined to health board hospitals. St. Vincent's Hospital, a voluntary hospital, are a good example of what is happening. They closed 100 beds during 1985. This year the Minister decided that Sir. Patrick Dun's Hospital should close. This was announced here on 13 January. The staff, the governing body, the Eastern Health Board, and everybody else interested believed that the hospital was not due to close until 1988 but the Minister and the Government decided that it should close. In fairness to the Minister, the Government decided that it should close in 1986.
Nobody has said what is going to happen to the patients who formerly attended or who were in the catchment area of Sir Patrick Dun's. There were 4,500 patients admitted and over 12,000 attending as outpatients. Because St. Vincent's is the closest hospital to them, many of these will find they are obliged to attend St. Vincent's for their hospital services. The point I want to come to about St. Vincent's Hospital is that their outturn for 1985 was £21.683 million. The allocation they are receiving for 1986 is £21.340 million. Therefore, they are receiving a decreased allocation taking no account of inflation or the increased number of patients they will have to treat.
Tralee Hospital, a new hospital, where not all the beds had come into operation are also closing some of the beds during the summer. There is a particular problem in Ennis where male and female patients share the same ward. This, as I am sure the Minister will agree, is undesirable. We had a motion on Beaumont earlier this year. Therefore, I will not say very much about it. Again, it is an indication of the thinking of the Government that a major and very necessary hospital on the north side of this city has been left idle for the past two years. Rather than open it as a major general teaching hospital, as it should be, the Government intend to open one unit as a psychiatric hospital for the north side of the city. It is very difficult to understand why the hospital could not be opened as a major general teaching hospital, as was originally intended and as we have asked the Minister to do on many occasions.
The Minister has deducted from the majority of hospitals their overruns for 1984 and 1985, leading to further serious difficulty for the hospitals, all of whom have had their allocations reduced. In the past four or five years all the health care agencies, health boards, voluntary hospitals and other agencies, have made major efforts to curtail expenditure in so far as possible. They have reduced their staffs and have reallocated them so that the highest level of care would be provided. In 1985 and 1986 the position has become critical because hospitals are obliged not to have replacements for holidays or sick and special leave. This means that doctors, nurses and other staff will have to carry extra loads.
Inevitably, that reduces the level of care, and in 1986 we have had a similar pattern as in the past three years, indeed since the Government came to office. The level of services is being reduced to a totally unacceptable state, when patients' lives must be at risk. We have longer waiting lists for outpatients, for tests, for X-rays and admissions. There is earlier discharge from hospital. Because of ward closures over periods there is a backlog of patients awaiting treatment, and a consultant surgeon told me he is unable to overtake the backlog because his specialist unit was closed for two months last summer. Now the hospital is unable to deal with the backlog because of the extreme pressure on staff.
In the long stay hospitals there have been staff reductions because of the no replacement regulations, and in the hospital at Clonakilty one nurse is looking after 98 patients. The Minister will agree with me that this is intolerable. It would be unacceptable to all of us. The psychiatric hospitals find it impossible to cope because of the closure of wards. It happened in the midland region in regard to St. Vincent's psychiatric hospital and St. Loman's in Mullingar. They will be closing for two months in the summer and patients never before discharged will be let go during the summer months. Earlier in the year the Government decided overnight to close eight hospitals including Castlerea and Carlow. So much for their talk about planning. It is typical of the way the Government have acted since they came to office. They make decisions off the top of their heads at Cabinet meetings, but when Fianna Fáil tell them they were wrong they deny it, and during the following three months everybody in the health services do their best to help the Government.
The Minister should read the document Planning for the Future for the psychiatric services because it spells out how the services should be proceeded with in the next ten to 15 years.
The nurses are feeling the effects and it is significant that the INO have found it necessary to march to this House tomorrow at 3.15 p.m., not for anything for themselves—it has nothing to do with wage or salary increases—but to highlight the effects of the cutbacks on patients. In the North West Health Board region 55 posts will be left vacant during ward closures this summer. Public health nurses have been asked to reduce their mileage by 10 per cent. So much for the nursing services which have given so much to community care. The number of public health nurses in training this year is 15 in the eastern region, ten in each of three other regions and four health boards have no training this year.
I appeal to the Minister to meet the nurses tomorrow to discuss their grievances with them. We all owe a debt of gratitude to Irish nurses at home and abroad because of their dedication to the care of the most vulnerable people in society.
During the past three years the number of posts left unfilled in the health services was 624 up to the end of 1985. That does not take into account the serious cutbacks in 1986. The dental services have suffered severely, and the ad hoc dental service is non-existent. What, for instance, does the Minister intend to do for a widow on a non-contributory pension who cannot provide badly needed dental service for herself and who has no access to a public service? There are 11,000 children in the Western Health Board area on a waiting list of from 12 months to 18 months. I appreciate that the Minister is trying to fill the orthodontic posts but what is he doing about providing a service, especially an optician service for the elderly who are unable to read or to see television and who cannot provide a service for themselves?
Hospital transport has been curtailed and many people are unable to travel to clinics because they have not got the facilities. Voluntary organisations are in competition now for reduced funds through Government policy. They are on the same allocation as in 1984 and in 1985 because there has been no increase in the last number of years. That is not a sign of the Government recognising the tremendous work they do.
In regard to the mentally handicapped organisations, it is wrong for the Government to say they have increased the allocation. The allocation in 1985 was £11.67 million and this year it is £11.25 million, a reduction of £500,000 approximately, therefore, the community services cannot be developed to the extent hoped for and more and more children will have to go back into residential care. What advice will the Minister give to parents who have a severely handicapped child in need of care but where that care is not available?
I should like to compliment the health boards and the voluntary health agencies with their management and staff for their excellent work in very difficult times. I wish to point out to the Minister that the morale of the staff is very low as a result of the cutbacks and of the fact that the has never admitted to them that there are serious difficulties. I ask him to take account of the low morale among the staff and to do something about it before further damage is done. The reduced allocations take no account of the needs of particular areas. As one consultant said to me, when he inquired about the matter in the Department he was told it would be even-handed. The cutbacks have not taken any account of the needs of the areas in question.
Fianna Fáil are conscious of the cost of health care. We believe there is and always will be a need for efficiency. We know that money will not be available for everything we would like to do. However, there is a duty and responsibility on the Government to provide an adequate level of service, but that is not being done. It is a disgrace that half way through 1986 chaos exists in the health services.
