Deputy Flaherty is in possession and the Deputy has ten minutes.
Private Members' Business. - Health Service Charges: Motion (Resumed).
The following motion was moved by Deputy Howlin on Tuesday, 28 April 1987:
That Dáil Éireann annual the Health Services (Amendment) Regulations 1987, Health Services (Out-Patient Charges) Regulations 1987, Health Services (In-Patient Charges) Regulations 1987; Numbers 114, 115 and 116 of 1987.
Debate resumed on amendment No. 1:
To delete all words after "That" and insert:
"In view of the serious state of the public finances and the need to maintain an adequate level of essential health services and protect the less well off in the community, Dáil Éireann approves the Health Services (Amendment) Regulations, 1987, the Health (Out-Patient Charges) Regulations, 1987 and the Health (In-Patient Charges) Regulations, 1987, Numbers 114, 115 and 116 of 1987 and supports the decision of the Minister in regard to the categories of person exempted from the charges and the provision by the VHI of a special scheme to cover the charges".
—(Minister for Health.)
Debate resumed on amendment No. 1 to amendment No. 1:
To delete all words after "Dáil Éireann" and substitute:
"calls on the Government to rescind its decision to impose a charge of £10 per day for non-medical card patients in public wards; and to raise and introduce instead a modest prescription charge which will reduce the excessive incidence of visits to doctors and the consequent overprescribing of drugs, to the extent necessary to produce equivalent savings in public expenditure".
—(Deputy Allen.)
With your permission, a Cheann Comhairle, and that of the other Members I wish to allow Deputy McGinley three minutes of the time available to me. Last night our spokesman in this area, Deputy Allen, outlined our position on our amendment. The Minister for Health, who I regret is not present at the moment, and the Fianna Fáil Government have thrown our health services into chaos and confusion. I have thought about the position and feel that I must say lives will be put at risk as a result of some of the cutbacks announced in recent weeks.
Another major side of what we are discussing — inpatient charges which we are seeking to have repealed tonight — heralds the beginning of the end of public medicine in this country for other than the medical card holder. This is a major issue we have not addressed in this debate. It is quite clearly only the beginning of a process. Next year, as has happened with all these charges, it will be £20 or more. We shall see the amount gradually increasing until the facilities and services which people have come to expect will no longer be available other than to those on medical cards. This is being done unilaterally, without consensus and without any clear sense of direction. This whole approach is totally unacceptable.
We are being offered brutal cuts together with these charges which are affecting jobs and services and leaving, as Deputy Allen in particular outlined last night, the huge bureaucracy of administration untouched. I should like to develop that point a little. Services and jobs are suffering most as a result of the level of cutbacks announced by this Minister, of which the charges are a further element and a further pressure, both on those already trying to administer the services and on the public at large.
In Dublin alone up to 1,000 jobs in voluntary and Eastern Health Board hospitals and services are being brought to an end — some of these have already been axed. In the Eye and Ear Hospital 29 nurses were laid off last week. All of us know the huge problems in the Dublin area and throughout the country. One of the hardest hit hospitals is to be St. James's Hospital. There we are seeing total services being abolished, services such as the maternity unit. That unit serves public patients only. It is unique in that it offers the poorer citizens of Dublin an opportunity to have a single class hospital service when they are having children, rather than going into a two tier hospital service as offered elsewhere. The maternity services, which are traditional, have been offered to people for well over 100 years now and they are to go. The vein clinics are offering a service to women in the city which is much needed; otherwise patients would be living in pain.
Most tragically, the service for infertile couples is also affected. It is proposed to axe entirely this service which is the only one in the country. The only alternative for people who find themselves in this sad situation will be to go outside the country for this service in the future. Perhaps if they are lucky enough to be able to afford it, they can get private services if these are developed here. The bone marrow transplant unit installed only 18 months or two years ago with a great deal of private finance is no under threat. Again, this offers the only service of this kind in this country. That is one of the most upsetting things about the whole effect of the ad hoc cutting that has occurred here.
The vital, unique services will go and moneys will not be made available to protect them. Similarly, doctors are having to face impossible choices. As one doctor put it to me, hospitals will now have to choose between spending on one expensive operation for a child with rare leukaemia or, say, on 20 elderly patients suffering from bronchitis. This is the kind of choice people will have to make.
The other side of the coin is that private medicine will flourish as public medicine declines and only those who can pay will be assured of service. In St. Vincent's Hospital in Dublin, an eminent heart specialist due to retire this summer is not to be replaced. This means that when patients are presented to the hospital with heart attacks, life saving skills will be present for only a minimal period of time when the single remaining heart specialist is on duty. There can be no doubt that this is putting lives at risk and ensuring ever longer waiting lists for much needed treatment.
The Minister is a decent politician and a reasonable person, but I put it to him that he has made a hames of the health services in this the Government's first budget. The charges are unacceptable and even more unacceptable are the further cuts he has implemented. A better way of saving as much money was rejected by him most unwisely and, as a result, not only were these charges necessary but the extra £10 million cuts in the services led to a great deal of the most unsatisfactory consequences I mentioned earlier. He and his party must bear full responsibility for the chaotic outcome, the beginnings of which we are now seeing in the hospital services today and which clearly will continue for months ahead.
The Minister had no mandate and sought none to do that. He approached the electorate with an entirely different approach to the health services. In that context I ask him to consider the much wiser and more publicly acceptable and humane approach of the outgoing Government. I ask him to reconsider their measures. If not, I ask him to approach the Minister for Finance and look for some of the funds which have come in over and above what was expected from the national lottery to ensure continuation of the vital services I have mentioned.
I call Deputy McGinley. The Deputy must conclude at 7.10 p.m.
Maith go leor, a Cheann Comhairle. I wish to thank my colleague, Deputy Flaherty, and you, Sir, for giving me a few moments to place on the record of the House the widespread concern and anxiety felt throughout the North Western Health Board area at the announcement last Thursday that they will be cut back by £2.83 million between now and the end of the year, in other words, £4.25 million in a full year. That will have a devastating effect on the sick, elderly and handicapped in the north-western region. I give a few facts. Already it has been decided by the health board that 300 people who have been looking after patients are to be laid off immediately. In Letterkenny Hospital, which is one of the acute hospitals in that area, 90 people have been laid off and from 1 May they will operate on a five day a week basis — something new and revolutionary.
This is in stark contrast with the policy enunciated by the Minister when he was in Opposition last year. I have here a copy of a motion which was proposed by him as spokesman on Health on 27 May 1986 in the House. I quote from column 189 of the Official Report a motion by Deputy O'Hanlon, now Minister for Health:
That Dáil Éireann warns the Government that the lives and the health of members of the public are now at risk in many areas because of the dismantling of the health services and calls for the immediate restoration of adequate funding to health boards and hospitals as a matter of extreme urgency.
That is the motion which was proposed on 27 May 1986 by the now Minister. Later on in his speech at column 190 he stated that:
For example, in Letterkenny they are closing down medical, surgical, gynaecological and ear, nose and throat wards for two months in the summer.
The health board in my area in Donegal operate a number of training centres for the mentally handicapped. In Gweedore there is a centre catering for Irish speakers. I met a number of patients at the weekend who are anxious and very worried about what the future holds for that centre. I appeal to the Minister to keep this centre open. These people have been forgotten and ignored for a long time. The services have been initiated and I ask him to continue with them.
I am surprised that this motion has been put down by the Labour Party. One of the people proposing this motion is the former Minister for Health, Deputy Desmond. He should know better because he was Minister for Health for almost four years and he is well aware of the very serious difficulties in the Department of Health, very serious difficulties he was not prepared to face when he was there. There was an overrun of £55 million which was not curtailed and was allowed to rise to that level.
We were not prepared to crucify the sick.
It is now up to the Fianna Fáil Government to resolve the problems in the Department of Health which the former Minister, Deputy Barry Desmond, was not prepared to deal with. He is prepared to put his name to this motion. I congratulate Deputy Mary Flaherty on her appointment as spokesperson on health for Fine Gael. I wish her well, coming from the backbenches and isolation in the FitzGerald administration. She is now a junior spokesperson on health under the leadership of Deputy Dukes.
Do you want to know how I voted?
I wish her every success in the long term. I challenge her to state what evidence she has that this heart specialist will not be replaced when he retires.
Saint Vincent's Hospital, Dublin.
Seemingly Deputy Flaherty has some information from a hospital stating that a heart specialist will not be replaced when he retires. Have you any evidence to substantiate that?
He is due to retire in August.
I would prefer if remarks were made through the Chair rather than direct to one another.
I apologise. I was anxious to get the message though to Deputy Flaherty in relation to this matter. The prescription charges proposed by the Fine Gael Government and the short-term Minister, Deputy John Boland, were a massive charge on the poor, the elderly and the sick. The most disadvantaged people in our society were being charged for prescriptions under a so-called caring Fine Gael Government.
At least the services were there for them. Services are going now.
The Fine Gael spokesperson and the Fine Gael Party are now decrying the action which must be taken by our administration. The prescription charges would have been as much as £5 per prescription from a doctor to a patient deemed eligible to have a medical card and so in the lowest income level in the State. That was a very tough and harsh policy to pursue.
A sum of £1 per prescription.
Per item on the prescription.
(Interruptions.)
We have had a very orderly debate up to now and I intend to keep it so. The Minister of State is in possession, without interruption.
I want to make it clear that it was a charge for each item on the prescription. Deputy McGinley may not have been aware how serious the charge was.
The seriousness of £10 per day for the sick when they are in hospital.
Order.
The issues arising from this motion were aired at considerable length in this House when the Minister for Health introduced the Health (Amendment) Bill providing for the imposition of outpatient charges. They were further and comprehensively debated in Seanad Éireann when I introduced that legislation in that House. We were in a minority in that House and the Fine Gael Party and the Labour Party were in a position to vote down the charges at that stage.
Even the proposers of the motion must admit that the detail of the regulations now being discussed was indicated precisely during those previous debates. The charges to be imposed both for inpatient and outpatient services and the categories of people which will be excluded from charges were also made crystal clear. In other words, the provisions of the three sets of regulations are not now being made known for the first time.
Before going on to deal with the provision of the regulations, I would like to make a few general comments. Despite the attitude in certain quarters, it is clear that there is a new realism among those involved in the management and provision of health services. There is a new and clearer appreciation of the issues which face the country. The unthinkable consequences if remedial action is not taken are widely understood and appreciated, but maybe not by the Labour Party who puts down this motion. The measures, however regrettable they may be, which have to be taken are recognised. Nobody is under any illusion that there will have to be a significant reassessment of what the essential components of the health services must be in the future. This will be quite traumatic given the expectations of the population and the providers of services derived from the days of unparalleled development in the late seventies and early eighties. It will mean that for the foreseeable future a much more streamlined health service will be the order of the day.
Five days a week.
Within this, essential services and services to the most disadvantaged must be preserved as a priority. As I said, the need for the present approach is by and large accepted. The tough decisions will be taken and carried through. The fact that there is this realisation current within the services makes it possible in the spirit of co-operation and understanding to see this crisis through.
It has been suggested that in the current and following years the health services will not only be decimated but that the standards and levels of care so painfully developed over the years will be lost forever. I do not accept that this will be the case or that it has to be the case. I suggest that the health services had reached the point where there was a great deal more emphasis placed on the quantity of services provided rather than the quality of services.
The future of the service must see a much greater emphasis on quality. The demands of former years for more and more of everything must be replaced by a precise assessment of what is actually needed, how much is needed and how best that need can be met. The motivation is certainly now present for taking this approach. It may be due to the very blunt instrument of economic necessity. It nevertheless affords the opportunity of taking the much needed critical look at what must constitute an affordable, efficient and effective service. Rather than wallowing in a gloomy resignation to hard times, it is essential that this more positive and constructive attitude be taken.
A great new philosophy.
In this critical evaluation, it must be recognised that the allocation of public funds brings with it a dual responsibility. Resources should be allocated in a manner which will ensure that we get the best value for the money we spend. In addition to getting value for money, however, we must also ensure that resources are directed towards those in greatest need. All public services, therefore, must be administered and delivered in a manner which will allow us to approach the achievement of these objectives.
It is unfortunate that it is only in periods of acute resource constraint that clear recognition is accorded to these essential goals. We must accept that the national pool of resources is limited, also that the demands of the population appear to be unlimited. There is thus inevitable tension which exists between demands and resources.
The current stage in the development of our health services might best be described as one in which the tension between demands and resources has been stretched to straining point. While the allocation from the national resource pool has been limited, the volume of demands to address health needs continues to increase. We are therefore faced with a basic inequality. Our resources cannot be stretched far enough and wide enough to cover the same level of demand which was previously possible. Good will and good intentions cannot, unfortunately, balance the equation between shrinking resources and increasing demands.
This leaves us with just one choice: to re-define the service needs which we can realistically meet from a smaller pool of public funds. In so doing we are also recognising the responsibilities which better off members of the community must bear if the more deprived groups are to continue to receive the health care required. The challenge we face is to introduce measures which are both efficient and equitable.
If we are to optimise the return on our resources, we must ensure that people are treated at the most appropriate level of care. One of the factors which has contributed to the spiralling demands on the health services is the fact that people have been drawn to seek the most expensive type of care. That type of care has been usually inpatient care, even if it is not necessarily the most appropriate type of care for their needs.
To make the system more efficient, therefore, we have had to introduce incentives to ensure that the best choice will be made regarding the type of service to be received. The provision of inpatient and outpatient services has therefore been carefully reviewed as we have worked to revise the system to enable the achievement of this objective.
The reduction in the rate of growth expenditure on health services has been the world-wide trend in recent years. The means of coping with this situation has been the pre-occupation of virtually every country and international health organisation. It is essential, therefore, that this country recognise that it is not dealing with a pecularily Irish problem but one which is being addressed internationally. The solutions which are being put forward by various countries arise from a consensus view of the problems they face. The lynch pin in these solutions is that spending by the State must in overall terms be controlled and brought more directly into line with what we can afford. It must be accepted, that while the signs of difficulty were recognised some years ago, no efforts were made to commence the remedial action necessary. The over-run of the budget by £55 million is a clear indication that with the conflicting ideological views within the former Cabinet they were unable to take the necessary action to deal with this massive over-run of public expenditure. That is why this Government are now faced with the major task of bringing some stability into the situation at this late hour.
It must be abundantly obvious that this Government are prepared to tackle this task irrespective of how difficult and how unpopular it may be. We were elected to govern and govern we will, irrespective of the electoral consequences because we believe that what we are doing is right.
Irrespective of the consequences.
What we are doing is required of us because of the lack of Government during the past four and a half years by Fine Gael and Labour.
Surely nobody expected that the almost unlimited demand for resource for the health services would continue. Yet the indications are that many people were prepared to ignore the inevitable consequences and continue to demand and spend unabated. There may have been some unrealistically optimistic hope that somehow and somewhere the day would be saved by an injection of funds from some unknown source. There are no unknown sources for funding public expenditure except taxation. The single major source is taxation which as everybody in this House knows is approaching its practical limits.
Those who now proclaim outrage at the measures being taken to contain costs would rightly be even more outraged if it were decided to continue spending in an uncontrolled way with the inevitability of further and unbearable taxation. The Government takes no pleasure in having to introduce these charges. It takes no pleasure in finding itself in an inherited position where the desirable level of resources for health services cannot be made available to agencies. It is an unfortunate and shameful price we have to pay for years of mismanagement.
The health services are no exception to the harsh reality of the budgetary situation which the Government are prepared to tackle and to resolve in its Programme for National Recovery. The need for such measures is universally recognised. The reality of implementing such measures has resulted in this debate here this evening on one aspect of the Government's programme. The charges for inpatient and outpatient services will allow health boards and hospitals to collect much needed revenue to maintain existing services and employment. Without such additional income the existing financial situation will deteriorate to such an extent that services will be reduced together with employment.
I would now like to turn to the detail of the provisions of the regulations. The basic philosophy underlying the charges is that those who cannot afford to pay for inpatient and outpatient services will not be asked to do so. Those who are in a position to pay the charges will be asked to pay. This philosophy is fully in line with the overall budgetary strategy of this Government in protecting the disadvantaged members of the community. Additionally, the revenue raised from these charges will assist in the maintenance of services for all, including the less well-off sections of the community.
I would ask the House to consider carefully the import of these regulations. I would ask the House to leave aside the political point scoring so that the community generally will be aware of what precisely will be involved.
There is no political point scoring from this side of the House.
Last night there were pictures——
Order.
——of fear being generated among some people. The political point scoring has been made by Members of the Opposition. Even Deputy Flaherty has already been trying to score some points in relation to this matter.
Deputy McGinley will have to desist from interruptions.
Everything I said is——
Deputy Flaherty this is a very limited debate and consequently disorder and interruptions of any kind are not welcome.
Most of the speakers are——
If Deputy McGinley insists on it and if he does not wish to listen to the Minister of State there is a way out for him but I cannot permit the interruptions.
The irresponsible statements being made by Opposition Members in relation to the effects of these charges are outrageous.
The Minister is living in cloud cuckooland.
(Interruptions.)
Some people ——
Deputy Allen, if there are any more interruptions from that side of the House I shall have to deal with the matter promptly.
I know I may be upsetting Members of the Opposition by pointing out that the statements they are making are irresponsible. They are creating fears among the community and the statements are untrue.
The Minister should ask the people who are awaiting hospital services.
Deputy Allen and Deputy Flaherty were heard without interruption and I am insisting that the Member in possession shall be heard without interruption.
Thank you for your protection. I have to reply to the points which were made by Members of the Opposition last night.
I would prefer if the Minister did not invite interruption.
Fear is being generated by irresponsible and incorrect statements on what these regulations imply. It has been suggested that people fear that they will be refused services at hospital because of these charges. That is totally untrue. It has been suggested that even lives would be put at risk. That is totally untrue. I believe it is a shameful playing on the basic concerns of people for ulterior political motives.
Let me make it very clear again that only those who are in a position to pay the charges will be asked to pay. Nobody will be refused admission to hospital because they are not in a position to pay. No lives will be put at risk because these charges are being imposed by our Government. It is not a situation, as stated by Deputy Howlin last night, of all but the very poorest being charged. This is a most exaggerated interpretation and indeed is untrue.
Let us take the Health (Outpatient Charges) Regulations. These regulations provide that a charge of £10 shall be made for the first visit only to an outpatient department. I want to emphasise that. The charge is in respect of a first visit only. All subsequent visits in respect of the medical condition which required that first visit will be free of charge. I would like to remind Members of this House that in the Western Health Board area, they were actually imposing a charge for some years for outpatient services at hospitals, a charge of £5 for every visit by a patient, and that was actually operating during the regime of the former Minister for Health, Deputy Desmond, a charge of £5 for outpatient services by the Western Health Board and other health boards and I presume the former Minister, Deputy Desmond, was aware that these outpatient charges were being imposed. That is why I regard it as being totally irresponsible for a former Minister for Health ——
He will speak for himself.
—— to come into this House now crying about the imposition of outpatient charges when he was aware that those charges were being imposed by the Western Health Board, the North-Western Health Board and other health boards possibly.
And the Minister will go on to double them by Statute?
If he was not aware of those charges he was not doing his job as Minister for Health. I presume the former Minister, Deputy Desmond, was aware of what was happening in the Department. I presume that he was aware of those charges and that he will clarify this if he has an opportunity to speak. In fact, I personally know of a case of a person who visited an outpatient department 12 times. He had a particular difficulty. A boiler blew up in his home and he was charged £60 for the 12 visits. There is nothing new about these out-patient charges. I fail to understand the former Minister. Maybe there was a majority decision. I will give him the benefit of the doubt. His party made the decision and then I presume he had to go along with it irrespective of whether he agreed with it. The point is that out-patient charges are not new and, in fact, a visit to a general medical practitioner would be more expensive than going to the outpatient department of a general hospital and paying £10 for all the services related to a particular problem. I also feel that £10 is a very reasonable charge for X-ray and other services. Of course medical cardholders and their dependants will not be liable for the charges.
By definition, people who are unable without undue hardship to pay for services for themselves and their dependants are entitled to medical cards. This covers about 40 per cent of the population. The second category is women receiving services in respect of motherhood. That means women who are receiving services related to their pregnancy will not be liable for these charges. The third category is children who are receiving treatment for the listed diseases and disabilities. The fourth category is children being treated who have been referred from child health clinics or school examinations. The fifth category is people receiving services in respect of the infectious diseases which have been prescribed. These exemptions also apply in the case of the Health (Inpatient) Regulations.
I suggest that it is only the most obstinate or those who insist on confining themselves to ideological point scoring who could claim that great care has not been taken to protect those who should be protected. The list of exemptions is comprehensive and keeps strictly to the principle I mentioned of only requiring those who can pay for services to do so. In speaking on the outpatient charges, I would like to refer in particular to the fact that the charges will apply in accident and emergency departments. I believe this is justified. It is justified not merely as a reasonable means of raising needed resources. It is justified, I believe, as a disincentive to what has been accepted as an abuse of casualty departments.
There has been considerable debate in recent years on the need to provide health services at the level that is most cost efficient and effective and appropriate to the particular condition. The inappropriate use of high technology and expensive hospital facilities has often been cited as a particular example. I would agree that such facilities should be used only for those conditions which require that level of expertise and specialisation. Therefore, the use of casualty departments of general hospitals for conditions which could much more appropriately be treated by general practitioners is an abuse.
However, it is not the case that the charges being imposed in such circumstances are punitive. A £10 charge is about the average charge made these days by general practitioners. As I have said the exemptions which apply to the outpatient charges will also apply to the inpatient charges. In addition, people who are in long terms care in geriatric, psychiatric or mental handicap institutions will not be liable for these new in-patient charges.
Again the level of charges for inpatient care — £10 per day subject to a maximum of £100 in any 12 month period — is a reasonable contributions to ask from those who can afford to pay. It is wrong to say that the £10 charge will apply to every day spent in a hospital over one 12 month period. In fact it applies only for a period of ten days and a maximum of £100, irrespective of how long a period a person may be required to spend in hospital. The charges cannot be regarded as excessive when regard is had to the trend in recent years of shorter and shorter lengths of stay in hospital with the trend of an increase of outpatient services rather than inpatient services.
Finally, there are two very important issues which apply to the provisions of both sets of regulations. The first is the powers of chief executive officers of the health boards which are enshrined in the Health Act, 1970, whereby they can deem people in cases of hardship to be eligible for a particular service. Those who have suggested major difficulties for people not eligible for medical cards should take note of this provision when making public statements. The second is the scheme that the Voluntary Health Insurance Board will be introducing to coincide with the commencement of charges.
Even though the charges which will be imposed are relatively modest, it was decided that people should have the option of insuring themselves against them. Therefore, a scheme has been developed by the Voluntary Health Insurance Board. The details will be announced shortly and will be available when the charges commence on 18 May. It is likely that the cost of the scheme will be of the order of £10 per year for a single person and £25 for a family of four. In other words, it will be possible for single persons to insure themselves against the charges for about 20p per week and a family for about 50p per week. Also this new VHI scheme, unlike other schemes, will be available to all persons who wish to join, irrespective of their age or medical condition. Existing VHI policy Holders will be covered free of charge for the current year. Given the need for the income from charges, can even the Opposition claim that such costs are prohibitive?
In the light of the limitations and exemptions which I have mentioned, I find it difficult to understand the logic of the statements made by a number of organisations representing people working in the service that, on principle, they would refuse to be involved in the collection of these charges. Does this mean that these organisations would prefer to see even more drastic reductions in the level of services rather than collect a charge from those who can afford to make a contribution? Is it appreciated that as approximately 70 per cent of health services expenditure is in respect of pay, further restrictions of available resource must mean a reduction in numbers employed in the services? While I can understand that this reaction may have been an immediate response to the proposed charges, I sincerely hope that, on reflection on the dire consequences, this stance will be reviewed.
I take this opportunity to appeal to those involved to review their position on the collection of these charges which are reasonable at this stage when resources are so limited. If these extra charges are not collected the health services will be in greater difficulty than they are today.
I wish to move amendment No. 2 to amendment No. 1.
This is a procedural matter. Amendment No. 2 cannot be moved while amendment No. 1 is before the House. You may, of course, discuss it.
The cutbacks in the health services in all sectors have now become one of the most controversial public issues. While the broad consensus now emerging on the need for this country to live within its means is very welcome, and largely arises from the arrival of the Progressive Democrats on the political scene——
(Interruptions.)
Order.
——I do not believe that the indiscriminate cutbacks now being made by Fianna Fáil in Government are being fairly and equitably allocated. It is also obvious that very little thought has gone into the proposed measures, either on their long term effects on the quality of health care for the general public or the practicality of collecting the various charges proposed.
What is particularly evident is that the bureaucracy of the health service is to be totally protected, while the full brunt of the cuts is to be borne by the frontline personnel, such as nurses, social workers and those for whom the services exist, the patients.
We seem to have an unhappy knack in this country of being unable to run any service without a massive bureaucracy which, in turn, eats up the vast bulk of resources allocated for the services, and thereby strangles their net value. The health services appear to be a major case in point. Over the years the cost of the health services has grown considerably but the greatest drain on the budget has been the doubling in the administrative cost of that service.
Where, I ask, is the evidence of the improved nursing and hospital services directly relevant to the patients? Therefore, one of the unavoidable issues of this debate has to be the future of the health boards and whether the health services could not be more efficiently delivered by a far more streamlined administrative structure. For instance, is it really necessary to have these large representative boards, including TDs and local councillors, whose relevance to the delivery of health services is highly questionable?
The Progressive Democrats' amendment accepts the need for health charges but one of our guiding principles is that the burden must be shared fairly. Where is the evidence that the cutbacks now being applied to the frontline personnel are being shared by the senior administrative grades in the health boards and by hospital consultants?
I would like to point out to the Minister one example of the crucifying effect the ad hoc health cuts will achieve. The County and City Infirmary in Waterford is indeed a very good example. Here we have a hospital which is jointly sharing the burden in many aspects of health care with Ardkeen Hospital. These are the only two general hospitals in this location. As I am sure the Minister is aware, the Department of Health and the health board agreed some 18 months ago that there should be a joint Department of Surgery and Anasthetics between the County and City Infirmary and Ardkeen Hospital. This combination has made available 80 surgical beds, which I believe is the average figure, but the Department of Health have now imposed a 24 per cent cut in the County and City Infirmary's budget. This cut is so savage that it will effectively denude this hospital of its ability to function to the required standards, thereby forcing its closure in the long term. This would mean an immediate loss of some 38 beds in the surgical area. On top of this, there will be 20 per cent fewer surgical beds available in Ardkeen Hospital because of the general cuts for that hospital.
This will effectively mean that in a catchment area of 110,000 people the total amount of surgical beds available will be 40. This, I put to the Minister, is a national disgrace. No other country throughout the EC, America or indeed most of the western world would have this kind of a ratio and it makes a mockery of the health service provided in this area.
When we look at the area of the acute medical service provided in Waterford, does the Minister not realise that 40 per cent of the necessary beds are located in the County and City Infirmary Hospital? It is already an established fact that Ardkeen Hospital is severely under-bedded as a county hospital and the County and City Infirmary has always been a necessary back-up.
There is also a genito-urinary service available in Waterford, 50 per cent of which is based in the County and City Infirmary. Equipment has been bought and installed, nurses have been trained and a surgeon appointed. The result of the Minister's cuts will effectively nullify this service and not alone will we be at the loss of the service but all of the large cost input will have been spent for nothing.
The County and City Infirmary exclusively provides a cancer treatment clinic which is held in Waterford under the auspices of St. Luke's Hospital. This is the only such service available in the whole area. I cannot believe that the Minister was aware of all these points when the quite arbitrary and crude cuts were applied to this hospital. This is not an area with many general hospitals but the people of Waterford and the surrounding areas depend largely on the County and City Infirmary Hospital providing a basic and very necessary service in the area of general hospital services without which people's lives would be put at risk. I am sure this example can be applied to many constituencies throughout the country.
I would also like at this point to highlight a very alarming dimension to the cutbacks which has received no attention. That is the vital work done by social workers in the disturbing areas of child neglect and child abuse. The cutbacks now mean that many social workers, who are technically classed as temporary employees, have lost their jobs and this vital work they were doing has to be abandoned.
Another key child-care issue falling foul of the cutbacks is the work of fosterage, also administered to a large degree by these social workers. Are these vulnerable children now to be abandoned and the whole work of moving children out of institutions and into foster homes to be seriously disrupted? While these are some of the elements of the casualties of the health cutbacks, the real overriding feature of this Government's budgetary strategy where health services are concerned is a continuation of the crude, ad hoc cuts of the previous Fine Gael-Labour Government.
There is no sign of any coherent plan based on the fundamental requirements of the Irish health care system in the late 1980s. That should be based on the strategic requirements of the service here. How many acute hospital beds do we need; how many psychiatric places? What services can be delivered in daycare centres? How is the service to be administered most efficiently? What is the appropriate structure for operating the services? How can a proper service be delivered, which does away with the scandalous waiting periods that GMS patients encounter for many services? How are specialists and consultants to be made accountable to the taxpayer for the fees they are paid under their contracts of employment?
What I am asking for simply is a clear national health plan to decide once and for all our requirements in different health areas. This should get us away from the present unfortunate ad hoc cutbcks, where some services, and some health workers, are excessively penalised.
Where the specific issue of the £10 charge is concerned, the Minister's exclusion category is too narrow and fails to take account of the plight of low-paid workers. That is why the Progressive Democrats in our amendment want the exemption category to be broadened to include family income supplement recipients. We also feel that a proposal we first put forward last October for a nominal prescription charge of 50p per prescription, with old age pensioners excluded, would be a more equitable way of reducing the cost of health services to the State.
I would like to turn now to the proposed special VHI scheme to cover people liable for the £10 charge subject to the annual ceiling of £100. The Minister in his speech last night said with regard to this scheme:
The scheme will be moderately priced, say of the order of £10 per year for a single person and £25 for a typical family of two adults and two children, full income tax relief will, of course, apply in the usual way in respect of these premiums.
I believe that very little thought has gone into this scheme by the Department of Health and I would like to know from the Minister on what basis he has arrived at the figure of £10 per single person per year and £25 for what he terms a typical family? How does the Minister propose that this scheme is to be costed? Who will join; who will pay? How are the VHI to seriously deal with long-term or pre-existing illnesses? How is the money to be collected? What will be the cost of processing the tax relief on £10 from all of the people the Minister expects to join the scheme?
If the scheme does not raise the expected £12 million as the Minister has indicated and the cost to the Revenue Commissioners of administering the tax reliefs is greater than the net gain, will the Minister scrap the tax relief from this scheme and then seize on the opportunity to do away with tax relief on the other VHI schemes? I want unqualified assurances from the Minister that he has no intention of doing away with tax relief on any VHI scheme.
The charges the Minister proposed in the House last night from the VHI, to me, seemed to be ludricrously unworkable and would appear not to have any basis in reality. This evening we had an addendum to that by the Minister of State who is now talking in terms of 20p per week for a single person. It may be that the intention is to make it sound more attractive. It is quite obvious that if the new scheme premium is to be as low as the Minister has stated, the funding of this scheme will quite obviously fall on existing members of the VHI, thereby increasing subscriptions. The alternative to this is to bring the VHI to financial ruin? If it is the case that this scheme is to be funded by existing VHI members the Minister should state so and come clean with the people.
If the Minister is really serious and wants to reduce the cost of the health service, there are many ways this can be achieved. One glaring example of this is that GMS doctors and pharmacists should not be paid on a fee per item basis but should be paid on a per capita system such as now operates quite successfuly in the UK. This, I believe, would not have a detrimental affect on the care of patients but would have a major impact in the cost of the medical service to the State. It would, of course, also have the effect of reducing the amount of prescriptions issued here. The cost to the State — the latest figures available are in the 31 December, 1985 report of the General Medical Services Payments Board — is £66,930,000. This is quite a staggering figure and I would respectfully suggest to the Minister, and to the Department, that if doctors operating on the medical card scheme were to be paid per capita payments, rather than a fee for every visit, not alone would you have a reduction of their huge costs to the State, but indeed, a substantial in excess medicines which are obviously consumed. Surely the Minister will agree that this is a far more practical, imaginative and caring approach to a proper health service than the disgraceful butchery in the type of ad hoc cuts that the Minister, and his Department, are introducing.
I want to point out also to the Minister that the VHI administration costs are very low by Irish standards and indeed, by international standards. In fact the administration ratio expressed as a percentage of subscription income was 6½ per cent as at 28 February, 1984 and this also included marketing costs a commendable state of affairs. Is it the Minister's intention to bring the VHI into line by making it another administrative bureaucracy by seriously increasing the area of required administration? It is obvious that no real thought and planning has been applied to what appears to be an ill-thought out hairbrain scheme.
Before leaving this issue, I want to highlight also the scandalous problem of arrears of health contributions from some self-employed people and some farmers — I deliberately state "some" because I accept that many self employed, and many farmers, do pay their health levies — resulting in millions of pounds being outstanding to the health boards around the country. I would like the Minister to give us now the most up to date data on the total amount outstanding in health contributions, and what steps are planned to ensure that this money is paid up. Clearly a no-nonsense approach here could lead to the recovery of much of this money and that would help alleviate the immediate difficulties of funding facing the health service.
To summarise our position, the Progressive Democrats do not believe that the health cutbacks are being fairly shouldered across the entire health service. Workers at the frontline are taking the full brunt. This must change, and hospital consultants and senior health board personnel must also bear their share. The health charges fail to take account of all categories of people who should be exempt. In particular, we propose that families on the family income supplement should be added to the exempt category. Moreover, we want to see proper planning introduced into our health services, and an end to the crude ad hoc cutbacks.
Without a radical rethink, Ireland's health services face a major crisis. Today the Irish taxpayer is paying over £1 billion for a health service that is grossly inefficient, very costly and would be better described as an illness service. It is now time for a major review of all aspects of the health service to cover its overall objectives, to bring about the delivery of an equitable and efficient service to clarify eligibility to various services, to determine how the services should be financed and to devise procedures for monitoring and controlling all health affairs.
Health services in many areas have been pared to the bone. The hallmark of any civilised society is its treatment of the elderly and the ill and yet it is those categories, particularly the lower income group, who will suffer as a result of the imposition of these charges. Those who can afford private medical care, who can pay for a stay in a private nursing home, will not be affected. It is clear from their first few weeks in office that Fianna Fáil have taken a decision to single out the health services for particular attention. The decision to introduce charges for visits to outpatient departments of hospitals and overnight stays is an indication that we are witnessing the systematic dismantling of the limited public service that has been built up over the years.
The Minister has said that there will be a free medical service available for familes of five, earning less than £130 per week but how can one expect a family, with an income of, say, £140 per week to pay these charges? That family will be over the limit for a medical card and cannot afford to pay charges. Those paying PAYE and PRSI are not assessed on net earnings for full eligibility and I contend that that amounts to a grave injustice. It is my experience that many of those who do not have full eligibility cannot afford to go to a chemist to get medicine after a visit to a doctor. How does the Minister expect such people to be able to afford to pay the charges he is now proposing to introduce?
Whatever one may say about the dire circumstances of the unemployed it is worth mentioning that a large number of families on low income are marginally over the limit for eligibility and are being caught in the poverty trap. Despite Government assurances that there will be a hardship clause people generally live in fear of getting into further debt. I am well aware, as I am sure every other Deputy in this House is aware, that the parents of asthmatic sufferers very often do not have the medical treatment provided that their children require.
The imposition of charges for outpatient treatment and maintenance is an attack on the dignity of people some of whom at prsent have to seek supplementary welfare allowance. I refer to the category of people on low income who have mortgages they cannot afford to pay and who have to seek supplementary welfare allowance. Those are the people who are now going to be asked to pay for inpatient and outpatient service in our hospitals.
The failure of successive Ministers and the Department of Health to reorganise the health services is deplorable. In the course of years the Southern Health Board, of which I am a member, have made submissions to successive Ministers, and as recently as 1986 after a great deal of deliberation a submission was made to reorganise the GMS scheme. That submission was ignored completely. If the scheme were changed as mentioned by the previous speaker, and a per capita grant or salary were paid there would be a massive saving to the health board and to the health services generally. Why has no effort been made to reorganise the GMS scheme? I suggest respectfully that it be done now rather than imposing the charges. The fee per item system should be abolished and replaced with a per capita grant.
Nothing is more important to a nation than is the health of its people, and health services should never depend on the ability of any citizen to pay for them. We in The Workers' Party believe that all health services should be free and should be paid for out of general taxation. Those who can afford to pay more should do so through taxes while those who cannot should get the same high quality care and treatment. That is not happening at present and it is deplorable that the charges being imposed will affect that position adversely.
The final point I want to make is that the transfer to central taxation of almost the entire burden of funding the health services is given as justification for transferring management control of services to the Department of Health. This is becoming more and more centralised. It is contended that Central Government are responsible for funding. That argument is as spurious as it is hoary as it is the people's money that is being used to pay for the services irrespective of which source it comes from. I ask to have this charge withdrawn because there is no doubt from what I have been hearing from the people, and I know they mean what they say, that they will not pay because to impose this on the less well off section of our society is a further grave injustice.
Deputy Michael Ahern and he has ten minutes.
I wish to refer this evening to a number of erroneous statements made by speakers especially from the Labour Party in connection with the regulations imposing charges for in-patient and outpatient services. Some Members in this House are deliberately misleading the public as to the extent of the charges, the level of the charges and the circumstances in which charges will be made.
I wonder where that practice started.
As the Minister for Health explained clearly and categorically, the charges will not be imposed where they will cause undue hardship. This is a fact and it is clearly enshrined in both sets of regulations, in paragraph 4(1)(g) of the outpatients regulations, and paragraph 4(1)(h) of the inpatient regulations. The reality of the statutory provisions has not been accepted or taken on board by Members on the Opposition benches.
Or the Deputy's own benches.
The reason is that if they acknowledge it they will undermine the very basis of their objections to these necessary measures. As certain Members have failed to recognise these provisions in the regulations I will refer to the Health Act, 1970, from which these provisions have their origins. Section 45(7) of that Act provides that, and I quote:
Any person...who, in relation to a particular service which is available to persons with full eligibility,
that is a medical card holder.
is considered by the chief executive officer of the appropriate health board to be unable, without undue hardship, to provide that service for himself or his dependants shall, in relation to that service, be deemed to be a person with full eligibility.
The section is quite clear. It means that if any person is unable without undue hardship to pay the charges in respect of inpatient or outpatient services he or she will not be asked to pay. What could be clearer or more specific? Yet it is totally ignored by Opposition Members.
Who decides that?
I wish to draw particular attention to the words "any person" in the section. It does not say "some" or "particular persons". It says "any person".
Will you bring in lawyers to the outpatient departments?
Deputy Howlin, please behave yourself. Deputy Ahern to continue without interruption.
The examples provided by Opposition Members of hardship cases should be re-examined in the light of what I have said. Perhaps then they will realise that the statutory protection exists for those who genuinely cannot afford to pay. The Minister last night gave details of a new VHI scheme which he had requested to cover these charges.
On a point of order——
Is it a point of order?
I do not wish to hand trip the Deputy, I would not dream of it, but are the rules of this House not that a Member must make his speech verbally and not read from a prepared script from the Department of Health?
Absolutely not.
I am glad to be so informed.
The Deputy may proceed with the reading of the script. Deputy Quinn is long enough here to know he is mischievious rather than looking for real information.
Some Deputies stated that the VHI scheme would not be ready in time. Let me make it clear that this special VHI scheme will be available to the general public in time to meet the commencement day of the charges which will be 18 May. The moderately priced scheme will represent excellent value for money at around £25 for a family of two adults and two children. This scheme is a reality. I noticed that Deputy Cullen was worried about the scheme and thought that it would not be workable; then he went on to praise the VHI Board for their great ability in administering the voluntary health scheme that is there at the moment. He will be glad to know that the VHI Board devised this scheme and will be operating it, not the Minister. I am sure he will be happy with that. It is about time that a sense of realism entered into the consideration of Members on the other side in relation to the proposals put forward. It is quite true there are none so blind as those who do not wish to see.
This is incredible.
We must remember that the responsibility for the need to introduce these charges rests with the previous Coalition Government who over the past four years mismanaged the economy.
(Interruptions.)
The country has been dragged down and the total debt rose by 50 per cent. Interest rates have also risen vis-à-vis inflation to unprecedented levels. The responsibility for all that lies on the shoulders of the Fine Gael/Labour Government.
Stick to the script, it was better.
(Interruptions.)
It is our responsibility now to straighten out the problems into which this country has been dragged by the ineptitude and lack of honesty of the previous Government.
Honesty — on your election platform?
The people can be assured that over the next number of years our policies will bring the country back to the position in which it was prior to the election of the Coalition Government in 1982. Do the Opposition parties really think that the people will accept their hypocritical objections to the honest endeavours of this Minister to save the health services?
By killing off the patients.
The Minister is saving the health services and when we go back to the people in four years time they will accept that the measures that have been taken were necessary and they will be glad that we were given the opportunity to save the health services and to save the nation.
Read the debate of last November on health.
Over two months ago we had a general election and three issues dominated that election to the virtual exclusion of everything else. The first issue was that there should be no further increase in the general rates of taxation. The second issue was that there should be no increase in Exchequer borrowing and the third was that there should be no cuts in public expenditure. About 90 per cent of the people who voted in that election voted in favour of those proposals and tonight they will reap the harvest.
Hear, hear.
About 10 per cent of the electorate did not support these three propositions. We pointed out in the general election that we were in favour of a fair and equitable general system of taxation to support essential health services. Our policy did not find the benefit of electoral support because we had Deputy Haughey standardising taxation at 35 per cent and the PDs standardising taxation at 25 per cent admittedly on a more modest time scale of five years. Fine Gael decided that a provision for health of £1,117 million in non-capital expenditure should be provided in the Estimate. The country supported that proposal because the country was in favour of reducing public expenditure.
In the immediate aftermath of the Labour Party leaving Government on that issue, we predicted in a press statement which we issued that major hospitals such as the Mater, St. Vincents, St. James's, Cork Regional, Limerick Regional, Galway Regional, Sligo and Ardkeen Hospital would be left seriously underfunded in 1987. We were right in assessing the position at that time. We said that all of these cuts would mean that staff throughout the health services would have to be made redundant and that this effectively would mean that the health services would suffer irreparable damage in 1987. The media did not give it much attention because they were fastening to a prospective gargantuan debate on RTE between the outgoing Taoiseach and the prospective Taoiseach and, of course, they were captivated by the PD's. We proposed in our analysis at that time that we should not give way on the fundamental need to preserve our basic health services, to speak honestly to the people and say we were not afraid to pay the price of funding those services even if it meant increased health contributions, even if it meant foregoing reductions in taxation and even if it meant bringing in a more draconian regime to ensure that those who were not paying their tax would pay it. We were not listened to at that time.
The Irish people are fortunate now in having at least 12 Labour Deputies who are prepared to put that historic development in Irish politics into perspective this evening, because there was a volte face of monumental proportions on the part of the Fianna Fáil Party. I recall the leader of the Opposition at the time, Deputy Haughey, accused me of accepting the Fine Gael shilling by becoming a Coalition Minister. I can say, with profound respect to the Taoiseach, that he has accepted a whole Fine Gael budget and another £9 million on top of it and he is implementing it now tonight in this health debate.
The Minister has said, and this is the nub of the issue, that demand for health services which are provided free at the point of use is to all intents and purposes insatiable. This is not a statement of political dogma, it is an economic fact. I would suggest to the Minister and to the Department of Finance that this is fallacious. It is true that the demand for health services is insatiable. However, in a fair society this demand is controllable in an equitable way by rationing a limited degree of hospital resources to citizens based on their health needs not on the money in their pocket. That is where we differ from the PDs who are obsessed by charges, who believe that if we charge people for everything in the health serivices the ordinary citizens will behave themselves,——
We are not saying that.
——that they will not make particular demands. That attitude is an affront——
A fair and equitable system is what we want to see.
——to the concept of health care. Our policy is based on the principle of an adequate level of general taxation to provide general eligibility for the health services. Admittedly the health services, in themselves are inately limited in scope and must be rationed at the point of usage, not on the basis of paying for the service at that time. One pays, in advance, by way of health contributions, by way of taxation. Then one uses the services and one is not crucified by £10 a night at the point of usage.
We have the new approach of the Fianna Fáil Party, an historic departure in health care. We have the approach of the Progressive Democrats — which I very much regret to say is the approach of the former Fine Gael Minister for Finance, influenced largely by the Department of Finance rather than by political reality — who will now foster a two-tier system of public and private health care based, for the most part, on an outmoded poor law health mentality. That is the reality of what we are introducing. Apparently these three parties now believe that the ordinary people will behave themselves in relation to the social services, will not use them if they have to pay £10 every time they visit an out-patients' department, or stay overnight in a hospital. Therefore it is a concept of modest or nominal charges. I reserve for the approach of the Progressive Democrats a special personal odium because they try to have it both ways. At least the Fine Gael and Fianna Fáil approaches are relatively honest. We know where we stand with them.
These charges will constitute a direct financial imposition on 1.2 million people, namely, those outside the scope of the GMS and the VHI. What do the Progressive Democrats propose to do? They propose to grant an exemption to 5,000 families in receipt of the family income supplement, 5,000 out of 800,000 families. What a glorious, caring concept.
The Deputy should read it again.
Five thousand families out of 800,000 families will benefit. I would suggest, with due respect to the Taoiseach — a man who has prided himself with monumental capacity to verbalise his care which, in many respects, I accept but he does tend to overdo it — that the introduction of a £10 charge in relation to children of six weeks and over, to say the least, is petty, mean and vicious.
We are today celebrating the anniversary of the inception of the 1937 Constitution which says that we will cherish all the children of the nation equally. One might well ask: what do we do on that basis? Take the case of the child of a man and woman with earnings of £125 a week going into, say, Crumlin, Harcourt Street or Temple Street Hospitals, the child being seven weeks old. Does one take a measuring tape and ask: is it seven weeks old, let us weigh the child, let us bring in the birth certificate because if the child is seven weeks old they will be charged £10 to see a hospital consultant? Of course, they will not see a hospital consultant. They will see a junior hospital doctor because on Mondays and Tuesdays the consultants are looking after their patients for the few hours they are there and, on Wednesday, Thursday, Friday and Saturday mornings, they are on private practice. So they will not see a hospital consultant.
Then the Minister says that from 18 May, those people can join the VHI. Will a person who joins the VHI and who pays £25 for himself, his wife and two children, when he turns up at an out-patients' department receive VHI treatment? Does he say: I have joined the VHI, I was never subscriber before, I want to see a consultant. He will, in his eye, see a consultant. The mother will wait for seven hours and will be lucky if she sees a senior charge nurse who, in due course, will mark her down for, perhaps, Tuesday next. Then she takes the bus back to Tallaght which will have cost her £3 or £4, goes back to her GP, pays him another £12, and then goes back to the outpatient's department and pays another £10 there.
Did the Deputy change that when he was in office? Did a woman in that position see the consultant when the Deputy was in office?
That is the concept of care of Deputy Harney. At least I would ask that children be exempt.
Pardon me, Deputy, we do not want any interruptions and no speaking behind Deputy Desmond's back, please.
In this budget, in this health situation, what have we done? We are cutting back on the basic health services. There was no great necessity to do so because we were short, roughly speaking, £60 million to £70 million. We could have increased health contributions from the 1.25 per cent to 2 per cent. That would have yielded the £70 million without the anger, frustration, loss of earnings and livelihood now being imposed on 2,000 people, or 2,000 jobs being abolished from the health services on a completely irrational basis through the application of a crude embargo policy on 500 separate grades in the Department of Health. It is now quite impossible to endeavour to operate a rational application of the Estimates for 1987. What happens? Health contributions are going up by a quarter of 1 per cent on a ceiling of £15,000 now, amounting to an extra £37.50 a year on a family with earnings of up to £15,000 annually.
If one wants to get cover now with the VHI for in-patient and out-patient care that will be free for the remainder of this year since the VHI have not yet proposed a scheme. A scheme is to be introduced on 18 May, it has not been advertised yet and we do not know its details except for the crude outline given by the Minister. One way or the other, on top of an additional contribution of £37.50 there would be another £25 payable to the VHI. Then, if one is sick what happens because of the interlocking between the Departments of Health and Social Welfare? There will be no point in having 26 stamps in order to claim disability benefit. One must have 39 stamps to one's credit; one gets nothing for the first nine months of insurable employment. Then what happens? One pays £10 a night in hospital and, on top of that one loses £20 a week in respect of pay-related benefit, constituting a double imposition.
Health expenditure is being cut massively and social welfare is being reduced simultaneously in respect of disability benefit. If one remains sick, the following year one is stuck for another £100 and, unless one has four years' stamps as against three, one will not go on to long duration benefit. Here is a caring society, all for the sake of the equivalent of four months of the national lottery moneys. That is all that is involved. We opposed that imposition on people.
I think the Taoiseach and the Minister for Health, on balance, were right in their decision to rescind the proposed prescription charges. I willingly concede that. I spent four years trying to convince people that if one imposes a prescription charge all that happens is over-prescribing. For every £1 in terms of visits there is £3 in terms of drugs prescribed involved. If one imposes a prescription charge it simply means that a doctor will prescribe twice the usual quantity to last two months and that medicine will be poured down the toilet at the end of four or five weeks. It is drugs that are the issue, not prescription charges, as such. It is the cost of the drugs that matters.
I am glad to see that the Minister has restored the GMS Vote to £107 million. I understand we shall have the revised Book of Estimates published within the next few days when I hope a per capita scheme will be introduced with a proper pension scheme, not a public service one, but one under which there would be contributions payable.
I shall conclude on this note. There is a price to be paid for the health services. The Labour Party are not afraid to pay their fair share. It is true that there is £28 million in health contributions outstanding and that the farming community do not want to pay these contributions. It is equally true that Fianna Fáil are bolstering up the farming community with the abolition of the land tax, by way of a further incentive not to pay. On that basis we must persuade people that they have a simple, stark choice. If they want less taxation they must accept a lower level of health services. That is the bitter corollary to be spelled out.
I very much regret that apparently this evening the Government will endorse a decision under which our health services will be diminished, affecting the basic fabric of one of the fundamental social services built up painfully over the years — right from the early forties — because our society has become mean, vicious and selfish. Those who are sick, unemployed or aged and those with disabilities will suffer from the cuts being proposed in this exercise. They are the people whom we were elected to protect and we have failed to do so. We ran scared before the electorate with cheap promises, particularly orchestrated by the Progressive Democrats and I reserve special odium for them.
Question put: "That amendment to amendment No. 1 be made".
The Dáil divided: Tá, 38; Níl, 99.
Tá
- Allen, Bernard.
- Barnes, Monica.
- Barrett, Seán.
- Birmingham, George.
- Boland, John.
- Boylan, Andrew.
- Bruton, John.
- Bruton, Richard.
- Burke, Liam.
- Durkan, Bernard.
- Enright, Thomas.
- Farrelly, John V.
- FitzGerald, Garret.
- Fitzpatrick, Tom.
- Flaherty, Mary.
- Griffin, Brendan.
- Hegarty, Paddy.
- Higgins, Jim.
- Kenny, Enda.
- Carey, Donal.
- Connaughton, Paul.
- Cooney, Patrick Mark.
- Creed, Donal.
- Crowley, Frank.
- Deasy, Austin.
- Deenihan, Jimmy.
- Doyle, Avril.
- Dukes, Alan.
- Lowry, Michael.
- McGahon, Brendan.
- McGinley, Dinny.
- Mitchell, Gay.
- Mitchell, Jim.
- Nealon, Ted.
- O'Keeffe, Jim.
- Shatter, Alan.
- Taylor-Quinn, Madeline.
- Yates, Ivan.
Níl
- Abbott, Henry.
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, David.
- Aylward, Liam.
- Barrett, Michael.
- Bell, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Matthew.
- Brennan, Séamus.
- Briscoe, Ben.
- Browne, John.
- Burke, Ray.
- Byrne, Hugh.
- Calleary, Seán.
- Clohessy, Peader.
- Collins, Gerard.
- Conaghan, Hugh.
- Connolly, Ger.
- Coughlan, Mary T.
- Cowen, Brian.
- Cullen, Martin.
- Daly, Brendan.
- Davern, Noel.
- Dennehy, John.
- De Rossa, Proinsias.
- Desmond, Barry.
- de Valera, Síle.
- Doherty, Seán.
- Ellis, John.
- Fahey, Frank.
- Fahey, Jackie.
- Fitzgerald, Liam.
- Fitzpatrick, Dermott.
- Flood, Chris.
- Flynn, Pádraig.
- Foley, Denis.
- Gallagher, Denis.
- Gallagher, Pat the Cope.
- Geoghegan-Quinn, Máire.
- Gibbons, Martin Patrick.
- Gregory, Tony.
- Harney, Mary.
- Haughey, Charles J.
- Hilliard, Colm Michael.
- Howlin, Brendan.
- Hyland, Liam.
- Jacob, Joe.
- Kavanagh, Liam.
- Kemmy, Jim.
- Kennedy, Geraldine.
- Kirk, Séamus.
- Kitt, Tom.
- Lawlor, Liam.
- Lenihan, Brian.
- Leonard, Jimmy.
- Leyden, Terry.
- Lynch, Michael.
- Lyons, Denis.
- McCartan, Pat.
- McCarthy, Seán.
- McCoy, John S.
- McDowell, Michael Alexander.
- Mac Giolla, Tomás.
- MacSharry, Ray.
- Mooney Mary,
- Morley, P.J.
- Moynihan, Donal.
- Nolan, M.J.
- Noonan, Michael J. (Limerick West).
- O'Dea, William Gerard.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Keeffe, Batt.
- O'Keeffe, Ned.
- O'Leary, John.
- O'Malley, Pat.
- O'Rourke, Mary.
- O'Sullivan, Toddy.
- Pattison, Séamus.
- Quill, Máirín.
- Quinn, Ruairí.
- Reynolds, Albert.
- Roche, Dick.
- Sherlock, Joe.
- Smith, Michael.
- Spring, Dick.
- Stagg, Emmet.
- Swift, Brian.
- Taylor, Mervyn.
- Treacy, Noel.
- Tunney, Jim.
- Wallace, Dan.
- Walsh, Seán.
- Wilson, John P.
- Woods, Michael.
- Wright, G.V.
- Wyse, Pearse.
Tellers: Tá, Deputies L. Burke and Durkan; Níl, Deputies V. Brady and Browne.
Question declared lost.
Question put: "That amendment No. 1 be made."
The Dáil divided: Tá 73; Níl, 16.
Tá
- Abbott, Henry.
- Ahern, Dermot.
- Ahern, Michael.
- Andrews, David.
- Aylward, Liam.
- Barrett, Michael.
- Brady, Gerard.
- Brady, Vincent.
- Brennan, Matthew.
- Brennan, Séamus.
- Briscoe, Ben.
- Browne, John.
- Burke, Ray.
- Byrne, Hugh.
- Calleary, Seán.
- Collins, Gerard.
- Conaghan, Hugh.
- Connolly, Ger.
- Coughlan, Mary T.
- Cowen, Brian.
- Daly, Brendan.
- Davern, Noel.
- Dennehy, John.
- de Valera, Síle.
- Doherty, Seán.
- Ellis, John.
- Fahey, Frank.
- Fahey, Jackie.
- Fitzgerald, Liam.
- Fitzpatrick, Dermott.
- Flood, Chris.
- Flynn, Pádraig.
- Foley, Denis.
- Gallagher, Denis.
- Gallagher, Pat the Cope.
- Geoghegan-Quinn, Máire.
- Haughey, Charles J.
- Hilliard, Colm Michael.
- Hyland, Liam.
- Jacob, Joe.
- Kirk, Séamus.
- Kitt, Tom.
- Lawlor, Liam.
- Lenihan, Brian.
- Leonard, Jimmy.
- Leyden, Terry.
- Lynch, Michael.
- Lyons, Denis.
- McCarthy, Seán.
- MacSharry, Ray.
- Mooney Mary,
- Morley, P.J.
- Moynihan, Donal.
- Nolan, M.J.
- Noonan, Michael J. (Limerick West).
- O'Dea, William Gerard.
- O'Donoghue, John.
- O'Hanlon, Rory.
- O'Keeffe, Batt.
- O'Keeffe, Ned.
- O'Leary, John.
- O'Rourke, Mary.
- Reynolds, Albert.
- Roche, Dick.
- Smith, Michael.
- Swift, Brian.
- Treacy, Noel.
- Tunney, Jim.
- Wallace, Dan.
- Walsh, Seán.
- Wilson, John P.
- Woods, Michael.
- Wright, G.V.
Níl
- Bell, Michael.
- De Rossa, Proinsias.
- Desmond, Barry.
- Gregory, Tony.
- Howlin, Brendan.
- Kavanagh, Liam.
- Kemmy, Jim.
- McCartan, Pat.
- Mac Giolla, Tomás.
- O'Sullivan, Toddy.
- Pattison, Séamus.
- Quinn, Ruairí.
- Sherlock, Joe.
- Spring, Dick.
- Stagg, Emmet.
- Taylor, Mervyn.
Tellers: Tá, Deputies V. Brady and Browne; Níl, Deputies Taylor and Howlin.
Question declared carried.
Motion, as amended, put and agreed to.
The Dáil adjourned at 9.05 p.m. until 10.30 a.m. on Thursday, 30 April 1987.