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Dáil Éireann díospóireacht -
Wednesday, 17 Feb 1999

Vol. 500 No. 5

Private Members' Business. - Confidence in Minister: Motion (Resumed).

The following motion was moved by Deputy McManus on Tuesday, 16 February 1999:
That Dáil Éireann has no confidence in the Minister for Health and Children.
Debate resumed on amendment No. 1:
To delete all words after "That" and substitute the following:
Dáil Éireann has full confidence in the Minister for Health and Children and, in noting with particular approval the Minister's achievement in securing an increase of 28 per cent in revenue funding and 43 per cent in capital funding in 1999 over the 1997 provision in place on coming to office, also welcomes the major service improvements under way across a whole range of areas as a result of the provision of this greatly enhanced level of funding.
–(Minister for Health and
Children.)

Deputy Crawford was in possession and I understand he is sharing time with Deputies Neville, Theresa Ahearn and Belton.

The increased prosperity of the State is not reflected in the provision of adequate health services. The two tier system is becoming increasingly unfair. It is unfair and unjust to those who cannot afford to go private for their operations, which would give them a better quality of life. It is also unfair that some people must wait in pain and discomfort for up to two years for hip replacements and others must wait one and a half years for cataract operations. Some elderly people must wait up to 12 months to have their eyesight tested, during which time they are deprived of the simple pleasure of reading the newspapers.

It is a disgrace that breast screening programmes which should have commenced last September will not commence until next autumn at the earliest. The Minister for Health and Children does not appear to have any understanding of the suffering and stress his policy is causing those who cannot pay upfront for services. I have been contacted by patients on medical cards who were advised by their doctors to go private because of the stress being caused by their condition. If they do that, they will be presented with a bill from the health board for which they do not have the finances to pay. They will then be threatened with court action, all of which does not help their convalescence.

Approximately 3,000 women are awaiting mammograms. In December 1998 an estimated 38,000 patients were on the waiting list and last month more that 400 elderly patients in acute hospitals in need of nursing home care or convalescent care were on the waiting list.

The Minister has failed to provide funding for the full commissioning of the Regional Hospital in Limerick. The people of the mid-west are entitled to hospital services on a par with those provided by the other health boards. The development of services at regional hospitals is crucial to achieving this. I ask the Minister present to review immediately the level of funding allocated to that hospital and to respond to the needs of the people of the mid-west who have the right to adequate hospital services. Hospitals in the mid-west will close wards during the sum mer. The policy of closing wards is a disgrace and should cease. The closure of wards to balance hospital budgets is a false economy. It results in paltry savings, prolongs pain and suffering, places at greater risk patients with life threatening conditions, demoralises hospital staff, contributes to the lengthening of the waiting list and, ultimately, puts additional pressure on the many accident and emergency departments. The cancellation of operations originally scheduled for the end of last year and early this year was partially responsible for the accident and emergency crisis which confronted our hospitals in January.

Last week I got a phone call from a member of the staff in St. Joseph's Hospital in Clonmel requesting that I come to the hospital immediately. I knew from the caller's concerned voice that there was a crisis at the hospital. I was devastated by what I saw when I visited the hospital. There were seriously ill patients there, one was unconscious, another was fighting bravely for his life having had a stroke and three others were on trolleys in the corridor. The staff were exhausted and management was under severe stress. This is not only a local story, it is a national one.

It is a disgrace that patients are being treated in the corridors of hospitals. It must be the greatest scandal of our times that our sick people cannot be admitted to a hospital ward. Can the Minister imagine the indignation, embarrassment and the sheer lack of human dignity of being treated in a corridor when one is at one's lowest ebb? That is human suffering due to the crisis in our hospitals caused by a shortage of beds. The Minister makes no secret of the fact that his priority is financial management, but his duty and responsibility is patient care. He has no business running a Department with responsibility for health unless he puts patients first.

We all recall what he said when he commented on his coalition partners, "when in doubt, leave them out". I fear he runs the hospital services on that ethos. We must be grateful to the medical profession who work on the principle of "when in doubt, take them in".

The matron in St. Joseph's Hospital told me last Monday morning, when he was under severe stress that the hospital will continue to admit patients who need hospital care, even if they can only provide them with a trolley on the corridor. He said the hospital would do its best to provide them with medical care rather than let them go without it. It is ironic that on the morning I visited Clonmel hospital the Minister was interviewed on "Morning Ireland". Did he talk about the health services or the crisis due to a shortage of beds? He did not mention hospital services.

If the Minister is not prepared to administer his Department on the ethos of putting patients first, he should pass on the responsibility to someone who will put patients first.

I spoke to the Minister about the problem in Tullamore hospital. A constituent of mine who requires a hip operation was told on the day he turned up for his appointment that he would have to return home because there was no bed available for him. He telephoned the hospital on the morning of his second appointment, but was also told a bed was not available. If one had a dental appointment for an extraction and was told on arrival that the dentist could not extract the tooth, one would be disappointed. One can imagine the disappointment of that elderly person, having prepared himself mentally for the operation when he was told on two occasions that a bed was not available. That man still has not had his operation. Tullamore hospital is in the Minister's home county and under the remit of the local health board, but he is not doing much to address the crisis there.

The former Minister, Deputy Noonan, and Barry Desmond, fought to secure funding for the Longford-Westmeath hospital in Mullingar, which is now lying vacant. I ask the Minister to invest the necessary resources in that hospital to ensure it is fully operational because that is what the people of Longford and Westmeath deserve.

I want to bring to the Minister's attention the position prevailing at Mount Carmel Hospital in Longford. There is no general hospital in Longford, patients must travel to the general hospital in Mullingar. We were promised a casualty unit in Longford hospital, but that has not transpired. The staff in the casualty unit in the general hospital are doing their best under difficult circumstances. I want the Minister to review the policy of closing beds in Mount Carmel Hospital. I represent that area and the Minister also represents the midlands. I want as many beds as possible in Longford hospital. I ask the Minister to ensure no beds are closed in that hospital. If he does not do that, I will come back to him on this.

I wish to share time with the Minister for Tourism, Sport and Recreation, Deputy McDaid, the Minister of State at the Department of Health and Children, Deputy Moffatt and Deputy Conor Lenihan.

I understand you will also be sharing time with Deputies Flood and Daly.

Deputy Flood will not be speaking in the debate.

This motion of no confidence is a juvenile exercise in pre-school parliamentarianism, proposed by an Opposition which is unable, either in policy or performance, to match the work record and achievements of the Minister for Health and Children. The motion seeks to exploit those most vulnerable in society. Under the guise of concern for those in our midst who are afflicted by illness and infirmity, the Opposition is seeking ineptly to inflict political damage. It does so in full knowledge of the complexities and difficulties which all in this House seek to address so as to provide a decent and caring health service for the people. The Opposition makes its attempt in the absence of any coherent policy proposal. This is play school politics at its worst.

Today the Opposition has chosen to engage in the politics of spite and bitterness. This is not new patriotism but rather new nihilism, attempted political destruction simply for the sake of destruction. It is mindless criticism proffered without any attempt at proposing policy alternatives. The health service is being seized as a crude political cudgel and used without regard to those most affected by it.

Any properly focused debate on the state of our health service would acknowledge the achievements which have been attained and built upon. It would acknowledge the high level of expenditure which successive Governments have directed at the health services. Any such debate would reassure those who need to have recourse to our hospitals and medical services that ours is a service in which patients can properly place their faith and trust. Our standards are comparable to those of any developed country and we have avoided travelling the American route where assets are frequently a prerequisite to medical care and assistance. We are entitled to be proud of our health service. We are entitled to expect constructive debate which will reassure those in hospital or who have relatives or friends in hospital. We ought not to have an exercise in tabloid scaremongering which is precisely what this motion represents.

Whatever criticism may be levelled at Fianna Fáil in Government or in Opposition, it cannot be said that we lack coherent policy alternatives. Time after time we introduced Private Members' Bills, set out our alternatives and frequently legislated from the Opposition benches. Ours was a constructive Opposition and our politics was that of democratic choice, policy alternatives and substance. The same cannot be said of the current Opposition which is geared to soundbite rather than substance. Baseless criticism, unfounded innuendo and political character assassination are the order of the day. In the contemptible prose of one of the chief gurus of this newly emerging school of political thought, this motion can be described as no more than a crude attempt to "take out" a decent and hard working member of the Government. Deputy Rabbitte, the self-appointed headmaster of this school of political thought, has transformed himself in a few short weeks from being the Voltaire of Democratic Left to the Dustin of the Labour Party, a turkey desperately seeking a microphone.

It is not for Fianna Fáil to decide whether the old intellectualism of the Labour Party is to be swamped by the new nastiness of their newly acquired brethren. The battle between those who think and those who merely talk has clearly just begun. New Labour has yet to decide whether its soul belongs to the Channel 4 of Deputy Michael D. Higgins or the MTV of Deputy Rabbitte. This motion is strongly indicative that they propose to move towards the politics of thrash and away from the politics of substance. This bodes ill for the future of the Labour Party. The newly demoted Deputy Shortall can hardly welcome the down market direction in which her replacement has stained her portfolio. As she sits smouldering, having been deprived of her former responsibilities, she can hardly welcome the advent of the new nihilism being dictated by the dialectic die hards so recently rescued from the wreckage of Democratic Left.

I frankly have no time for those who expound the politics of nihilism, those who criticise without proffering a solution, those who under the guise of social concern seek only to foster political mayhem. Their methods are base, their tactics deplorable and their motives dishonourable. The primary purpose of those who support tonight's motion of no confidence has nothing at all to do with the health service. Their motivation is far removed from concern or constructive criticism. This is a debate about politics, about the last general election, about the winners and losers. Most of all it is a debate which exposes the extent of the tactics which those ousted from power are prepared to utilise to overturn the democratic will of the people. Innuendo and rumour are the weapons of those bereft of political policy or popular appeal. The decent, hard working politicians who cannot be challenged fairly in the light of day are being stalked in the shadows by political opponents who have neither the honour nor courage to confront them openly.

For the sake of politics and for the sake of a Minister discharging his responsibilities and duties without fear or favour, I urge that this opportunistic motion of no confidence be roundly defeated.

Not a word about health.

The Deputies opposite will have to forgive me if I am more than a little sceptical of their approach to this debate. The Labour Party Deputies who have put their names to this motion know very well that they will not improve our health services one iota or better the lot of a single sick person in the country by coming to the House and heaping a litany of abuse on my colleague, the Minister for Health and Children. It is a pity the Labour Party has chosen to exploit the difficulties in the health service in a negative, simplistic and unfairly peronsalised fashion. I say to Deputy McManus that this is only a personalised attack on the Minister, Deputy Cowen, and is not for the benefit of the health service.

The facile tactic of putting down a no confidence motion of this nature contributes nothing towards a serious constructive debate on the realities which any Minster for Health and Children has to deal with in the effort to provide our people with the kind of health service we all want to make available to them. Last night the Minister, Deputy Cowen, provided a very thorough analysis of the difficulties which exist. As doctors, patients and public we would all love to believe that there is such a thing as an instant quick fix solution to all the problems affecting our health services. We all know in our hearts and souls that there is no such magic solution – every Deputy who will enter the division lobbies this evening knows that. That is why I deplore the insincerity of the Opposition in this debate. We all accept there are problems not alone in health but in many areas, and it is the responsibility of Government to deal with those problems in as constructive a manner as it can. If there were no problems there would be no need for Government.

Our health services are being provided with £3.3 billion this year. In 1995 the total health budget under the rainbow coalition was £2.2 billion. In 1996 it was £2.3 billion. We entered Government in 1997 and from that time we have increased the health budget to £3.3 billion, an increase of £800 million. How is it possible for a newspaper to quote Deputy Shatter, as one did this morning, that the Minister is locked in a 1980s time warp of economic recession and that his main political mission is limiting health service expenditure? How can this comment be quoted in a newspaper when we have doubled what Deputy Shatter's Government invested in the health service?

Health service costs are rocketing all over the world. This is a feature of every health service in Europe, USA, Australia and New Zealand. We are not the only country which faces such a problem. The day we have no waiting lists, medical science will be at a standstill. Britain is constantly forced to overhaul and reform its national health service. Escalating costs are further enhanced by the rapid and, I emphasise, welcome advances in medical science.

To illustrate the magnitude of the problem – we had "no confidence" motions in the Minister for Health in 1990 and 1991. At that time the health budget was £1.3 billion. A sum of £2 billion extra has been put into the health service in that short time by successive Governments involving Ministers from all the major political parties.

Besides trying to cope with normal health services, such as primary care, preventive medicine, geriatric and psychiatric care, paediatrics, mental handicap and so on, it is trying to stretch resources to meet the cost of medical advances and breakthroughs. High technology medicine is now the order of the day. Procedures unheard of ten years ago are now commonplace such is the rapidity of modern medicine.

Take the example of a patient with arthritis of the hips or the knees, a condition which until relatively recently was accepted as the inevitable degenerative consequence of advancing years. It is not long ago since I was prescribing Brufen 400 milligrams three times a day and the cost was £3 to £5. It is now seen as a treatable condition but with availability of treatment comes demand. Replacement of joints renders patients mobile again and pain-free. We do not consider the cost nor should we. Who wants to talk about cost, particularly when a patient is well. In 1997, a time when it cost £3 to £5 per prescription, £11 million was spent on 2,502 artificial hip operations, representing an average of more than £4,000 per joint replacement.

Let us take the example of a patient with increasing chest pain and invalidism, a feature of progressive coronary heart disease. There was a time when such patients were told – I did it myself – to put a tablet under the tongue, being reassured that they would be all right once they remained at home and never moved out. This disability is no longer acceptable. A patient can be whisked into hospital, his chest opened, the diseased heart vessel bypassed rendering the patient mobile again and pain free. It costs more than £10,000 to £12,000 per operation and over 1,006 such operations were carried out here last year.

If the heart becomes more and more diseased, then a replacement is now possible. We now have the heart transplant which is commonplace according to Mr. Maurice Nelligan, the cardiac surgeon. In 1997, 12 heart transplant operations were performed at an average cost of £40,000 and that does not take into account the very expensive drugs which are necessary to prevent rejection of the transplanted organ. That is a long way from a few tablets under the tongue.

Kidney transplants are now regarded as commonplace procedures, so commonplace we do not mention them anymore. What may not be known is that renal transplants cost an average of £2,500 and there were more than 348 renal transplants last year at a total cost of more than £1 million.

Besides kidney transplants, a patient while awaiting a kidney transplant must have renal dialysis, and go into hospital overnight and be treated. Last year we had more than 110 kidney transplants averaging a cost of more than £20,000.

Liver transplants can restore dying patients to normal active life at an average cost of £40,000 per transplant. This is a small country. We would have done more than 20 liver transplants last year and some 49 bone marrow transplants were carried out at an average cost of £27,000 each. It is a great tribute to our country and to our health service that we were able to do this volume of work in the past year.

There are now diagnostic procedures, ultra-sound, CAT scans, nuclear magnetic resonance and cardiac catheterisation, new sophisticated procedures which facilitate more accurate diagnosis, but we also must remember the cost. More sophisticated and expensive procedures are coming on stream daily and availability creates demand.

The more the high technology procedures become available, the greater the demand for them. When the public sees these items on television and reads about them in magazines, they wonder why they cannot have access to them. Expectations are very high and why should they not be so. With the rate of advances and breakthroughs in medicine, I can see that health costs could outstrip the gross national product in the not too distant future.

The blame does not lie with the Minister for Health and Children. The Minister does not stand indicted before the Dáil and the public. He, like any other Minister for Health, is faced with agonising choices, as Ministers for Health the world over are with so many demands on the finite resources at their disposal.

The problem arises in that the budget for geriatric, psychiatric and mental handicap care, the so-called Cinderellas of the health service, may become more and more curtailed as more high technology medicine devours increasingly more of the finite health budget but that is not the case even in the Cinderella area. Last year in those areas we spent £270 million up £11.3 million on 1997.

We, the politicians, stand indicted before the public for failing to spell out the escalating costs of high technology medicine and for failing to educate the public on this subject. We are the people who should be indicted, not the Minister for Health and Children. As I said to Deputy McManus, this is just a personalised attack on the Minister and will not do one iota for the health service.

The criticism by the Labour Party of our Minister for Health and Children is a futile exercise in negativity, propped up by the Samba band on the Opposition benches. As Minister with responsibility for older people, I emphasise what the Minister has done to enable him and me to improve services for older people by injecting a significant level of additional funding, both revenue and capital, into the system since we came into office in mid-1997 and also in developing a planned, focused and phased programme of overall improvements in our health service.

Excluding the nursing home subvention scheme, which we will deal with separately, the amounts of additional revenue funding provided to services for older people by the previous Government in the years 1995, 1996 and 1997 were £2.1 million, £2.5 million and £3 million, respectively. In 1998, the additional amount provided by this Government was £7 million and in 1999, the figure was £16 million.

As regards the nursing home subvention scheme, the annual budget in mid-1997 when this Government came into office stood at £17 million. The allocation in 1999 is £33 million, an increase of almost 100 per cent. So much for our newspapers today. Combining the two lots of figures mentioned, £25 million additional revenue funding was provided to services for older people in 1999 over and above the 1998 figures.

On the capital side, this Government has more than doubled the level of capital resources previously made available for health facilities for older people to £14 million in 1998. The investment will accelerate the provision of additional residential care units, rehabilitation, respite care and day care facilities for older people as well as enhancing existing services so that older people and their carers will have better facilities closer to where they live.

The construction or planning of new community nursing units is under way in places such a Ballyconnell, Virginia, Clonmel, Killybegs, Birr and Achill. A new 50 bed unit will be opened in Dublin this year. Funding was also provided last year for 11 day care centres and in recent days I announced the availability of funding for a comprehensive day care centre in Finglas.

Funding was provided in 1998 for a range of minor capital works in relation to services for older people in locations such as Dungarvan, Thomastown, Limerick, Ennis, Cork city, Loughrea, Ballina, Clonakilty, Bandon, Dingle, Dunmanway, Macroom, Schull, Castletownbere, Kanturk, Cobh, Clifden, Newcastlewest, Raheen, Castlebar, Athlone and Bellmullet. The capital allocation for 1999 has not yet been finalised but it will exceed last year's figure of £14 million.

The National Council on Ageing and Older People, the statutory advisory body on issues affecting older people, has identified support for older people in the home as well as support for carers as fundamental to improving the quality of life of older people. This is also the consensus view of the various organisations which represent the interests of older people. A number of initiatives have been taken this year which will enable health boards to provide greater support for older people in their homes.

The home help service is widely recognised as a key service in supporting dependent persons in their homes. Notwithstanding this, it is generally accepted that there are a number of problems relating to its organisation and development which need to be addressed if the service is to realise its full potential. The findings of a report commissioned by the Department which have just been published are being studied. In the meantime steps have been taken to deal with the most immediate problems. A sum of £1.5 million has been earmarked for the development of the service. This will be used to extend its coverage, providing more hours' service, and improve training for home helps.

Older people should not be deprived of medical care because of inability to pay. In line with its commitment in An Action Programme for the Millennium, the Government has decided to increase significantly the income guidelines for entitlement to a medical card for those over the age of 70. This improvement will be introduced over three years beginning on 1 March.

That is the Minister of State's hope.

The difference is that the Government delivers on its promises. An area of concern to Deputies on all sides of the House is the remuneration of home helps in terms of rates of payment and standardisation across health boards. An additional £3 million has been allocated to health boards to raise the minimum rate of payment for all home helps to £3 per hour from 1 April. This is part of a phased improvement of rates of payment, the remaining phases to be implemented as resources permit.

Improvements have been introduced for carers who will receive an additional £6 per week. A sum of £200 will be available towards the cost of respite care. Improvements will also be made to extended care services. Grants to voluntary bodies will be increased while additional geriatricians will be appointed. There will be a new psychiatric service for older people as well as other development programmes. The Minister's hallmark is that he delivers on his promises.

Deputy McManus said that the events at Tallaght Hospital were the catalyst in tabling the motion of no confidence in the Minister. I apologise on behalf of my constituency colleague, the Minister of State, Deputy Flood, who, due to ministerial duties, is unable to participate in this debate. He and I are at one. We have complete confidence in the way the Minister has handled the issue. It has been handled in an efficient and proper manner. The Minister is ensuring the long-term viability of the hospital.

There is a wider dimension to this debate. There is a disturbing trend in new Labour towards the blackguard practices of infiltration and destabilisation of The Workers' Party in attacking Ministers or seeking scalps when they will not be given. No scalps will be offered because of the way the Tallaght Hospital issue is being handled.

Beds are being sought, not scalps.

Political bounty hunters.

This is not the first time I have been called on to defend the Minister. I am proud to do so because he is as concerned about taxpayers' money as he is about patient care.

The Minister and the three person group have made it clear – the Opposition does not want to hear this – that, despite the lurid headlines, there will be no enforced redundancies at Tallaght Hospital. There will be no reduction in the resources and facilities available to the paediatric service at the hospital in respect of which there has been scaremongering and talk of a move to Crumlin resulting in the run-down of state-of-the-art facilities. The Opposition and some of the newspapers have been trying to imply that, because of funding difficulties, there has been a reduction in the level of patient care at the hospital. There will be no such reduction, as has been confirmed by Arthur Stirling who is a member of the board.

I am disappointed that new Labour, perhaps in its first motion in Private Members' time, is engaged in a cynical exercise in political opportunism. It is playing politics with anxious patients awaiting medical treatment, including surgery. It is undermining the confidence of health service personnel who are working hard in difficult circumstances to provide a service. It is seeking cheap publicity at the expense of sick patients, their families and relatives. It is a sick motion which should be withdrawn.

I pay tribute to those who work in the various institutions, hospitals, clinics, day care centres and so on, for which the Minister has responsibility. They are dedicated, highly skilled and highly motivated. I appeal to health board management to improve communication, especially with the families of those awaiting medical treatment, including surgery, in which, perhaps because of misunderstandings, there is often a breakdown.

I pay tribute to the former Minister for Health, Deputy Noonan, on the work he did in reconstructing the regional hospital in Limerick. Under a plan devised in 1995 nine new operating theatres were provided. A sum of £22 million or £23 million has been spent in developing the hospital, including the provision of new out-patient facilities and an intensive care unit. The modernisation programme has been accelerated by the Minister. A sum of £26 million will be spent this year in providing a new paediatric service, which is badly needed, new laboratories and a new accident and emergency department and in modernising the radiology department. Improvements have also been announced in Ennis. This indicates a desire on the part of the Minister to improve the services available in the regions.

Much of this discussion has centred on Tallaght Hospital which everyone is anxious to see working successfully. However, there have been major problems in the regions. I compliment the Minister on travelling to see the problems at first hand and providing almost £3.5 billion for health services. This is a uniquely large amount of money which, along with improved managment, will boost the delivery of services over the coming years. Instead of condemning the Minister we should be withdrawing the motion and giving him our full backing for the work he is doing.

I wish to share my time with Deputies Rabbitte, O'Sullivan, Ó Caoláin and Joe Higgins.

Is that agreed? Agreed.

This motion is worthy of the sup port of Deputies on both sides who recognise and are concerned about the chronic state of public health services. The contrast between the resources available to this Minister and the lengthening queues for vital treatment confounds the public. The Labour Party believes the Minister has failed. Given the prosperous state of the nation's finances, the health services should be entering a phase of expansion and improvement. However, with the Minister at the helm we are living through a crisis which has caused severe pressure, particularly on public hospitals. It is time to call a halt to this deterioration and to make a fresh start.

Last evening I spoke to patients in Beaumont Hospital. One patient informed me that, on average, 27 patients are on trolleys in the accident and emergency department awaiting admission to the appropriate ward. This is the main acute hospital for north Dublin, city and county. This patient also stated that the length of time patients remained on trolleys varied from 16 to 19 hours. This is totally unacceptable.

I also met a constituent who had brought his 90 year old mother into the A&E department four hours earlier. Hopefully that woman is receiving attention in a ward or has been discharged. This is totally unacceptable in a Christian country.

Given the pressure on staff, particularly on doctors and nurses, I acknowledge the professional and humanitarian care they provide for all patients. This acknowledgement should be made in a more appropriate way by the Minister and the Government. I could give numerous examples of the problems of waiting lists. For example, young men and women have been waiting for more than ten years for orthodontic treatment, since they were children.

The following case illustrates the hardship faced by thousands of men, women and children awaiting heart surgery. I will refer to the individual involved as "John". In 1976, after a visit to Dr. O'Brien in Jervis Street Hospital, he was diagnosed with blood pressure and mild angina and gave up smoking immediately. In November 1996, he suffered his first heart attack and spent three weeks in hospital. He was informed that he would be taken in at a later stage for an angiogram.

In 1997, while awaiting an angiogram, "John" had a second heart attack and was hospitalised for two weeks. He was called for an angiogram after two months which highlighted three blocked arteries leading to the heart. "John" was informed that he needed heart bypass surgery and was put on a waiting list for the operation at the Mater Hospital. At the same time he was informed that he would not survive another heart attack.

Today, February 1999, this patient is sitting at home in a distressed and breathless condition. He is awaiting the bypass operation having being forced to give up work in 1996. This case is typical of thousands of people who are waiting for urgent medical treatment. Most of these people have paid their taxes and PRSI contributions over the years and contributed to the upbeat economic climate.

We should compare their situation with those who can obtain medical care through private health insurance. These people have almost immediate access to the Mater Private Hospital or the Blackrock Clinic. I doubt if they would have to wait two weeks for treatment, let alone two years, which is the norm for public patients.

This is the real world which exists for the majority of people and it cannot be allowed to continue. The Minister's attitude is unacceptable. He continuously states that he is putting more money into health in 1999 than ever before. However, the facts show that since he took office waiting lists have jumped from 30,000 to 35,000 at a time when the coffers of the Department of Finance have never been so full or when finance has never been as readily available for the few rather than for the majority.

As Labour spokesperson on older persons' issues I am deeply concerned at the lack of residential and other long-term care facilities for older people in need of important, if non-acute, care. This is a major problem which is leading to a substantial blockage in the availability of acute hospital beds. Unless this issue is resolved now when the money is available for much needed capital investment, the situation will get infinitely worse given the projected increase in the number of older people as we enter the new millennium.

A number of issues can and should be addressed as a matter of urgency. In many out-patients departments numerous patients are called for the same appointment time. It is not unusual to see 15 or 20 people waiting for the same time resulting in large queues. In many cases, elderly people, particularly those living in the city centre and in more rural areas, have to leave home well before their bus passes come into operation in order to make hospital appointments.

The lack of co-ordination of administration in hospitals results in patients who have to meet other consultants or specialists having to make different appointments on different days. This system needs to be streamlined and reformed. The change in the drug refund scheme recently announced by the Minister and signalled on budget day will mean an additional cost of £10 per month for people who require regular medication. It is scandalous that this will take up the increase in social welfare payments.

It is available for the family.

Carers have not been given the due recognition they require.

What did the Deputy's party give them?

They have saved the country millions of pounds and the Government has forgotten them.

The Deputy is living in limbo.

I wish to address the controversy unnecessarily and unfortunately provoked in respect of Tallaght Hospital. I make no comment about the wider range of health issues so comprehensively covered by Deputies except to say that if I was pouring as much money into the health service as the Minister claims to be and the result was an additional 5,000 people on the waiting list, I would be taking a long and hard look at the calibre of managment in the health service, including in the Department of Health and Children.

I am deeply concerned about the impression given last night by the Minister that the service plan has been adopted by the Tallaght Hospital board and all is well. This is emphatically not the view on the ground and I refer the Minister to the insightful report in today's The Irish Times by Carol Coulter and to the views of the Tallaght Hospital Action Committee.

Without being partisan, I am persuaded that a serious miscalculation was made in respect of the funding requirements of a new hospital which comprises the commissioning of three old hospitals with their own traditions and ethos. The funding mechanism was inappropriate for such a new hospital and that was one of the conclusions of the Deloitte & Touche report. It also concluded that capital overruns could not have been avoided. Admittedly, there was a blurring of expenditure in terms of these overruns and the requirements of equipping, furnishing, etc, which were imperatives acknowledged by the Department at the time. The Department knew that the 21 June opening date would not otherwise have been met.

Deloitte & Touche acknowledges that the management had to spend above budget on capital. However, the Department did not shout stop. Furthermore, I wish to state with a full sense of responsibility that the Department had full knowledge of and left the impression that it acquiesced in the overspend. I am further concerned that having facilitated the considerable achievement of the June opening, the Department sent in the accountants after 105 days. Their remit was supposedly for three weeks. However, the consultancy went on for ten weeks during which a great deal of valuable management time was deflected.

From a Department which has not distinguished itself in terms of management efficiency, the indecent haste to intrude into the affairs of Tallaght Hospital is curious. I am mindful of the traditional struggle to protect the Adelaide ethos. I recall previous conflicts not between Government and the Adelaide but between the Department and the Adelaide. I hoped the patient accord, put in place by the for mer Minister, Deputy Noonan, had put that debate to bed. The people of Tallaght and the surrounding catchment area do not want that debate reopened. They want the delivery of quality health care. I profoundly hope that we are not contending with the problems of contrived indebtedness.

The people of Tallaght do not wish to engage with the Department in a battle for control of the new hospital. I do not implicate the Minister in pursuing such an agenda, but the least he owes to the long standing and long suffering population who have waited 20 years for this hospital is to be alert that he is not being walked into old battles that have no place in the new Ireland. In this regard I am gravely disappointed that the Minister last night gave the impression that all is now well at Tallaght. All is far from well and I hope the Minister knows it.

The board has been brow beaten into reluctantly endorsing a service plan which a majority do not believe can work. The realpolitik of the situation dictates that they had no choice but to bend the knee to the Department. They have not received the extra £1 million mentioned by the Minister and they believe it will not arrive before April. Services inevitably will be curtailed and a union management meeting scheduled for tomorrow may or may not clarify the staffing position. Meanwhile, there is no reassurance for the distraught parents campaigning to ensure that the paediatric haematology services realise their tremendous potential at Tallaght. Patients being transferred from the Tallaght cardiac catheterisation unit to St. James's Hospital may be at risk in some cases. A total of the 16 unapproved staff working in the sterile supplies department are essential to comply with EU regulations. For these and other reasons, some board members voted against acceptance of the service plan and others abstained.

We have lost a chief executive of international standing and embroiled a new hospital in unnecessary conflict. Dr. McCutcheon was attempting to build a management team which would manage the successful transition. Given the background, the situation required tact and consultation. Relocating three established hospitals with their own traditions and ethos to a single campus, inevitable start up and commissioning problems and hugely delicate industrial relations and people problems demanded great patience, tact and conciliatory skills. The situation did not require a Minister for Health and Children hurtling around the pitch like an overcharged rugby player, crashing into members of his own team and undermining the team effort.

The tremendous achievement of Tallaght Hospital derives from the patient, co-operative team effort which the Minister for Health and Children, Deputy Cowen, should be encouraging and not undermining. It is a pity, for whatever reason, the Minister has chosen to spoil the ship for a ha'p'orth of tar. It was unnecessary that this tremendous new hospital for which the people of Tallaght waited so long should have been born in conflict and controversy. We can only hope that when this controversy abates, the Minister will change his inflexible approach and respond to the justifiable and reasonable requirements of the new hospital.

I am sorry the array of Ministers who spoke in support of the Minister for Health and Children, Deputy Cowen, are not present because I wish to respond to some of the comments they made. I assure them and the Minister for Health and Children that this motion is not about play school politics, but serious politics. We are not looking for magic solutions to our problems. We want responses to real problems which have been identified, costed, planned and pleaded for by health boards.

I am a member of the Mid-Western Health Board and we are blue in the face trying to plan for the health needs of our region. We have not received the required response to the extent that a number of the members of the board voted against the service plan this year. For the first time since I joined the health board, including times when I was in Opposition and representative of a Government party, I and other political representatives voted against the service plan. Professional representatives, including doctors and nurses, also voted against it. We are not, as Deputy Daly suggested, undermining the staff in the health care area. Some of them voted against the service plan because we are so aggravated by our efforts to meet the health needs in our region.

Deputy Daly referred to the paediatric ward. However, we have no guarantee that we will be in a position to open the ward in the new regional hospital because we have not secured funding for it. Another area of need is the regional maternity hospital. It was necessary to send twins from there to Cork although the needs had been costed. Plans had been made and money had been sought.

We have also sought money for mental handicap services. A total of 76 residential places and 81 day care places are required. We have received money for 19 residential places and 17 day care places. I am aware of the case of an elderly man who is on a waiting list. He is 84 years of age and at the top of the list. However, he has been told that all the people on the waiting list must be reassessed because it has grown so much.

The Fianna Fáil Party said it would reduce the waiting lists as a priority, but instead, the lists have increased by over 5,000. The motion is not electioneering or an attempt to play politics. It is about serious issues for people like me who are members of health boards and who are trying to get a response to proposals which have been costed. Plans have been submitted and funding sought. The Minister of State, Deputy Fahey, may be interested to know that we have sought funds for children who are being cared for outside the country because they have specific behavioural needs. We submitted a plan to the Department but we still have not received funding.

Our service plan asked us to close wards at a saving of £470,000. However, those wards need to be kept open. Sick people in our region need those beds. I understand the point made by the Minister for Tourism, Sport and Recreation, Deputy McDaid, about medical inflation, growing costs and a growing elderly population. However, we have planned for that situation and we are trying to address it. I urge the Minister to respond to this debate which is not about point scoring or casting aspersions on members of other parties. It is a serious debate about the real needs of people.

I support the motion. I do not regard it as a personal attack on the Minister and I do not join those who have brought personalities into the debate. However, the state of our health services is such that I cannot but support the motion which represents a lack of confidence in the Government's health policy and the Minister's implementation of it.

Many Members cited the tens of thousands of people on hospital waiting lists. The figures speak for themselves, but they can never speak as eloquently as the individual men, women and children in desperate need of health care, who are forced to endure pain and anxiety while waiting for attention in our public hospitals.

Let me cite the case of a young constituent of mine who has suffered from tonsillitis for a long time. It has made life a misery for her. Her future career prospects have been affected because she has had to suspend her studies due to the debilitating nature of her condition. She requires a simple straightforward operation to remove her distress, yet she is told she must wait another year before getting that operation.

I received a copy of a letter to another of my constituents from a surgeon. He writes to the family doctor of this three year-old child, again describing the severe symptoms of tonsillitis, from which she suffers. Once again a simple operation could end her and her distraught family's ordeal, but she too must wait. At the end of the letter the surgeon notes that he can arrange for the operation to be done privately.

Tonsillitis is not a life-threatening condition. It does not require hugely expensive care or complicated surgery. However, in a period of unprecedented economic prosperity, this State cannot manage to provide the resources to treat it promptly.

In this case we see exposed the inequality at the very heart of our health service. Neither this Minister nor any of his predecessors have seriously challenged this inequality. It is an absolute obscenity that in Ireland in 1999 a person with sufficient financial resources of their own or with sufficient borrowings can walk past the queues in our public hospitals and receive immediate care, often within those same institutions and from the same consultants. Health is for sale as a commodity in Ireland today.

The debacle of Tallaght Hospital has been mentioned by many speakers. I wish to mention briefly one aspect of it. Parents of children suffering from leukaemia have been forced to come together to resist the threat from the Minister for Health and Children to close down the haematology and other units in Tallaght and move them to Crumlin children's hospital. The Minister's handling of this issue has been appalling. He refused to respond to the parents for three months and only met them last week after their newly-formed campaign group CHILD received nation-wide publicity. This group of parents is totally disillusioned with the Minister's approach. Their anger and disillusionment is shared by patients and staff across the health services. They have no confidence in the Government's ability to manage the services on which the health and well-being of their children depends. I must concur with their judgment and support this motion.

(Dublin West): I will be voting against the Government in tonight's vote. That is not because of the personality of any particular Minister but because of the way the health service is administered and the philosophy that is allowed to dictate the way it is administered. We do not have a health care service that is just and treats all our people equally. We have a health service that is very unequal indeed in the way it treats people who are wealthy, people on average incomes and poor people.

A Leas-Cheann Comhairle, how much time remains?

There are six minutes remaining.

(Dublin West): I propose to share that time with Deputy Gormley.

Private health care is allowed to develop and encouraged in some quarters to the detriment of those who are unable to afford it. The health service is the subject of a major rip-off, and that is why there is a tightening of the lid on the public sector of the service. Consultants in the private area are ripping off the health service big-time by the huge incomes they receive from limited resources and in the way they organise their business. The health service is the subject of a massive rip-off by pharmaceutical and health supply companies, and this is not being investigated by the Government. The rip-off of the health service by the drug supply sector is nothing short of a scandal – pills and so on that cost a few pennies to develop are allowed to be sold for pounds to fatten the profits of private multinational companies. These are some of the issues that should be challenged.

The Minister may tell us the amount of money being spent on the health service, but as a percentage of gross domestic product it is one of the lowest in the European Union, and has slipped considerably in recent years. The facts bear that out.

It is particularly nauseating to see private medical insurance companies coming on the scene, and the way these people sell their intervention into the health service, using terms such as "products, "packages" and so on. In other words, nursing care, medical care, the care and attention that people who are sick or old need is reduced to a crude product to be marketed just as one might market a soap powder. These people should be booted out of the health service area. We need a comprehensive, public, democratic health service that is equally accessible to all our people. The resources could then be redistributed and new resources found to create a situation where we did not have the crisis of waiting lists and crises such as we see in Tallaght at present. The Tallaght Hospital Action Group must be weary that they have to go to the barricades again after their tremendous fight to get the hospital in the first place. They should get the full support of the Dáil.

I thank Deputy Higgins for sharing his time with me.

There are many stories circulating about the Minister for Health and Children. Some of them may well be apocryphal; some may be true. There is a story that the Minister referred to the Department as Angola.

The Deputy should get a sense of humour.

There is a story that in respect of the Minister's most recent appearance on "Morning Ireland" he did not want to go out to the studio but would prefer to take a phone call in bed.

Deputy Gormley should not cast reflections on a Member of this House.

Do not worry about it. I thought the Deputy had a bit more intelligence.

There is also a story that when a delegation went to see the Minister recently he said, in the hearing of his officials, that he had not wanted the job in the first place.

Nonsense.

This gives the impression of a lack of enthusiasm for the job.

Grow up.

That is the overall impression that has been given.

I intend to speak on a very important issue. If the Minister wishes to heckle, he can. The question I wish to raise concerns the haematology unit at Tallaght Hospital. The Minister is aware of this issue, but I do not know whether he understands the heartache it is causing parents and the suffering it is causing many of the children.

We have a state-of-the-art hospital in Tallaght. We have this haematology unit there and the expertise. However, it is suggested that it be moved to Crumlin children's hospital. Tallaght Hospital is fully accredited. International trials are taking place there. It is a fact, credited in independent reviews, that children attending such a facility have a 10 to 15 per cent better chance of survival. This is reason enough to maintain that unit in Tallaght. I ask the Minister to address that issue directly tonight because it is giving rise to grave concern among parents.

The impression now is that the money given to Tallaght Hospital comes with strings attached and that the individual ethos which was part of the Adelaide is being undermined. The Minister must address that.

The motion of no confidence in the Minister, Deputy Cowen, proposed by the Labour Party is another typical example of its new approach to politics. It has come looking for a head and has failed miserably. At the adjournment of the debate last night it became clear this was the most facile motion of no confidence tabled in the House for years.

Most timely.

As the Labour Party "big hitters", Deputies Quinn, Howlin and Rabbitte, drifted from the Chamber in the face of a solid rebuttal by the Minister, Deputy Cowen—

It was terrible.

—it was clear this pathetic attempt to personalise the debate had failed miserably.

Deputy McManus's main argument, that the Minister was only concerned with accounting and accountability rather than the quality of patient care, is as false as it is grossly unfair to the first Minister for Health and Children to undertake a fundamental reform of health services. He is the first Minister to have taken on the old habits and prejudices of a lifetime. He has addressed the old demand-led structures where those who shouted loudest got the most. He has initiated a properly planned approach in partnership with all the players in the delivery of health services for whom he has acquired substantial increases in resources.

That is why the beds are closed.

How can any Labour Party Deputies castigate the Minister for a poor performance when his record is compared with that of their party in Government? He has secured an additional £800 million from the Minister for Fin ance, Deputy McCreevy in the 20 months of the Government.

Five thousand more on the waiting lists.

Compare this to the totally inadequate £400 million allocated by the then Minister for Finance, now Labour Party leader, Deputy Quinn, between 1995 and 1997. In three budgets, Deputy Quinn had more than £40 billion to allocate. Why was the Labour Party not so concerned then about the health services? Why did it not put money towards the waiting lists then? Why in its period in Government did it reduce the funding for the waiting list initiative from £12 million to £8 million in one year? Perhaps Deputy Quinn, when replying, can explain why the only specific initiative for public patients was reduced by a Government of which the Labour Party was a member and which claimed to be socialist.

The Labour Party and Fine Gael must feel a sense of shame in the way they have run away from the 1996 accountability legislation which they introduced when in Government. It is the chaos resulting from this legislation which has bedevilled the development of a modern caring health service. All the Labour Party can offer in this debate is a return to the old days. How can there be quality patient care without accountability? How could we return to the days of the then Minister for Health, Barry Desmond, in 1986, when the Labour Party ignored every principle of accountability? In that year Barry Desmond allowed an overrun of £35 million on the health services.

Fair play to him.

If we had allowed that percentage increase of an overrun last year, it would have meant a budget deficit in last year's figures of a whopping £85 million. Under the accountability legislation which the Labour Party introduced, this would mean a first charge on the 1999 budgets of health boards and hospitals and would result in £170 million being taken out of services. What kind of perverse logic is it from Deputy McManus and Deputy Shatter that demands of a Minister for Health and Children that he concedes everything to the loudest voices and to the most organised special interest groups, thereby damaging quality health care across the spectrum which the Opposition pretends to care so much about?

The Minister, Deputy Cowen, cares—

(Interruptions.)

The Minister of State should sack his scriptwriter.

—and the first quality required of a caring Minister is that he has courage, in this case, the courage to move forward with the most comprehensive set of radical health care pro posals contained in the Government's An Action Programme for the Millennium, and also the courage to take on the shroud carriers from the Opposition benches who are prepared to play on the emotions of a public tired of parish pump politics.

The Labour Party, in its zest to make the big impact, is displaying all the attributes of the old-style gombeen politics.

(Interruptions.)

The Minister of State would know all about that.

It is a case of getting personal and ignoring the realities and one's own legislation. The Labour Party's cry is, "We're here for a head."

The Minister of State should finish his speech.

There are no heads to roll from these benches, not least that of the Minister, Deputy Cowen, who will pursue, with his own inimitable style and vigour, the challenging task of providing for the people a caring and accountable health care system.

I wish to share my time with Deputy McManus.

Is that agreed? Agreed.

This is a serious but not a personal motion.

The Deputy attacked the Minister. That is his problem.

I have been in Cabinet with the Minister, Deputy Cowen, and have worked with him, so I have no doubts about his ability. We have only one out of every four slots for Private Members' time, so when we decided to use that time, we were doing so against a background of parliamentary scarcity. We did not choose something which was not a serious issue but something which was not just of concern to the Labour Party and people in the Chamber but also something which was a serious problem beyond. We do not have political confidence in the Minister for Health and Children because neither he nor his Department is doing a good job. I heard him on the radio this morning talking about the increase in resources. That compounds the criticism because alongside the increase in resources has been an increase in the waiting lists. The Minister consistently evaded the question put to him by Richard Crowley. While we unfortunately do not have political confidence in him, it is not personal.

I will make another observation which could be construed as being personal but do not wish it to be taken so. I am amazed that a Minister for Health and Children in whom a motion of no confidence has been tabled in Private Members' time is not directly supported in the Chamber by the Secretary General of his Department. The ongoing row in the Department, where one senior Assistant Secretary has not spoken to the Secretary General for more than a year, is a clear indication that the Minister cannot do his job, even if he wanted to. There is a crisis in the Department of Health and Children where a breach of promise relating to promotions ended up in court, where senior civil servants, in an unprecedented manner, testified against each other.

Attack me, not the Department.

The Minister is politically responsible for the running of the Department and both he and the Minister for Finance should not have allowed that case to go to court. It is a matter of fact and public record that people legally testified against each other.

We have been in Government together in the past and have done things, some of which we would have preferred to have done better. The Minister is speaking to a party which has the experience of Government and which knows what happens when a Department does not function properly or completely. Part of the difficulty for which he has political responsibility is the management of the Department of Health and Children and the way it relates to the rest of the health infrastructure which is immensely complex to administer. Anyone who knows anything about the politics of medicine and health in any OECD country will concede that.

One classic example of where the internal failure of the Department of Health and Children under the Minister's stewardship hit reality, taking into account the legacy of problems from the past which he inherited, was the way in which the Tallaght Hospital was established and the fact that the original budget was not realistic. The failure consequent to that is what created the crisis in Tallaght which has already been referred to and about which Deputy Rabbitte and others spoke.

We are not engaging in any type of personal vendetta against the Minister or any other individual. The Minister of State may take some comfort in that kind of criticism, but that is not the case. We are saying there is a crisis in our health service that has been failed, in terms of the resolution, by the actions taken so far by the Government. It is because that failure is so manifest and because we are hearing about it in our clinics and reading about it in our newspapers—

Why did the Deputy cut the waiting list initiative? Answer that question. It was cut from £12 million to £8 million.

The Minister, Deputy Fahey, should allow Deputy Quinn to conclude.

Speaking this morning to an audience of perhaps half a million people, the Minister could not square two facts; on the one hand he got an 11 per cent increase in the overall allocation and yet the waiting lists today are longer than they were when he went into Government.

Because of the Deputy's cut from £12 million to £8 million. That is what caused it.

Allow Deputy Quinn to conclude.

I welcome Deputy Fahey back to the Lower House after his sojourn in the Seanad. The Minister is now 20 months in Government and he cannot begin to hide behind the past. He has to take responsibility for what he is doing now.

We are proud of our performance.

It is because of what this Government and the Department of Health and Children have done over the past 20 months that we have no confidence in the Minister, and members of the public are telling us they do not have confidence in him.

Why did the Deputy run away from his own accountability legislation?

I thank everybody who has contributed to the debate. It is an unusual step to propose a vote of no confidence in a Minister but it is clear that our health services are in a serious crisis when there is such consensus across a wide range of parties on the need for a fresh initiative in the health care area.

This is not a personalised attack, it is something much more serious than that. The Minister made a lengthy contribution in which he trawled through his Estimates to highlight every project, hospital extension and other spending to impress us.

I explained what I am doing.

A considerable amount of money is involved and it would be extraordinary if it were any other way. If there had not been a significant increase in health spending in a time of such prosperity we would not be looking for a vote of no confidence in one Minister but in the entire Cabinet.

The achievement of this Minister has been that while he obtained the increase in spending power, the increase is more than matched by an increase in hospital waiting lists. That failure to save lives and alleviate suffering gives us the power to challenge the premise by which this Minister is in office. We do not know the true extent of the waiting lists; we only have figures up to September. Before Christmas, the Irish Hospital Consultants Association estimated that the figure is increasing to 40,000.

In my contribution last night I raised important points with the Minister, including the issue of hospital waiting lists. Unfortunately, the Minister was not willing to join me yesterday morning on the radio – instead he spoke on the radio this morning.

It is my prerogative.

He referred to the Opposition bringing up peripheral matters. Hospital waiting lists are not peripheral matters.

Hear, hear.

They are not just figures—

They were for the Deputy's party.

Allow Deputy McManus to make her contribution without interruption.

We are putting the money in.

Each number represents a human being and I want to refer to one human being. This week, in reply to a parliamentary question, a colleague of mine received the information that 73 children are waiting for cardiac surgery in Our Lady's Hospital for Sick Children in Crumlin. It was noted that the number had dropped, which is welcome, but the reason one name is off that list is because that person, Baby Murphy, who last August was promised by the Minister that he would have his operation, never made it to the operating theatre because he died. Others have died, small babies, young adults and adults who were entitled to expect the best treatment this country can provide but which this Government and this Minister failed to provide. We are not talking about numbers, we are talking about Baby Murphy.

Did any babies die when the Deputy's party was in office?

Please allow Deputy McManus to continue.

I was looking forward to a debate with the Minister on radio and I was disappointed when he refused to come forward. That is a characteristic—

I did not refuse. I am not afraid of the Deputy.

I never said the Minister was afraid.

I was in transit on my way to Dublin.

I believe he will appear on Prime Time tonight when he will be on his own again.

I will debate this issue with the Deputy at any time on any radio station.

It is important that the debate is taken outside this Chamber.

Is the Deputy producing the programmes as well as everything else?

It is a pity the Minister is reducing this debate to a contest to see who can shout loudest.

I am not doing that.

I want to make a specific point about Tallaght Hospital. The statement the Minister made last night in the House is misleading. Yet again, he is shifting blame elsewhere and refusing to tell it as it is. I want to tell the truth about this because I do not want the record to show, when the hospital is again in crisis in the summer and when services are being curtailed, that his statement went unchallenged. I challenge the Minister on the statement he made in which he presented a picture that everything was well and that his generosity in providing an additional £1 million would sort out the problem.

It was a progress report.

There cannot be enforced redundancies at Tallaght Hospital because the contractual deal is such that permanent staff cannot be affected, but over 100 key jobs are likely to be lost.

Why did the Deputy suggest that last week?

The Minister should allow Deputy McManus to conclude.

Political dishonesty straight from the Deputy's mouth.

We are talking about doctors' and other jobs lost because the Minister for Health and Children cannot ensure that his own Department gets its sums right. Services will be curtailed in Tallaght Hospital. People will be unable to avail of treatment and there will be bed closures.

Read the report.

We must not mess about with this issue. Let us hear the reality of what the Minister said.

Exactly. Let us come clean.

Deputy Conor Lenihan will have to explain to the people of Tallaght the reason services will be curtailed and jobs lost.

I am sorry to disappoint the Deputy.

People will not see the developments they are entitled to at Tallaght Hospital that affect the elderly because they cannot get their day care unit.

There is an elderly unit there. It opened on the first day.

Cardiac patients are being put at risk because they are being shunted to and from St. James's Hospital. That is the reality.

Other people referred to rumours. I heard a rumour today which I thought was interesting, that the Independent Deputies are trying to ensure the Taoiseach will provide additional money for Tallaght. We must remember that the Independents as well as the Government will carry responsibility for what happens in that hospital. It is not that they are on one side and the Government is on the other. I represent west Wicklow, along with Deputy Mildred Fox. Will the Independents be able to explain what is happening to their constituents in Baltinglass, Blessington and Dunlavin who access facilities at Tallaght Hospital, the parents of children with leukaemia? How can any Deputy ask people to support what is happening in Tallaght when there is an opportunity for the Independents to use their muscle and for the Minister for Health and Children to seize this unique opportunity presented to him in these prosperous times? At the same time there is a failure in the system, which is the responsibility of the Minister and his Department, which is leading to some people losing their lives and to others living in unnecessary pain and suffering.

It is disgraceful scaremongering.

This is escalating.

Please allow the Deputy to conclude.

We are not even talking about a situation which is under control.

They closed beds in Galway last December.

Deputy Shatter, allow Deputy McManus the courtesy of concluding without interruption.

Before the Minister for Health and Children took office, he described the hospital waiting lists as being out of control. Those hospital waiting lists have lengthened consistently since he took his place in Hawkins House.

Not as fast as when the Deputy was in office.

Deputy McManus, I would ask you to conclude your remarks. It is now 8.30 p.m.

In three years when I go to the public I will be judged on it. The Deputy should wait and see.

That has been the case every time the reports have come out. Next time no doubt the lists will have lengthened again. Only the Minister is responsible. He should move aside and let somebody else take over. That is what is needed now.

We will provide the money for it.

I commend the motion and hope it is supported.

Amendment put.

Ahern, Michael.Ahern, Noel.Andrews, David.Ardagh, Seán.Aylward, Liam.Blaney, Harry.Brady, Johnny.Brady, Martin.Brennan, Matt.Brennan, Séamus.Briscoe, Ben.Browne, John (Wexford).Byrne, Hugh.Callely, Ivor.Carey, Pat.Collins, Michael.Coughlan, Mary.Cowen, Brian.Daly, Brendan.Davern, Noel.de Valera, Síle.Dempsey, Noel.Dennehy, John.Doherty, Seán.Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.Foley, Denis.Fox, Mildred.Gildea, Thomas.Hanafin, Mary.Harney, Mary.Haughey, Seán.Healy-Rae, Jackie.Jacob, Joe.Keaveney, Cecilia.Kelleher, Billy.

Kenneally, Brendan.Killeen, Tony.Kirk, Séamus.Kitt, Michael.Kitt, Tom.Lawlor, Liam.Lenihan, Brian.Lenihan, Conor.McDaid, James.McGennis, Marian.McGuinness, John.Martin, Micheál.Moffatt, Thomas.Molloy, Robert.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Donoghue, John.O'Flynn, Noel.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Malley, Desmond.Power, Seán.Roche, Dick.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Dan.Wallace, Mary.Walsh, Joe.Wright, G. V.

Níl

Ahearn, Theresa.Allen, Bernard.Barnes, Monica.Barrett, Seán.Bell, Michael.Belton, Louis.Boylan, Andrew.Bradford, Paul.Broughan, Thomas.Browne, John (Carlow-Kilkenny).Bruton, Richard.Burke, Ulick.Clune, Deirdre.Connaughton, Paul.Coveney, Simon.

Crawford, Seymour.Creed, Michael.Currie, Austin.D'Arcy, Michael.De Rossa, Proinsias.Deasy, Austin.Deenihan, Jimmy.Dukes, Alan.Durkan, Bernard.Enright, Thomas.Ferris, Michael.Finucane, Michael.Fitzgerald, Frances.Flanagan, Charles. Gilmore, Éamon.

Níl–continued

Gormley, John.Gregory, Tony.Hayes, Brian.Higgins, Jim (Mayo).Higgins, Joe (Dublin West).Higgins, Michael.Howlin, Brendan.Lowry, Michael.McCormack, Pádraic.McDowell, Derek.McGahon, Brendan.McGinley, Dinny.McGrath, Paul.McManus, Liz.Mitchell, Gay.Mitchell, Jim.Mitchell, Olivia.Moynihan-Cronin, Breeda.Naughten, Denis.Neville, Dan.Noonan, Michael.

Ó Caoláin, Caoimhghín.O'Keeffe, Jim.O'Shea, Brian.O'Sullivan, Jan.Owen, Nora.Penrose, William.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Reynolds, Gerard.Ring, Michael.Ryan, Seán.Sargent, Trevor.Shatter, Alan.Sheehan, Patrick.Shortall, Róisín.Stagg, Emmet.Stanton, David.Timmins, Billy.Upton, Pat.Wall, Jack.Yates, Ivan.

Tellers: Tá, Deputies S. Brennan and Power; Níl, Deputies Barrett and Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to".

Ahern, Michael.Ahern, Noel.Andrews, David.Ardagh, Seán.Aylward, Liam.Blaney, Harry.Brady, Johnny.Brady, Martin.Brennan, Matt.Brennan, Séamus.Briscoe, Ben.Browne, John (Wexford).Byrne, Hugh.Callely, Ivor.Carey, Pat.Collins, Michael.Coughlan, Mary.Cowen, Brian.Daly, Brendan.Davern, Noel.de Valera, Síle.Dempsey, Noel.Dennehy, John.Doherty, Seán.Ellis, John.Fahey, Frank.Fleming, Seán.Flood, Chris.Foley, Denis.Fox, Mildred.Gildea, Thomas.Hanafin, Mary.Harney, Mary.Haughey, Seán.Healy-Rae, Jackie.Jacob, Joe.Keaveney, Cecilia.Kelleher, Billy.

Kenneally, Brendan.Killeen, Tony.Kirk, Séamus.Kitt, Michael.Kitt, Tom.Lawlor, Liam.Lenihan, Brian.Lenihan, Conor.McDaid, James.McGennis, Marian.McGuinness, John.Martin, MicheálMoffatt, Thomas.Molloy, Robert.Moloney, John.Moynihan, Donal.Moynihan, Michael.Ó Cuív, Éamon.O'Dea, Willie.O'Donnell, Liz.O'Donoghue, John.O'Flynn, Noel.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Malley, Desmond.Power, Seán.Roche, Dick.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Dan.Wallace, Mary.Walsh, Joe.Wright, G. V.

Níl

Ahearn, Theresa.Allen, Bernard.Barnes, Monica.Barrett, Seán.

Bell, Michael.Belton, Louis.Boylan, Andrew. Bradford, Paul.

Níl–continued

Broughan, Thomas.Browne, John (Carlow-Kilkenny).Bruton, Richard.Burke, Ulick.Clune, Deirdre.Connaughton, Paul.Coveney, Simon.Crawford, Seymour.Creed, Michael.Currie, Austin.D'Arcy, Michael.De Rossa, Proinsias.Deasy, Austin.Deenihan, Jimmy.Dukes, Alan.Durkan, Bernard.Enright, Thomas.Ferris, Michael.Finucane, Michael.Fitzgerald, Frances.Flanagan, Charles.Gilmore, Éamon.Gormley, John.Gregory, Tony.Hayes, Brian.Higgins, Jim.Higgins, Joe.Higgins, Michael.Howlin, Brendan.Lowry, Michael.McCormack, Pádraic.McDowell, Derek.

McGahon, Brendan.McGinley, Dinny.McGrath, Paul.McManus, Liz.Mitchell, Gay.Mitchell, Jim.Mitchell, Olivia.Moynihan-Cronin, Breeda.Naughten, Denis.Neville, Dan.Noonan, Michael.Ó Caoláin, Caoimhghín.O'Keeffe, Jim.O'Shea, Brian.O'Sullivan, Jan.Owen, Nora.Penrose, William.Perry, John.Quinn, Ruairí.Rabbitte, Pat.Reynolds, Gerard.Ring, Michael.Ryan, Seán.Sargent, Trevor.Shatter, Alan.Sheehan, Patrick.Shortall, Róisín.Stagg, Emmet.Stanton, David.Timmins, Billy.Upton, Pat.Wall, Jack.Yates, Ivan.

Tellers: Tá, Deputies S. Brennan and Power; Níl, Deputies Barrett and Stagg.
Question declared carried.
Barr