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Dáil Éireann díospóireacht -
Wednesday, 2 Feb 2000

Vol. 513 No. 4

Private Members' Business. - Health Services: Motion (Resumed).

The following motion was moved by Deputy McManus on Tuesday, 1 February 2000:
That Dáil Éireann:
(a) deplores the continuing deterioration in the acute hospital services which is causing suffering and hardship for thousands who are ill and great distress for their families;
(b) condemns the failure of the Government to honour the commitment made in ‘An Action Programme for the Millennium' to ‘tackle the crisis in the hospital waiting lists' and notes that in most cases waiting lists have lengthened significantly during the lifetime of this Government;
(c) expresses concern at the crisis in many Accident and Emergency Units since Christmas; the closure of hospital beds; the non-use of operating theatres; the cancellation of many elective procedures, which have led to the further lengthening of waiting lists;
(d) notes that the current two-tier system of medical care discriminates against those who are unable to pay for private cover and condemns the fact that public patients with life-threatening conditions are left on waiting lists for long periods because they are unable to pay for private care;
(e) calls on the government to deal with the crisis by:
(i) immediately increasing resources and staff levels, improving bed numbers and providing additional step down facilities; and
(ii) committing itself to the introduction of a universal health insurance system which will ensure that access to health care is determined by medical need rather than ability to pay.
Debate resumed on amendment No. 1:
To delete all words after "That" and substitute the following:
"Dáil Éireann:
(a) welcomes the substantial increase in capital and revenue resources that are being committed by this Government to the development of acute hospitals and all other aspects of the health services;
(b) commends the significant progress that is being made in developing services through a comprehensive series of strategic initiatives in areas such as cancer services and cardiovascular disease;
(c) endorses the Government's ongoing strategy of dealing with waiting lists and waiting times in a structured, coordinated and multi-disciplinary manner, involving all relevant aspects of the health system; and
(d) welcomes the intention of the Minister for Health and Children to continue to progress the development of a quality-based, patient-focused, well managed and closely integrated service for acute hospital users.".
–(Minister for Health and Children).

I congratulate the new Minister and Minister of State on their appointments to the Department of Health and Children. I wish them well in their new duties. Members on this side of the House, particularly the Fine Gael Party, will put them under considerable pressure. I thank the Labour Party and Deputy McManus for tabling this motion and giving us an opportunity in their Private Members' time to discuss issues of great importance relating to the health service.

It is a national scandal that at a time of unprecedented economic prosperity there is a sickness at the heart of our public health service. The Government promised to reduce public hospital waiting lists. However, approximately 38,000 people are awaiting essential in-patient hospital surgery and treatment, an increase of 30% since the Government took office two and a half years ago. The Government has failed to implement any targeted reforms of, or improvement in, our health service within specified time scales during its period in office. Its approach has been marked by fire brigade responses to various crises and piecemeal initiatives. On occasion, parish pump politics have taken precedence over any coherent strategic plans. The scandalous conduct of Deputy Cowen in his final days as Minister for Health and Children sadly illustrates this.

The National Disease Surveillance Centre was established in Sir Patrick Dun's Hospital in November 1998. The NDSC is being developed as a centre of excellence for the surveillance, prevention and control of infectious diseases. In the 12 month period following its establishment, specialist trained staff to enable it fulfil its functions were head hunted and recruited. As part of the staffing process, in recent weeks the Department of Health and Children approved the recruitment of a microbiologist jointly by the NDSC and James Connolly Memorial Hospital.

The NDSC was set up on an interim basis, pending the enactment of legislation to give it an independent statutory remit. It was proposed that its staff complement ultimately expand to 20 and that it have a permanent centre sited in Blanchardstown. Its work requires it to maintain close and frequent liaison with other national organisations such as the Royal College of Physicians, the Irish College of General Practitioners, the National Virus Reference Laboratory and with academic libraries and university departments. The NDSC has been requested by the Department of Health and Children to develop guidelines on issues such as anti-microbial resistance and viral haemorrhage disease and has been asked to review infectious disease legislation. The Scientific Advisory Committee, through its subcommittees, has more than 50 professionals who have given their time freely to develop these guidelines. Membership of the scientific advisory sub-committees by the professionals who voluntarily give of their time is dependent on these committees meeting in Dublin. All those head hunted and employed by the NDSC reside in Dublin and were recruited on the basis that it would be based in Dublin.

One day prior to the appointment of Deputy Cowen as Minister for Foreign Affairs, the chairman of the board of the National Disease Surveillance Centre received a fax from the Department of Health and Children informing him that a decision had been made by the then Minister for Health and Children, Deputy Cowen, to transfer the centre to Tullamore Hospital. No public announcement was made of the Minister's decision and no explanation has been offered.

It is clear that while the Government may lamely attempt to justify this action on the basis of its commitment to decentralisation, in the context of the agency concerned and the location to which it is being sent this is nothing more than parish pump politics at its worst. If the Government persists with implementing this proposal, it is likely that most, if not all, of the staff recruited to the NDSC over the past 12 months will seek other positions. A newly established national institution, with a remit of great importance in the context of the future workings of our health service, has been treated by the Government as little more than a parting political gift to his local town by a departing Minister, given to commemorate his time in the Department of Health and Children.

As a consequence of the Government's failure to put in place and properly promote a comprehensive 'flu vaccination programme this winter and last, patients with 'flu and respiratory viruses who required hospital admission have put our major acute hospitals under intolerable pressures. This year, like last year, patients who already had to wait too long for essential surgery had their already delayed surgery further postponed.

In the midst of a deep economic recession in 1987, 20% of the beds in our acute hospitals were taken out of service. Despite the extraordinary up-turn in our economy, they have still not been restored. Even more astonishingly, during the lifetime of the present Government the overall number of acute hospital beds has been further reduced. At the beginning of 1997 there were 12,356 acute beds, by February 1999 these had been reduced to 12,292. In 1997 there were 9,030 public acute hospital beds; in December 1999, despite increased demands on our hospitals and the dramatic escalation in the waiting list, the number was reduced to 8,995.

With our population increasing and people living longer, the proportion of elderly patients will continue to increase. Yet, to date, the Government has failed to put in place the essential additional nursing home and step-down facilities required to provide care for elderly patients who need to recuperate before going home but who do not require acute hospital facilities. Instead, the Minister for Health and Children has financially penalised various hospitals throughout the country for retaining elderly patients in need of care who live on their own and who lack the strength and well-being to return home.

The failure of the Government to provide sufficient resources to our health services is directly responsible for escalating hospital waiting lists, insufficient acute hospital beds, closed beds, wards and theatres and a crisis management ethos permeating our public health service. It is also the reason for the inordinate delays that occur in the implementation of long awaited sectoral health strategies, such as the cancer strategy.

As at 30 September last, there were 1,180 nursing posts vacant in our health service. Some 95% of the vacancies occurred in the Eastern Health Board area and voluntary hospitals, and the majority of these posts still remain vacant. As a consequence of these vacancies, hospitals with responsibility for national specialities, such as cardiac surgery, have been unable to meet targets prescribed in their service plan, operating theatres are either closed or under utilised and the waiting times for patients requiring essential surgery have substantially increased. As a consequence of these vacancies, nursing staff have been forced to work under intolerable pressures. The Government has failed abysmally to anticipate our nursing needs and to put in place policies to encourage and facilitate nurses with specialist qualifications obtaining or remaining in crucial nursing jobs within the Eastern Health Board area.

Instead of putting patients first, the Minister for Health and Children has targeted patients and implemented policies to penalise the sick. Increases by the Government this month in the cost of private beds in public hospitals have guaranteed that private health insurance payments will increase by 9% again this year. No recognition is given by Government to the fact that the 42% of the population who pay private health insurance are also, through their taxes, entitled to free hospital care. If they relied solely on our public hospital system, our waiting lists would double and the health service would implode under the strain.

Our health services require radical reform. Whether the necessary reform can be brought about by the introduction of a universal health insurance system is questionable. What is needed is less, not more, bureaucracy. In the area of health insurance, what is required is more, not less, competition. The core problem is not the public-private mix. It is the absence of public health service planning, a gross inability to use resources efficiently, a failure to put in place modern management techniques and information gathering systems and a lack of dynamism.

Greater resources need to be allocated to primary care, health promotion and health prevention. The acute beds taken out of our public hospitals over a decade ago must be restored to the system. New imaginative initiatives are needed to ensure we have the number of specialist doctors and nurses required to cut our waiting lists in half. We must also reduce waiting times to ensure no person, either adult or child, need wait in excess of six months for essential in-patient hospital surgery or treatment, or wait in excess of three months for an assessment by a consultant after a GP referral. A new patients' charter which imposes a statutory duty on health boards to provide essential in-patient treatment within specified timeframes should be put in place. There is also a need to target resources for the provision of patient care and to put in place a more cost effective health administrative structure. Capital and current resources must also, on a planned basis, provide the essential nursing home and—

The Deputy's time has concluded.

If the House will bear with me, I have only half a page left to read.

Unfortunately, it will come out of the time of your colleagues across the House.

Perhaps if I complete what I have prepared. I will only be a moment.

Capital and current resources must also, on a planned basis, provide the essential nursing home and step-down care required to ensure our elderly are properly looked after and acute hospital beds are available to those who require them. Incidences of patients lying for days on trolleys in our major hospitals and of hospitals short of beds retaining ambulance trolleys and preventing ambulances responding to emergency calls must end. Incidences of hundreds of patients having surgery dates postponed and prolonged must also end.

Throughout our health service dedicated doctors and nurses are working under intolerable pressures. Despite everything they do, our public health service, as managed by the Government, is drifting leaderless and rudderless from one crisis to another with no central policy vision of its ultimate destination. Crisis management must be replaced by a comprehensive planned strategy with a fixed implementation time frame—

Deputy Shatter, I have to ask you to conclude.

Sir, two more sentences.

You have gone one minute over time. The rules of the House are the rules of the House. I call on the Minister of State, Deputy Moffatt.

As in the past, the Minister has allowed me to complete—

I call on the Minister. Deputy Shatter has gone one minute over time. This never happens on Private Members' time. The times are laid down carefully.

Sir, I recall allowing the Minister to go ten minutes over our Private Members' time.

Not in my time. There is a very tight schedule and a number of speakers offering.

In future I will require Ministers to stick rigidly to their time—

You will have no difficulty with the Chair as the Chair will do that anyway.

I wish to share my time with Deputies Flynn, Batt O'Keeffe, Michael Kitt and Keaveney. I wish the Minister every success in his new portfolio and to thank the outgoing Minister, Deputy Cowen, for his courtesy and good work during his time in the Department of Health and Children. I note that any decentralisation to Tullamore or otherwise is described as parish pump politics but if it goes elsewhere there is not a word about it.

The Minister in his speech last night outlined the very considerable advances which have and continue to be made in the development of our health services under this Government. These advances are being made because of good planning and the substantial increase in capital and revenue resources which are being committed by this Government to the development of acute hospitals and all other care programmes of the health services.

Strategic initiatives in the acute hospital section in areas such as cardiovascular health, cardiac services, cancer services and waiting lists, to mention but a few, will properly steer our health services to meeting the needs of the population. We heard much last night and tonight about the various aspects of health but there was no mention of any real planning and there was no professional attempt at strategic planning as regards our health problems.

In referring to our accident and emergency services, the Minister pointed out that a majority of persons presenting at accident and emergency departments who required admission to hospital were aged 65 years and over. I am aware that many of these had to wait, in some cases for considerable periods, before eventually were admitted. However, more casualty consultants are being appointed which will alleviate some of the problems. I share the Minister's concern at the distress and inconvenience which this has caused in recent weeks, not only to elderly patients but to all who presented at accident and emergency departments of acute hospitals. Much of this, as Members will know, was due to the 'flu at the time.

I am pleased to note that preparations to deal with an anticipated surge in activity at our accident and emergency departments began in March 1999 with an emphasis on the provision of additional sub-acute places for many of our older people who, having completed the acute phase of their illness, required a level of care more appropriate to their needs.

This initiative in providing additional sub-acute places to relieve pressure on acute hospital beds does not stand alone. It complements an established programme of developing services for older people which has gained considerable momentum since this Government came into office.

As Minister with responsibility for the development of services for older people, I would like to outline some of these developments. Excluding the nursing home subvention scheme, 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. This figure has risen to £27 million in 2000. When subvention is included, investment of additional revenue funding will total £35 million in 2000.

While support of older people in the home is an important part of the Government's policy in relation to the care of older people, there will continue to be a need for residential nursing care when it is no longer possible for people to be looked after at home. The 1999 budget allocation for older people included a sum of £1.45 million which included funding for a new 50-bed community nursing unit at St. Clare's in Ballymun. In 1999, the full year costs of contracting an additional 65 nursing home beds was allocated to the Eastern Health Board, which helped to alleviate the pressure on acute hospital beds in the major general hospitals in Dublin.

More than £7.7 million has been allocated in 2000 for the provision of additional community nursing units, day hospitals, day care centres and specialist services across the eight health board areas, from Carndonagh to Schull in County Cork. In 2000, an additional £7 million is being allocated to health boards to meet, inter alia, increased demand for nursing home subventions and the additional costs arising from increased dependency levels.

In 1999, more than £3 million was earmarked for the further development of a combination of services which included specialist assessment units which play such an important part in the effective treatment and care of older people, together with improved staffing levels in a number of extended care and day care facilities, with a view to optimising the use of these facilities. More than £1 million has been allocated this year for the future improvement of staffing levels in a number of extended care and day care facilities.

The benefits of having specialist-led services for older people attached to general hospitals are well documented and additional funding of £300,000 was allocated in 1999 to allow four additional physicians in medicine of older age to be recruited – two in Dublin and one each in Cork and Galway. This brought the total number of physicians in medicine of older age to 31.

In 2000, additional geriatricians with support staff have been approved to supply specialist-led services in acute hospitals while psychiatry of old age services were also boosted, including the provision of £250,000 for the establishment of a unit for the elderly mentally infirm at Merlin Park Regional Hospital in Galway and a further £250,000 for a similar unit in Beaumont Hospital.

The Government is also very much aware of the enormous contribution of family carers to looking after dependent older people and other people with disabilities in the home. The Minister for Social, Community and Family Affairs took measures to improve assistance to carers through the carer's allowance. On the health side, £1 million was provided to help carers in 1999. This fund was used to provide support through the employment of liaison officers and nurses and the provision of respite breaks. An additional £1 million was also provided in 2000. This funding will be allocated through the health boards based on local needs.

The important role played by home helps in the care of older people is widely recognised and there is growing demand for home help services to be better organised and developed. Some £2.3 million was provided between 1999 and 2000 to extend the scope of the service to cover more people and to provide more hours for existing clients.

We are not only talking about the health services, we are putting our money where are mouth is. We are developing services right across the board, whether elderly, general hospital, psychiatric, paediatric, cardiovascular or cancer services. They run across the whole gamut of health care services. We are expending much more money than the previous Government. In fact, the previous Government cut back in many areas, especially in the waiting list initiative. It is no wonder that some of the waiting lists have increased because we were starting from a poor base.

A poor base.

We have done a strategic analysis.

This is Alice in Wonderland.

The Deputy has forgotten about the £8 million and the cut backs from £12 million to £8 million in the last year of that Government. The Deputy and her colleagues have short memories.

Allow the Minister to speak without interruption.

Members opposite are full of rhetoric but they have no plans and no money. That is their problem.

I welcome the opportunity to speak on this motion and I will support the Government amendment to it.

I take this opportunity to congratulate the new Minister, Deputy Martin. I wish him every success in his new Department. I also thank the previous Minister, Deputy Cowen, for his contribution to the Department of Health and Children during the past two and a half years. That contribution was unequalled and unmatched by the previous Administration.

It is incredible that Opposition Members have tabled a motion on the health issue, given their performance in that area when they were in Government. The facts and figures speak for themselves. The commitment the current Government has shown in respect of health, when compared with that of its predecessor, must surely leave many red faces on the Opposition benches.

The Deputy is joking.

Deputy Neville should be fair to Deputy Cooper-Flynn who is, after all, very good on figures.

A Leas-Cheann Comhairle, please ask Members to allow me to continue.

Deputy Neville should allow Deputy Cooper-Flynn to continue without interruption.

The relevant figures are surely embarrassing for Opposition Members.

The Deputy has a hard neck.

The Minister confirmed that more people are being treated by the health services than ever before. In addition, there are more people employed in the health services – an increase of 12% on previous years. There are also more capital projects under way. However, Opposition Members continue to harp on about a crisis in health in a bid to attract cheap headlines. It is unfortunate they did not concentrate more on health issues when they were in Government.

The type of headlines the Deputy attracts are too expensive.

Time is limited and I ask Deputy Howlin to desist from interrupting.

I apologise, but Deputy Cooper-Flynn is being provocative.

I understand that my comments are difficult for Opposition Members to take.

The Deputy has a hard neck.

The Government's recent record has been excellent. There has been a 4% increase in the number of patients using the health services. Under the acute hospital initiatives, we have introduced a cardiovascular health strategy at a cost of £150 million. In addition, £14 million has been spent on cardiac services since 1998.

I welcome the national cancer strategy on which the Government has spent £34 million to date and which is extremely important to people living in the west. I am glad the Government has recognised the need for a regional balance in this regard, a fact ignored by previous Administrations. The national cancer strategy has improved the availability of cancer services throughout the country. Unfortunately, the Labour Party does not have any Members from the west. If it had a representative from the constituency of Mayo, its members would understand how difficult it is for a person who is obliged to seek cancer treatment in that part of the country—

Does Deputy Cooper-Flynn not consider Deputy Michael D. Higgins as a representative of the west?

He is not from County Mayo.

So County Mayo represents the entire west?

I do not like to mention that £2 billion has been earmarked for health care under the national development plan. I should point out that the Government obtained Objective One status for the west, something to which the Labour Party was opposed. A sum of £2 billion has been set aside under the national development plan for essential improvements in health care. These improvements will take the form of upgraded infrastructure, new equipment for acute hospitals, upgraded facilities for intellectually and physically disabled people, upgraded health centres and new information technology.

In the year 2000, the Government has allocated £38.7 million for people with intellectual disabilities. This investment has been widely welcomed by the various associated groups throughout the country who will benefit from it. The amount to which I refer is four times more than that allocated by the previous Government. In addition, £80 million is to be spent in the next three years in speeding up the process of putting in place the necessary infrastructure to support the new services.

There has been a great deal of discussion about waiting lists in recent weeks, months and years. Funding for the waiting list initiative in the year 2000 stands at three times more than what was provided by the previous Government in 1997. We are providing £23 million, our predecessors provided £8 million. The previous Administration actually reduced funding for the waiting list initiative between 1996 and 1997 from £12 million to £8 million.

We also reduced the waiting lists.

However, listening to Opposition contributions in recent months, one would hardly believe that this happened. I also welcome the fact that the regional imbalance throughout the country has been addressed by the Government's investment in capital projects in Galway, Limerick, Cork, Tullamore and my hometown, Castlebar, where £25 million has been spent on phase two of Mayo General Hospital.

Deputy Cooper-Flynn's time is exhausted.

I take this opportunity to remind Opposition Deputies that many people live in regions outside the Pale and I am delighted the Government recognises that.

As Minister for Health, I announced the development at Castlebar to boost the Deputy's by-election campaign.

The Deputy announced the development on ten occasions.

Everyone recalls the major announcements made by Deputy Howlin when he held ministerial office, but when we went to the kitty in search of funds they were not there.

He is all talk and no action.

We all know what Deputy Howlin achieved in Government. He left us with a legacy which, thankfully, we have been able—

I was in Government with Deputy O'Keeffe.

We all know how the Deputy handled the major issues with which he was faced in Government. He ran away from difficulties when the opportunity presented itself.

The Deputy is a joke.

He left it to his colleague in Fine Gael to deal with the problem.

Deputy Howlin got out in time.

In 2000 alone, total spending in the health service will breach the £4 billion barrier. It exceeded £3 billion for the first time in 1998 whereas under the previous Government it only reached £2.75 billion in 1997. If Members consider new service developments in the hospital sector they will see that £17 million was provided in 1997. Under the current Administration, the figure for this in 1998 was £44 million and it rose to £71 million in 1999. Obviously there will be a further increase this year.

In terms of capital spending, a sum of £230 million will be made available this year for spending on health infrastructure. This compares with the £100 million provided on the last occasion the Members opposite were in Government. As Deputy Cooper-Flynn indicated, £2 billion will be provided between 2000 and 2006. This represents a trebling of the capital investment in the health sector.

As the new Minister, Deputy Martin, and his predecessor, Deputy Cowen, indicated, the health services have an insatiable appetite. Everyone is pleased that health funding, particularly that provided for mental handicap services, has been ringfenced. This is the first occasion on which that has been done. When the Opposition was in Government, funding was not provided or ringfenced in that sector.

In terms of the delivery of acute services in hospitals, we will be obliged to consider the provision of an effective and efficient service. We will also be obliged to consider funding and ensure that its provision is performance related. Money has been invested in waiting list initiatives over a protracted period. While there are now far more patients and the throughput in hospitals is far higher, the situation requires that we should consider the mean in terms of the procedures performed in the various disciplines. Why, for example, in the first nine months of last year did two consultants in one hospital perform more than 500 public operations? Why did five consultants in another hospital perform 700 such operations? Where lies the mean in those cases? Is there any relationship between the amount of money being provided in respect of the waiting list initiative and the number of procedures performed?

If funding is to be provided for the waiting list initiative, we should ensure there is a major improvement in terms of the number of procedures carried out in each of the various disciplines. It would be an interesting exercise to discover if there is a correlation between hip replacements and cardiovascular operations because there is a major divergence in terms of performance in various hospitals. This matter must be tackled. I wish my colleague, Deputy Martin, every success in the Health portfolio. He was an excellent Minister for Education and Science and will bring many attributes to the Department of Health and Children where he will do an excellent job. This Fianna Fáil-led Government will continue to deal with people in the most caring way possible.

I congratulate Deputy Martin and wish him the same success he enjoyed in the Department of Education and Science. I also congratulate the Government on the increased spending allocated for the health service which will exceed £4 billion this year. There has been much activity in the acute hospitals sector which has grown every year and many more people will benefit from these services in 2000. I welcome the fact that day-care services have grown by 12% in the past year, reflecting developments in modern medicine which allow more people to be treated on this basis.

A major difficulty for hospitals is the disruption caused by the building of more theatres and wards, as is happening at University College Hospital, Galway. The Government is to be congratulated on these construction projects and the 12% increase in staffing levels on the 1997 figures when the last Government was in office. There are about 75,000 posts in the health service, including over 28,000 nursing posts. I am committed to the provision of services in the regions and the Government has attempted to address the regional imbalance by funding major capital developments in Galway, Limerick, Castlebar, Cork and Tullamore. These are important developments for the implementation of the cancer and cardiovascular strategies.

The Government has delivered the phase one development at University College Hospital, Galway, and the expanded services will be up and running in 2000. The phase two development, costing over £70 million, has been put out to tender. I thank the former Minister, Deputy Cowen, and Minister of State, Deputy Fahey, for these developments which will lead to the provision of cardiac surgery, radiotherapy and MRI facilities in Galway. The provision of orthopaedic services in Castlebar will free up places in Galway as there is a long waiting list for hip replacement operations in the Western Health Board area.

I welcome the provision of £6 million for an extension to Portiuncula hospital, Ballinasloe, which is now completed. The Government also provided funding for the medical records section. I hope the negotiations taking place between the health board and the authorities at Portiuncula will conclude soon as it is important that health services in Ballinasloe are under the aegis of the health board as soon as possible. I pay tribute to the sisters for their work in Portiuncula hospital over the years.

A sum of £405,000 has been made available for a new health centre in Ballinasloe and a total of £1.6 million will be spent to complete the work. Other outstanding issues are the urgent need for the provision of a welfare home in Ballinasloe, for which a site is now available, and the replacement of St. Brendan's hospital, Loughrea, by a more modern building.

Step-down accommodation has been referred to in this debate and the Government has provided £2 million this year for measures which include such accommodation. The Bon Secours hospital, Tuam, which serves many people, particularly those from north Galway and south Mayo, could relieve overcrowding in Galway if beds were made available. Local doctors in the Tuam area are in favour of such a development and I hope negotiations will take place to ensure that these beds are made available.

I welcome the Government's waiting list initiative which will receive three times more funding in 2000 than was made available by the previous Government in 1997. University College Hospital, Galway, has made great progress in reducing waiting lists and waiting times, particularly in the main specialities, and the Government will provide further funding for this initiative in 2000.

I wish the Minister, Deputy Martin, well in his new portfolio. He did a tremendous job in the Department of Education and Science as accepted by those in all areas of education. The Minister will bring to the health portfolio the energy, enthusiasm and dedication which is his trademark. I also wish the new Minister of State, Deputy Hanafin, the best in her new role and wish the former Minister, Deputy Cowen, success in the extremely important role he takes over from Deputy Andrews. Progress towards peace and stability on the island is paramount for all Ulster Deputies.

Never before has so much money been allocated to the health service as is the case under this Administration. As the Minister reiterated last night, the Government is committed to ensuring that we have a health service which is responsive and effective in meeting the needs of our people. This objective cannot be achieved overnight and it is only through the provision of a range of programmes such as those already initiated and continuing to concentrate on policy development that we can tackle the structural difficulties which exist.

The Minister cited statistics which prove the increased numbers of people receiving treatment. He also outlined the investment of £150 million in the cardiovascular health strategy; the £14 million investment since 1998 in cardiac services; the £34 million invested in the national cancer strategy; the establishment of the Medical Manpower Forum which has the vital job of reviewing key aspects of medical staffing in public hospitals with obvious implications for the quality of service the public can receive; and the implementation of a co-ordinated waiting list initiative. These developments acknowledge the difficulties that exist and show that action is being taken to address them. I commend the Government on these developments.

The problem of waiting lists is not new and the recommendations of the review group are being followed in the short, medium and long-term. For those waiting heart and other vital operations, any delay is extremely traumatic. I would prefer if there was no waiting involved, but a strategy is in place and the Government has provided three times the funding made available by the previous Government in 1997 – £23 million in 2000 compared with £8 million in 1997.

I welcome the fact that the national development plan has earmarked £2 billion for health care, a trebling of capital investment in this area. This funding will have an impact on the acute hospital services infrastructure, the disabled, the elderly, the mentally ill and children in need of care and protection. The Minister will continue the development of services in Letterkenny which cut down on the massive amount of travel endured by patients and their families when they are most vulnerable. These people often have to return home because no beds are available in intensive care or in a ward.

Simple measures could also be looked at to alleviate conditions for rural patients. At present there is a less than satisfactory co-ordination of services for patients from Donegal, for example, in that they are called for early morning appointments necessitating their leaving the county in the middle of the night. A little co-ordination would mean that patients from Dublin could be scheduled for early appointments and rural appointments could be set for a reasonable time.

The Minister will appreciate the proximity of Derry and Belfast to the people of the north-west and that opportunities exist to work together in partnership for the mutual advantage of medical providers in Ulster. He will also take a keen interest in rural district hospitals, health centres and nursing units, and continue to support their upgrading for the provision of vital services and facilities. Such facilities are located at Carndonagh, Moville and Buncrana in County Donegal. When Minister for Health and Children, Deputy Cowen opened many of the new facilities last year, and I extend an invitation to the new Minister to visit these facilities to see the excellent work being carried out and hear the plans for the future, such as those for a new Alzheimer's unit or whatever.

The Ministers, Deputies Cowen and Martin, are aware of the needs of those who are intellectually or physically disabled. The Minister gave details of how the £38.7 million this year and £45.7 million next year will be spent in this area. On a parochial matter, I commend the tremendous work being carried out on facilities such as the James Connolly Memorial Hospital, Carndonagh. The hospital has many plans which it hopes to see addressed by the moneys made available through the national development plan and I will discuss these plans with the Minister at a future date.

I reiterate my best wishes to the Minister and Ministers of State as they implement their policies with the substantial funding at their disposal. I welcome the funding made available. It is good that we have energetic, bright, intelligent people putting policies in place which will lead to a better quality health service. This will not take place overnight but we have made a good start under the policies introduced by Deputy Cowen and we enter the new millennium in a good state.

The Deputy should not hold her breath.

If I did I would need to be hospitalised.

Dr. Upton

I would like to share my time with Deputies Wall, Shortall, Howlin, O'Sullivan, Ryan, Crawford and Bradford.

Every day I deal with queries or complaints and sometimes heartbreaking stories from constituents who are waiting in vain for a call from their hospital to tell them that they have reached the top of the waiting list. Some of them are angry, some of them are resigned but all of them are afraid and worried. They are worried that by the time their turn comes, it will be too late, or the pain will be unbearable or their quality of life will be useless. The mission statement of the Department of Health and Children includes, "To protect, promote and restore the health and well-being of people by ensuring that health and personal social services are planned, managed and delivered to achieve measurable health and social gain". Judging from the concerns of my constituents, there is no reason to believe that these aspirations are being fulfilled. The planning, management and the delivery of the health services is certainly not available to a very large number of people in a way that achieves measurable health. Those people who are suffering most because of the inadequacy of the current services are, as always, supposed to have no voice – those who cannot afford to pay. They are placed at the end of a very long queue. Some of them never reach the top of the queue; they die before their turn comes. Last week I tried in vain to acquire an available bed for an elderly man who needs constant care, a man about whom all the professionals, including the public health nurse, social worker and his doctor, agreed should be in hospital but there is no bed available for him. This elderly man is not alone in his suffering. His wife, who is 83, is now his full-time minder. She is frail and frightened and has become a prisoner in her own home because she is afraid to leave her husband unattended even for a few minutes. This is not the health service and support that the elderly deserve. They worked all their lives, they paid their dues and made few demands on the services. Their expectation was that they would be assured of security and protection in their old age. Instead, they live in daily fear. Unless they have a medical card they are afraid to send for or to visit their GP because of the cost involved. They suffer on in silence, in fear and often in pain. They feel neglected and discarded by a society that shows no signs of caring or compassion.

The elderly population is on the increase and as people live longer, more services are going to be needed to cater for them in a dignified and protective fashion but if the current provision and planning is an indicator, there are bleak days and years ahead for this sector of the community. It is predicted that between now and the year 2006, the number of people who will require constant care will increase by 80%. For those unfortunate people whose treatment is not considered urgent, waiting lists seem to be measured in decades now and not in months or years. Perhaps the elderly man who is waiting for a simple cataract operation and who can no longer go out, read the newspaper or watch television is supposed to be delighted to be told he will have to suffer only another nine months blindness and maybe then he will get a place on the list.

Does "urgent" refer to the teenager with cerebral palsy who has waited five years for orthodontic treatment and is still waiting? He has not yet received an indication of when he will be seen by a consultant, an absolutely appalling situation for this boy and his family. There is a chronic lack of beds for people who have had strokes, heart attacks, neurological diseases and who are in need of physiotherapy, occupational or speech therapy and who would benefit from such services but these services are not available, only to those who can afford to pay.

More than 300 people with cystic fibrosis are in need of physiotherapy and outreach nursing on an ongoing basis. This and many other such life threatening illnesses are propped up through voluntary organisations providing a service through their own fund raising activities. When such services are being denied to people in need, and in pain, the Taoiseach tells us that spending hundreds of millions of pounds on a new stadium for the city of Dublin is good for us. This is not the view of the constituent who phoned me last week to tell me that she thought the Taoiseach was behaving like a schoolboy with pocket money to spend, who found a new toy that was not very practical, certainly not needed but nice and colourful so he would spend his money on it anyway – a nice, new, unnecessary stadium for Dublin that would take priority over the needs of those on the hospital waiting lists.

I raise with the Minister the situation relating to the support groups for attention deficit hyperactive disorder and attention deficit disorder. The Minister was keenly aware of the problems relating to these conditions when he was Minister for Education and Science and he did work on this area. That is recognised by the relevant support groups. Now I ask that the Minister move the work he did while Minister for Education and Science on to the next phase. When pupils leaves school with these problems, they continue to suffer with this condition. I ask the Minister to put in place a proper support group for these particular conditions, which are currently a problem. I raised this with the Eastern Health Board and there are facilities being made available in Carmichael House for the support group and also I understand there will be a national forum on this.

I ask the Minister to ensure that group includes members from the ADH and the ADHD groups and that, as soon as possible, he will put some support in place for them. Up to now, the Mary Farrells and Maeve Dalys of this world are using their own money to ensure that the relevant information available to them is being given to the people with children who suffer from these conditions. They are using their own facilities and money for telephone calls, faxes, etc. I ask the Minister in the short-term to ensure that this does not continue any longer and that after the efforts made to create the office in Carmichael House, the relevant groups can use it. It is recognised that when the Minister was in the Department of Education and Science he supported these groups, and we are now asking that as a matter of priority he would do the same as Minister for Health and Children.

On the waiting lists in my constituency, major development is ongoing in Naas General Hospital but there is serious overcrowding concerning beds, etc. I tabled a question to the Minister recently on the use of the military hospital in the Curragh to alleviate that problem. The answer I received was that one of the problems concerned security. What could a sick person do to create a security problem? For many years I was trying to have the houses in Orchard Park sold. The Minister has now agreed to sell them. The reason given up to now was a problem relating to security. That is gone now. There is no problem with security in the houses in Orchard Park but now that security risk seems to have moved from those houses to the hospital, which seems now to be a security risk when one puts patients there. I ask the Minister to consult Deputy Michael Smith on this matter. The are not enough beds in Naas hospital. The situation there is unreal but 11 miles down the road there is a fully fitted out hospital which could be used in the short-term and certainly would be of benefit to all the people in Kildare. I have no doubt that if common sense prevails that hospital can be used. The Minister should forget the silly statements about security problems. I never heard anything as stupid as the suggestion of security problems relating to a military hospital with sick people.

I ask the Minister to examine the case of the support groups and in the short-term using the Curragh Military Hospital to alleviate the overcrowding in Naas General Hospital.

Like every other Member I find that complaints or representations about health matters constitute the single biggest issue of concern to my constituents. Not a day goes by when I do not receive half a dozen complaints about health issues. The public finds it incomprehensible that at a time when our economy is booming the health service is in crisis and particularly a public health care system which is approaching Third World standards, and getting worse. The public wants to know why, at a time when the Government coffers are bursting, so little attention has been given to ensuring a decent health care system for all our citizens. The Minister has probably discovered at this early stage that he has inherited a Department which is a shambles. His predecessor presided over a health care system which is a shambles. Ask any member of the public – it is the single biggest issue of concern to them. They cannot understand why there are Third World conditions in a First World economy.

The most obvious area of the health service which needs urgent attention is the acute hospital sector where the waiting lists are growing continuously, and where the Government's earlier commitment on maximum waiting times seems to have been thrown out the window. People are waiting longer for necessary and sometimes urgent procedures. This has been affected by the lack of planning for services for the elderly. Two years ago the Eastern Health Board produced a fine report on planning services for the next ten years. It clearly set out the level of funding required to cater for our ageing population, in terms of nursing home care, community care and other necessary services. In the allocation of this year's budget, the Minister's predecessor ignored that report, as he did last year and only a fraction of the necessary funding was given to the Eastern Health Board. Planning is taking place at health board level but the principle of forward planning was not accepted by the Minister's predecessor – I hope the present Minister accepts it. Large numbers of acute hospital beds are being taken up by elderly patients who need appropriate care – nursing home care or step-down facilities. The Minister's predecessor failed to provide that.

The same applies to services for children – the waiting lists are a disgrace. Children are being robbed of their childhood because of a lack of services. Many children need tonsillectomies and urgent attention for hearing, speech and chest problems. They are waiting two or three years for important operations and meanwhile their development is delayed because of the Government's inactivity. There is also a problem with children who should be in care – those who are most at risk and need urgent intervention by social workers to remove them from danger and put them in places of safety. There are 500 children awaiting the intervention of social workers – neglected children at risk of physical and sexual abuse. The Minister's predecessor presided over that totally unacceptable situation and allowed it to continue. I urge the Minister to take action on that.

A whole range of community care services should be provided, particularly for the elderly. Home help services are inadequate. Services which are essential for civilised living have been neglected over the years. I urge the Minister to correct the serious mistakes made by his predecessor.

I welcome the appointment of the Minister, Deputy Martin, to the Department of Health and Children. It is a Department about which I care a great deal, not only because it is, as other Deputies said, a huge concern to every constituent and citizen but because I had the privilege of working there for two years, as you did for several years, a Leas-Cheann Comhairle. It is a most important ministry of State. I also welcome the appointment of the Minister of State, Deputy Hanafin, to the health team. They are both capable people who genuinely promise much in bringing a fresh air of change to a Department which desperately needs it. As any insider knows, morale in that Department has been dreadful in recent years.

As I said privately to the Minister this morning, I am hugely disappointed he responded to the general expectation for change and a decent health service which we can now afford for every citizen, with a dreadful speech last night. This debate can be a set piece where this side of the House makes arguments followed by political rhetoric from the other or, if this Minister wants, it can be the start of something different where there is a recognition of the huge deficiencies evident to every man, woman and child dependent on our health services. If the acknowledgement of those deficiencies characterised the Minister's response and he mapped out a path to change, we would applaud him.

We heard appalling rhetoric in the Minister's response last night – the typical material drafted by civil servants in response to a pro forma speech. Obviously, many script versions were provided for Government backbenchers to recite tonight. It is a dreadful start and I know the Minister is capable of better. I say that still having great expectations of the Minister. He can do better than this drivel – reciting the litany of success of his predecessor. He gave six examples of success in two and a half years of Government. There is not a single example which was not a follow through from initiatives taken by his predecessors who were not in office for as long. The cardiovascular health strategy was vaunted by many speakers – this is simply a subset of the national health strategy drafted when I was Minister. The national cancer strategy was initiated by Deputy Michael Noonan when he was Minister. The genesis of these was laid down. I initiated the waiting list initiative which was mentioned by virtually every speaker. Some £20 million was expended on the first waiting list initiative in 1994. We only arrived at that level of expenditure last year. The impact of that was a great deal less than was the impact of the first waiting list initiative.

There are major structural deficiencies in the Minister's Department, the administration of health services and particularly in the delivery of acute hospital services. The Minister can do something about it. However, he should approach it as one would approach alcoholism. The first step is to stop denying it – recognise it and deal with it. A great deal can be done because the Minister has a wonderful Department with dedicated and able civil servants, forged in a crucible of crisis. However, he needs to be radical and to afford leadership. He needs to listen to the voices of the people and their representatives here. The Minister has made a poor start. On reflection, he may do better.

The essence of the proposals put forward by the Labour Party is that they are not grounded in criticism. They are grounded in mapping out an alternative, sustainable way forward in a national health insurance system. This was spelled out by our spokesperson, Deputy McManus. I ask the Minister to listen to the proposals, to be open to them and be willing to change a system which is not delivering the quality service the people deserve.

With regard to my home town of Wexford and its needs, I ask the Minister to take note. The geriatric facilities provided in Ely hospital when I was Minister were to be met by a development in Wexford General Hospital. A theatre suite, a day ward and a range of facilities, including a third surgeon were promised some years ago. I ask the Minister to provide these.

The maintenance of gynaecology and obstetrics facilities is a major issue. The institute requires three consultants per hospital. Many of the smaller hospitals, including Wexford, and several others only have two. I ask the Minister to ensure that gynaecology and obstetrics is preserved in every general hospital. I am confident the Minister can do better, that he can make a tremendous mark in this Department. However, he should acknowledge the deficiencies and set about rectifying them. He should not follow in the path of his immediate predecessor.

Last week my office celebrated because an 84 year old man, who had been waiting for a knee replacement operation for four and a half years, who lived alone in the country and who would have been in an institution if he had to wait a week or two longer, finally got his knee replaced. He is one example – there have been many others given during this debate – of what is wrong with our health service. Our waiting lists are growing at a time when there is extra funding. The Minister needs to ask why this is happening in our health service. Instead of listing separate issues, the Minister should examine the way money is spent in the Department of Health and Children. He must examine how it is allocated to see how we can improve the health services in a way which makes a difference for people such as this 84 year old man.

While this man was on the waiting list, the Mid-Western Health Board, of which I am a member, adopted a positive plan for the care of the elderly and was involved in the ongoing waiting list initiative. At the same time, however, wards were closing. There was a shortage of funding for a new wing of the hospital. It had been allocated capital funding but there was no revenue funding to open both wards and theatres. Beds were closing so elective surgery could not take place. The waiting list continued to grow as a result. That illustrates the fundamental problems in the health service, problems which must be tackled in a systematic fashion, which must be analysed. In his speech the Minister indicated increased funding in health, but only 5.3% of GNP is spent on health services, one of the lowest figures in the EU and the OECD countries. It is not good enough.

Why do we spend such a small amount of available funding on health? Why is it not enough? Increased demands are being placed on the health services. That is an issue that must be faced rather than saying that extra money is being spent so the fault must lie with the health boards or hospitals.

In my experience as a member of a health board, one of the major cost factors is growing medical inflation in acute hospitals. Sophisticated treatments and drugs cause a natural increase in demand. Instead of turning our backs on that problem, it must be analysed. We must correspondingly fund the health boards and hospitals so they can deal with this because otherwise all the extra money goes to acute hospitals, not to other more cost-effective areas.

It was stated in a newspaper that the Department of Finance has indicated that providing health and social services for the disabled would cost too much and for that reason the recommendations of the commission on disabilities should not be implemented. I would like the Minister to address that immediately. It is not acceptable in a civilised society.

Yesterday afternoon I was telephoned at my office by a very angry and concerned constituent. She was ringing from the accident and emergency unit in Beaumont hospital to demand action on behalf of her husband and other sick people who had to wait more than 20 hours for admission to a ward. She informed me that the spouses, partners, children and other relatives of the ill had said they had enough and were threatening to hold a protest to get action. Eventually they decided to march through the hospital to the administrator's office to highlight the problem. This action was deemed necessary in a Dublin hospital yesterday. That is an utter disgrace.

I agreed to visit the hospital. That was not the first time I had reason to visit a hospital in the greater Dublin area in recent times. When I arrived the scene resembled an episode of "Emergency Ward 10" in the aftermath of a major disaster. The department was full of people, with doctors and nurses running around. The centre and side aisles were filled with trolleys and chairs occupied by those who were ill and in pain. In the unit itself, people were lucky if there was a chair available for them. The people who had a chair had to sit in pain for 12 hours. Then they would be lucky if a trolley was available. In most cases they had to wait over 24 hours.

Relatives and friends comforted their loved ones in the cubicles where they were being treated by doctors and nurses. As I spoke to some of the relatives, a constituent came to me and asked me to see her 87 year old mother. This woman, with her rosary beads in her hand and tears running down her cheek, put her hand on my arm and asked me to get her out of there. That was no solution for this elderly person who had reared her family, who in turn made a major contribution to the economy. I witnessed the doctors, nurses, administrative and general operative staff working in such stressful conditions that I asked myself if these people could be blamed for leaving the public service. Thankfully there are concerned, professional staff who are prepared to continue.

The financial support necessary to ensure that people have access to proper health care must be put in place. It is up to the Minister to improve on the performance of his predecessor and provide the health care patients deserve. The Labour Party will pursue the Minister to ensure he delivers. Nothing less is acceptable to us.

I congratulate the Minister, Deputy Martin and the Minister of State, Deputy Hanafin, on their appointments. I have no doubt they will bring a fresh impetus to the beleaguered health service. I do not blame the Minister of State, Deputy Moffatt, for the condition of the service, I lay the blame entirely at the door of the previous Minister for Health and Children, Deputy Cowen. The Minister should ensure that there will be nurses in the hospitals rather than administrators. In the Mater hospital 100 beds are lying idle. That cannot be allowed to continue. Waiting lists in the North Eastern Health Board region have increased by more than any other area in the State over the past two years.

I was telephoned today on behalf of a 77 year old man who lives on his own. He was told by Monaghan General Hospital that if it had the equipment, the staff could carry out the operation which he requires. The hospital does not have the equipment and now he must join a waiting list. God only knows how long it will be before he receives his operation in Dublin. A person needing a blood pressure monitor was told last week that the earliest one would be available from Monaghan General Hospital would be 24 February. This trend cannot continue.

Monaghan General Hospital was voted £5 million by the health board with the support of the Department of Health and Children. The Minister's predecessor delivered the £500,000 his predecessor had already promised. That is all the hospital has received in two and a half years. How can I tell someone the Government has no funds when it agreed to the spending of £230 million on a sports stadium? That is all very well if the aged and handicapped are looked after first. I hope the Minister, who proved he had flair in his last Ministry, which we in Monaghan appreciated, will respond to the problems that exist and of which we will advise him.

Is mór an onóir dom labairt anocht mar Aire Stáit ar chúrsaí sláinta mar tuigim go maith go bhfuil siad an – tabhachtach do chuile dhuine sa tír seo. Equally it is an important issue for all public representatives and it is only right that we should be discussing it tonight.

It is the nature of Private Members' motions that they are critical and negative, but I see no reason for them being so unconstructive and superficial as the debate has been last night and tonight.

That is a bad start.

It is a debate that has not acknowledged the programme of renewal and the delivery of services put in place by the Government. I, too, recognise that there are faults in the system, people whose experiences are less than satisfactory, areas that need improvement and services that could be delivered more efficiently, but I also recognise the Government's resolve to tackle issues, the commitment to major expenditure and the realistic proposals and strategies to improve the delivery of those services. The Labour Party motion and some speakers referred to a number of issues as if they were the panacea, in theory, without giving any of the practice behind them, particularly the reference to universal insurance. There was no explanation of how it would work in practice or how much would be diverted from patient care towards bureaucracy and regulation.

Is there any openness?

It is not enough to say that it is a panacea ensuring efficiency and equality or to throw out a campaign slogan without realising that the health sector is a highly complex and dynamic area that challenges policymakers the world over. The problems we have exist in other countries, including those with a universal insurance system.

They are worse here.

The Government is committed to dramatically increasing resources and addressing structural weaknesses, to implementing the programme, cutting waiting lists and ensuring the medical professionals have resources, including the measures the Minister, Deputy Martin, whom I wish well, outlined in his address last night.

We must acknowledge that in these changing times hospitals respond with a routine rapidity and flexibility that we could do with in other areas of the economy. The changes have resulted in 800,000 people being treated in in-patients each year, 700,000 in casualty and two million in out-patients. The hospitals are responding to changes in demography, litigation, technology and medical advances. The delivery of care is at the centre of our policy. The Government shares the concern of Deputies that public patients can access services when they need them. There is no point in having a major public service unless we can do that. Access to a quality service is our aim and we aim to deliver, but not through the cutbacks we evidenced under the previous Government.

My colleague, Deputy Gilmore, raised the issue last night of St. Columcille's hospital, Loughlinstown. Like him, I am interested in the proposal before the Department for a major upgrading and development of services at the hospital. The new eastern region health authority will soon be taking responsibility for the planning and development of services in this area and across the eastern region. The findings of the chief executive will obviously inform decisions on the hospital. It is only because the Government has made a major increase in funding that we can even consider taking any action on this hospital.

The issue of children and child abuse was raised, which is close to my heart. Where the tragedy of abuse existed it is an indictment of our society that ignored it, but it is a challenge to which the Government continues to respond positively.

The Government's actions have ensured, and will ensure, that more people are being treated than ever before. We have an active, progressive and ambitious programme. I look forward to working with the Minister, Deputy Martin, and the Minister of State, Deputy Moffatt, and to playing a part in delivering that programme.

I wish to share my time with Deputy McManus. This is not some kind of political beauty contest. We tabled this motion because we are working on the development of a health policy. We would not have wasted our time had the previous incumbent still been in office. We tabled it because we believed two former teachers, one a Minister for Education and Science, might be open to listen to the basic concept of equality. Both of them taught in schools. What would they think if the principal of a national school gave part of his time to all the pupils but, on a private basis, gave some of his extra time outside the school or in the same classroom to other pupils? What is wrong with our medical system is what is right with our educational system. It does not distinguish between pupils. What we are talking about is equality of access. The Minister's sad speech last night did not mention the word "equality". We ran a computer check on it.

If the Minister and the Minister of State want to engage in comparisons, when the rainbow coalition was formed we had a windfall current account surplus of £50 million in December 1994. Last December the Minister for Finance projected a current account surplus of £4,850 million. Comparisons can be odious.

This motion in the name of Deputy McManus is about fundamentally transforming our health system. The pictures painted by my colleagues and those in Fine Gael are to try to convey the message, of which the Minister and the Minister of State are aware, that the system is not working. It is not because the Government is not spending money on it or that it does not care. It is not because the beleaguered officials in what the Minister's predecessor referred to as Angola, the Department of Health and Children, do not care. If any group cares, it does because it is dealing with a system in crisis. We are not saying our national insurance based system is a panacea or that we have all the answers. We do not. We will publish a document in a few weeks outlining how it might work and will invite responses to it.

Research has not shown the country that has the best medical health system. Most countries, however, have better systems than ours, and all of them cost money. We can keep putting money into health systems and still get a bad service, as is the case in the United States. In other countries such as Finland, Denmark or the Netherlands, most of which are combinations of insurance based systems, there is one fundamental value that was absent from the Minister's speech last night, that is equality. You can ask why we did not come up with this before. Dr. Noel Browne provided for equality of access in a mother and child scheme. I am happy to see that Cardinal Daly apologised publicly for the regard in which James Connolly was once held by the church. Perhaps it might extend that sense of forgiveness to Dr. Noel Browne. We must move on from the past.

The two new Ministers, together with the Minister of State, Deputy Moffatt, are not responsible for the existing health services but they have responsibility for their development and improvement. What we are doing is providing an alternative model that will work better than the current system. I implore the Deputies, as two young Ministers, one recently appointed, to do better than the nonsense which the Minister read last night and the Minister of State read today. If that is what they are depending on to defend themselves as politicians at a time when we have a first world economy, the highest performing economy in the OECD and the lowest expenditure on health, perhaps Deputy O'Keeffe is right and Fianna Fáil has forgotten the values once held by its founder.

I thank Members who participated in the debate. The Labour Party tabled this Private Members' motion because we believe that health is a key issue facing policymakers and any Government in power at the moment. Regardless of one's views, it is vital to have a serious in-depth debate about the issues and problems affecting the health system. I, too, share the deep disappointment other Deputies have expressed in relation to the paucity and poverty of thinking from the Government in this regard. In any socially developed country access to health care is a right, not a privilege, which is exercised on the basis of need, not on the ability to pay. That principle of social solidarity underpins health care systems within the European Union. It is accepted as a norm.

The first time I heard of the idea of solidarity at the heart of health care was when I attended a European conference. I am sorry Deputy Cooper-Flynn is not present to hear what is meant when we talk about European standards and norms. In 1998 Commissioner Padraig Flynn stated, "Our health systems are open to all citizens. We have introduced a range of health insurance schemes which make sure that access to health care is virtually universal. This distinguishes the western European model." Not here; we do not do things in that way in Ireland. We have an insurance system which is anything but universal. We have a two-tier hospital system that militates against the poor, the vulnerable, the sick and the elderly, a system that is crying out for reform. We in the Labour Party are dedicated to bringing about that reform, despite the limits on our resources.

In the present economic climate which offers unlimited possibilities for bringing about reform, it is only fair to expect that the Minister for Health and Children would seize the opportunity to make a mark by leaving a legacy which would be something to be remembered, particularly a Minister from the new generation. He is the heir apparent to the leadership of the biggest political party in the State. No wonder our expectations were heightened. Last night I listened with disbelief to the Minister's speech; I could not believe what I was hearing. What was so profoundly dispiriting about his speech was not that he was fully au fait with his brief – he is new to the job and is entitled to some latitude in that regard – but that he had nothing new to say. I thought initially it was the worst speech I have heard a Minister for Health make but I then realised it was pretty well the same speech the previous Minister for Health and Children had made in this House. If this is the best and brightest the Fianna Fáil Party can produce, Heaven help the health services. This was not always the case.

It seems the Minister of State, Deputy Ó Cuív, was correct when he spoke about new Fianna Fáil being a party without values. If Donagh O'Malley had been Minister Martin, children would still be denied access to secondary education on the grounds of parental income. If Erskine Childers had been Minister Martin and taken the attitude he took last night, the poor would still be queueing outside the dispensary door. Those men were reformers; they were different men in different times, times that were hard and when the economic obstacles were enormous. Yet those men were able to break through. Those Ministers introduced reforms that had lasting impact and benefit, not just for the people of this country, but for the economy. The reason this country has been doing well is that we have an educated people which we did not have in the past. The lack of health services carries a cost. Sick people are not able to work, they need more medicines and people on waiting lists create a cost. Let us not forget that fact.

When the Minister stood up I did not expect to hear a bright young man with a closed mind parroting what civil servants were telling him to say. He was very happy to defend health insurance and its benefits for some, but he was not willing, indeed he was decrying the idea of health insurance with its benefits for all. Fianna Fáil has changed. He quoted selectively from the OECD report which had other things to say about the health service. It states, "The fact that better-off people who are likely to be privately insured did not experience such delays [this refers to the waiting lists] gave rise to concerns about the equity of the system." The OECD is concerned about the inequity in our health system. In an update the OECD pinpoints the dilemma of unresolved equity considerations. This point has been made repeatedly by the OECD and the new, fresh and bright young Minister is silent and has nothing to say on the matter.

The Government motion is smug and self-congratulatory. It promotes the idea of the extra funding in health care to be remarkable in this economy. What is surreal about the motion is that it talks about the strategy on waiting lists. What have we got as a result of this extra money being channelled into the initiative on waiting lists? There are more people on waiting lists since the Government took up office. Things have got worse despite the extra money. The Minister who lectures GPs about being cost effective should spend 24 hours in the company of a GP and see how hard they work and what they provide for the State. He talks about administration costs for health insurance. The administration costs for the VHI is 6%. The Minister talks about cost effectiveness yet he has provided £20 million in one year, £12 million in another year and £23 million this year for the waiting list initiative. The Government has swelled the ranks of people waiting for procedures to which they are entitled and which they cannot access. If the Minister calls this cost effectiveness, he has a very different definition than I have.

The sick and elderly in this society deserve better and the Labour Party wants to ensure they receive better as quickly as possible. The real tragedy, which was exposed last night, is that the Government does not recognise there is a crisis. It does not see what is happening in A & E units. I commend Deputy Ryan for putting the point so well because sometimes Ministers tend to get disconnected from the real world. He brought to this House images of what is taking place daily in A & E units, of people who are in pain and distress and who deserve better. These are the people who contributed to building this economy. There will be a cost involved; costs will always be involved in health care.

However, this is not just about money, it is about leadership. Last night the message went out loud and clear that leadership will not come from the Government. There is no commitment, direction, thinking or intelligence being put into this problem. I say this to the Minister: if the Government will not do the job, we will, despite our limited resources. We will show leadership when it comes to providing thought, commitment and dedication. People who are sick are being deprived of the excellent health care to which they are entitled. We will provide leadership if the Minister will not.

Amendment put.

Ahern, Dermot.Ahern, Michael.Ahern, Noel.Andrews, David.Ardagh, Seán.Blaney, Harry.Brady, Johnny.Brady, Martin.Brennan, Séamus.Briscoe, Ben.Browne, John (Wexford).Byrne, Hugh.Callely, Ivor.Carey, Pat.Collins, Michael.Cooper-Flynn, Beverley.Cowen, Brian.Cullen, Martin.Daly, Brendan.Dempsey, Noel.Dennehy, John.Doherty, Seán.Ellis, John.Fahey, Frank.Fleming, Seán.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.Lenihan, Brian.Lenihan, Conor.McCreevy, Charlie.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'Donoghue, John.O'Hanlon, Rory.O'Keeffe, Batt.O'Keeffe, Ned.O'Kennedy, Michael.O'Rourke, Mary.Power, Seán.Roche, Dick.Ryan, Eoin.Smith, Brendan.Smith, Michael.Treacy, Noel.Wade, Eddie.Wallace, Dan.Wallace, Mary.Walsh, Joe.Woods, Michael.Wright, G. V.

Níl

Barrett, Seán.Bell, Michael.Belton, Louis.Bradford, Paul.Broughan, Thomas.Bruton, Richard.Burke, Ulick.Carey, Donal.Clune, Deirdre.Connaughton, Paul.Coveney, Simon.Crawford, Seymour.Creed, Michael.Currie, Austin.D'Arcy, Michael.Deasy, Austin.Deenihan, Jimmy.Dukes, Alan.Durkan, Bernard.Enright, Thomas.Farrelly, John.Finucane, Michael.Fitzgerald, Frances.Flanagan, Charles.Gilmore, Éamon.

Gormley, John.Gregory, Tony.Hayes, Brian.Higgins, Jim.Higgins, Joe.Higgins, Michael.Hogan, Philip.Howlin, Brendan.Kenny, Enda.McCormack, Pádraic.McDowell, Derek.McGahon, Brendan.McGinley, Dinny.McGrath, Paul.McManus, Liz.Mitchell, Gay.Mitchell, Jim.Mitchell, Olivia.Naughten, Denis.Neville, Dan.Noonan, Michael.Ó Caoláin, Caoimhghín.O'Keeffe, Jim.O'Shea, Brian. O'Sullivan, Jan.

Níl–continued

Owen, Nora.Penrose, William.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, Mary.Wall, Jack.Yates, Ivan.

Tellers: Tá, Deputies S. Brennan and Power; Níl, Deputies Barrett and Stagg.
Amendment declared carried.
Motion, as amended, put and declared carried.
Barr
Roinn