We resume on Second Stage of the Health Insurance (Amendment) Bill, 2000. Deputy Penrose was in possession. He has 20 minutes left to speak. I call Deputy Penrose.
Health Insurance (Amendment) Bill, 2000: Second Stage (Resumed).
Question again proposed: "That the Bill be now read a Second Time."
Am I in order to propose under Standing Orders that the House suspend the agreed programme of work to discuss an urgent matter?
The Deputy is not in order because I have called Deputy Penrose.
I am glad to have an opportunity to contribute to this important debate on health. This is an extremely important topic. If the Labour Party is in Government after the next election, I will want substantial reform of and policy changes in the health services, particularly in terms of access. There must also be a complete root and branch approach to abolishing the two-tiered health service.
I was amused to hear some Government speakers in particular say that people are doing well and that things are changing for the better when they do not qualify for a medical card. That is not amusing. We must change the system to ensure that people on medical cards have the same access to health services as those who can buy private health insurance. We are not demanding that standards should be reduced but that they should be the same for everyone, including people on medical cards. Access to the service should be based on need, not on the size of a person's cheque book or on their ability to pay.
This Bill seeks to amend the Health Insurance Act. As the Labour Party spokesperson on health, Deputy McManus, stated, it serves to further separate primary care from hospital care by removing cover for general practitioners from community rating. I detect a market approach to this matter rather than an approach which embraces the fundamental concept of universal access to the health service. Surely the essence of the community rating concept is to ensure that cherry-picking does not occur at this or any other level? Every health Bill should be measured against the impact it has on reducing inequality of access to health care. We should not lose sight of the fact that immediate access to treatment is critical at primary or secondary level.
At a time when announcements are being made about £2 billion surpluses and money is floating about, it is an indictment of the Government and a clear reflection of its failure that thousands of people have been on waiting lists for two years or more for elective surgery, such as cataract and hip operations, heart by-passes and cardiovascular operations. People get only one chance at life and money should be spent to ensure they are treated.
I have tabled parliamentary questions in the House on the provision of hip operations for people in the Westmeath constituency. I am sure the situation there mirrors that in other constituencies. I was told on 3 October that a Mr. X was placed on a routine waiting list for a total hip replacement two months ago. There is currently a two year waiting list for such an operation. I was told that by the general manager of the acute hospital services in the Midland Health Board. Mr. X is currently on a routine waiting list for a total hip replacement at Tullamore General Hospital and I was told that, having regard to the number of patients on the waiting list before Mr. X, it would be a number of months before he would be scheduled for surgery. This man was in the Army and served his country abroad and at home. His payback is to be left suffering on a waiting list until he gets to a critical level and then his general practitioner will try to force the issue. If that is what the health service is about, I or my Labour Party colleagues do not want any part of it. The Labour Party wants such people to have the same access to hip operations as someone who can pay £5,000 or £6,000 to have it done in three or four days in some of the private hospitals.
There are significant staff shortages in the health service. People at all levels must work longer hours and often in demanding conditions. Staff are renowned for giving excellent service in medical support care. However, extra beds are often required. Mullingar General Hospital, for example, is still awaiting the go ahead to finish phase 2B in the capital programme. The £25 million required to finish phase 2B should be forthcoming to ensure that the commitment given to the people of Longford and Westmeath is honoured and there is no further delay. People should not have to wait. They are angry at the possibility, as the Minister for Health and Children said, that if things do not go well it could be another four years before it is completed. Otherwise, it will be ready in two and a half or three years. The hospital is waiting for an additional 60 beds. Those are the type of problems we are experiencing, despite all this money. I urge the Minister and the Minister of State, who is in the Chamber, to ensure that this matter is given greater priority. I know the project will shortly go out to tender – because it costs more than £1 million it has to go through the European tendering process – but it is vital that it be put on a fast track and that no further impediments are placed in the way of ensuring the completion of that hospital.
There can be no doubt that there is a two tier health care system in place. Public patients with medical cards are left languishing on waiting lists while those with private insurance cover have instant access. It is time to end this inequality because one's ability to survive should not depend on having a healthy bank account.
There is even a problem getting medical cards. I heard Deputy Callely say earlier that there has been a huge increase in the income guidelines for eligibility. There was an increase for those aged 70 and over—
(Carlow-Kilkenny): I think he was talking about the Fine Gael policy.
—but for the ordinary person eligibility should be based on a net income at a standardised rate. People do not get any credits and I agree with Deputy Browne that the income guidelines should be substantially expanded from their current position because if a married person goes beyond £138, they cannot qualify for a medical card. Deputy Callely had the gall to stand up here and say that is a sign of progress. Who do they think they are codding? They are certainly not in contact with the people who are deprived of medical cards. One has to be very poor to get free care under the general medical services scheme. The income guidelines are too low. Only the PRSI element is taken out of them. I am calling for significant changes in those income guidelines. It will be costly but we have to take steps to reform these income guidelines for eligibility for a medical card.
Deputy Boylan referred this morning to people who have cancer. That is a traumatic event in anyone's life and I have no doubt that the Minister will appreciate that as much as anybody in this House. When someone receives the initial diagnosis of cancer they should be granted a medical card without being put through the wringer of an eligibility examination. That would give them some solace. I am sure the Minister is caring and compassionate and he should direct the chief executive officers of the health boards to immediately grant medical cards to people diagnosed with cancer and not put them through the eligibility guidelines wringer. He should put an end to that practice. Government policy lacks coherence. Our primary purpose should be to ensure that those who require access to health care get it. The whole system should be centred on the patient to ensure that those who need it get care immediately.
It is not too long ago that we spoke in this House about junior doctors. It is vitally important to ensure that a career structure is put in place for junior doctors. I accept some progress has been made in that regard but junior doctors, some of whom have to work up to 100 hours per week, have told us that they are unable to give the appropriate level of patient care if they have been on their feet for hours on end. I hope that a proper career structure will be put in place for the people working in that area.
I am concerned about the number of beds available for the elderly in various hospitals throughout the country. There would be an even greater need were it not for the amount of care given by relations to elderly people at home. There should be a root and branch reform of the carer's allowance. I know this may not directly affect the Minister's Department but the Department of Health and Children has an input in this area. We have no detailed information about this matter. I put down a question on this the other day. There are conflicting replies on the number of carers in Ireland. Some say it is 50,000, others say it is 100,000 but only 15,000 are awarded the carer's allowance at present. That figure is due to rise to 20,000, but how many carers do not receive any assistance? It is time to prepare an adequate database and detailed information on carers.
It is essential that we abolish the means test for the carer's allowance. The Minister, Deputy Ahern's officials told me last week that that will cost £150 million. The Minister told me last week it will cost almost £200 million and that if there were 100,000 carers, it would cost over £320 million at current levels of payment. If there were 50,000 carers, it would cost £125 million. Carers look after their relatives all hours of the day and night to avoid their relations having to go into institutional care. They receive a very small allowance of approximately £80 and it would be important for them to get some sort of respite care. It is time to commence the process of abolishing the means test for the carer's allowance. A substantial sum of money has been recovered as a result of the DIRT inquiry. We should give that money back to people who suffered in the early 1980s. This is one area where the Minister should ensure that some of that money goes to them.
I feel strongly about another area of the health service, which may have been referred to earlier by some of the Minister's backbenchers, and that is the orthodontic service, particularly for young people. Despite the economic affluence we are supposed to be enjoying, the waiting lists for orthodontic services are lengthening. Orthodontists throughout the country are working flat out; it is not their fault if treatment is not forthcoming. Many more people would get access to the service if the Department of Health and Children examined the recommendations of the Moran report which has been lying on a shelf in the Department for the past 18 months. That report referred to upgrading and refining the guidelines.
The severity of a child's orthodontic problem must conform with the Department's guidelines which are nearly 16 years old. In a time of plenty, that drastic position should be changed. Parents who come to see me are keen to outline the difficulties in this area, particularly if they have young daughters. If a young girl's dental outcrop is only a millimetre less than what is in the Department's guidelines, she will not qualify for treatment. Young people in their formative years are desperately in need of treatment, whether it be braces or other orthodontic appliances. The parents who find themselves in that position, some of whom are on social welfare, disability benefit or whatever, have to go to the local credit union and borrow up to £2,000 because it is essential that treat ment is given in time. Our methods of determining measurements for teeth outcrops are outdated yet lying somewhere in the Department is the Moran report in which there is a recommendation that guidelines which follow a more internationally accepted index should be implemented. I understood that the chief executive officers of all the health boards had agreed on a number of matters in this regard. I appeal to the Minister to ensure that the recommendations of the Moran report are implemented without further delay to give hope to the many young people on the waiting list and the parents who must borrow to meet this significant cost.
The Labour Party put forward proposals to reform access to health services, based on a universal health insurance scheme designed to bring the benefits of competition not only to some of our citizens but to all of them. Instead of a debate on the issue, we had a clatter of prepared statements from some of the Minister's backbenchers. I laughed when I heard the utterances of two representatives from my constituency. The two of them made the same point. It was a case of ‘great minds think alike'. The machine producing the scripts was busy that week. Instead of scaremongering citizens, we want to ensure health services are developed at local level. That is why we put forward our proposals. We proposed the establishment of a national forum on health to engage those involved in health care, including patients who should be the primary focus in the debate on health care reform and future policy making in this area.
I note from the White Paper that the Government undertakes to promote and facilitate not a national health forum for all but a private health care forum, which will bring together interests delivering exclusively private health care for some. This Bill is tinkering at the edges of addressing problems in this area. It is maintaining the status quo, tweaking a little bit here and there, but it does not propose a radical or fundamental reform. I may be wrong and stand open to correction but I believe the Bill weakens the safeguards established by a previous Government, including one of which the Minister was a member. The Bill is based on free market principles, yet it denies many access to that market. The Minister should rethink that aspect of the Bill.
Some people thought that, in absolute terms, the level of expenditure on health care had increased. I cannot deny that, as that is proven by the figures. However, our expenditure on health care is very far behind that of other member states of the European Union. One Member had the gall to say that is not the case, but various reputable European reports put Ireland very far down the line in terms of the percentage of our GDP spent on health care. The average spent by our counterparts in Europe is 8% compared to a little more than 6% here. We have much work to do to bridge that gap. Previous speakers referred to those who will come under GMS, those who have private health care insurance and a great cohort that fall between those two categories. That cohort will be lost in the system. That is why we need to ensure all citizens have access to adequate health care services.
We are one of the two or three European member states that spend less than 7% of our GDP on health care. That reflects that our expenditure on health care is not excessive by any standards. Given that, it is hardly any wonder that up to 40,000 people are on waiting lists for hospital treatment and that some public patients have to wait many months for an appointment with a dermatologist or ophthalmologist. Some people have to wait two years for a hip operation. That salient fact is enough to serve as a severe indictment of our health system. If it has to be reformed, let us carry out a root and branch reform of it so that people who hold medical cards are given the same opportunity to survive and live as those who have healthy bank balances and private affluence and can get access to treatment within days while others have to languish for two or more years.
The debate opened on a general note and has taken the form of a general discussion on health services. The major cutbacks in health services began in 1985 and were implemented under the last Minister for Health from the Labour Party to hold office. No Minister with responsibility for health, apart from those in office in the past three years, has been given sufficient funding from the Administration of the day to implement measures necessary to provide a proper health service. When one hears of problems in the delivery of health services discussed by commentators or medical personnel on television or radio programmes, one of the comments made is that finance is not a problem. That is a major change that has taken place, particularly in the past two years.
Deputy Penrose quoted records, waiting lists and other data, but he may not have been aware that the start of the major cutbacks in the health services were implemented under the then Minister for Health, Barry Desmond. It is important to highlight that, as we are trying to move forward and improve on that situation. I do not want to beat the Opposition with facts and figures about the number of additional and new types of procedures being carried out, the new medical equipment being made available or the list of health centres provided. The last time health centres were built by health boards was in 1986. That programme was then suspended, but it was reactivated in the past 12 months. That is fact, not history. People like Deputy Browne might not like to hear that, but those facts and figures are available, if he wants to get into a verbal tussle on that point.
(Carlow-Kilkenny): I reserve the right to reply to the Deputy in a few minutes.
That is only one aspect of our health services.
While it may help a Minister or a Deputy to quote the latest case that features in the media to focus attention on his or her argument, I do not know if that helps the debate on this area. I was asked at a late stage to speak on this Bill and I was a little concerned about doing so, but I need not have been too concerned. I agree with Deputy Penrose that there is a need for a root and branch reform of the provision of health care.
We are dealing specifically in this Bill with private health insurance cover. Health is the most important aspect of life for a large section of our population. Even when people are badly off financially, they say, "Thank God, I have my health". Health is critical and good health is relative to age. It is taken for granted up to a certain age, but as we get older most of us pay more attention to our health and start to worry a little more about our health and health insurance cover.
We are hypocritical in how we deal with the concept of health cover. In the distant past, people accepted that the State would not be able to afford to fund a total health service to care for all. People were encouraged and, in some cases, required to take out private health cover. The concept of private health cover was endorsed and has been promoted openly by all public representatives and major parties. I have not heard any Member argue against the concept of private health insurance cover. Successive Governments supported it and successive Ministers for Health have encouraged the idea of people contributing as much as possible for the provision of cover in the event of the need to avail of health services. The VHI was established and the Government encouraged other health insurance agencies to provide health cover. Assuming everyone supports the idea of paying in, the bottom line with the concept is, what do we pay out? That is where the difficulty arises. What do people get for their contributions? Like other Members, I would argue vehemently against any concept of a two-tier health service, but we need to decide what benefits we are prepared to give. Deputy Penrose described at length how people are getting privileges and facilities. That is a disgrace. Everyone should have equal access to the same service. However, if we are to argue that point with consistency, we should argue for an end to private insurance cover. We are getting muddled up in our approach to this area. There is great public confusion about the division between so-called public and private health care and the relationship between them. This debate may not allow for full clarification of all aspects of this matter, but, without adding to the confusion by going into technicalities, issues such as the extension for those over 65 not getting involved in risk sharing and so on will add to that confusion.
The rows between private health insurers and the consultants and hospitals regarding levels of care, the cost of care and so on have added to that confusion. There is a need to straighten out this issue once and for all. That will stop politicians from talking of jumping the queue. If people pay a lot of money for a service we should know exactly when and how they can get it in addition to what they are paying for it. However, we are looking at both sides of the coin almost constantly. We should debate this at some future date.
Regarding the Bill, the key aspect has been to maintain the concept of community rating from day one to avoid cherry-picking, as has been said. To some people the VHI is in the wrong and does not want to compete on a level playing field, but I pay tribute to the VHI. It has a great record and has done a good job for the State since it was established. Competition will do VHI good. Although the organisation may feel it will suffer, competition will strengthen it.
I am extremely concerned with community rating. Long before competition came in from abroad I had spoken to insurance people and others about community rating and some professionals assured me that if there was a voluntary mode involved there would be no difficulty and that the requirement was not necessary. I compare that situation with an earlier debate here regarding the difficulties young people have getting car insurance. We have seen how companies can blackguard people if there is no statutory requirement. The Minister and the Department involved are helpless in bringing those insurance companies into line. There is no legislation to do so and as a result people are being denied the civil right to put a car on the road and have it insured at a reasonable cost in order to go about their business. I am well aware of the risk factors associated with a certain age profile among males in particular, but these companies have gone too far. If there was no requirement for community rating among the private health insurers we would see similar difficulties.
I am concerned that the Minister maintains the standard that has applied to the VHI from the start. Like others I am getting worried about some EU directives. Although they have opened up competition here, which is good, I am concerned that we might lose some benefits, particularly those enjoyed by older people and other vulnerable groups. Such groups had a measure of protection and I want to be sure they will continue to enjoy that protection when this Bill passes. I know such matters will be teased out later.
I mentioned earlier the confusion regarding the allocation of funds taken in from the private sec tor and that is where I would carry out a root and branch examination, where the money is going, what elements are available and who does what. The common contract for consultants is being tampered with – that is the best way to put it. Changes are being put in place on an individual basis. Regarding the hiring of an individual consultant, the general common contract is there, but there was huge public confusion about that. If the public pays a consultant, should he or she be entitled to work in private practice? Under the Act they are, but it is related to the amount of work done. The argument in favour of the common contract was that we would not get the best talent to work for the State but that they would emigrate, though I do not know where they would go – they would not work for the poor people.
Those days are gone and we should revisit this matter. If people want to work in the private or public sector they can choose. Very few people would have the privilege of overlapping. I have no radical proposals or suggestions, but there is confusion here regarding the management of this area, whether people should clock in and out and so on. It is a matter of historical fact that we have been afraid to challenge medical personnel, and the more senior they were the less one challenged them, perhaps because we thought they might be operating on us at some point. Those days are gone and now patients have rights and a charter. The public is paying and demands a service, and rightly so.
The issue of whether people are demanding a service because they are paying private health insurance or they are just contributing to the public kitty is one that will arise again. The range of services is improving radically and many people involved through health boards and advisory committees will have a knowledge of this area. It is difficult to explain to the public why waiting lists for orthopaedic services can expand so rapidly. When one examines the facts one can point out that nowadays several different types of operations are being carried out, whereas in the past it was just the hip operation. That can quadruple the waiting list.
We need to identify the number of procedures for the public, and the way to do so is to count them, to see how long a procedure takes and how much it costs. Allowing for the difficulties from case to case, most procedures are very similar. With a little management we could carry out a far better evaluation of the care the public is getting. Every procedure can be measured. When I was chairman of the Southern Health Board we took a very crude approach to hip operations. We looked for the price that would be charged and we got prices from the three or four leading hospitals in the State. We then looked to the North and found that the charge was about 50% to 60% of the charge in the Republic. We immediately shipped the few helicopter loads of patients up to Belfast where they were operated upon and they returned and everything went very well. It made people in the South think a little more about competition. We have not had to repeat that procedure since. We are now looking at transferring ENT cases. Whatever the procedure, we need to evaluate the output and my constituency colleague, the Minister for Health and Children, should not be afraid to measure what is happening. We all know how hard nursing staff and junior doctors work but we need to measure how all staff perform, be they management, consultants or others.
There is a general improvement in the position in my locality. Cork University Hospital is located in Cork South-Central and a £110 million development programme is in place there for various services. Oncology received considerable media coverage during the week and a new service has been put in place in the hospital. Similar to what we found with the opening of the new offices last week, difficulties and impediments will arise when a new service is first provided. There is a saying in the engineering business that one cannot shoe a running horse. There will always be impediments while new facilities are being installed.
However, it raises the question of an equal level of service throughout the country. I appreciate that there cannot be an acute hospital in every parish or village, but we should examine the level of service throughout the country. Just because the west has done badly in terms of oncology services does not automatically mean it is doing badly in terms of other services. We should look to the centres of excellence where they have tended to specialise and try to implement that standard throughout the country. It can be done. The best medical training has been provided and money is freely available to provide the best equipment and the centres exist. We should now be able to assure the people that their health needs are being catered for.
I emphasise again my concern that the core principles of the health insurance system will be safeguarded despite competition. Only BUPA has entered the market so far to compete and it has about 160,000 customers. We were told that, when the market was opened up, there would be a flood of companies touting for business and offering different rates. Why has only one major company, BUPA, entered the market? Are there reasons for that other than the scattered population? Why is competition not being encouraged?
I compliment the VHI on the job it did until the market was opened to competition. It served us well and I wish it and BUPA well in their future business.
(Carlow-Kilkenny): I am glad to have the opportunity to speak on the Bill after Deputy Dennehy who always aggravates me when he says how great the Fianna Fáil Party was in the past.
It is still great.
(Carlow-Kilkenny): He referred to all the trouble that was caused and mentioned the 1980s. I will deal with a little history myself. I remember a good man, Dr. Garret FitzGerald, coming into office when inflation was at 21%. One cannot repeat that often enough to people in Fianna Fáil who think they have done a great job running the country. If we had inflation of 21% today, the country would be down the Swanee. Cuts were needed. The then Minister for Health and Children, Barry Desmond, had no money to spend nor did many good Fianna Fáil Ministers. If some of the current Ministers had to operate in such conditions, they might not do such a great job.
I welcome the Bill and am glad the VHI and BUPA can compete. I join with Deputy Dennehy in complimenting the VHI for the wonderful assistance it has given to so many people. I shared in that benefit last Christmas and during the summer, unfortunately, when another member of my family spent some time in hospital, the bills for all of which were paid by the VHI. One can say that we are fortunate to be in a position to pay the cost of VHI cover, but it does not question anything and just pays the bill and it should receive credit for that. BUPA can compete and, if it is able to provide a better service, so be it. It might not be easy if it covers the whole community, as it should, to provide figures for premia which will compete with the VHI.
In contrast to the discussion on the VHI and BUPA, there is the other side of the medical service which has been discussed at length today, namely, the public health service. If I can paraphrase Shakespeare, I come to bury the public health service, not to praise it. One could not praise the public health service given the direction it is taking. The fact that I am in a position to pay for VHI cover does not make me feel that I should be treated in a superior way to those who suffer the same as I do.
I had an accident ten years ago and was referred by my GP to a specialist in Dublin. When nothing had happened after three weeks, I rang to know what was happening and was told that it would be six months before I could get an appointment. Having expressed amazement, the person on the other end of the line discovered I was a private patient and, after checking, asked if I was available the Friday of the following week. The pain I had was probably no more severe than that which thousands of others had who were on waiting lists. They had to wait six months whereas I was fortunate enough to be seen in less than ten days. There is something wrong with that.
Waiting lists at present are grossly unfair to people with serious illnesses. During the summer a person with a brain tumour was told it would be four months before he could be seen, even though he had suffered strokes at the time. He was treated but his family had to live with the thought of this person having to wait four months to be seen. I had to contact Beaumont Hospital yesterday because of another case and was told, which I accept, that, if they had more nursing staff, they could cater for many more because they must cater for the whole country. It is grossly unfair to people, especially family members watching, that patients are left waiting for months. One person contacted me this week looking to have an MRI scan. He can have one next March as a public patient but can have it next Wednesday as a private patient.
There is a shortage of staff and I know this because I visited a hospital daily this summer. Nurses are in short supply and it must be asked what is being done about it. For years they were treated with contempt as far as pay was concerned. They went on strike for the first time ever some 12 months ago and received what appeared to be a reasonable increase in percentage terms. However, given that they started on such a miserable salary, they are still grossly underpaid. For that reason, it is difficult to recruit nurses. I also discovered that the health services are employing a large number of agency nurses who are quite happy to pick the days on which they wish to work and the number of hours they work. These people can also avoid working at weekends. We must train more nurses, even if it takes three years to reach the stage where there will be an adequate supply. There is an urgent need to tackle this problem.
I was concerned when I discovered that from next year the standard of admittance to nurse training will be based on the CAO standard. On many occasions I have stated that there will be a medical group in the country, namely, doctors, who will be highly intelligent but who will have no personal interest, perhaps, in medicine. At college, medicine is a status symbol. When parents ask why a certain young person did not take medicine on entering college, the answer they are given is that the individual in question did not want to take it even though they had reached the required points total.
I have heard it stated that nursing has become a technical profession and that those who take it up must have a good knowledge of science subjects, etc. However, what a patient in hospital really needs is a kind person to care for them. If we go through the CAO and only accept those with top grades into the nursing profession, we will have taken the wrong road. I know a girl who repeated her leaving certificate this year because since she was a child she has wanted to do nothing other than become a nurse. However, she was not successful in being accepted into nursing at college and she was devastated. The girl in question has an interest in people and in caring for those who are sick. Next year a person with nine A1 grades will want to become a nurse. She may be interested in science, experiments, etc., but will she be interested in people? I am not stating that a person who does well in the leaving certificate would not make a good nurse but I am afraid that we will go overboard and employ those with above average intelligence rather than those with an interest in the profession.
We must ensure that any nurses who come to work here from abroad have a good bedside manner. There is nothing as bad as a gruff medical person, be it a consultant, a doctor or a nurse. A small measure of kindness goes a long way towards helping people feel better.
With regard to other staff, I have long believed that speech therapists and physiotherapists are also badly treated. The salaries paid to these people are not nearly adequate when one considers the work they do. Speech therapists and physiotherapists are obliged to invest a great deal of effort into their work – they do not merely examine people, they must do a great deal of physical work. We are not paying these people enough and they are moving abroad as a result. Speech therapists, in particular, are badly needed to help young people with difficulties and old people who have suffered strokes. I understand they are travelling to Scotland where they can obtain twice the amount they are paid here.
The issue of relativity as regards salaries is a major problem for health boards. At present, if one person receives an increase someone else must also receive it. None of my relations is involved in either speech therapy or physiotherapy but those who are employed in these professions should be rewarded for the difficult and important work they do.
I suffered from a heart problem in the past and I was lucky to receive excellent advice from the Leas-Cheann Comhairle, Deputy O'Hanlon, which led to my having an emergency operation in hospital. As a result, someone's name was pushed further down the waiting list. It is dreadful that people with heart problems are obliged to wait for their operation, year after year. The concerns of family members in this regard must also be considered.
Debate adjourned.