Private Members' Business. - Health Services: Motion.

I wish to share time with Deputies Connaughton, Ulick Burke, Bradford, Deenihan and Gerry Reynolds.

Is that agreed? Agreed.

I move:

That Dáil Éireann condemns the Government's mismanagement of the health services despite the taxpayer contributing unprecedented levels of funding and in particular in its failure to:

provide fair and equitable access to health services;

reform the administration and governance of health services;

make the structural and staffing changes necessary to eliminate hospital waiting lists;

provide for current and future medical, nursing and therapist manpower needs;

provide additional hospital beds;

relieve the chronic overcrowding in hospital accident and emergency departments;

make proper and timely investment in primary care;

provide medical cards for those on modest incomes;

develop and provide positive mental health programmes;

and calls on the Government to immediately address these deficiencies and in particular to ensure:

the appointment of a health ombudsman;

the creation of a covenant of rights and responsibilities for patients and health care providers, overseen by the health ombudsman;

the provision of adequate support services to allow older people to live in dignity and independence in the community; and

the setting up of an independent inspectorate of both private and public nursing homes.

It is wholly unacceptable that 30,000 people, many of whom are in pain, are currently on waiting lists for hospital treatment while thousands of others are in a queue to see a consultant so that they can get on the waiting lists. Such long lists do not exist is any other European country and the advent of such lists in Ireland is a relatively recent phenomenon. In spite of the millions of pounds spent on so-called waiting list initiatives, the Government has singularly failed to put in place the broad range of measures necessary to reduce such lists.

The Government has been in office for almost four years but, in spite of various PR announcements and significantly increased spending, the health services are in a state of crisis. Those who can vote with their feet take out private health insurance while those who cannot live in fear of getting sick or, worse, live in pain as they await treatment. The core problem with the Fianna Fáil-Progressive Democrats Government approach is that it has created an apartheid system.

To listen to the Minister for Finance and, indeed, the Minister for Tourism, Sport and Recreation, Deputy McDaid, last Friday night, one would be forgiven for thinking that a fortune is spent on our health services. While health spending has increased in recent years, we still spend considerably less than our European neighbours, a fact borne out by our poor life expectancy. In 1980, Ireland spent 8.7% of its GDP wealth on health. By 2000, Ireland's spend had dropped to 5.1% of GDP or 6.05% of GNP which is probably a fairer measure. While it must be acknowledged that Irish GNP increased rapidly in recent years, Ireland is nonetheless 22nd in a list of 29 OECD countries in terms of health spending. From a low base in the early 1990s, health spending has more than doubled but it remains far behind the European average of more than 8% of GDP. Part of the reason for health spending in Ireland being below the EU average is explained by the population's young age structure. However, this is changing.

The state of the nation's health and the question of access to treatment when it is required are the key issues of concern. An essential element of Fine Gael health policy is the proposal to increase resources closer to the EU average and to put structures in place to make health spending more efficient. Resources will be provided on the basis of need. We will also ensure that health services are provided in a more egalitarian way and that services paid for by the public purse, currently amounting to over £5 billion annually, which we intend to significantly increase when in government, will be accounted for to the citizen in a more professional and proactive way.

Fine Gael does not apologise for proposing to spend an additional £300 million on primary health care and an additional £500 million on secondary care annually, targeted at specific objectives aimed at creating a more effective and fairer health service. We do not want this funding to be swallowed up in the system. We propose to spend £190 million specifically to meet private insurance costs currently borne by taxpayers on an individual basis. Fine Gael proposes to introduce a universal and uniform health system. The total extra cost of our proposals in a full year would be £990 million.

We also advocate management and accountability reforms to ensure that the extra funding will not simply be consumed by current structures. We intend to immediately increase spending on medical card entitlement by £130 million. In addition, we propose to allow doctors and pharmacists a 100% investment tax write-off for capital expenditure on surgery-pharmacy improvements which the health authority certifies as expenditure which will ease pressure on hospitals. We also propose a once-off spending of £10 million to clear the backlog of waiting lists for home-based aids for the elderly – hand-rails, shower fittings etc. – and £10 million on research into mental illness. Fine Gael has given serious consideration to how the system should be reformed and where funds should be targeted.

We further propose productivity audits which will realise additional resources to be retained within the health services. Fine Gael's spending proposals would increase health spending to 7.52% of GNP or 6.34% of GDP on a year 2000 basis. This would still not reach European levels of health spending as a proportion of GDP or, indeed, previous Irish levels. We believe that spending on non-salary benefits for taxpayers will assist in easing pay demands and inflationary pressures. In any case, this spending is justified in its own right.

Fine Gael proposes a legislative basis for health policy so that members of the public will know their entitlements and will not be dependent on the whim of administrators or others, as evidenced by the administration of the nursing home schemes by the health boards.

If the scandal of waiting lists is in itself a horror story, the state of the nation's health is equally horrifying. Ireland has the highest rate in Europe of death from heart disease. At almost twice the EU average, heart disease is responsible for about half of all deaths here. One third of all those who die in Ireland aged under 65 die from cancer. Ireland has the third highest death rate from cancer in Europe and many of those who die are awaiting so-called elective treatment. We can improve our health treatments in these areas while ensuring that such medical advantages as Ireland enjoys are maintained and built upon.

Fine Gael estimates that almost £1 billion of additional annual spending will be necessary to fund its ambitious proposals. However, we are only too well aware of the evidence given by the Department of Health and Children to the Committee of Public Accounts that almost 60% of the extra spending on health from 1994 to 1999 was for pay costs. That is why we set out in our recently published document a new strategic approach to health services with six specific proposals for performance measurement in the section on healthy governance. We also propose greater accountability and tendering procedures for hospital management contracts to ensure greater productivity. We propose three yearly productivity audits of all hospitals and health services paid for from the public purse to ensure that, for example, laboratory procedures or radiology services are modern and efficient and contribute to necessary medical information being readily available.

We note the case made by the Department's chief medical officer in his 1999 annual report which suggested that the debate about health services should be widened to a debate about health itself and health inequalities in particular. This is not simply a debate about money. As the chief medical officer pointed out, health is a fundamental human resource, something to be invested in which is inextricably linked to social and econ omic progress. We agree with him that we should place the promotion of health and, in particular, the narrowing of inequalities of health experienced by different segments of our population at the centre of all our efforts at social and economic development.

In the Ireland of today, you will live longer and in less pain if you can pay, but those on low incomes must suffer on. This is unjust, unacceptable, and untenable and runs counter to the principles of a just and inclusive society which the Government allegedly espouses. We must end this double standard. A comprehensive, modern and high quality health service must be available to all, based on fair criteria, not the size of a person's bank balance. In its policy document Fine Gael commits to the provision of such a service and sets out proposals for bringing it about. We will return to the citizens' trust in the health services. It has been eroded because our citizens are not confident of being appropriately treated when ill. Major health care services and providers have not justified the trust placed in them. The poor, the elderly and other patients suffer second class treatment or worse, receive no help when they need it. There is a glaring of lack of leadership and direction by the Government in its fourth year in office in solving the problems in the health care system.

The Fine Gael plan is designed to restore trust in the health services. For this reason – and others set out in our policy document – we will create a citizen centred service which will be trustworthy, effective, efficient and accountable to the citizens it is designed to serve. Under our plan, health care will be funded to meet the needs of our population, fundamentally reoriented, needs led and outcome-driven.

We propose a thorough reform of the way the health services are governed, with a White Paper on Health followed by legislation to replace crisis management with strategic planning, a major investment in primary health care including pharmacy and preventive medicine, and a targeted extension of the medical card general medical service (GMS), doubling the income limits for qualification as an immediate measure. We will extend free GP services to children up to the age of 18 years, and beyond if in full time education which is not uncommon throughout the European Union, we will also include senior citizens over the age of 65 years and those in the lower 60% of income group. There will be special provision for asthma sufferers and those with similar chronic disabilities. Asthma will be included in the long-term illness scheme. Access to secondary care will be on the basis of need through a tax funded universal health insurance scheme. Secondary care will be reformed with identified priorities.

Hospital management contracts will be reformed with new, specific performance measurement criteria which put health gain and fairness first. Citizens' and voluntary organisations will have a role in health administration and there will be productivity audits throughout the health service. We will establish a covenant, not just a charter for display, between providers of health services and patients which puts the patient first and is reported on annually. Specific funding commitments will meet these objectives.

The Fine Gael reforms will constitute the biggest change in health care delivery since 1947 when a separate Department of Health was established. We do not underestimate the enormity of the task, but recognise its importance and of early, comprehensive reform. The method of implementing reform will be a matter for detailed discussion involving a White Paper followed by legislation. It may be prudent to initiate reform on a rolling basis rather than to introduce a nation-wide change all at once. Subject to agreement by the bodies concerned, they will be piloted in two or three health board regions and extended to the rest of the country on a phased, programmed, decisive timetable over two years. This will allow later regions, as well as the insurance companies and the Department of Health, to benefit from the earlier experiences, and plan accordingly.

These radical and comprehensive reforms are rooted in the principles of equity, quality, and cost effectiveness. They are being formulated when our health services are at breaking point under the strains of an outmoded structure. They are analogous to reforms undertaken over the past ten years or more in virtually every other European country. They are distinctive, taking account not only of our own cultural and philosophical values but also benefiting from the experience of those countries ahead of us in reforming. In contrast to this radical plan, the Government, as exemplified in its amendment to the motion, congratulate themselves on their PR announcements but fail to deliver on the ground.

Let us look at some facts underlying the health service. There are 30,000 on waiting lists and thousands more waiting to get on lists. There are reports, forums, initiatives, but still no sign of the large increase necessary in consultant numbers. We have an under-funded, under-resourced general practice system on the point of collapse with doctors' representatives threatening industrial action. The childhood immunisation scheme has scandalously low levels of uptake. In some areas more than one in five children have not been vaccinated against measles. The system of blood collection is in crisis and patients face the prospect of cancelled operations due to insufficient supplies. The inadequate medical card scheme leaves people on the minimum wage ineligible for treatment and in some cases they have to choose between food and medical care. Excellent strategy documents, such as that on cardiovascular disease, have not been implemented. For example, the recommendation to make nicotine replacement therapy GMS reimbursable has not been implemented two years after the report was published. A further recommendation to remove tobacco from the consumer price index has been blocked by the Taoiseach and the Minister for Finance. Instead of real action, we see sponsorship of snooker matches with lovely pictures of the Minister and "the good news" Taoiseach.

Four years into Government, Fianna Fail and the Progressive Democrats, look to develop a new health strategy. Let them face the facts – they have neither the courage nor the imagination to develop and implement such a strategy. Fine Gael in contrast, has developed such a strategy which puts patients and their needs first, rather than one which seeks to fit patients' needs into outdated and ineffective current structures and practices. The Fine Gael plan for health and health service reform is at the core of our aspiration for a just society. It empowers us to meet the challenge of providing quality, affordable and appropriate health care for all. It is a plan for the nation.

Let the Government implement this plan or stand aside and let us get on with the job. There is no worse service delivered in such an unfair, unjust and apartheid-ridden way as our health service has been for the last four years. If we are not prepared to reform this system – to move it into the 21st century – for the poorer people who suffer most, let us think of ourselves. How would any of us like to be old and frail, or to fall on hard times and put our children at the mercy of this system which is chronically ill and needs the chronic, urgent, overwhelmingly reformist and integrated attention it has not been receiving? We have put forward our proposals, as have the Labour Party, to be fair. This Government, after four years in office, is only now coming up with a plan as it faces into an election. I have no doubt it will be indicted by the people when it goes before them. It will be found guilty when its mandate runs out at last in this House.

I compliment my colleague, Deputy Gay Mitchell, on the production of an absolutely excellent health document. Irrespective of the politics involved, one can see that a huge amount of effort and thought was put in over a wide area. I am disappointed that the Minister, despite the resources of the Department of Health and Children, has failed to come up with an overall strategy for the health service. The whole thing seems to be breaking down. When questioned about poor services, the Minister says more money has never been invested, which is true, relative to what was invested in the past. It is also true that there has never been less value for money. There is more aggression and complaints and less confidence among the vulnerable in society than ever before.

I notice that elderly people do not want to go to hospital. They try every trick in the book not to go, which is unsurprising, as it is a job in itself to get admitted to most hospitals. It takes at least four or five hours, and often over 12 hours, to get through the admissions section. Not only do we want more funding in the health service, we also want more value for money. I sincerely hope that more will be done for GPs, who are highly committed to their patients. With a little imagination, it should be possible to ensure that their services lead to fewer people going through hospital outpatient doors, which would be hugely important.

I wish to return to a topic I have previously discussed in this House, which is the closure of the Bon Secours hospital in Tuam. This is another example of the glaring omissions in the health service due to a lack of strategy. For several months, it appeared the last thing the Department and the Western Health Board wanted was a community hospital in Tuam. As the hospital is closing on 5 April, I hope the Minister will guarantee the people of Tuam a replacement hospital. Tuam cancer care used the services of the hospital to good effect down through the years, which means that a number of patients will be discommoded in the next couple of weeks. I hope that the Department and the health board will look after them until the new community hospital is planned and up and running.

There is a good psychiatric service in the Bon Secours hospital. One day a week, over 30 outpatients come there, it is a service which benefits the area generally and I am informed there is nowhere for them to go after 5 April. I hope the Department and the Western Health Board will ensure that these 30 people are well looked after in the Tuam area. They should not be moved somewhere else, as they are used to coming to Tuam. It is incumbent on us to ensure that arrangements are made long before 6 April. I sincerely hope there will be an early announcement regarding what the Department of Health and Children will do in Tuam.

We are waiting for the health board to get back to us.

When the health board gets back, we will want to see the colour of the Minister's money. I must admit that the Western Health Board has not shone in this instance either. I hope the Minister will get its plans soon and react immediately.

I compliment Deputy Gay Mitchell for bringing this timely motion before the House. The Minister must realise that access to health services is becoming more difficult for ordinary people. It is difficult to understand how the Minister can stand idly by, while acknowledging there is a two-tier health system. I cannot understand how the Minister can justify a young schoolgoing child having to wait four years for orthodontic treatment. Nor can I understand the Minister's justification of a terminally ill person in casualty in University College Hospital, Galway, last week having to wait for a bed from midday on Thursday until midday on Saturday, when they were finally admitted. This person was taken care of in a cubicle by their family and spouse. If the Minister stands over this situation in the Celtic tiger Ireland of 2001, then he needs to ask himself some very serious questions.

I believe that reports, assessments and photocalls are no substitute for action on the ground. The Minister and his predecessor in this Government have failed to take meaningful action to rectify and readjust the health services over the last four years, so that people in need have access. The Minister will probably say that additional funding has been provided, which nobody can doubt. This additional funding has been thrown at the problem, while no effort was made to solve it. The Minister has not used his authority to bring changes about.

Like my colleague, Deputy Connaughton, I wish to bring an ongoing problem to the Minister's attention. When will Portiuncula hospital be given over to the Western Health Board so that the uncertainty of the last few years can be eliminated? The hospital always had a good ethos, but morale has been low and will continue to decline unless the Minister indicates, as a matter of urgency, when he intends to take over the hospital and restore it to its proper place.

It is appropriate that the state of our health services be brought to the Minister's attention. The Taoiseach made a comment on the Order of Business that sums up this problem. He boasted about the large amount of money being spent on our health services and the major increase in the moneys in question. That is beyond dispute, as the figures speak for themselves.

The other side of the equation is that queues for hospital treatment are lengthening and more and more people are crying out for a health service that does not appear to be readily available to them. Whatever about the financial side of the Minister's management of our health services, from an administrative point of view, there are serious problems. I am sure every other Member is given details daily of people awaiting admission to hospital, who are crying out for a health service that does not seem to be there. More and more people suggest that in today's Celtic tiger economy, the state of a family's health is becoming more and more dependent on the size of that family's wealth. That is unfair, immoral and should be tackled by the Minister.

While no Minister has had more financial resources available nor has any Minister invested more money in the health service, the Minister, the Minister of State and the civil servants in the Department must ask what is wrong. Something is wrong from an administrative point of view when the queues for hospital treatment are lengthening at a time when more money is being provided. An audit of how that money is being spent is urgently required. In today's Ireland, if one can pay, one will live longer and have less pain, while those on low incomes must suffer on. That is the type of double standard that should not be accepted and is not necessary in a modern European economy such as ours.

There are 31,000 on the waiting list for hospital treatment. That is only the official waiting list, there is also the waiting list of those awaiting an appointment with a consultant. I am sure the Minister would not attempt to defend those figures, but it must be asked how those lists can be so obscenely long at a time when more and more money is being invested in our health service.

Our party spokesperson, Deputy Mitchell, produced a worthwhile document, Restoring Trust in the Health Service, and Deputy McManus brought forward an interesting, informative and impressive document on our health service on behalf of the Labour Party some months ago. Ideas on how to address the problems have been put forward, but the Minister's approach to tackling the 31,000 on the hospital waiting list appears to suggest that the money invested in the health service will solve the problem. It has helped, but it has not made the problem go away.

The Minister cannot justify the state of the health service. Some patients are being left on hospital trolleys because beds are not available, 31,000 people are on the official hospital waiting list and there is a lack of health services available to the elderly while more people are losing their entitlement to a medical card. What new steps does the Minister intend to take, as investing money alone has not worked and will not work? Has the Minister asked himself, how that money is being spent and the value for money of such investment? We are not getting value for money from that investment, as my constituents and other citizens have decided they are not willing to accept a second rate health service in a first rate economy.

I am delighted to speak on this motion. I compliment my colleague, Deputy Mitchell, on tabling it and on the work he did in providing an excellent health policy document on behalf of Fine Gael.

I agree with much of what my colleagues said. I have articulated two specific issues and I would like to hear the Minister's view on them. We have a two tier health system. The majority of representations made by constituents who call to my clinics concern the health service. Most of those constituents are waiting for more than a year to be called for a medical procedure and, in most instances, they cannot afford to pay for private health service. The Minister is lucky the Government is in a position to invest a good deal of money in the health service. I do not question that nor the Ministers for Finance and Health and Children securing money for the health service. I question how that money is being spent and that this issue has not been dealt with in a period when a good deal of money has been available.

Statistics given by two consultants on an RTE radio programme two years ago highlight a problem that no political party has addressed. I do not know who will address it, but doing so would be one of the ways this problem would be resolved. In 1969, 95 administrators administered the health service in the greater Dublin area, I am told that today there are 11,000 administrators in the Eastern Regional Health Authority set up on the Bill introduced two years ago. That is where the vast majority of money is being spent in our health service. The number of administrators in the health service throughout the country is great. I note the Minister's adviser is shaking his head and probably saying to himself that those statistics are not correct, but they were given on an RTE radio programme two years ago. That official is an administrator. I have no difficulty with that, but a great deal of the money being spent is not getting through to the forefront of our health service. It is not being spent on providing extra beds, recruiting more nurses and doctors or appointing more consultants. The money is not getting through to the coal face which is where there is a serious shortfall.

If the Minister could resolve part of that problem under his watch as Minister for Health and Children, he would go a long way towards reducing the hospital waiting list. The additional money that has been spent on the health service in recent years has not resolved that problem. Therefore, there is a difficulty. One of the problems is the high administration cost of the health service.

Another fact given on that radio programme was that in the greater Manchester area, which is similar to the size of Dublin, there are about 3,000 administrators in the health service. That contrasts greatly with the many more administrators in our health service. The high administration cost of the health service is difficult to accept and must be dealt with urgently.

There is a need to provide medical cards for those on modest incomes. The income thresholds that qualify a person to hold a medical card have not increased much in recent years. The Government must examine that qualification criterion on the basis of gross income rather than net income, as the number of people who no longer qualify for a medical card has increased dramatically, particularly in the North Western Health Board regions, especially in my constituency of Sligo-Leitrim. Many of my constituents have told me they are no longer entitled to a medical card, as their income has risen above the qualifying threshold income. Given that the income threshold for qualification has not increased, those people have been taken out of the system. That is not right and it is contributing to the development of a two tier health service.

I strongly support the setting up of an independent inspectorate of private and public nursing homes. That must be put in place as matter of urgency. A number of complaints have been made concerning nursing homes and the establishment of a independent inspectorate is the way to proceed.

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

commends the Government on its commitment to provide a high quality health service directed at those most in need and acknowledges:

–the dramatic increases in current funding since 1997 to the health services made by the Government compared to the previous Administration;

–the provision under the national development plan of £2 billion in capital funding which will transform the health infrastructure;

–the Government's strategic approach to planning for the health system, in particular the launching of significant major strategies, such as the children's strategy, the cardiovascular strategy and the national health promotion strategy;

–the Government's strategic and reforming approach in regard to the work now under way in areas like the reform of the medical structure advocated in the report of the Forum on Medical Manpower, the review of bed capacity in the acute hospitals and the pending review of primary health care;

–the Government's commitment to the preparation of a new health strategy which will make recommendations on how best to implement a high quality, equitable and accessible health service; and

supports the Government in its approach to modernising the health system through the development and implementation of strategies underpinned by solid investment.

I welcome the debate and thank members of the Fine Gael parliamentary party who supported Deputy Mitchell's motion and for giving me and my colleagues the opportunity to discuss health policy. The Opposition has asked the House to condemn the Government's record on health in a broad motion. A broad response is, therefore, required.

As it has dramatically demonstrated in recent weeks, the Opposition is driven principally by the whim of the latest opinion polls. Having thrown overboard its recently reaffirmed leader, the Fine Gael Party has stated that it is willing to change any policy and say anything in its attempt to scramble back into government. As it appears likely that it now has in place the leader who will bring it into next year's general election, it has resumed the desperate search for issues which will perform the political alchemy of converting the base metal of its record and policies into something more alluring to the electorate.

As has been demonstrated again, the leadership may have changed, but the basic tactics remain the same – never explain one's record, pretend one was never in government, never make a hard choice, pretend there is an easy answer to every problem and, when in doubt, play the man, not the ball. We continue to hear much from the Opposition parties about their commitment to openness and transparency. It is in that spirit that I suggest to the Labour Party and Fine Gael contributors to this debate that they take the opportunity, which they have declined to take for the last four years, to explain the reason Deputies Quinn and Noonan chose to cut back funding for the reduction of public waiting lists in 1997. They might also explain where their health reform agenda was when they were in a position to do something about it.

As I have said many times in the House, the Government is proud of its investment in the health service. It is proud of the reforms to the service which it has implemented and has confidence in its programme for the rest of its term. These stand in dramatic contrast to the disinterest and neglect of those who now present themselves as the answer to the ills of the health service. We are proud of our record. I am aware that the leader of the Fine Gael Party is proud of his record in the Department of Health and Children and that the leader of the Labour Party is proud of his record in the Department of Finance. Together they aspire to persuade the people that the Government should be condemned for our record – so be it.

I will set out the progress made since the people chose to change the Government. I will also outline our proposals for the rest of our term and how, taken with our record to date, they add up to an unprecedented programme of investment, modernisation and reform of the health service. While much has been achieved, much more still needs to be done. Central to further progress is a Government which is concerned with the reality of action, not just the empty rhetoric of superficial, opinion poll-driven empathy.

One of the interesting directions the Opposition's policy has taken in recent months has been to stop basing its attack on the Government on the idea that it is refusing to allocate resources to the health area. On countless occasions the Government was attacked for not putting enough into health. Having looked increasingly threadbare for some time, the motion signals a formal surrender on this point by acknowledging the "unprecedented levels of funding" the Government has provided for health services.

The scale of the increase in resources has been dramatic. The House will be aware that the health service received just under £2.5 billion in the rainbow Government's last full year in office. With a last minute spurt, that Government managed to increase its year on year average increase to around 7%. This was the record it brought before the people and which they rejected. This year, the Government doubled the rainbow Government's funding through an allocation of approximately £5 billion. This demonstrates yet again that for all the effort the Opposition puts into trying to demonise him, the Minister for Finance, Deputy McCreevy, has looked after the health service much better than his predecessor.

Before the argument about newly available resources is used, we should not forget there was no fiscal crisis in 1997. It was the rainbow Government's choice to cut funding for reducing public waiting lists. Deputy Quinn's party has confirmed that it believes in running budget deficits. I remind the Fine Gael Party that Deputy Noonan claimed on budget day last December that the Government had provided for too much spending this year. In the light of the huge proportion of Government spending which now goes to health, the only reasonable construction we can place on this is that he is of the view that we are spending too much on health.

The new Opposition attack is based on the idea that the Government is throwing money down a drain and achieving nothing for those who need services. The Government has chosen to dramatically increase health spending. We will defend this decision because it is delivering on the ground. There is much more to be done, but it is having an impact. With 3% and 8% increases respectively in 2000, the extra funding meant that 50,000 more day cases and almost 40,000 more in-patient cases were dealt with in our hospitals than in 1997. These 90,000 extra cases were not dealt with by accident, but because the Government is committed to funding and reforming the health system. In addition to these improvements, there are more health professionals employed in our hospitals than at any time in our history. For example, there are over 400 more doctors in place than in 1997.

A sustained expansion in public investment is an essential building block for a world-class health system. It has been shown year after year that the Government is providing the required investment. It is also pushing forward a wide series of initiatives to develop and implement meaningful and lasting reforms. Given the problems we face, it is too easy to divorce them from domestic and international contexts, particularly in relation to progress being made. Significant advances are being achieved. Services are improving, but as they are not yet good enough, we must continue with an aggressive programme of reform. Some want to stand at the crossroads and sell an easy elixir, guaranteed to cure rheumatism, gout and the ills of the health system in return for one vote for a bottle. The people are not that foolish and we are confident that they will respond to a record of investment and a credible reform programme.

At the heart of any successful health system are the professionals who work within it. There is no doubt that our system has not had an effective means of developing, using and acknowledging the skills and dedication of many professionals. This has led to various problems, particularly in the context of a tight labour supply in society, but matters are improving significantly. One of the key initiatives in this area is the Medical Man power Forum. The forum was established to address issues relating to the medical staffing of hospitals. Agreement has been reached on the principles and approaches to be adopted in relation to the main service, training, research and career issues affecting medical staff. It has also been agreed that the introduction of these changes should coincide with an extension of the core hospital working day. This will require an increase in the current number of hospital consultant posts and significant change in the way hospitals work.

The key outcomes from the implementation of the report of the forum will lead to the provision of a better quality service, with greater continuity of patient care, delivered 24 hours a day by appropriately trained staff. The proposed increase in consultant numbers will be coupled with a rationalisation of the number of doctors in training. The report recommends major changes to medical training in order to retain medical graduates and accommodate the needs of women who wish to combine medical careers with family commitments.

The recommendations of the report of the national joint steering group on the working hours of non-consultant hospital doctors are closely linked to the report of the medical manpower forum. The report is the result of a major study of the hours worked by NCHDs and a blueprint for reducing these hours to 48 hours per week. The thrust of the report will mean the employment of more hospital consultants which will lead to a consultant-provided service as opposed to the current consultant-led service. The result will be improved patient care and greater access to hospital consultants in the public hospital system. This report is another milestone in a series of initiatives aimed at improving the pay, conditions and career opportunities of non-consultant hospital doctors. It follows the £90 million package announced last year which provided substantial improvements in overtime payments, training grants and associated conditions.

These reports should be published shortly and I intend to move quickly to the implementation phase, including the opening of negotiations on the consultants' contract. It should be recognised that these reports will present significant challenges. The Government will consider the reports in detail with the key objective being the improvement of the quality and availability of services for patients. They will provide greater opportunities and improved career paths for doctors, coupled with greater access for public patients to senior clinical decision-making. This, in turn, will lead to more prompt treatment, more streamlined admission and discharge procedures and a reduction in waiting times.

The almost 30,000 nurses who form the backbone of the health system must continue to be central to health policy. We must continue to attract to and retain and properly utilise people in a world-class nursing profession. I am glad to report that the recent recruitment and retention initiative for nurses seems to be having a positive impact. International recruitment has attracted over 750 nurses and significant progress has been made in many hospitals. Deputies will remember that there were over 70 nurse vacancies at Beaumont Hospital at one stage last autumn. I am sure they will be pleased to learn that the number is now down to ten. No doubt the Deputies who attacked the initiative at the time will have the good grace to use the time available to them in this debate to acknowledge the progress which has been made.

The last year has seen a range of fundamental improvements in the education and training of nurses. The introduction of more flexible practices, including new part-time rostering, represents a dramatic improvement in the responsiveness of the system to the personal and professional needs of nurses.

Increasing the number of training places is a central plank of my strategy for addressing the nursing shortage. The number of nursing training places has been increased by 300 to 1,500 until, at least, 2002. A further 20 places have been filled on a new direct entry midwifery programme which has been introduced on a pilot basis. Over 1,500 nursing students started training in October 2000 with record in-takes to psychiatric and mental handicap nursing. This is a strategically important area where progress has been achieved, but which requires continuous attention. The same issues arise regarding other health professionals such as therapy grades, social workers and psychologists on which there is the same commitment to action as evidenced by the full implementation of the report of the expert review committee on paramedics and the necessary provision of funding.

The objective must always be to ensure the public has high quality care available when it needs it. We have put in place the necessary planning procedures to identify the level of provision which required to meet this objective, while implementing a series of initiatives which meant that last year there were roughly 90,000 more day cases and in-patient cases dealt with than in 1997.

We have committed to and significantly progressed the first comprehensive review of bed capacity for some time in acute and non-acute settings. The review is being conducted by the Department of Health and Children in conjunction with the Department of Finance and the social partners. It is of critical importance in the context of assessing the capacity of the hospital system to manage periodic surges in emergency admissions and achieve a significant reduction of waiting times for elective treatment.

Funding of £32 million has been approved on foot of phase one of the review to alleviate service pressures on the acute hospital sector. This funding is being targeted at a number of key service areas and the provision of aids and supports for older people. The second phase of the national bed capacity review is under way and involves the development of a longer term investment strategy for the acute and non-acute sectors. The review will also involve a detailed assessment of need, including an analysis of future bed requirements by medical and surgical specialty. It is anticipated that this phase of the review will be completed shortly.

The motion makes specific reference to our record on waiting lists. If the Opposition would like to spend every day of the next year holding a debate comparing records on waiting lists, I would be delighted. At some point it might get round to explaining the previous Administration's cutback of funding for reducing public waiting lists. As opposed to this, we are providing the resources which are having a significant impact on waiting lists. We have also completed a proper in-depth study of the impact of different measures on reducing waiting lists.

Waiting lists are not a uniquely Irish phenomenon. They feature as part of many publicly funded health systems. Throughout the developed world health systems are experiencing similar difficulties in catering for all the demands in key specialties.

It is my intention to pursue continuous reductions in waiting lists and waiting times for hospital treatment in 2001, following the significant success achieved in this area last year. Dedicated funding for waiting list procedures of £34.5 million has been indicated to health agencies under the waiting list initiative for 2001. This funding has been made available to health agencies in conjunction with longer term measures associated with the £2 billion investment under the national development plan, the ongoing implementation of the recommendations of the expert review group on the waiting list initiative, the national bed capacity review and the winter initiative investment. I also approved an investment package of £32 million to address a number of key service issues in the acute and non-acute sectors. The investment is being targeted at a number of areas, including the provision of additional step-down facilities for patients who have completed the acute phase of their treatment. Many of these patients are older people and who require a further level of care in a more appropriate environment. Under the winter initiative, there will be an increase in the capacity of the acute hospital sector to address the problem of the inappropriate use of hospital beds and enhance the level of extended care available. It is my intention to continue to take all available steps to address the short and longer term issues associated with lengthy waiting lists and, more importantly, waiting times.

The motion refers to the Government's policies on primary care. We have launched a range of initiatives in order to develop policy on this area, which, without going into detail, have improved the infrastructure of primary care. We have also acknowledged the need to further develop general practice to ensure it plays its full role in the strategic development of primary care and a broader integrated health care service. It was in recognition of this that it was decided to undertake a major examination of the nature and role of general practice with the issues surrounding its development in an integrated primary care setting. The purpose of the review was to identify the measures which would be necessary to meet the challenges posed if general practice were to be properly and strategically developed.

The findings of the completed review will serve as the basis for the future strategic development of general practice. Accordingly, it is intended that future investment in general practice will be on the basis of the review and involve a process of consultation with the relevant representative bodies which have prepared their own vision of the future. This will be a wide-ranging exercise and progress will be made on an incremental, but structured basis which will have full regard to existing realities of general practice organisation, infrastructure workload, etc. The evolving outcome of the process will be, therefore, a more complete and rationally developed general practice and primary care system fully integrated into the overall health care sector which meets patients' needs in a value for money framework.

One of the principal policy thrusts of the Government's work across Departments has been to help older people to retain the dignity and independence to which they have a right. The rainbow Government's derisory 1997 pension increase of £1.80 has been replaced by a series of the largest increases in the history of the State pension. In the same way investment in supports and services for older people have been to the fore of the health agenda of the Government. Automatic entitlement to a medical card for all those over the age of 70 years represents a huge step forward.

The Government's commitment to this philosophy of care is proven by the considerable injection of funding into the services which are at the heart of care in the community, namely, expansion of the home help service, specific assistance for carers, additional community support services, that is, public health nurses, care assistants, physiotherapists, occupational therapists and dieticians, with the provision of new day care centres.

Additional funding for the development of services for older people has increased significantly from £3 million in 1997 to an additional £7 million in 1998, an additional £12 million in 1999 and an additional £28.5 million in 2000, while in 2001 an additional £33 million will be provided. These figures do not include additional funding for the nursing home subvention scheme or to expand medical card eligibility to those over the age of 70 years. The additional funding has resulted in approximately 880 posts approved for services for older people between 1997 and 2000. Between 1998 and 2000, over 400 additional beds have been provided in ten new community nursing units and over 1,000 day places per week have been provided in ten new day care centres.

On top of the various areas mentioned, we have undertaken and are implementing a process of strategic planning for a wide range of specialisms. These have been based on our essential approach, which is, to properly examine and strategically plan the development of services. We have worked to end the days of reactive planning. We are not interested in the empty posturing involved in pretending that there is an easy answer to every issue. We are interested in delivering real improvements and the way to achieve this is to plan properly.

An additional element of this and a firm answer to the idea that all we are interested in doing is spending money is the first ever comprehensive audit of value for money within the health system. The specific remit of the review is to examine the trend in resource inputs versus the trend in service outputs to clients over the last ten years; the trend in demand for health services in the last ten years; the difference, if any, between the trend in the level of contribution to cost of public and private patientsvis-à-vis service levels to each category; and differentials in output costs across health boards and hospitals, including specialties. Consultants have also been asked to make recommendations on the development of a management information system for the health service. The study is expected to be completed shortly.

I am determined that quality will be at the centre of everything we do in the health service. My Department has been working with eight of our major academic teaching hospitals to put in place a formal health service accreditation scheme. This will be based initially on the major teaching hospitals and set standards against which hospitals will be surveyed. These standards will allow for real measurement of performance and quality improvement. Best international benchmarks will be used in what will be an independent system. I am confident that it will be a key element in providing a hospital system comparable to best international standards. The health system has required sustained expansion in public investment in a wide range of areas. We have provided this, but perhaps the biggest departure has been the inclusion in the national development plan. A total of £2.0 billion has been made available under the plan. This represents a trebling of investment compared to the previous seven year period. The purpose of the plan will be to create an infrastructure that will bring significant and tangible advances in delivering a more patient centred and accessible service. This investment represents the largest modernisation programme in the history of our health services.

There is a commitment to shift the balance of capital investment towards the non-hospital sector so that the £2.0 billion is divided equally between the hospital and non-hospital areas. In the case of services for older people, it is proposed to provide a greatly improved physical environment to ensure a high quality and client centred service. Approximately £200 million will be available for the capital development of services for older people over the period of the plan. This will allow for the provision of approximately 20 new community nursing units and 20 day care centres and for the expansion of some existing facilities.

Over recent years, a significantly ambitious programme of developments has begun and is in train. We have been carrying out the work required to provide the foundations of effective plans for the future. Additional resources are delivering better care and greater access to care. Various detailed studies have given us a better understanding of the needs and failings of the system. We have now begun the next and final stage of the process, which is to bring together the different elements into an overall national reform strategy.

I could spend a great deal of time responding in detail to the health policy documents launched by the opposition parties last year. However, this would not be a productive use of time. The Fine Gael document is typically a mile wide and an inch deep. It is all things to all men but ultimately a loose collection of promises targeted at a few select groups. The Labour Party has been more ambitious in presenting its simple solution of universal health insurance. The difficulty is that it is so full of holes that it has given up trying to justify it and have reverted to empty catch phrases.

No doubt during the debate the Labour party will claim to be proposing real reform but no one should be fooled. Just because one claims that it is reform and it will cure the world's ills, does not mean it will do so. Deputy McManus has found increasing refuge in the sort of approach quoted inAlice through the Looking Glass: “Things mean exactly as I say they mean, no more and no less”. In spite of consistent calls for it to do so, the Labour Party has refused to answer fundamental questions about its fundamental reform.

How can it claim that all local hospitals will survive if it also says all funding must be competed for in negotiated contracts? How much is it proposing to spend on administration? How much additional care will be provided under its plans? If, in every country that has tried it, universal health insurance has failed to deliver the quality and quantity of care to which we aspire, why should we want to adopt it? The answers are increasingly clear. The Labour Party's intention is not serious reform, but short-term electoral gain.

What we are interested in is investment and reform of public health services. Equity, quality and accountability will be at the core of the new health strategy, on which we have begun consultations. With major professional and research issues behind us, the strategy will demonstrate again the commitment of this Government to modernisation, development and reform of our health services. Thestatus quo is not an option. Serious reform of administrative, funding, service delivery and professional practices will have to be considered where this is required to deliver a world class public health system for all who need it.

I am not interested in the empty rhetoric of superficial responses. This is too important an area. The record of investment and reform which we have already established, is delivering results, as evidenced by the 90,000 extra cases treated last year. However, we have only begun to see the impact of many of the policies and investments already in place.

Increased investment, detailed research and lengthy negotiations with professionals, have been the essential starting points to long-term reform. Some people think it possible to pre-empt this process and buy an off-the-shelf reform. That is not possible and any attempt to do so will simply result in a worse situation than before. The final year of this Government's term will see us developing and implementing further significant reforms. While the Opposition engages in political ambulance chasing, we will get on with the serious work of investment and strategic reform.

The Minister for Health and Children, Deputy Martin, has set down the strategic reforming approach this Government is taking to enhance our health services. I reiterate the message of better strategy and considered reform to utilise effectively the massive increase in funding for health delivered by this Government. As compared with the previous administration, there has been a 100% increase in the over all spend since 1997, from £2.6 billion to £5.2 billion. The present Government's record is second to none. This increased funding is being matched by strategic policy initiatives, reviews and evaluation of health delivery, which will all contribute to a higher quality of service in the years ahead.

A dramatic example of the increased targeted funding delivered by this Government to an area virtually ignored by the previous Administration, is in the area of disabilities. Spending on disability services has grown dramatically since 1997. In the case of services for the intellectually disabled, the amount allocated by the previous Government for 1995 to mid-1997 was £36 million, compared to an allocation of £205 million by this Government for the mid-1997 to 2001 period. For the physically disabled, the amount allocated by the previous administration for 1995 to mid-1997 was £10 million, compared to £107 million by this Government for the mid 1997 to 2001 period.

Last December, we announced that everybody over the age of 70 years will be automatically entitled to a medical card. We have been the first Government to have made a real difference to the vulnerable in our society. The policy of the Department of Health and Children is to maintain older people in dignity and independence at home, in accordance with their own wishes as expressed in many research studies; to restore the independence at home of older people who become ill or dependent; to encourage and support the care of older people in their own community by family, neighbours and voluntary bodies and to provide a high quality hospital and residential care for older people when they can no longer be maintained in dignity and independence at home.

As well as providing the funding for those services, we have a strategy. In planning for service developments in the next few years, particular attention is being focused on the achievement of substantial service improvements in a number of key areas. These include assessment and rehabilitation units and day hospitals; extended care and community nursing units; community based services and community support such as day-care centres and care in the home – care teams, home helps etc; palliative care services; services for older people who are mentally infirm and nursing home subvention.

We do not have a copy of the speech being made by the Minister of State.

Can the Minister of State provide a copy of his speech to Deputy Mitchell?

Yes, it should be available outside.

The Government's approach is based on delivery, not just talk. The funding and strategies have been put in place for further developments. This range of initiatives shows the Government's commitment to the vulnerable in society and to the health of all the people. This Government cannot be faulted, given the massive extra resources it has applied to health care. This, together with the strategic and reforming agenda now being energetically pursued by this Government, will provide the results to answer any criticism. I am honoured to be associated with this Government, which is providing the funding, infrastructure and strategic policy for the further development of the health services.

I wish to share my time with Deputies Healy, Penrose and Wall.

Notwithstanding the spin which the spin doctors have put on the speech of the Minister for Health and Children, one of this Government's great failures is seen on a daily basis in the chaos of our hospitals, which is growing despite economic growth and extra funding, and in the suffering and anxiety experienced by thousands of people who cannot access quality health care when they need it. The Government proclaims it is spending more on the health service, yet the overall waiting times for public patients have lengthened rather than shortened during the Government's time in office. Staffing problems, especially in Dublin, have also become more acute during its time in office. The pressure on hospital beds is worsening and dissatisfaction among the public with the health service is deep ening. The Government is floundering while people die as they await cardiac and other operations.

This is an intolerable situation which would not be tolerated in most other EU countries. The inequality which permits private patients to fast track treatment at the expense of public patients would not be tolerated in many other EU countries where access to health care is recognised as a universal right and where equality as well as quality form the basis upon which health care is delivered.

I listened with amazement to the Minister attack the Labour Party discussion document. I do not mind him criticising or attacking the proposals but I object when the points he makes are dishonest. We all know that the only future for many local hospitals is if they accommodate change. The Minister has dealt with such hospitals which are in danger of closing and with services which either have already closed or will close, especially where obstetrical services are concerned. Litigation will deal with issues for many local hospitals and the Minister knows it. For him to pretend that local hospitals in certain cases will not have a future unless they learn to change and develop in a different way to survive and flourish is dishonest.

We have never made any pretence about the need for change in the health and hospital services. However, it is also clear that there is not an excess of hospital capacity throughout the country. Given the cutbacks in the 1980s, it is clear that there is not enough capacity overall and that there is space for local hospitals and a necessity for them to deliver for local communities. We support that.

The other point the Minister made which I found extraordinary in the context of other EU countries is that universal health insurance has failed to deliver the quality and quantity of care. A great number of EU countries have some form of insurance based system which establishes universality of care. Not one of those countries would choose willingly to have our system and give up the superb care available in France, the fast access in Germany or the capacity in Austria for the type of service we have which belongs to another era, which harms people and which does not support or deliver for them when they are sick.

We should be clear what we discuss. I do not mind engaging the Minister in a debate about how to resolve the issue of inequality and the differences in quality. However, despite the fact that we have put forward honest opinions and views as to how this issue can be dealt with, the Minister has rubbished our proposals. While that may be politics, he does not have the right to do that and not to put forward his views. That is a cowardly thing to do. It does not deal with the core issue of how our system does not deliver for public patients. It does not deal politically with one of the greatest political issues facing us. It is a cow ard's way out to rubbish proposals presented in good faith without presenting one's own. The Minister has not dealt with the core issue of inequality between the experiences of private and public patients. There is an inequity at the core of the health service and the Labour Party believes it is time to resolve it, not by levelling down but by levelling up. Fianna Fáil does not have an answer to the questions we ask about how it intends dealing with this issue.

A self-serving, self-congratulatory amendment has been tabled by the Minister to the motion. It is an insult to those directly affected. These people are too poor, sick, elderly or vulnerable to exert power and influence over Fianna Fáil and the Progressive Democrats. That is clear. That said, they are part of the community and they suffer at present because the system does not deliver the care they need. That is too often forgotten by a Government that has grown complacent and self-satisfied.

I warmly welcome the motion tabled by Deputy Gay Mitchell and Fine Gael because it gives us an opportunity to speak out on these people's behalf. Many others want to speak out on their behalf, such as people working in the health service who are frustrated and angry at what is happening to patients who should be able to access care and who are unable to do so. That experience of frustration and anger is present in the health service and is palpable.

We see it in a report that a consultant in one of the major public hospitals has taken the ultimate stand. Mr. Patrick Plunkett, accident and emergency consultant, has announced he is resigning his position on the board of St. James's Hospital because he can no longer stand over the mess that daily presents itself in his emergency department. He said:

At 9 a.m. today, there were 18 patients in the emergency department of St. James's Hospital waiting for admission to the wards. [This is a letter he wrote to the Minister] Of these, 10 had been waiting for a bed since before midnight. Eight of them were over 70 years of age. One [of them] is over 90 years of age and has been in the emergency department for 24 hours now [waiting on a trolley to get a bed].

How can we have this glorious presentation from the Minister for Health and Children? He quotedAlice Through the Looking Glass. I quote Alice in Wonderland. You can have jam yesterday, you can have jam tomorrow, but you cannot have jam today. One cannot have the service denied these poor people waiting in the accident and emergency department in St. James's Hospital.

I want to cite another extreme example.

We provided the funding.

Allow Deputy McManus without interruption.

The Minister has had time enough.

The Deputy is being selective.

Is the Minister trying to gag me?

I would never try that.

He is trying his best but he is not succeeding. I cite another example and perhaps the Minister could do something. This is an issue I raised on the Order of Business concerning haemophiliacs. This is an area where the system failed people in a way that is almost incomprehensible. We established the Lindsay tribunal to find the truth, discover what happened and, in some way, to try to alleviate the terrible experience of these people. When discussing health care in the past, it is important to be scrupulously fair and take into account the distorting prism of hindsight. However, in the cases of the HIV and hepatitis C infection of haemophiliacs by contaminated blood products, the responsibility for the most scandalous and tragic episode in health care history lies squarely with the State. The Lindsay tribunal was established by the House to discover the truth of what happened.

The Irish Haemophiliacs Society has a difficult and sometimes terrible duty to discover that truth while being conscious that some of its members face premature death as a consequence of what was done to them. The society has shown great determination and dedication. To be fair, the Minister waived his privilege and promised to provide documentation for the Lindsay tribunal. I ask him to go further. Four other institutions are withholding necessary information which they could deliver to haemophiliacs and which they refuse to do. They shelter behind privilege at a time when they should provide every support they can to these unfortunate people. It is inexcusable. The Tánaiste stated publicly yesterday that she wanted these institutions to reveal the truth.

Will the Minister ask the Taoiseach to ensure these institutions comply with their moral obligation in this regard. It may not be their legal obligation to do so, we understand that. There is a moral argument that will not and should not go away. The Taoiseach is the one person who could ensure this happens. Let us remember, we are talking about the slaughter of the innocents. The health care system in this country delivered the death sentence to those who died.

The Government can ensure that the Lindsay tribunal is provided with all the documentation to discover the truth. We will only have one shot at it and time is very rapidly running out for those involved in the process of discovering the truth. A very extreme example is that many of the problems in our health service, under-funding, lack of accountability and poor management, remain to be addressed now.

We have to recognise that after four years the Government has failed to deal with the same issues. Many reports have been compiled on the health services and I would like to see them, we have waited long enough. The medical manpower forum report was due about two or two and a half years ago – it is a long time in gestation. I know there were problems with it but it appears the Minister is sitting on it instead of publishing it. The real problems in the health services has to be measured by the experience of the patient who needs to be placed centre of service. The reality is that thousands of patients are on hospital waiting lists today despite the fact that the Government promised to tackle that problem – the Minister spoke about the last election, perhaps the problem is that the rainbow Government told the truth. The Government has spent a great deal of money but has achieved only minimal change in the reduction of hospital waiting lists. Fianna Fáil promised the people it would tackle the hospital waiting list problem. The reality is that not only have the lists not decreased but the waiting times for many specialties have risen. What kind of record is that? The Minister of State, Deputy Moffatt, said that the Government's record speaks for itself. I could not have said it better myself.

It is positive.

The Government's record is that people are still waiting, in their thousands, for necessary procedures, hospital wards remain closed, staff shortages have increased and morale is becoming more and more problematic. Consultants are leaving hospital boards out of sheer and utter frustration. If that is a record to be proud of, I am not living in the same country as the Minister. I would have preferred to hear an honest view presented, not the spinning of spin-doctors. I have a great deal of respect for the Minister. From time to time he tells it as it is.

Not tonight.

No, that did not happen tonight. Perhaps he does so in front of a television camera when it suits him to be a little more ingratiating. I do not know but it is an aspect of his disposition which does not reveal itself very often.

What we are seeing is a sham. I ask that the Minister stop looking at this as a party political speech and look instead at the problems which exist in the health service from the patients' point of view.

I welcome the opportunity to speak on this motion and thank the Labour Party for sharing time. The health services are in a malaise, a malaise dominated by crisis management of the services where rich and powerful people can get immediate medical treatment but public patients must wait for months and years for treatment, and sometimes they die. A symptom of that mal aise can be seen any day of the week at St. Joseph's Hospital, Clonmel, where up to 12 patients await treatment in very narrow corridors. These are elderly and very ill patients, they have no privacy and their personal belongings remain at the end of their beds. They are left in full view of visitors to the hospital. These people are unable to receive treatment via medical equipment and the staff, medical, nursing, non-nursing and administrative, are absolutely frustrated by the situation.

Similar problems exist throughout the country. The only solution is to provide additional beds. We must put back into the system the beds which Fianna Fáil took out in the mid-1980s. They closed the district hospital in Tipperary town with the loss of 50 beds. From that day on, difficulties of overcrowding arose in hospitals in south Tipperary. The mid-1980s was a time when we saw slogans such as "Health Cuts Hurt the Old, the Sick and the Handicapped". Fianna Fáil was re-elected on slogans such as that. However, when it resumed office it did the opposite. We need to re-open all those beds which were closed. We need long-stay beds, more step down facilities and more district hospital beds if the difficulties are to be surmounted.

The policies initiated in the mid-1980s have resulted in overcrowding and long waiting lists. There are now approximately 30,000 public patients on waiting lists in public hospitals as against 24,000 in 1994. Those policies also mean that the health spend per head of population today is about 15% lower than the European Union average. It means that the death rate from heart disease is the highest in the European Union and the death rate from cancer among women is the second highest in the European Union. Thousands of sick people are forced to travel long distances for necessary treatments which should be available locally. Local communities are forced to fund-raise for essential medical equipment. A CT scan is essential medical equipment which should be fully funded by the Department of Health and Children, but locals in Tipperary are forced to fund-raise for it.

Emergency services are needed to bring access to medical services for public patients up to the same level as those available for private patients. I want to refer to the very sad and sorry situation where our elderly patients are forced into private nursing homes and are being denied their legal entitlement to public funded treatment in such homes. The recent Ombudsman's report pointed out that elderly people have a statutory entitlement to publicly-funded nursing home care. It is incumbent on the Minister to immediately bring forward legislation which will provide elderly people with their entitlement to nursing home care.

Deputy Healy, I must ask you to move the adjournment of the debate. There are ten minutes remaining in the slot tomorrow evening.

Debate adjourned.