Dáil Éireann díospóireacht -
Tuesday, 22 May 2001

Vol. 536 No. 5

Private Members' Business. - Health Services: Motion.

Ms McManus

I move:

That Dáil Éireann notes, that during the four wasted years of the term of office of this Government,

(a) many public health services have actually deteriorated causing pain and suffering to those in need of treatment, care and support;

(b) despite the urgency of the crisis now facing the health service, at the much hyped special Cabinet meeting held at Ballymascanlon on 14 May, no decisions were made nor any initiatives agreed to improve the situation;

(c) the clear divisions between the Minister for Health and Children and the Minister for Finance which are a further obstacle to health care reform;

and deplores, in particular:

–the failure of the Minister for Health and Children to create a customer-focused health care service as promised in An Action Programme for the Millennium, or to produce any comprehensive programme of health reform;

–the failure of the Minister for Health and Children to deliver on the commitment given in An Action Programme for the Millennium to tackle the crisis in hospital waiting lists, as almost 28,000 public patients are waiting for treatment and waiting times in certain specialties have increased;

–the failure of the Minister for Health and Children to substantially improve mental health and autistic services as promised in An Action Programme for the Millennium, especially in view of the restrictive nature of the Mental Health Bill and the deplorable delay in progressing it through the Oireachtas;

–the failure of the Minister for Health and Children to increase income levels for eligibility for medical cards for large families, as promised in An Action Programme for the Millennium, as a result of which many people in need are deprived of access to the level of health care they require;

–the failure of the Minister for Health and Children to tackle the grave inequity caused by the two tier nature of our hospital system;

–the failure of the Minister for Health and Children to provide the additional beds in acute and non-acute hospitals needed to provide for our growing population;

–the failure of the Minister for Health and Children to introduce repeatedly promised legislation to further control tobacco advertising, despite the continuing toll that smoking takes on health and the additional financial burden placed on the health service;

–the failure of the Minister for Health and Children to honour commitments made in February last to ensure speedy repayment of moneys improperly demanded from adult children of those in nursing homes;

–the failure of the Minister for Health and Children to end the practice of keeping patients with intellectual disabilities in psychiatric hospitals;

–the failure of the Minister for Health and Children to ensure adequate community care services to support families caring for dependants in the home;

–the failure of the Minister for Health and Children to deal with the serious shortage of nursing staff or to address the concern of nurses in regard to working conditions;

–the failure of the Minister for Health and Children to fill all the 29 consultant AE and anaesthetist posts announced last October under the winter beds initiative;

–the failure of the Minister for Health and Children to fully progress the commitments made on working times and conditions for non-consultant junior hospital doctors;

–the failure of the Minister for Health and Children to deliver a full national breast cancer screening service and cervical cancer screening service;

–the failure of the Minister for Health and Children to deal with the serious crisis in the orthodontic service, especially in the Eastern Regional Health Authority area where more than 12,000 people are awaiting treatment or assessment;

–the failure of the Minister for Health and Children to adequately fund the child welfare and protection services resulting in growing waiting lists for social work services and inadequate residential care services for many children at risk;

and instructs the Minister for Health and Children to report back to the Dáil not later than the last day prior to the summer recess, on what progress he has made on all of these issues.

I wish to share time with Deputies Stagg, Penrose, Rabbitte and Upton.

The Labour Party is tabling this motion because it recognises health as the most urgent political and social issue facing the public. It is obvious that the Government is neither aware of the depth of the crisis, nor is it capable of producing a coherent response to tackle it. The much-hyped Cabinet meeting at Ballymascanlon was supposed to deliver on health care and silence the critics of the Government's failure to address the crisis, or so the Minister for Health and Children, Deputy Martin, wanted us to believe. Instead it resulted in a ministerial mauling, a Cabinet in confusion and a victory for the hard right. The slapping down of the Minister for Health and Children by the Minister for Finance, Deputy McCreevy, left no doubt as to the true nature of the Government. In the face of an ideology that rewards the rich and denies the poor in successive budgets and discriminates in health care on an ongoing basis, the Minister for Health and Children is like a rabbit caught in the headlights of the Mercedes of the Minister for Finance. The Minister for Health and Children wants to spend more money on health while the Minister for Finance wants to stop spending more money on health. Both have spelt out their positions and both are wrong.

We need more money for additional beds and staffing and value for money. However, unless the health service is based on proper funding allied with a new dispensation of universal care and a new relationship between patient and care provider, the opportunity to deliver a world class service to all our citizens will be lost. We have the economic capacity to provide such a health service. The Labour Party has set out the framework for a 21st century health service based on a universal insurance scheme that would encompass everyone, regardless of means, and ensure those of us who can afford to contribute towards it would do so. Such a system would provide the safeguard of a free general practitioner care service while maintaining the current drug schemes. It would integrate primary care with secondary care in order that only those who need to be in hospital would go to hospital and it would encourage effective health promotion. It would abolish the two tier system in our hospital sector whereby hospital consultants are paid differently for their public patients and their private patients leading to gross inequities and waiting lists. Under our proposals the patient would be central to the service because the money would follow the patient.

We have set out the framework which would deliver care on the basis of need, guarantee excellence of care and encourage value for money. After four years in office the Government has still to declare how it intends to tackle the issues. They have been four wasted years. Why should sick Irish people expect anything less than the best? Other European peoples expect quality care when they need it and that is what they get. The French health system is the best in the world; yet, the French economy is not growing as fast as ours, nor are they wealthier than us anymore. The most disturbing aspect of the meeting at Ballymascanlon is that it is clear the Government has no intention of reforming the health service, it never intended to and is not going to. It has run out of time and what is needed is not just a new start in health care but a new Government to deliver on it. The record speaks for itself. During the four wasted years of the Fianna Fáil and Progressive Democrats term of office there has been unprecedented prosperity and a real opportunity to create a quality health service for all our people. Instead of taking that opportunity the Government has presided over a deepening crisis.

The opportunity was squandered first by a Minister who did not know or care about health reform. Never was a Minister more glad to be rid of a Department than Deputy Cowen. When he left his legacy was two years of industrial relations chaos, ward closures, shattered morale among hospital professionals and lengthening queues. Now Deputy Micheál Martin is in the job, though not in the driving seat. Thatcherism has put him in his place and now, as if things were not bad enough, we have the Minister for Finance imposing his ideas on health care. The McCreevy solution is not to increase bed numbers but simply to remove private beds out of public hospitals. Like many of his views, it is simplistic and superficially attractive. It is also wrong. It ignores the fact that the vast number of admissions nowadays are through accident and emergency departments while 50% of people take out health insurance. The increased cost of his approach would force more people out of private health insurance and on to the public waiting lists which, in turn, would put additional pressure on public beds. The cycle would become more vicious.

Under the proposals from the Minister for Finance, our health service would become worse and more unfairly divided between those who can afford to buy quality care and those who are denied it. The Minister is proposing the US model of health care and the Taoiseach appears to be happy to row in behind his right-wing ideologue in the Department of Finance. He wants to know what crisis we are talking about. The Taoiseach is adamant there is no crisis in the health service. At Ballymascanlon there was subliminal jostling for position in the next leadership contest within Fianna Fáil, but the sick and dying are the losers. They are the victims of a Government which has grown complacent and is protected from the harsh realities affecting the sick. The desperate state of our health service impacts directly on the most vulnerable – the elderly, the poor, the ailing and those who cannot afford to buy any American style health care the Minister for Finance might like to offer.

It is clear that, despite his good intentions, the Minister for Health and Children is powerless to make the necessary changes. He has not succeeded in reaching his own modest targets. Last October he announced with great fanfare his winter beds initiative and the appointment of 29 new consultant posts. Eight months later, as we approach midsummer, 450 hospital beds are still inappropriately occupied and all the consultant posts have not been filled. Hospital wards are still closed and nursing staff are in short supply. Almost 30,000 people are on waiting lists for procedures and thousands more are waiting to see a specialist. The hospital building programme is bogged down. The sick and elderly in our major hospitals are forced to suffer the indignity of lying on trolleys for hours and days while they wait for a bed.

The four wasted years have left a terrible legacy of pain and suffering in their wake. I am talking about suffering such as that experienced by a man who contracted diabetes in middle age and needs an operation in one eye. His consultant says it will be at least six months before he gets it. His general practitioner has told him that if this operation is delayed, his other eye will become affected and he could end up being blind. If he was a private patient, he would not have to wait. What type of country are we living in where the coffers are overflowing, yet a man may lose his sight because he cannot access the treatment he needs and he cannot afford to buy it? I am talking about the type of pain experienced by the young paraplegic who cannot start his rehabilitation because he is stuck on a hospital waiting list for an operation on his legs. I am talking about the anguish of a mother who is afraid to bring her children to her family doctor because she cannot afford to pay him, although she knows they need medical care and attention. I am talking about the 90 year old man who spent days on a trolley in an accident and emergency department because there was no bed for him. Is this what the Government means when it says it is paying special attention to the needs of the elderly?

What about the people who provide for those needs? I am talking about a typical nurse in St. James's Hospital who works three 12 hour shifts a week and a further two 12 hour shifts to pay her £800 a month mortgage. A 60 hour working week for a nurse in an understaffed and over stretched hospital may be value for money in the eyes of the Minister for Finance, but it is not right and it is not sustainable. Our health service is staffed by people of the greatest dedication and professionalism. Is it any wonder they are worn out and worn down by their frustration at a Government which is incapable of addressing the needs of their patients? I have not outlined isolated instances because this is the experience of thousands of people who are forced to endure the deficiencies of an under funded and an iniquitous health service.

We are tabling this motion tonight to highlight how common these experiences are and to affirm that the Labour Party is keeping the needs of patients on the political agenda in every way we can. We are reminding the public of the commitments the Government made when it took office and of the promises reneged on by the Taoiseach, the Minister for Finance, the Minister for Health and Children and all the others. They promised in their Government programme to deliver a customer focused health care service, to tackle the crisis in the hospital waiting lists and to increase income levels for eligibility for medical cards for large families. These promises are on the public record. However, after four wasted years not one of those promises has been kept. Failure is piled upon failure at the Minister's door. He has failed to tackle the hospital waiting lists, to deal with our two-tier system, to provide more beds in acute and non-acute hospitals, to develop community care, to support carers in the home and to cherish our children. The only difficulty we had in drawing up the list of failures of this Government was to decide where to draw the line.

The argument in favour of a health service based on quality and equality is not new. When Dr. Noel Browne was Minister for Health, he attempted to tackle inequality in health care for mothers and children. He made the point at the time that in any two-tier system the better off will get the better service, while the worse off will get the worst service. He fought against means testing eligibility because it institutionalises inequality. He said that in medicine he did not see rich and poor people, but sick people. Dr. Noel Browne fought for the universality of health care, but the forces of reaction defeated him. The Labour Party is fighting today for the universality of health care. The forces of reaction are still with us in a new guise and in this Cabinet, but we do not intend to let them win again.

We are seeking what other Europeans accept as their right – a good, fair, properly resourced and insurance based health system. It is an ambition shared by many people both inside and outside this House. Only 24% of Irish people are satisfied with our health service. That figure is 78% in Finland and 71% in Austria. Satisfaction is also high in France, which is not surprising since it does not have hospital waiting lists. French people live a good deal longer than Irish people. It is possible to provide a quality health system not just to meet the current needs but for an ageing population. France and other countries have done it. There will always be stresses and strains and further demands, but we do not yet have the major demographic challenges facing these European countries. However, we have a Government incapable of meeting the challenges facing us.

It is worth comparing the Government's failure on health with the extraordinary planning, preparation and funding commitments to the establishment of Stadium Ireland. The Government could have chosen to set up a task force to create a world class health service. We could have had the equivalent of a Paddy Teahon or a Laura Megahy in place to take on the work of dealing with the management problems, the anomalies, the staffing shortages, the lack of patient responsiveness and the modernisation project that is demanded if we are to reach the objective of a 21st century health service. However, we do not have that commitment from the Government. We have two Ministers bickering over money, while the Taoiseach, as usual, keeps his head down and out of trouble in a Government which is bereft of direction.

We have heard and I have no doubt we will hear a great deal tonight about the proposed health strategy. Drawing up a strategy when a Government is coming to the end of its term of office begs the question about what this Government is about. At a time when the Government has to defend such an appalling record of the failures listed in the motion, the exercise on which it is embarked is more about trying to rescue Fianna Fáil from the anger of the electorate than it is about reforming and transforming the health service.

Mr. Stagg

Many have described the health system as a two tier system. I go a step further and say that it is a three tier system. There are medi cal card holders, those who make health contributions or subscribe to the VHI's plan B, and super plan people. The modus operandi of the health system is to question what insurance cover people have when they present for treatment. Patients are then streamed into a variety of levels of treatment, not on the basis of their health condition but their wealth, and how much they can afford to pay for insurance. Some wait one week for treatment – the super plan people. Others wait one year, while some wait forever. Many die while waiting.

It is totally unacceptable that patients are treated not because of how sick they are but how well off they are; not due to the condition of their heartbeat but on the depth of their pockets; not on the shortness of their cough but on the money in their wallet. It is outrageous that in the time of the Celtic tiger, in a society that describes itself as Christian, we are behaving in a way that was unacceptable 150 years ago. Patients, at their time of greatest need, are treated on the basis of their ability to pay. That this practice is rampant is grossly insulting in a civilised society.

The role of money grabbing senior consultants deserves attention. Their greed knows no bounds and their power within the medical system is nearly as great as their greed. It is not the regional health boards which dictate policy in hospitals; it is the medical consultants. I served on a large hospital board in Dublin and saw consultants spend more time on committees dealing with their hip pockets rather than with their patients. They strove to ensure their money was protected and income enlarged.

At the same time, junior hospital doctors and registrars were run ragged. Patients with medical cards who eventually get into hospital rarely see their consultants. If a senior consultant is involved, the patient who is supposed to be under his or her care does not have a snowball's chance in hell of being seen. A closed shop is operated. Consultants decide on their numbers. Nobody else is involved, not even the Minister for Health and Children, although he would like to be. The Minister does not have the bottle to tackle them.

Mr. Martin

The Government has tackled the issue.

Mr. Stagg

We will see. We will also see if the Minister for Finance allows the Minister for Health and Children to tackle the consultants. I doubt he will. Consultants ensure, due to the closed shop and the ensuing scarcity of consultants, their fees are extraordinarily high. It is time for the Minister for Health and Children to take them on.

There are five medical schools in Ireland which have places to produce more than enough doctors to meet our needs. Instead, we produce them for export because the Government will not hire them. When it does hire them, it will not pay them and forces them to work in excess of 100 hours per week. Even then, it will not produce a system where doctors will be trained and further educated and promoted. It surrenders to the fat cats, the blockers, and the senior consultants who say, "No".

The Labour Party has clear proposals and policies. We guarantee that if in government, we will ensure the level of sickness will be the test for treatment, not the level of wealth. There will be equal access to treatment which will be funded by a universal insurance scheme. We will make provision for beds, staff and theatres to ensure those in need in hospitals, out-patient departments and the community receive quality treatment when they need it.

Mr. Penrose

I am glad to have the opportunity to contribute to the debate on this important motion as health is a matter that affects all citizens. It is an old saying in County Westmeath that one's health is one's wealth. Ironically, at a time when the nation is experiencing an unprecedented level of wealth, sections of the health service are nearing collapse. This is not reflective of an economy held up as a shining example of success throughout Europe. If anything, our two tiered, under-funded, understaffed and overstretched health services are akin to what one might expect to find in a developing country.

Members will be aware through contact with their constituents that access to the health service is an issue that causes incredible pain and frustration. It is underpinned by the philosophy that the poor must wait. Some weeks ago an aunt of mine was left on a trolley waiting for services. This is disgraceful. Who can crow about the wealth and prosperity of the country when such instances occur? It is bad enough that it happened in the 1940s and 1950s, when a particular person tried to root out the problems, only to have his efforts put down by reactionary forces. That person was Mr. Noel Browne, and if he was here today, he would do much considering the current level of wealth. That is the barometer by which to measure this issue.

A parochial example, that of Longford-Westmeath General Hospital, may help to illustrate the situation. It highlights the Government's mismanagement of the health infrastructure and indicates how the hospitals building programme has got bogged down. This issue exercising the people of Counties Longford and Westmeath relates to the completion of phase 2B of the hospital. This is a critical infrastructure, providing an upgraded, state-of-the-art facility to accommodate the medical requirements of the expanding populations in the two counties.

Phase 2A at Longford-Westmeath General Hospital provided for a new accident and emergency unit, a modern x-ray unit, an out-patient department and other ancillary facilities which were completed in July 1997 and fully operational in 1998. At the same time, a five-storey block – phase 2B – was also constructed. This was to be fitted out at a later date to provide the additional beds required for this busy and progressive hospital. The critical nature of this element of the infrastructure – which should be put in place without further foot dragging, side stepping and obfuscation from the Department of Health and Children – can be gleaned from the fact that the completion, equipping and staffing of the building will mean an additional 100 beds being made available for those counties.

They are badly needed. In January each year, there has been 130% occupancy of the current facilities. Nurses must put beds side by side while staff struggle to do their professional best in difficult conditions. Yet, when they look out of the hospital they see the five-storey empty shell of phase 2B gathering moss. This is a scandal. It is no surprise that the people of Counties Longford and Westmeath are seething with justifiable anger when they observe the Taoiseach and Government championing their pet projects and securing the necessary finance to have them completed. What I am concerned about is the health of the people of County Westmeath.

I have been involved in many sporting activities and I support the allocation of money to sporting organisations. Not, however, at the cost of people's health. A person only gets one chance to live. As Deputy Stagg pointed out, it is sometimes discovered that the numbers on waiting lists have decreased because some of the people had died while awaiting treatment. We need £40 million to complete construction of the facilities at Mullingar. That is small beer in terms of the great celebration the Minister for Finance, Deputy McCreevy, announces each year in regard of our £2 billion or £2.5 billion budget surplus.

If the Minister for Health and Children is short of money, as a socialist who believes in the fundamental wellbeing of others and in helping those less well off than myself I have no difficulty in paying an extra penny tax in the pound. I am prepared to pay to ensure that ordinary people less well off than I am can obtain treatment. The Government is giving in to the greedy in our society and those who want everything for themselves. I would rather ensure that elderly people are cared for and if I have to pay to ensure that this happens I will do so, because I will be old one day and I hope the younger generation will care for me. If the Government does not want to charge me tax at a rate of 42%, let it charge me at 44%.

This country is beset by the Progressive Democrats' philosophy, which epitomises what happened in Britain under Thatcher vis-à-vis the privatisation of services. It also epitomises the “greed is good” philosophy. I want neither hand, act nor part in that philosophy and I am prepared to pay extra tax if the Government cannot provide additional funding out of the budget surplus. People such as I should be allowed to pay for those unfortunate individuals who are obliged to lie on trolleys in hospitals throughout the country.

I am aware that there is a general election on the horizon and we are expecting news in Westmeath, where Fianna Fáil will have a Senator and a current Minister seeking election to the next Dáil.

Mr. Ring

Did not Senator Cassidy make an announcement?

Mr. Penrose

Yes, but the people will not be deceived any longer. The members of the electorate in Westmeath are intelligent and they will be on the streets by September unless the Minister makes an announcement.

Mr. Rabbitte

The Minister for Health and Children in a matter of fact manner accepts that we have a two tier health service. Private patients get treatment which is better, faster than do public patients. The damage done by the cutbacks in the 1980s has not yet been overcome. Our citizens, who have built a first rate economy, cannot understand why our new found wealth has failed to deliver high quality health care accessible to all. The health system is not just based on ability to pay, but we have acute staff shortages in certain areas and lengthening waiting lists.

The quality of life endured by many of our people is being destroyed because of the huge delays in access to health care. No Member on any side of the House is without a personal file of heart rending cases of people awaiting access to hospital. Hospital appointments do not carry any meaning now. I know of a constituent, a cancer patient who was admitted to Tallaght Hospital for further surgery in January 2000 and altogether presented on seven further occasions last year by appointment, before having the necessary procedure performed. Hundreds of my constituents have discovered that, having waited 20 years for it, they cannot gain admission to their own hospital when the need arises. As Maev-Anne Wren wrote in her series in The Irish Times quoting one administrator “we are giving one set of taxpayers more rapid access to better treatment for the payment of very little extra money.”

Glib phrases such as "there is no point in throwing good money after bad" and mooting daft solutions like taking private patients out of public hospitals will not tackle the crisis in those hospitals. We are spending less on our health services than most European countries. For example, between 1980 and 1996 only three EU member states reduced health spending as a proportion of GDP and the biggest reduction, at 20%, was in Ireland. However, greater investment must proceed hand in hand with structural reform.

Focus on lifestyle and development of primary care would take some pressure off the hospitals. After Ballymascanlon, however, it is impossible to know where the Government is going, other than to the country, having signalled that it acknowledges there is a crisis in health. Did it have to take four years for the Government to discover that fundamental reform of the health services is necessary? After Ballymascanlon we have the spectacle of Fianna Fáil, in the persons of the Minister for Health and Children, Deputy Martin, and the Minister for Finance, Deputy McCreevy, taking both sides of the road. The focus groups have probably concluded that this formula is an electoral winner "Sure the Dauphin from Cork would tackle the health crisis if only he was allowed. He is really a social democrat, you know." For others it is a case of thank God for Deputy McCreevy, only over whose dead body will more money go into the health services. It is called a Fianna Fáil each way bet.

Access to decent health care ought to be a right taken for granted in a wealthy democratic society. However, to be a public patient in Ireland today is to be a second class citizen. The stress and anxiety that dominates the lives of so many people on waiting lists cannot be exaggerated. The fear of falling ill, knowing that admission to hospital in many cases is a lottery, dominates the lives of many people on low incomes.

Meanwhile, the Taoiseach will not be deterred from building a monument to his memory at Abbotstown, no matter how much public money it takes or how many blank cheques have to be used to win the nominal allegiance of the sporting organisations. If Deputy Bertie Ahern wants to leave behind a monument as his political testament, why not invest £1 billion in a reform programme for the health services? That would truly be a monument which would improve the life chances and quality of life of all our citizens.

How can we justify the spending of enormous sums of money on a monument that will be empty or partially empty, except on a few occasions annually, when patients are consigned to trolleys, when children are disfigured before they can obtain an appointment to see an orthodontist and when people die while on waiting lists? How can we justify a monument that must enter into a contractual arrangement to poach spectators from another stadium, when we are so short of hospital staff and necessary beds and when people short of money are bypassed in lengthening queues? The Taoiseach, Deputy Bertie Ahern, like his mentor, former Deputy Charles Haughey, is about to discover the extent of the crisis in the health services. What kind of Government puts a monument to vanity ahead of the real need of ordinary people for a decent health service?

Dr. Upton

Graduates of Irish medical schools are, more than ever, opting out of the profession for which they have been trained. The cost to the State of training each doctor and the subsequent loss to the health service is something about which we hear relatively little. Junior doctors are exercising their right to move away from a profession that is increasingly demanding and they relate mind-boggling stories about the length of hours worked, poor pay and the lack of promotional prospects. In respect of any other occupation, a body or organisation such as the Health and Safety Authority would set standards for the length of the working day and would penalise any employer who would expect an employee to work under such conditions and endure such levels of stress for such long hours. Would somebody be allowed to operate heavy machinery or operate a lorry for the same number of hours that junior hospital doctors are expected to work?

Overworked doctors and other health care professionals do their best to ensure that patients are given a quality service. Any of my constituents who have been patients in hospital are frequently complimentary about the care they received from individual doctors. Patients, in general, are considerate and are aware of the strains within the health care system.

There is, perhaps, one thing worse than the level of patient care in our hospitals, namely, "after hospital" care. One group of patients most at risk is that comprised of those with psychiatric illnesses. These people frequently complete a course of in-hospital treatment and are then left to find their way, unguided and unprotected, in the outside world. The people to whom I refer are in need of special monitoring and management, long after their hospital stay is complete. They are sent home, frequently to live alone, with a list of instructions and a bag of medication but without supervision, support and nobody to offer them advice. The most vulnerable are, once again, left to fend for themselves. These patients need good community support, dedicated social workers, sheltered housing on occasion and careful reintegration back into everyday life. A well resourced backup home care team is the least that should be provided if these patients are to have any chance of attaining a reasonable quality of life.

Provision of information for patients and their families is another area which needs to be reviewed. Hospital management systems with responsibility for dealing with patient complaints have broken down, and many of my constituents regale me with details of indifferent treatment, dismissal by hospital management or, at best, a superficial public relations exercise. It is not good enough that patients should have to endure a protracted and often unsatisfactory hearing of their complaint. They invariably believe that all the cards are stacked against them and that they have little or no chance of ever being taken seriously. This syndrome applies, in particular, to the public patient.

For this and many other reasons, the time has come to review the management structures of hospital systems. The new structures that allow the Minister for Health and Children to refer almost all questions to the appropriate health board when a parliamentary question is tabled are an indicator of the layers of bureaucracy within the system. The Department of Health and Children, the Minister, the health boards, hospital management and administration systems and individual consultants play a role in defining the quality of the health service provided for a patient. As a result of this myriad of layers of controls in the system, it is time to consider an ombudsman to oversee patients' rights and ensure the most effective and efficient hospital and health care system is available to all regardless of income.

Reviewing and revising the structures of health boards is not the way forward. This is, at best, cosmetic and a new slimmed down version of each health board should be considered to ensure an effective delivery of health care, or perhaps a root and branch pruning should be given some considerable thought. Each patient should be clearly informed of his or her right to make a complaint and the process in place to have that complaint treated seriously. This suggestion is not intended to offer a facility for spurious and trivial complaints against the system. It is for this reason an ombudsman should be appointed to deal with the detail of the complaint and make the necessary arrangements to ensure justice is done for all sides. The ombudsman would be the first point of contact and alleviate pressure on the management of hospitals to allow them get on with their business, namely, management.

The current two tier system of health care we experience should be phased out and ability to pay should not be the criterion on which we try to ensure the health of citizens. On a daily basis I hear stories of deferral of appointments, waiting lists that last for months or, in some cases, years and the chaos in accident and emergency wards in major hospitals. These are only some of the reports I receive on a daily basis. The health care system needs a complete review.

Minister for Health and Children (Mr. Martin)

I move amendment No. 1:

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

"–commends the Government for the unprecedented increases in health funding which it has been implementing since 1997;

–recognises that this funding has led to significant improvements in a range of important services; and

–endorses the process which has been adopted to facilitate the development of a new health strategy."

I thank Deputy McManus and her colleagues for tabling the motion which provides a welcome opportunity to set out clearly the Government's record on health and the series of initiatives coming together in the context of the most comprehensive and inclusive strategy statement on health services prepared to date.

The House should be in no doubt that the motivation behind this debate has nothing to do with a wish to discuss facts or have a serious debate about the future of the health system. Once again, the Labour Party and Fine Gael des perately hope that a continuous stream of attacks on health will help to reverse their ever more abject failure to gain the interest, much less the support, of the public. The tactics are as clear as ever: talk everything down, deny progress and try to hawk half-thought out and uncosted proposals as the all-purpose elixir for what ails us.

The press release issued by Deputy McManus announcing the tabling of the motion is as transparent as it gets. At the head of the release it is stated that the purpose of the debate is not to promote a serious discussion but to mount what she termed a "strong political attack" on me and the Government. The scale of the motion's denunciation is impressive even by the standards of the Labour Party's daily hyperbole. Almost no area is left untouched where the House is asked to deplore our record. As such, it is difficult to know what to address in a short contribution. However, there is one simple message I can give to the Opposition: the Government has no fear of comparing records of action in health and presenting alternative visions for the future reform and development of health services.

Last week I heard various members of the Opposition say that after four years the Government has done nothing on health. This follows a bizarre claim by Deputy Noonan on the 5 April edition of "After Dark", and I quote directly because most seem to have missed it, that: "the health services were significantly better . . . four years ago when I left the Department of Health than they are now. Now you can check that out objectively with anybody". If Deputy Noonan sincerely believes this, I look forward to him producing these objective observers, although I suspect that they will be about as easy to find as the people who fund Deputy Jim Mitchell's opinion polls.

The objective evidence shows that the Government's programme of sustained expansion in health funding is making a difference. There are more doctors and nurses in our hospitals today than in 1997; more than 80,000 more treatments were carried out last year than in 1997; the largest capital investment programme in the history of the health service is under way; there are more than 3,500 more residential, day and respite care places for people with disabilities; and there are 400 more places in community nursing units for older people. These are real improvements helping real people and none of them was in place during the self-described golden days of Deputy Noonan's time in the Department of Health and Children.

Central to these improvements has been the doubling of health funding to over £5 billion this year. As has now become traditional, the Opposition has spent much time attacking the Minister for Finance, Deputy McCreevy. It tries to present him as someone who has been slashing through the health service by refusing to provide new funding. It has one great problem: the Minister has allocated increases to my Department which dramatically outstrip those allocated by Deputy Quinn when he and Deputy Noonan were making the decisions.

It would be foolish to expect any element of consistency in the Opposition's critique of Government policy. Last December we heard Deputy Noonan say that the Government was spending too much. We subsequently heard Deputy Quinn say that the Government should listen to the European Commission's opinion that we run a tighter fiscal policy. Today, however, both parties want us to believe that they will match and exceed our spending record. There were no major fiscal pressures in 1997, but choices were made and these did not include giving health the same level of priority given to it by the Minister, Deputy McCreevy. As with many other areas, the facts of health spending during his tenure in Finance show that he will be remembered much more fondly than those who preceded him and now try to reinvent themselves as champions of health spending through a spurious denunciation and misrepresentation of his record.

One can see where the extra money is going in the fact that last year there were 500 more junior doctors and 15% more dentists working in the health service than in 1997. Nursing is an area where the Opposition loves to shout "crisis" in the House. The fact is, however, that by December of last year there were 1,774 more nurses working in the health service than in 1997. Many Deputies have steadfastly refused to acknowledge the existence of these extra working nurses. They also refuse to acknowledge the major expansion in the numbers training and the high level of demand for places on nursing programmes. We have increased training places to 1,500 and I am sure the House will welcome the fact that the number of applicants for nursing registration-diploma courses is up 21% on last year. We would have less problems filling nursing posts today if Opposition Deputies had created training places when needed. To be fair to Deputy Quinn, he has acknowledged that failure of planning during the rainbow Government's term in office.

The continued implementation of the Commission on Nursing report is a key priority. Movement under the first action plan has shown what can be achieved by everybody working on a common agenda to improve the development, utilisation and rewarding of nurses. I am sure that Deputies will also be pleased to acknowledge that the increased funding which we have provided has meant that there were 625 more doctors and dentists working in the health system last December than in 1997. As part of this, there are more than 250 more consultants working in hospitals.

The motion before the House accuses me of personally failing to implement the commitments made on working times and conditions for non-consultant hospital doctors. As in so many areas, the Opposition is choosing to ignore the facts. In this case, the facts of implementation amount to a bill of £90 million this year. The training fund has been established, overtime rates have been increased, senior managers are being appointed in hospitals to roster non-consultant hospital doctors' working hours, funding for locum cover has been increased and a phased refurbishment of doctors' residences has begun. The implementation of the deal is being pushed with commitment and speed. It is a record of action which I have no problem defending to anyone.

At the same time, there has been a significant increase in the number of professionals in the paramedic grades. There were 1,631 more in December than there were in 1997. Overall since 1997 recruitment in the health sector has resulted in approximately 14,000 extra posts. For these professionals, just as for nurses, one of the biggest difficulties in filling new posts has been the lack of previous planning to create the necessary training places. In contrast to our predecessors, we have created new training places across the range of specialisms and we are also providing for future needs.

These are the just some of the facts of where our dramatic increase in health funding is going. These are the inputs, and they are being felt in the level of service provision. Last year over 90,000 more treatments were carried out in our hospitals than in 1997.

Ms McManus

Can the Minister clarify the figure for the number of treatments last year for the record? Was it 90,000 or 80,000?

Mr. Martin

It was 80,000.

At the same time as refusing to acknowledge these increases, the Labour Party has asked the House to deplore the Government's record. I think it is worth taking some time to explore and compare records and policies in relation to waiting lists.

The starting point is the obvious fact that too many people have to wait, and wait too long, for important treatments. Waiting lists are not uniquely Irish and they have not emerged recently. In spite of the major increase in hospital activity and the numbers of people receiving treatment, waiting lists are still there and they remain an issue which must be tackled. Our increased population, and in particular the increased number of people in groups likely to require hospital treatment, has been a key driver in the continued existence of waiting lists but there has also been a lack of bed capacity and a difficulty in catching up with previous under-investment.

Our policy has been very clear. We have shown a consistent commitment to improving the situation in relation to public waiting lists. The figures show that the waiting list at the end of last December was 2,596 lower than it was in June 1997. Of course the proper comparison should be with the figure at the end of 1997, because this more accurately reflects the results of the Quinn/Noonan health settlement of January 1997. This comparison shows that the lists are down by 4,349.

I have heard Deputies McManus and Mitchell come up with ever more ingenious ways of trying to pretend that the lists are worse today than they were when we took office, but no matter what way they try to twist the figures, they cannot get away from the fact that they are down. As in so many areas, when one compares this with their own record the results are striking. The Opposition are now presenting themselves as the champions of the public hospital patient, but they were nowhere to be seen during Deputy Noonan's golden era when public waiting lists actually increased by an unprecedented 6,600, or 27%. This figure does not even include the further rises at the end of 1997 which came as a result of their budget of January of that year.

People will forgive the Deputies opposite for trying to forget the night of 22 January 1997, because that date marks an event which destroys any credibility which they, and particularly Deputies Quinn and Noonan, claim on this issue. It was on that night that they went through the lobbies in this House to vote through a budget which actually cut by 20% the funding dedicated to reducing public waiting lists. On at least three occasions I have directly called upon Opposition Members to explain their vote and why we should believe that they can be trusted to cut waiting lists if their record simply shows them cutting the waiting list funding. Unsurprisingly they have refused to reply. Tonight and tomorrow night there will be enough time available for them to end their silence and explain that damaging decision.

The Government is well aware that the hospital system in general is experiencing increased pressure on elective beds because of the growing number of admissions through accident and emergency departments. Available data indicate that about two-thirds of all admissions now come through the accident and emergency departments in major hospitals.

Against this background, I initiated a national review of bed capacity in both the acute and non-acute sectors on foot of the commitment by Government in the Programme for Prosperity and Fairness. The review is being conducted by my Department in conjunction with the Department of Finance and in consultation with the social partners. It involves the development of a long-term investment strategy for the acute and non-acute sectors and includes a detailed assessment of future bed requirements in response to increasing demand and changing demographics.

In order to meet some of the immediate service difficulties facing the hospital sector, a £32 million investment package was provided aimed at alleviating service pressures and maintaining services to patients in the acute hospital sector, particularly over the winter period. The investment package has been targeted at a number of key service areas, including the recruitment of an additional 29 accident and emergency consultants and 15 consultant anaesthetists. To date, 19 accident and emergency consultants and 12 consultant anaesthetists have been appointed, or have been offered or are being offered, temporary contracts on foot of the decision to recruit additional consultants. It should be noted that it typically takes over 12 months to recruit a consultant on a permanent basis.

Deputy McManus could have been more supportive of that initiative, particularly in the light of Deputy Stagg's comments this evening and his perspective on who decides how many consultants go into the system. The Government took a decision on accident and emergency consultants and we are implementing that decision to the letter.

The national bed review is at an advanced stage and will be completed shortly. I will be bringing the findings of the study to Government with a view to agreeing an investment strategy for the development of the acute hospital sector. Under the National Development Plan 2000-2006, the Government is already committed to investing £1 billion for the development of acute hospital services including new facilities, re-equipping and additional capacity.

The recruitment of additional consultants is designed to reduce any unnecessary delays experienced by patients attending accident and emergency departments and to ensure that patients have improved access to a prompt senior clinical decision making service. Funding has also been provided for the contracting of additional private nursing home places by the Eastern Regional Health Authority and the health boards. Over 700 additional places were contracted under the initiative for patients who had completed the acute phase of treatment and who required continuing care in an alternative setting. I am satisfied that the initiative has been of significant benefit in freeing up acute hospital beds for patients requiring admission during the winter period.

Finally, Comhairle na nOspidéal has commenced a review of the structure, operation and staffing of accident and emergency services and departments with the aim of improving the provision and quality of patient care. The review will take into account the report of the medical manpower forum, policies of the Irish Accident and Emergency Association and the Institute of Orthopaedic Surgeons, international best practice, the views of health authorities, management and medical practitioners and other relevant matters. The finding of this review will inform future policy decisions in relation to the provision of accident and emergency services.

There are significant developments initiated by the Government which will have short, medium and long-term benefits. As the motion recognises, there is much more to our health services than hospital care, indeed one of the key challenges is to develop other elements of the system to a stage where some of the pressure on hospitals can be relieved. That is why we have accompanied the investments I have already mentioned with an unprecedented expansion in other services.

For older people, a series of service improvements have been implemented. Over 400 additional beds have been provided in ten new community nursing units and over 1,000 day places per week have been created in new day care centres. Improvements have been and are being implemented in the home help service, in carers' support and a range of other community support structures. The Quinn/Noonan budget of 1997 gave £3 million to develop these services. This year's budget has built on past expansions and provided £33 million. These figures do not include the extension of medical card cover or the series of unprecedented increases in pensions provided through the budget of the Department of Social, Community and Family Affairs.

The Government's commitment to a philosophy of caring for older people is proven by the considerable injection of funding into the very services which are at the heart of care in the community – expansion of the home help services, specific assistance to carers, additional community support services such as public health nurses, care assistants, physiotherapists, occupational therapists and dieticians together 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, an additional £28.5 million in 2000 while in 2001 an additional £33 million is being provided. These figures do not include additional funding for the nursing home subvention scheme or additional funding to expand medical card eligibility to the over 70s. The additional funding of £5.11 million since 1999 has resulted in approximately 880 posts to help cope with the growing level of dependency in extended care facilities. A sum of £34 million has been provided for the improvement and enhancement of existing services, for example, additional funding provided to community nursing units, day care centres, community services and for innovative approaches to the delivery of services for older people at a local level.

Disability is another area where action has been prioritised and where results are already being seen. The historic under provision of essential services for people with disabilities has caused a major backlog of unmet needs and inappropriate placing. When we came to office we replaced a Government which talked a great deal about these services but had done nothing about putting in place a strategic plan to tackle the backlog. Our investment programme has already delivered 1,250 more residential places, 360 more respite places and 2,100 more day places for people with disabilities. For people with intellectual disabilities we are delivering on our promise to end the waiting list for service. The creation of new services and the erection of new buildings takes time but the results are there to be seen. As regards the historic level of funding that has been allocated to this sector, we should acknowledge the efforts of my predecessor, Deputy Cowen, and the Minister for Finance, Deputy McCreevy.

The part of the Labour motion which fights off stiff competition to win the prize for gross distortion of the facts relates to our record on transferring people with intellectual disabilities who are inappropriately placed in psychiatric hospitals. An objective assessment of the programme already being implemented shows how we are making major progress towards ending this situation. I will cite the example of the situation in the Mid-Western Health Board. Some 85 persons in the board's area have been determined as being inappropriately placed. Of these, 36 persons will, over the next few weeks, begin to move from St. Joseph's Hospital, Limerick, to new facilities in Lisnagry. A further 25 will be accommodated in a new unit which has been built in Our Lady's Hospital, Ennis. In relation to the remaining 24 persons, planning is already under way to provide new facilities for them.

If the Opposition was motivated by a wish to genuinely discuss developments in our health services it might have the good grace to recognise this progress. Unfortunately, the Government inherited a situation where there was no planning, no commitment and no resources to achieve this important objective. The motion also refers to child care policy to which the Minister of State, Deputy Hanafin, will respond in tomorrow's debate.

We have discussed the dangers of tobacco use many times in the House and will do so again shortly when the Public Health and Tobacco Bill is published. Last year, we ended all newspaper and magazine advertising and sponsorship of tobacco. We will go further in controlling and minimising the impact of tobacco when the new Bill is published. We will also work with Commissioner Byrne at EU level on whatever measures may be required to ensure that the Union can take co-ordinated and effective action.

Our record to date not only shows that we have been willing to invest unprecedented resources in our health services but that we have been working on a programme of credible and lasting reforms which are providing the essential foundation for a most comprehensive and ambitious health strategy for the coming years.

The House will be aware that the 1994 health strategy which had many strengths, has been faulted for a series of fatal flaws. It was drawn up quickly, few people were involved in the development of the policies it addressed and, most fundamentally, it did not set out a real agenda for investment and development of the health system. The objective of achieving greater equity was mentioned but a plan was not outlined to achieve it. It was during the period of this strategy that the 1997 cutback in waiting list funding was implemented.

The starting point for the development of the new strategy has been a series of crucial reports which examine in great detail fundamental issues relating to the future of our health system. The Medical Manpower Forum report and the report on junior hospital doctors' working practices have shown the way forward to a radical improvement in the level and quality of hospital care. The Commission on Nursing has shown us what we must do to attract, train, utilise and retain nurses of the highest calibre.

A detailed study showing us how to work to significantly improve the effectiveness and accessibility of the full range of primary care services is under way. A value-for-money audit is for the first time detailing exactly how resources are deployed and utilised within the system. Vitally, a detailed strategic assessment of the bed capacity of our hospitals is being finalised.

To these studies we are adding the largest public consultation ever carried out in the health sector. More than 2,000 submissions have been received from the general public and, in addition, a national consultative forum has been established, representing a large cross section of stakeholders. At the same time, detailed work is being carried out on how to bring diverse needs together into a coherent overall strategy. In order to give an outside perspective, we are also bringing together a group of independent international experts to evaluate the strategy as it develops.

The Opposition has spent a great deal of time over the past week attacking us for not producing it now or for not having produced it earlier. The Opposition also seems to believe the Cabinet should not get involved in discussing matters before they are brought to it for a formal decision. The lessons of the Opposition's various health policy documents demonstrate clearly that our approach is the more credible and effective one.

Fine Gael has managed the extraordinary feat of facing both ways at once in its policy. It has both embraced a move to a universal insurance model and kept its distance from it. Fine Gael has dramatically under costed its proposals and often seems to be making it up as it goes along.

Mr. Ring

We could add to that.

Mr. Martin

The Labour Party has at least been consistent in pretending that it has the all-purpose answer to solving all of the ills of the system. Deputy McManus has spent countless hours claiming that the party has a comprehensive and worked-out plan. The problem is, however, that a full year after it was launched, she has failed to address any of the fundamental weaknesses in, or implications of, the policy. The policy states that hospitals will only get funding through negotiated contracts but Deputy McManus also claims that no hospital will lose out. Having promised that detailed costings and a legislative framework would be produced, we are still waiting. She has retreated behind an ingenious defence that an Opposition party cannot be expected to fully work out its proposals. Well, I am sorry, but if she claims to have the answer to all that ails us, details are required. It is not enough to point to her party's already outdated budget document and say that there will be enough health funding to go around so we do not need to be bothered with the details.

Even a cursory examination of the Labour Party's policy shows a series of basic flaws. Generally speaking, insurance-based funding systems, whether social or private, significantly increase the percentage of funding which goes in administration costs. Similarly, an essential element of an insurance-based system is to have spare capacity so that there can be a meaningful negotiation of contracts. In that we have an under-supply of beds and it will take some time to build new facilities, from where will come the competition for contracts, which the Labour Party talks about?

The Labour Party also talks about integrating primary and secondary care. How can this be done, however, if one system is based on ensuring community access and the other is based on competition for contracts? The Labour Party proposal would fundamentally undermine any real integration of primary and secondary care. The Labour Party might also like to explain who will plan new hospital facilities if all contracts are to be negotiated with a private insurer.

Much of the party's discussion document is based on trying to suggest that there is an easy, off-the-shelf answer to everything. Deputy Quinn frequently talks about his sister party in Britain. He might perhaps look at its recent NHS reform document which pointed to the many failings of private and social insurance funding models and said that systems funded like ours are the least regressive. The bottom line about the orgy of self-congratulation which we have heard from the Labour Party, is that its plan is like the story of the emperor's new clothes – it is naked when it comes to costings, credibility and the capacity to deliver real improvements.

Our record is clear – more funding, more doctors, more nurses, more treatments being carried out, more community care, more disability care places and the largest capital investment programme in the history of the health service. The difference between us and the Opposition is that we have not ever pretended that our work is done. We have always said that further dramatic improvements are required in health services. Progress so far is making a real difference to the lives of thousands of people throughout this country but there is much more which can and must be done.

Members of the Opposition have spent a great deal of time thinking up new and creative ways of attacking the Government. They have whipped themselves up into a frenzy over the idea that the Government would discuss policies before being presented with decisions. As we have seen con firmed many times, this sterile posturing does not impress anyone, least of all the electorate.

Mr. Neville

Not even Deputy Brian Lenihan, at the moment.

Mr. Martin

Next year we will face into a contest where health will almost certainly be one of the central issues but we will face it with confidence. We will have shown an unequalled commitment to delivering the resources required to develop health services and we will have in place a framework for delivering the quality and level of health services which all our citizens have a right to expect.

Acting Chairman (Mr. Kirk)

Deputy Lenihan has about three and a half minutes.

Mr. Martin

On a point of order, I started at 7.45 p.m. so he must have five minutes, at least.

Mr. B. Lenihan

I am quite content to use my three minutes. I thank the Labour Party for introducing this motion and for the opportunity to discuss our health services. We on the Government side of the House are certainly very concerned about the health service. We are concerned about the historic under funding of the service, which goes back to the 1980s and for which all the political parties that were in Government during that period must bear responsibility. There was an historic cutback in the level of provision of health services. The first real attempt to undo this has been undertaken by the Government since the 1997 general election. There has been a significant increase in expenditure on the health service. There are many problems, which were outlined by Opposition speakers, including Deputy McManus who opened with a catalogue of them, but, overshadowing the debate, the Labour Party invoked the ghost of the late Deputy Noel Browne and said his plans for improvements in the health service were destroyed by unspecified dark, sinister forces of reaction. It may shock these Members to learn their party was among those which formed the forces of reaction which brought down the late Deputy Noel Browne and that he had to turn to this side of the House to implement what little part of his policy remained.

The Minister demonstrated in his contribution a great deal of knowledge about the problems and how they should be addressed. Let there be no doubt that we, on this side of the House, require an inclusive health service which will provide the best medical care for all our citizens. I agree equal access to health care is a basic right of the citizen and there should be equality in health provision but that cannot be done by prohibiting private medicine. Such thinking might have been possible 20 or 30 years ago when we had ghosts further east to look at but it cannot be implemented today. However, a basic level of service should and ought to be guaranteed to all citizens. How that is done is another question.

The speakers from the Labour Party were long on rhetoric but did not go into the specifics of their own interesting health policy. It proposes universal insurance for all patients but there would be difficulties with this. The first and obvious one would be the great administration costs and expenses associated with it. However, there would be a greater difficulty where the policy states public and voluntary hospitals would be required to cover their operating costs through income from health insurers and patient co-payments where applicable. In other words, where a small hospital was unable to win a service contract from an insurer it might be forced to restrict services or close. We witnessed screaming from Deputy Penrose who referred to the minds of the population of counties Longford and Westmeath being exercised and seething with rage. When the new compulsory health insurers begin to close essential services and entire hospitals in the BMW region we will see many seething with rage in the House. That would be a concomitant of the policy proposed by Deputy McManus.

I accept, as an urban Member, there may be a case for rationalisation in the provision of provincial hospital services but an insurance company operating at one remove from those elected to run the State and those responsible for the local administration of the service should not undertake such rationalisation. These questions arise on the Labour Party policy but at least it has put forward a policy. The principal Opposition party seems totally confused. It is not a year since Deputy Shatter stated: "Whether the necessary reform can be brought about by the introduction of a universal health insurance system is in question. What is needed is less, not more bureaucracy".

Mr. Neville

I welcome the opportunity to contribute to the debate and congratulate the Labour Party for tabling the motion. The Minister referred to the grandiose policies he has introduced and the moneys he has spent but I would like to come back down to earth and outline what is happening on the ground. Hospital overcrowding is now so severe, the Irish Nurses Organisation conference was told, that a man on a life support machine had to be taken from his bed and placed on a chair overnight to make way for a more critical patient. That is the service being provided. Letterkenny General Hospital recently had to put an emergency plan, similar to that which would apply in the case of an airplane crash, into operation to find room for seriously ill patients, the conference was also informed.

Hospitals frequently must resort to ambulance trolleys to allow patients lie down. Patients have had to be housed in the coffee dock in Letterkenny General Hospital overnight. Patients were recently put in a confined room in a hospital normally used for plastering broken limbs. Some patients can spend three days on trolleys and never see beyond the door of the casualty depart ment while others develop further illnesses as a result of having to stay in casualty departments. The Minister stands indicted for supervising such a service given that it is his responsibility.

A survey carried out by the INO found that Naas General Hospital treats an additional 25% of its total bed capacity in its accident and emergency department and there is a lack of consistency in following admissions policies and bed management strategies aimed at alleviating the problem. Accident and emergency staff prioritising patient admissions tend to allow elderly and vulnerable people to be first in the queue. The survey also revealed how patients who arrive by ambulance are regularly left with no trolley on which to lie. One Waterford bed manager said she was the most hated person in the hospital. She also said: "I am expected to pull beds out of thin air like rabbits out of a hat. I am a nurse, not a magician".

Deputy Ring regularly raises the issue of the orthodontic service, in which he has a great interest. I received a letter yesterday regarding a constituent from a consultant orthodontist. I had asked him when the constituent was likely to receive treatment. He replied: "There is some confusion at national level which is hindering the delivery of orthodontic services. For this reason it is difficult to predict when we will able to see" the person concerned. Why would a consultant orthodontist give me such information? What is happening to create confusion at national level such that the consultant orthodontist of the Mid-Western Health Board cannot even inform me when it is likely the person concerned will receive treatment? This is an important, necessary treatment for patients.

I received a letter from a local general practitioner who had received a reply regarding a patient from a consultant urologist who had received a referral request from him for an outpatient appointment. The urologist stated: "Unfortunately due to the volume of referral requests and current service limitations the waiting time for this appointment is approximately two years". The GP has replied to the consultant and copied the letter to me. He stated: "The two year delay is absolutely unacceptable to the patient and to me". I ask the Minister to respond to those two issues.

Mr. Ring

I recall when Fianna Fáil was on this side of the House in 1996 Deputies Cowen and Martin and many other members of the party lectured the then Government on problems in the health service and told us what they would do when in office. Fianna Fáil has been in government for 12 of the last 14 years. The previous Government was in office for two and a half years. Fianna Fáil preached to the public about what it would do in regard to the health service because it had received such a scalding in the election prior to that when the famous Charlie Haughey did not know what was happening and did not realise the health service was collapsing.

I heard the Minister say today that under this Government the waiting list had been reduced by 25%, from 32,000 to 28,000. I will tell the Minister the reasons those figures are down to 28,000. First, many families had to raise loans to pay consultants to treat their people privately and to pay for operations. Second, many health boards sent out letters to people who had already died calling them into hospital for operations. My colleague, Deputy McCormack, knows of such a case and I know of one in my own health board area. They are the reasons the waiting list figures are down. That is why the Government and its PR people are lecturing us about the waiting lists.

I listen to people in my clinics complaining about the health service on a daily basis. Last week I was in Belmullet and I heard from a woman whose 13 year old son is waiting to be called to St. Luke's Hospital. I do not want to get annoyed with Deputy Lenihan because if I do, I might say something I will regret. It is fine for Deputy Lenihan to talk about health services in Dublin but people in the west have to come to Dublin by train and sometimes they do not know if the train will even run. They come up to St. Luke's Hospital but they do not know how they will be treated.

I recently had to ring Beaumont Hospital to try to get a woman admitted. She had been crying in my clinic with back pain which she had suffered for the past 12 months. I rang the person who dealt with administration in the hospital but he did not have much sympathy for this woman and he certainly was not a Fine Gael man. I suppose he was a hack who had been put into that position to deal with the general public but he treated me with disdain and disrespect. He lectured me about the health service and criticised the Minister as not providing enough money and staff and for putting pressure on the health services. I can tell the Minister, however, that we will not take lectures from him or from hospital consultants. If people are sick, they should be entitled to get the same service as the people who have private health insurance, whether it is VHI or whatever.

I spoke to somebody in my constituency yesterday who heard me giving out on the radio last week about people on medical cards waiting to be called for operations. This person was paying VHI but was also waiting to be called into hospital. Even people who are paying for their own private health insurance cannot get called for the operations they need.

The Minister sent out a signal last week through his PR people, who are the very best, but the taxpayer—

Mr. Martin

I do not have any.

Mr. Ring

The Minister should not make me name them because they are all colleagues up there on the back benches. The taxpayers are paying for the PR people. Last week, a signal was being sent out that the Minister would deal with the health services before the election. The impression was given that everything would be fine but the Minister's colleagues in Government disagreed. There is a programme on television called "The Weakest Link". On it the contestants are asked questions and at the end of each round, they are asked to decide who is the weakest link. The Minister is the weakest link in this Government. The Minister for Finance, Deputy McCreevy, told the Minister that he was the weakest link, that he was out and that the programme was over. The Minister, along with his colleagues in the Department, are the three weakest links because we have problems in every sector of the health services. People cannot get called for orthodontic treatment. There are 32,000 people on the waiting list. Deputy McManus talked about 12,000 in the Eastern Health Board area but the total is 32,000 nationally waiting to be called for orthodontic services.

I put down a question to the Minister about cataract operations and the answer was that 2,500 people were waiting to be called. We are talking about a 20 minute operation to address a problem that affects the old. A woman came into my constituency clinic a number of months ago who was waiting to be called for treatment. She had a problem with one eye and the other eye was beginning to cause her concern. She begged me to tell her when she would be called for treatment but I could not give her an answer.

The Minister has to take on the health boards, the programme managers and the PR people. I put down a Dáil question to the Minister recently. It took about six months to get a multi-page reply. I wanted to know the number of people employed by the health boards on a year to year basis over the past three years. There were reams of them – programme managers, assistant programme managers, press officers, assistant press officers, etc.

The Minister has lost control of the chief executives and the power must be returned to the Dáil and to the Minister. We should start at the beginning by getting rid of the chief executives and the health boards. We should try to give the people back the services they deserve because they are paying enough taxes for them. People do not mind paying taxes but they want to be treated when they are sick. They want their families to be treated when they are sick and they do not want to have to beg politicians or doctors to bring them into hospital to be treated.

The Minister talked powerful language when he was on this side of the House. Fianna Fáil has been in Government 16 out of 18 years, and Deputy Moffatt is a great man for telling me what Fianna Fáil has done.

Dr. Moffatt

We are delighted in Mayo.

Mr. Ring

The people are waiting in the long grasses for the Minister and the Ministers of State and if they are ready to go, we are ready for them. I know where they will be sitting this time next year or next month, if they want to take up the challenge. They will be on this side of the House.

Mr. D. Carey

I support the Labour Party motion because of the state of the hospital services in my constituency. The Minister spent some time in the constituency last week and I was interested to find out who accompanied him. I was told that local Deputies were available for the Minister's sneak preview of St. Joseph's Hospital and the county hospital, and to outline the various problems that existed in the area. I understand the health board sought ten additional nurses for St. Joseph's Hospital. I am told the hospital got sanction in January but the nurses still have not been appointed. If the Minister is boasting that there is a surplus of nurses and they will be trained, I do not understand why this problem has not been resolved.

If the Minister goes to any hospital, and regardless of how nice he is to them, he will see that there is a real staff morale problem. There is a staff morale problem in the County Hospital in Ennis and that almost led to a tragedy for a next door neighbour of mine who began to suffer from a complaint and went into hospital on Wednesday night. Because she was not getting satisfactory treatment in the County Hospital in Ennis, she had to go into the Regional Hospital in Limerick on Sunday. When the consultant in the Regional Hospital saw her, she was operated on as an emergency. That speaks ill of the County Hospital in Ennis and its services.

The major problem with the hospital in Ennis is that nobody has full confidence in the service. I do not know what will restore that confidence. There is a Fianna Fáil councillor on the radio morning, noon and night taking pot shots at the health board and the Minister. I do not hear his party disagreeing with him but as far as I am concerned, he seems to have the inside track. I prefer to use the system as it currently stands. Perhaps there should be a watchdog in the Department of Health and Children monitoring the way these hospitals operate.

The major issue in County Clare is that we do not have a large hospital. There is a large hospital in Galway, Kerry and Limerick yet the 90,000 or 100,000 people in Clare do not have a proper system. All the inquiries, reviews, strategy meetings and consultations the Minister and his predecessors have had did not work. Dissatisfaction with Ennis General Hospital and with the ser vices is growing and if that hospital is closed, the people will have to go to Limerick and as the Minister knows, the accident and emergency service in Limerick is over-run with problems. We hear about those problems every day of the week.

Debate adjourned.