On 6 May 2002, the Taoiseach promised the people that he would end hospital waiting lists within two years. There are now 184 days remaining for him to make good his promise but, of course, he will not do so. It was never anything other than an outlandish commitment made in bad faith and deliberately perpetrated on the people in the middle of an election.
The extent of that deception is revealed in today's published figures which show that 28,130 patients are still waiting for hospital treatment. These patients have already been forced to wait to see a specialist and they are denied necessary treatment. The only evident change is a slight reduction of a paltry 2% over the figures of the last quarter. By the end of 2002, according to the health strategy, the Government promised that no adult would wait over 12 months for treatment. We are coming to the end of 2003 and 4,252 adults are still waiting over 12 months. The stark reality is that at the rate the Government is delivering, we will have to wait 30 years to abolish hospital waiting lists.
It is worth remembering that the Minister for Health and Children colluded in what was a callous deception, and that deception continues in the health services. The truth is that this and the last Fianna Fáil-Progressive Democrats coalition have failed abjectly to provide a high quality health service despite unprecedented resources. That is why the Labour Party is proposing this motion. Ours is a challenge to the wasteful, wanton squandering of time and resources which could and should have gone into making patients better instead of making them wait. It is a challenge to the Minister for Health and Children to state clearly how he intends to fund the thousands of beds and hundreds of hospital consultants necessary to improve the health service and make it accessible to patients who are sick and in pain.
Rather than making a difference, the Government has made itself busy with reports and working groups and with consultation and commissions. Management consultants have grown fat while the health service and those working in the front line struggle to overcome Government cutbacks that undermine their patients' care.
Over 140 reports and commissions have been established since Fianna Fáil and the Progressive Democrats took office six years ago. The publication rate of these reports is matched only by their attrition rate. In 2002 the health strategy was launched with great fanfare before the general election but even before its publication, the Minister for Finance informed the Minister for Health and Children, Deputy Martin, that no money would be made available for its initiatives. The strategy was launched anyway as it was election year and again the people were made promises the Government knew it would not keep – 200,000 new medical cards, 3,000 new beds, shorter hospital waiting times and new legislation. Each one of these promises has since died a death.
The primary care report was published soon after, but it has been strangulated because of a lack of funding. Recently, the Prospectus and Brennan reports were published and these have been beaten into unconsciousness under the weight of a myriad of committees that are stuffed with health board and Department officials who cannot even decide among themselves who is to chair the meetings.
When it comes to health the Government has displayed an ongoing and long-standing pathological aversion to the truth. The reality with which the public is all too familiar is that Government cutbacks mean fewer home help services and the closure of hundreds of hospital beds. It also means crucial medical equipment cannot be replaced – for example, the cardiac equipment in St. Vincent's Hospital which is so defective that it has failed at least 28 times this year – and hospital waiting lists are as high as ever.
Today, we read in the newspapers that Our Lady's Hospital for Sick Children was promised an MRI scanner after years of prevarication, yet it is still waiting. In this case, the truth is that even desperately sick children are being betrayed by unfulfilled ministerial promises.
As public cynicism grows, the Government is trumpeting the latest report, the Hanly report. It offers the promise of a high quality health service with consultant provided care, better training for junior hospital doctors and an end to their ridiculously high working levels resulting from the extension of the EU directive. However, this directive is like a train coming straight at the health care system, according to the president of the Irish Medical Organisation, and he is right. The Hanly report contains major implications that cannot be shredded or binned in the same way as other reports.
The Labour Party and others have argued for a consultant provided service, significantly more hospital consultants, streamlined medical training and resourcing general practice, but they are under no illusions. That the Government is now in agreement with us means little. Unless the Government is committed to investing funds wisely and well, change will come, because it must, but it will be paid for in reduced patient services and greater limits on access rather than in an improved service. Frankly, the prognosis is not good. The Government has promised change but made no commitment on funding, timing and implementation. That is why we tabled this motion.
It is important to note that like all the other reports the Government has published there is the token nod in this one in the direction of equality. We have a two-tier health service unique in Europe in that it discriminates against public patients who end up on waiting lists while private patients are fast-tracked to treatment. Equality is central to real reform. Creating a new basis of equality would bring about a more effective and efficient health service in itself. The Hanly report states that it is important to ensure that all patients, whether public or private, have equal access to services based on clinical need. The report does not mention how this aim might be achieved. As in all other Government reports, lip service is paid to the principle of equality but no action is taken and nothing real is ever done. It too is a form of deception, this kind of tokenism that refers to the great scandal of apartheid in our health service and then proceeds to ignore it.
Hanly has made clear that his report was formulated without political, funding or industrial relations considerations. The rest of us live in a world where these considerations are only too real and we know from bitter experience that Government promises are made to be broken. A weakness in the report is the lack of costings. No cost is given for infrastructural development and there is no mention of costs arising from industrial relations negotiations or from the great investment required in general practice. The only figure relates to increasing hospital consultant numbers. The Minister should spell out the total estimated costs for the implementation of the Hanly report in full. He should also inform us from where the money is to come because it is clear the Minister for Finance is yet again refusing to support his colleague's ambition.
The silence of the Minister for Finance, Deputy McCreevy, is notable. It is likely that the Department of Health and Children will only receive €500 million extra funding for next year. The Revised Estimate for 2003 was €7.9 billion. The additional amount would constitute a 6.3% increase. The Secretary General of the Department is on record as saying that it would take €900 million to maintain the current level of service. Taking into account medical inflation and the cost of benchmarking, there is only one conclusion to be reached, namely, that services will be cut next year and not extended.
The most likely outcome from the Hanly report is that the cost cutting elements of it will be implemented and the parts that cost money – the positive agenda – will be ditched. That is the fear people have and it is justified because the funding simply does not add up. What Hanly is proposing is change of seismic proportions. This requires good management and, in particular, skills in change management, but these are not the characteristics that define the Department of Health and Children. The sorry experience of the Brennan report should be a warning to us all.
The Brennan report was published in July of this year. The Minister, the Taoiseach and the Tánaiste promised that its implementation would be swift; that it would include the abolition of health boards and bring about major efficiency in the health service; and that the implementation body would be set up in mid-October, as would the shadow HSE. Instead the process is bogged down in a total of 14 committees and there is still no independent person appointed to drive the reform for which Brennan argued so trenchantly. Health boards meanwhile are merrily adding numbers to their staffing complement, even though they are supposed to be cutting back. Since the July date when the Minister for Health and Children announced their abolition, health boards in the ERHA area alone have recruited 232 new temporary staff and ten new permanent staff. Is it any wonder that Niamh Brennan is scathing in her criticism?
I ask the Minister for Health to state how he intends to meet the deadline of August 2004, as defined in the EU directive. According to a rough estimate almost 1,000 new non-consultant hospital doctors would be required by that date to comply with the EU directive. Since Hanly rightly rejects that solution, we need to hear from the Minister how many new consultants will be in place on that date. The loss of 75,000 medical working hours cannot simply be made up by new rostering arrangements and cross-cover.
We need to hear from him too the planned timetable for industrial relations negotiations in relation to both NCHDs' and the consultants' contracts. Already difficulties have arisen because the employers have not resolved the ongoing disagreement over rosters still in place in some hospitals. This is causing problems in setting up new negotiations.
It is incredible that the Department of Health and Children refused to begin negotiations before now, considering the tight deadline which confronts it. I understand that in March of this year the IMO wrote to the Department to seek a meeting and was told that nothing would happen until Hanly was published, yet the Hanly report makes very clear that it would not deal with industrial relations issues at any stage.
The Hanly report, it can be argued, presents a producer-driven, centralised model that ends up suiting consultants rather than patients. One major hospital to serve a population of 350,000 people may make sense in terms of multi-disciplinary teams and providing a range of specialties but there is a sacrifice involved and a cost that has not been counted. The sacrifice is that made by patients who will no longer be able to access accident and emergency services and acute services to which currently they have access. There will in all likelihood be no accident and emergency department between St. Vincent's Hospital in Dublin and Waterford in the ECHB region, for example. According to this proposal every emergency case will be funnelled into the major hospitals. All acute beds will be taken out of the local hospitals but there is not even the reassurance of a commitment to provide additional acute beds in the major hospital.
In the East Coast Health Board region, which is one of the pilot areas, there are hundreds of acute beds in three locations. After Hanly there will be no accident and emergency department or any acute beds in St. Colmcille's or St. Michael's hospitals. The same will be true of Nenagh and Ennis hospitals.
This will create major problems for my constituents in County Wicklow. The distance to St. Colmcille's is already significant for someone living in Shillelagh or Tinahely. I heard Dr. Peter Kelly state that it takes only seven minutes to travel on to St. Vincent's hospital from St. Colmcille's in Loughlinstown. His comment would be met with hilarity and disbelief in Wicklow. Anyone who travels the gridlock that is the N11 would know better. There is a suspicion already that this report is about concentration of services to suit consultants rather than to serve patients, and comments like that only fuel that suspicion.
At present an acute cardiac surgical or medical case can access treatment in these smaller hospitals and thousands of people do, particularly older acute patients for whom a local service is invaluable. This service is to be lost but we have yet to hear of a commitment to enlarge the capacity in the major hospitals. Already the big hospitals are overstretched and unable to cope with demand without going over their budgets
Again let us look at the Government record on delivery. The Minister for Health and Children promised 709 new acute beds. Only 568 beds have been provided by 2002 and some of them have meant taking older beds out of the system. However, there was in that same year a daily average of 269 beds closed. According to the Minister's own figures 23,413 bed days were lost for the first quarter of this year alone because of bed closures. How is the Minister to give any guarantee of keeping these acute beds open let alone providing the significant increase in new acute beds that Hanly would require?
I would also like the Minister for Health and Children to explain why he accepts the argument in this report that bigger is better, without hard scientific proof. Is he aware, for example, of recent research carried out by health economists in the University of York that proves otherwise? In Britain similar hospital rationalisation has been taking place as is proposed now in Hanly, but there is a danger that yet again Ireland is adopting a system just when it is coming under question in other countries.
The empirical literature shows that the optimal size for acute hospitals is relatively small and ranges from 200 to 400 beds. Above that figure average costs increase. Hanly is ambitious on this point and recommends the end of single specialty hospitals and the combining of these with acute hospitals on single sites. The National Maternity Hospital in Holles Street, for example, would go to the St. Vincent's complex, yet we know there are additional costs when managing a larger organisation. The only clear way to reduce costs is to reduce capacity in merged hospitals but that is hardly what Hanly has in mind.
Hanly argues that patient outcomes will be better in major hospitals and that is generally accepted to be the case. Again the York study challenges this presumption. The study states:
There is no reason to believe that further concentration in the provision of hospitals will lead to any automatic gains in efficiency or patient outcomes. Maybe the research base is inadequate, but the onus is on those who advo cate the benefits of concentration to prove their case.
In withdrawing local services and downgrading local hospitals the least the Minister can do is prove the case for greater efficiency and outcome. He has not done so. Instead the public is being told that because junior hospital doctors will no longer be exploited the entire hospital service is to be reconfigured. No one doubts that change is inevitable but serious doubts are being expressed about the Government's judgment, its inability to manage change and its failure to target funding effectively. It is the patient who will pay the price of Government incompetence.
We have had report after report after report. We are committeed out. After all the effort the picture is even more confused. There is no one road map forward for the health service. We have a number of maps and they need to be brought together. If the Minister for Health and Children intends to implement reforms he needs to create an overall template from all the different reports.
He must be able to guarantee ring-fenced funding for his reforms and agree a timetable for implementation. On the basis of his record there is little public confidence that this Government is capable of meeting the challenge. Indeed today's published hospital waiting lists confirm that the Government has totally failed in its much vaunted claim to create the world class health service.
The Hanly report was in its own terms formulated without any political, financial or industrial relations considerations. It described an ideal world in ideal conditions. The truth about our health service is the indignity of an elderly patient lying on a trolley for hours and even days in an accident and emergency department; the torment of waiting in pain for months and even years for treatment that a private patient can access in days or weeks; and an incompetent Government that was presented with a growing healthy economy and squandered a golden opportunity.
