Private Members’ Business.

Hospital Waiting Lists: Motion (Resumed).

The following motion was moved by Deputy McManus on Tuesday, 4 May 2004:
That Dáil Éireann:
—notes that this week marks the deadline for the ending of hospital waiting lists following the commitment given by the Taoiseach, the Minister for Finance and the Minister for Health and Children on 6 May 2002 that, if returned to office, they would "permanently end waiting lists in our hospitals within two years through a combination of bed capacity, primary care, secondary care and targeted reform initiatives";
—deplores the failure of the Government to honour the commitment made and the cynicism displayed in making a promise that they clearly had no intention of honouring;
—condemns the continuing unacceptable waiting lists which at September 2003, the latest date for which figures are available, showed more than 27,000 people waiting for treatment, with more than 9,000 waiting for more than a year;
—calls for the immediate introduction of targeted initiatives to ensure a prompt reduction in the numbers and end the suffering and distress of so many people awaiting treatment, including:
—opening all hospital beds currently closed or under threat of closure;
—ensuring a full nursing complement in acute hospitals with waiting lists;
—tackling the crisis in accident and emergency departments;
—taking measures to relieve "bed blocking";
—providing additional new hospital beds and commissioning new units awaiting opening; and
—enhancing community care.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"commends the Government's commitment and concentrated effort to reducing waiting times for public patients and:
—notes that some €250 million was being provided to reduce waiting times for patients between 1998 and 2003;
—acknowledges the extensive additional resources which have been provided for acute hospital services since 1997 and notes that over one million patients were treated in acute hospitals in 2003;
—notes the reduction in waiting times and welcomes the substantial progress which has been made in meeting the targets set out in the health strategy, Quality and Fairness — A Health System for You;
—commends the targeted approach being adopted in relation to the long waiters to the extent that 80% of patients now wait less than one year for surgical treatment;
—acknowledges the reduction in cardiac surgery waiting lists where adult waiting lists have fallen by 90% and children's waiting lists have fallen by over 90%;
—welcomes the initiatives taken to reduce the number of inappropriately placed patients in acute hospitals;
—welcomes the initiatives being taken with regard to the staffing of emergency medicine departments;
—acknowledges the investment of €46 million into GP co-ops which provide 24 hour GP availability;
—notes that almost 600 additional acute beds were provided in 2002/2003;
—acknowledges the 41 % increase in consultant numbers in the last six years and the 32% increase in the number of nurses; and
—welcomes the achievement of the national treatment purchase fund for arranging treatment for 13,000 patients since July 2002."
—(Minister for Health and Children).

I wish to share my time with Deputies Fitzpatrick, Fiona O'Malley Peter Power and Devins.

Is that agreed? Agreed.

I welcome the opportunity to speak on this motion on hospital waiting lists and on the health service in general. We welcome that a sum of €250 million was provided for the reduction of waiting lists for patients between 1998 and 2003. We also welcome the general reduction of numbers on cardiac surgery waiting lists, regarding which it has been clearly proven that the number on adult waiting lists has fallen by 90% and that on children's waiting lists by in excess of 90%.

Having listened to the debate on the state of the health service, one would be forgiven for thinking one was living in a different country to that described. The statistical facts demonstrate that there has been a 41% increase in consultant numbers in the past six years. Having listened to the debate yesterday evening, one would never believe the number of nurses employed in the health service has increased by 32%. The increased general activity in the acute hospitals has been phenomenal. In 2003, there were more than 1 million patient activities in general acute hospitals.

A sum of €46 million has been provided for the development of general practitioner co-operatives throughout the country. This is an innovative idea and there has been considerable activity in the co-operatives where they have been set up. However, we must extend them to the entire country, no more so than in Duhallow in my constituency, where we hope to set one up. It is necessary to have a major health centre in which the first interaction of the patient with the health service can take place and in which minor issues can be dealt with. Local accident and emergency units, regardless of the hospital, get clogged up if they are the first point of contact with the health service for patients with minor problems. I know that GPs are anxious to get involved in the co-operative movement. Those in my area have informed me that, in the old days, each GP had a particular area to cover and each covered his area "24-7", long before this term was ever coined. The development of GP co-operatives must be welcomed.

In recent years, a monumental amount of money has been pumped into the health service, although I know we were starting from a very low investment base. Over successive years, the health service had been starved of resources. Now, under the Minister for Health and Children, Deputy Martin, we have increased the amount being pumped into it to well in excess of €10 billion. We have come a long way and the Minister has shown great courage in taking on sections of the health service.

In every public sector area, different empires, for want of a better word — I do not use it lightly — have come into being in the health service. The Minister is prepared to take them on, and this is most evident in the rationalisation of the health boards, regarding which he will be bringing legislation before the House in the not too distant future. I wish him well in this regard and sincerely hope the new legislation will establish a health service that will be much more beneficial to the public.

Would that apply to Mallow?

Allow Deputy Michael Moynihan speak without interruption.

Does the Deputy really accept that what the Minister said was correct?

The issue of Mallow General Hospital has been politicised over the years. When the Minister visited the hospital on Good Friday morning, he dealt with the major issues concerning the hospital's future. I and my family have been patients in Mallow General Hospital at various times over many years and the Minister——

Does the Deputy really accept that what the Minister said was correct?

The Minister will ensure that Mallow General Hospital is in safe hands. Over the past six years, there has been more investment in the hospital than there was under any other Government. I commend the Government's amendment to the House.

The subject under discussion is the length of waiting lists but, in the past 12 months and with the introduction of the national treatment purchase fund, they have been reduced quite drastically, as the figures demonstrate. One of the most interesting points about waiting lists, which I believe we touched upon in the Joint Committee on Health and Children, is that there are no real statistics on sickness or health, waiting times and waiting lists. I am glad the Minister has announced that the national treatment purchase fund is undertaking the validation of the waiting lists. However, the number of people on waiting lists must be seen in the context of a continuing increase in the number treated in public hospitals. In fact, the number discharged from hospitals having been treated as either in-patients or day cases in 2003 was, for the first time, more than 1 million. This represents a 4.7% increase over 2002.

Much progress has been made to decrease waiting times and we are on track to achieve health strategy targets. The transfer of responsibility for waiting list figures to the national treatment purchase fund will result in a more accurate and complete picture of the numbers waiting and, more importantly, the length of time for which they are waiting for procedures. It is important that patients are waiting for treatment for the shortest possible time and that the list states correctly how many are available for treatment. Having obtained these figures, one should endeavour to shorten the waiting times even more. There is no point telling elderly people waiting for cataract surgery that they will have an appointment in a year's time. One could have to wait six to 12 months for an appointment for one's condition to be diagnosed and probably another 12 months before it is treated. People waiting for cataract surgery are approaching the end of their lives and cannot be kept waiting for two years. We should shorten the waiting period. The surgery involves an improvement in the quality of life.

Advances in modern surgery help reduce waiting lists. I will offer an example from personal experience. Some years ago I had a patient who, in the course of his work, almost had his hand removed. It took surgeons 12 hours to re-attach the hand and make it functional. Fifteen years ago that would not have happened, the hand would have been amputated. That is another factor in delaying procedures for patients on waiting lists. It took 12 hours to re-attach that patient's hand and the people on the waiting lists had their appointments pushed back days or weeks as a result.

Maureen Lynott, director of the national treatment purchase fund, said yesterday that one of the first patients to be treated under the national treatment purchase fund had waited over eight years for her operation. That is something one cannot dwell on lightly.

Is there a correlation between that and the lifetime of the Government?

Now, however, 80% of the people on waiting lists are waiting less than a year for treatment. That is a remarkable statistic.

Is it true?

The Government can be proud of this achievement. The Opposition is correct that it is not 100% but it is nearly there. As the Minister said yesterday, if one does not have an ambitious target, one will not strive with ambition. There has been a slight failure in reaching the target of 100% after two years. However, I and many Members of the House are delighted that 80% of the people on waiting lists are waiting less than a year for treatment. There is more to do.

A lot more.

The Labour Party undermines its credibility by stating that it deplores this type of achievement. Look at its record. I do not like Private Members' time becoming a batting contest of "we did this" and "you did that" in Government but my attention was drawn to the fact that waiting lists under the rainbow Government increased by 27%. If the Opposition puts down a motion which deplores the Government's achievement, it must be prepared to answer for what happened on its watch. The Opposition cannot teach the Government anything in this regard.

This Government and its predecessor reversed the historical trend in health care. As a result of the willingness to change, it has reversed the under-investment. We now have the extraordinary situation of a 188% increase in the level of funding for health care, and we are proud of this. It was necessary. However, it demonstrates that the health care problem is not simply a question of the amount of money we throw at it but is also related to the structures and the reform and partnership that are necessary on the part of Government and the practitioners to deliver change to the people who matter, the patients.

The issue is to deliver it on the ground.

The investment is being made. I repeat for the Deputy's benefit that 80% of the people on waiting lists wait less than a year for treatment.

Go to Beaumont Hospital.

Before the establishment of the treatment purchase fund, people were faced with an indefinite wait. Now, they know how long they will be waiting for treatment. This was the major problem with the waiting lists. When one knows one will get treatment relatively quickly, the waiting does not appear quite so bad.

The issue we must examine now is reform. Money is being invested in the health services but the service is not being delivered quickly enough. It is only through partnership between the Department of Health and Children and the practitioners that health service reform can be delivered. Progress has been made in terms of public patients getting the same treatment and buying their own treatment. This has delivered better results and long may that continue. I commend the Government's motion.

I thank my colleagues for sharing time with me. Few issues in politics attract greater attention than hospital waiting lists, yet few issues have been characterised by more inaccuracies, misinformation and distortions. This debate provides an opportunity to define the essential characteristics of what it means to be on a waiting list and to outline the undoubted progress that has been made over recent years by the Minister.

If a person is diagnosed by a consultant or a medical specialist, is prescribed a course of treatment and is not transported directly to the operating theatre or day care surgery, the person will, by definition, wait for treatment.

Not unless they are waiting for three months.

We will give the facts.

In the utopia in which the Labour Party lives, patients would be seen by consultants without notice and those diagnosed as ill and in need of treatment would be treated immediately, without waiting, but that is not how the system works in the real world, in this country or any other. People must wait to some extent for the type of treatment they need.

Except in France or Germany.

The issue in this debate is not that people are waiting for treatment but how long they wait, the quality and nature of the treatment and, perhaps more importantly, the number of people being treated each year by the health service. In those three areas, the Government has made enormous progress.

The number of people being treated in the health system is just as important as the length of time patients are on a waiting list. There has been substantial progress in reducing the length of time people wait for treatment. The national treatment purchase fund is on course to achieve its target of having no patient waiting more than three months for an operation. Second, 80% of patients wait less than one year for surgery and nobody can deny that this is progress. Third, a mere 16 months ago, in January 2003, one would have had a 60% chance of waiting between 12 and 14 months for treatment, but that has now been reduced by 50%.

The essential issue is not just the length of time people wait for treatment but the amount of treatment the health service has the capacity to deliver each year. That undoubtedly has increased over the years and this is often overlooked. It is a deliberate attempt to disguise that simple and straightforward fact. The increase in the number of people being treated in the health service — more than 300,000 in the past five years — is staggering. It compares most favourably with any health care system in the world. In the context of the number of people being treated, the reductions in the waiting lists and in waiting times are extremely impressive

I wish to deal briefly with one factor in the improvement in waiting lists over the past three years, day care treatment. This has been, perhaps, one of the most fundamental revolutions in the provision of health care in Ireland. Huge technological advances have led to less invasive surgery, for example, keyhole surgery and spectroscopy. With increasing technical innovation and more sophisticated use of anaesthesiology a greater number of people can be treated each year. This is the hidden success story of our health system and it should be spoken of more.

People justifiably ask where the billions that were invested in the health service have gone. They have gone into new disciplines such as the increases in day care surgery. There have been huge expansions. One need only take the example of the regional hospital in Limerick where the number of people now being treated on a day care basis compares favourably with even three years ago. I commend the Minister for pioneering real and substantial investment in this area.

Given that no straightforward proposal has come from the Opposition benches in this debate, it is clear the Opposition is determined to ignore the indisputable advances made in recent years. I commend the amended motion to the House.

I am delighted to have the opportunity to speak in this important debate. Fianna Fáil is the only party interested in developing our health services rather than just using it as a populist football. The sole objective of our policy is to develop a service where employees are enabled to work to the best of their ability and every patient has equal access to a high quality of care. We have already increased health spending by more than 188% since 1997 and we will continue with this unprecedented investment. At the same time we are carrying out the most radical programme of change for the health sector since the establishment of the health board structure in 1970. We are not interested in the empty soundbites of the Opposition.

In recent times we have heard talk from Fine Gael and the Labour Party about an alternative. The reality is that the last time the parties of the self-styled "coalition of the caring" held office, their record did not compare favourably with the progress of recent times. In the mid-1990s the Labour Party and Fine Gael, the dynamic duo now offering themselves as the saviours of the health system, held the portfolios of finance and health, respectively. The Opposition parties were in prime position to drive the agenda of investment and reform in our health services. They failed miserably on both counts.

I listened to Opposition Deputies trying to distort the Government's record and the achievements of those who work in our health services. The irony is that many of those who are predicting the worst are the same people who trooped through the division lobbies in Leinster House in support of the shameful record of the rainbow coalition. Let me remind those Deputies that waiting lists stood at 23,000 in December 1994 when the Labour Party and Fine Gael assumed control of the health services. In their programmes for Government they spelt out clearly: "We will continue the progress of the past two years in reducing waiting lists." Despite their pledge the waiting lists rose by 27% under the rainbow coalition, from approximately 23,000 in December 1994 to more than 30,000 in June 1997. That is the record of the caring coalition.

What was the reaction of the rainbow coalition to this state of affairs? In January 1997, in the face of a 27% rise in waiting lists, it cut the funding for the reduction of waiting lists by20%. Does that sound like a coalition of the caring? I would say it was a coalition of the callous. While Opposition Deputies will say they did not have the benefit of the boom that the policies of this and the previous Government have generated, I reject that argument. While a shortage of funding can excuse early failings at health system reform, by 1995 there was sufficient funding available to advance the agenda of reform but this was not done. Starting from the low base left by the rainbow coalition, Fianna Fáil has since increased the health spend to more than €10 billion, an increase of 188%.

No multiannual funding was provided for capital projects under the rainbow coalition. It is almost impossible to plan and construct large projects on the basis of year-on-year funding. Through the mid-1990s the health system was crying out for development funding. Renovations and new building were required. The coalition of the callous refused the necessary funding. In 1997 it actually made cutbacks in this key area. In 1996, €152 million was spent on health capital projects. In its final budget of 1997 this was cut to €138 million. In reality, the Labour Party is now engaged in a sorry attempt to try to rewrite history. It is asking the people to engage in a mass act of collective amnesia and forget the policies it put to them at the last election, and which are still Labour Party policies, would have left the health service in chaos. Bankruptcy in every sense of the word perfectly sums up what the net effect of the Labour Party's health policy would be.

During the last general election campaign the Labour Party proposed a highly dangerous, quick-fix approach called universal private health insurance to force all hospitals that could not win a competitive contract from a private insurer to either cut back or close. If the Labour Party is still committed to funding the universal health insurance system, it must also add that expenditure to its published spending plans. I look forward to seeing how Deputy McManus will make these figures stand up. The Deputy knows this is an impossible task. In the most damning indictment of the Labour Party's credibility on health issues——

The Government parties are the ones downgrading the hospitals, not us.

The Government is closing hospitals.

How many accident and emergency units will the Government close?

Let us hear the reality now.

——two days before the last general election, Deputy McManus conceded that her party's health policy was not workable for five years, as stated in The Irish Times on 15 May 2002.

Will the Deputy give way for a question?

The Deputy does not like to be asked questions.

We have limited time.

The Deputy is also limited by his lack of imagination.

And his lack of reality.

Bearing this in mind, if the Labour Party wants to make a meaningful contribution to public debate, rather than wasting time tabling futile motions, its time might best be spent meditating on how it has no policy or credibility to deal with the present challenge to the reform the health service.

Shame on the Deputy.

I wish to share time with Deputies Finian McGrath, Connolly, Gormley and Ó Caoláin.

Is that agreed? Agreed.

I thank the Labour Party for tabling this valuable motion. As one who has worked at the coalface for many years, frustration on this matter drove me to politics. I got fed up with the inequality in the system and the health apartheid that exists. While those with money who can afford insurance through VHI or BUPA get looked after in days or weeks, those without money must go on a waiting list. I will add one important point to this debate. I will lay bare the lie about the waiting list and expose the hidden waiting list.

When I heard the Minister last night speaking on the "Six One News" I saw red. He gave the impression that things were going well. He said that 80% of patients wait less than a year for surgery. Many Deputies repeated this tonight, but left out the words "for surgery". There was argument as to whether the real number was 27,000 or 22,500. I live in the real world and know the real situation. However, the Minister does not live in the real world because his world is apparently going very well. He lives in the world of make-believe, worthy of Disneyland or fantasyland. His is the world of spin where our money is used to fool us into believing this web of deceit.

The other list, which the Minister failed to mention, contains at least 100,000 people and stretches for many years. This real waiting list is the one on which people live and die. In the case of rheumatology, patients must wait for four years and in the case of urology, patients must wait for six years to get on the Minister's list. What good is a year to a patient after that length of time? Only those with cancer can be added to the Minister's list within weeks. That is the bottom line reality.

I am here to bear witness to the suffering, pain and damage done, and the deaths that occur all the time. I want to lay bare the web of deceit the Minister is spinning. The issue is not whether there are 27,000 or 22,500 on the list — there are at least 127,000 on the list. The real issue is that the Minister for Health and Children thinks people are so stupid they will not know the real waiting list contains at least 122,500 people and probably many more than that.

The Deputy should know.

The Minister conveniently ignores the existence of this list. How can a problem be addressed without accepting the reality of the situation? The Minister is not doing this and I am very disappointed. Transparency is needed. If the extent of the problem is not acknowledged, it will not be addressed. There is none so blind as he who will not see.

While the Minister is not so stupid as to believe the other list does not exist, he can forget, as it is election time again. Have we returned to the land of high spin due to the elections? Does the promise that waiting lists will disappear within two years if the people elect Fianna Fáil candidates sound familiar? When the Minister said that two years ago, the people believed him and provided the Government with its undeserved majority. If the Government had told the truth, it would not have it. People are getting wiser and they may well fail to swallow what the Government is telling them this time. The local elections will tell their own tale. We wait expectantly to see what happens. Until such time as the Minister faces up to reality, circumstances will get worse not better.

I am grateful for the opportunity to speak to this motion on the major crisis in our health services. I intend to deal with the present and with reality. Before dealing with the issues, it is essential for the Government to accept that we face a crisis. There are times when it seems to ignore people on waiting lists, trolleys and chairs. It seems to ignore the 27,000 who are awaiting treatment, of whom 9,000 have been waiting for more than a year. It is unacceptable and disgraceful after two years in power. Further delays in the publication of the proposed disabilities Bill is a national scandal while 2,826 families of people with intellectual disabilities remain on residential, day care and respite waiting lists. It is a scandal that after all the talk, reports, spin and so-called extra revenue that people continue to wait. This is not good enough. It demonstrates a lack of professionalism and competence in dealing with an important national issue.

I welcome sections 2, 3 and 4 of the motion as it is not enough simply to attack the Government, particularly on its failure to deliver a quality health service and its constant squandering of public funds without accountability. We require targeted initiatives to ensure a prompt reduction in the numbers of waiting lists and an end to the suffering and distress of so many of those awaiting treatment. The Government has done nothing of significance to our health service. There are still 13,000 elderly people in need of high to maximum dependency care in their homes. We have seen cuts in the home help service, grossly under resourced day-care centres and waiting lists of 27,000 people, 9,000 of whom have been waiting for treatment for more than a year. In the Ireland of 2004 with its great economic growth and resources, people cannot access a hospital bed.

I challenge the Minister for Health and Children and his Ministers of State who are failing to deliver services. Our accident and emergency departments are being neglected while the Minister of State opposite looks the other way and blames the Opposition for bringing forward motions such as the one before us. I urge all Members to support the motion. It refers to our health service in respect of which all Members have a duty to stand up for radical reform and more investment. If we are serious about helping patients on trolleys and chairs and people with disabilities as well as about reducing waiting lists we will reform and invest in our health service. "Reform" and "investment" are the key words in this debate. They describe the way forward. I urge all Members to support the motion and, above all, to support our health service.

I support the Labour Party's excellent and timely motion. It represents a kind of mid-term review, which gives us the opportunity to consider the commitments made in the programme for Government more than two years ago. The Government promised that waiting lists would be gone within two years and that we would have 3,000 extra beds in the health system. The waiting lists remain in place and the beds have not arrived. Whereas the Minister for Health and Children once spoke of commitments, he is softening that to talk of targets, which are not really achievable. He has admitted that the commitments no longer exist.

There have been many reports on the health services and, more specifically, on accident and emergency units. We have had the accident and emergency review committee, the Capita report and the equity of access report. If reports could cure, we would have the cure by now. The reports have all come embellished with lovely language at great cost to the taxpayer but there has been no end result. We must ask at this point when a waiting list is not a waiting list. The time between visiting a general practitioner and seeing a consultant is not regarded as waiting time. Despite the fact that these patients are waiting to be treated, they are regarded instead in the lovely phrase currently used as being on the pathway to patient care. While the reports have identified the problems, we are not acting on their recommendations. We are not doing anything.

A major part of our problem involves consultant numbers and how we measure in this respect against our European partners. While the average number of anaesthetists in the EU is 139 per million, the Irish average is 63 per million. There are 142 consultant surgeons per million in the EU but only 31 per million in Ireland. There is an average of 131 obstetrician gynaecologists per million in the EU and 23 per million in Ireland. The European average in respect of paediatricians is 146 per million while the Irish average is 22. There are approximately 49 radio-therapists per million in Ireland whereas the EU average is 98. Ireland is some 12 times worse off than the average EU member state in terms of the number of neurologists we have. Despite these statistics, we ask ourselves why we have waiting lists. We will continue to have waiting lists until we begin to approach the European norms and employ more consultants.

We are far ahead of the European averages in terms of chief executives, deputy chief executives and programme managers. We have no shortage of senior executives and people with folders under their oxters. That is a real part of our problem. We must employ more hands-on people who can deliver a service directly to patients. It is not fair that somebody must wait on a public or private list for a neurologist for far in excess of 12 months. Any requirement to see a neurologist is urgent. Time is of the essence and in Beaumont and other hospitals neurologists are under extreme pressure. We have been given promises but there has been no action. Perhaps the Minister for Health and Children intended to borrow the magic wand the Minister for the Environment, Heritage and Local Government, Deputy Cullen mentioned some time back. Perhaps that wand is not working at the moment.

Real people are involved. Many of those who have waited for elective surgery have arrived at hospitals to find that it has been cancelled due to accident and emergency overcrowding. In these cases, somebody who was brought through the accident and emergency system has taken the bed which was originally assigned to the candidate for surgery. In such instances, a theatre has been prepared for an operation and a full surgical team including consultants and anaesthetists has been assembled, but they cannot work. They are left idle because accident and emergency services have not been addressed. This is the type of scenario we must tackle. We are wasting resources.

On behalf of the Green Party, I support the Labour Party motion and reject the Government amendment, which represents yet more spin. We have heard it all before. We have had launch after launch, policy document after policy document and promise after promise, especially in the run up to elections. As I said at my party conference, it is a bit like the film "Groundhog Day". The same thing happens over and over again as if it were a bad dream. That is particularly true for those who are suffering in accident and emergency units and on waiting lists.

We must ask who we should trust on this important issue. A person I trust implicitly is Dr. Maurice Neligan who published a very interesting article in The Irish Times in March this year. He stated that the promises made by the Government are reminiscent of the story of the emperor’s new clothes with which we are all familiar. In quite a humorous piece, Dr. Neligan wrote “Children, it is a fact that when things called elections are looming, grown ups become very generous and tell great stories. It is a sign of great rudeness not to believe them.” We have heard all the great stories and tonight I will be a little rude and not believe what the Government is telling us on this occasion.

The Government is in an ivory tower when it comes to the health service. It is out of touch with reality and the suffering of ordinary people. It is actively promoting a two-tiered health service. Its ultimate aim is the privatisation of medicine. Privatisation in almost every sector is the aim of the Government, particularly the Progressive Democrats. I believe they would privatise their grannies if it resulted in a few bob for their supporters.

The reality is that accident and emergency units, in particular in Beaumont Hospital — I have mentioned this before — are a disgrace to any civilised society. It is now the case that not only can one not get a bed in Beaumont Hospital but one cannot get a trolley. If one is lucky, one will get a buxton chair. I know of a polio victim — this is a true story which I have outlined in the House before — who had to sit in such a chair for three days. She was eventually placed on a trolley but died in circumstances which no civilised society should tolerate.

What is being done to deal with the waiting list problem? The Government established the national treatment purchase fund, a Progressive Democrats election gimmick. However, it is now permanently in place. Dr. Maurice Neligan and the Green Party want to know why we are pouring money into that fund so that people can be treated in private hospitals, often abroad, when it should be spent upgrading our service. Why can that money not be spent on the 3,000 extra beds we were promised, a promise that will never be fulfilled in the lifetime of this Government?

We are now faced with the same agenda. The Government is pushing us towards private medicine, what the treatment purchase fund is ultimately about. As a result of the Hanly report, many public hospitals are being downgraded while at the same time the Minister for Finance, Deputy McCreevy, is providing generous tax breaks for similar sized private hospitals. That is the reality of what is happening. The reforms now being suggested will result not in more beds, more consultants or better care but in less accountability in our health service and a poorer service for everyone.

There is a shortage of physiotherapists in this State but yesterday the Minister for Health and Children, Deputy Martin, tried his hand at a little physiotherapy when he massaged the hospital waiting list figures. However, he fooled no one. It can only have been a half-hearted effort given the revelation at the weekend of the Minister for Health and Children's memo to his Cabinet colleagues exposing that health care facilities provided at a cost of €400 million are lying idle while people wait months and years for treatment.

The Minister requested €50 million to open these facilities, €2 million less than the sum squandered by the Government on its flawed electronic voting machines. I urge the Government to provide that funding. Perhaps the Minister or his colleagues will tell the House if it was the Minister for Health and Children who leaked that memo.

Last week, during Leaders' Questions, I highlighted the fact that 25 April marked the second anniversary of the Fianna Fáil general election manifesto 2002 when the Taoiseach and the Minister for Health and Children promised to permanently end waiting lists within two years. It is a pity our national public service broadcaster, RTE, did not view this matter as serious when it dismissed it almost without comment during last Wednesday morning's television coverage of Leaders' Questions.

I welcome that the Labour Party has again highlighted this most serious issue, as already done by Sinn Féin in its Private Members' Business motion on 2 March. A week later, having voted down our motion, the Taoiseach admitted that the total elimination of waiting lists would never happen. Yesterday, the Minister for Health and Children put a new spin on the broken promise when he said it was not a promise but, in his words, "a target". He should have told us and the electorate that at the time.

The context for the latest Government spin was yesterday's public relations exercise whereby the waiting list figures were rejigged by the Minister with the help of the national treatment purchase fund in what can only be described as a statistical exercise. Numbers on waiting list were reclassified to give the impression that the list had reduced. Some 4,500 people, under various headings, were removed from the list. The bottom line remains in that more than 27,000 people are awaiting surgical treatment longer than they should. Some 12,000 of them have been awaiting treatment for more than six months and 3,500 have been awaiting treatment for up to two years. This brings to mind another commitment from the national health strategy that by the end of 2004 no patient would have to wait more than three months for treatment.

The Government's health policy is a tattered patchwork of measures which sustains a grossly inequitable and wasteful two-tier system, a matter continuously addressed to the Government, particularly the Minister for Health and Children. Health care facilities, including public hospital facilities, provided at a cost of €400 million, are lying idle while public money, through the national treatment purchase fund, is used to buy treatment for public patients in private hospitals in Ireland and Britain. That is a scandalous waste. It is happening in a State where half the working population are paying double for their health service: they are paying tax and PRSI and private health insurance. The other half, who cannot afford private health insurance, must pay their own way or be on the verge of destitution to qualify for the medical card unless they are over 70 years of age, when they are given a card without a means test. However, young children with real needs are denied that right. That is especially notable in a week when children in Ireland were shown to have the fourth highest rate of asthma in the world.

The other side of the crisis-ridden public system coin is a flourishing private health care business, the latest manifestation of which is the €100 million private clinic now under construction in Galway. From day one, people with money will be able to check in for treatment but public patients must serve out their sentence on the public waiting lists before getting a chance to see the inside of it if they are lucky enough to qualify for treatment under the treatment purchase fund. That is inequality at its most obscene.

I welcome the news today that the two senior doctors at Peamount Hospital who won their case are to be reinstated. I hope the TB and respiratory unit there will be allowed to continue its great work. If the Minister had intervened and if the Government had coherent policies for delivery of services, this debacle would never have happened and need not have gone to court in the first instance.

I make no apologies for repeating my request that the Minister for Health and Children immediately restore on-call status to Monaghan General Hospital for the sake of the deserving population who depend on it or for the sake of his party colleagues, whichever moves him.

I wish to share time with Deputies Burton, Lynch and Penrose.

Naas General Hospital in Kildare, a wonderful facility, was upgraded in recent years. However, when the Labour Party spokesperson on health commenced the debate last night she identified Naas General Hospital as one of the places where between 34 and 40 people wait on trolleys. They lie on trolleys because the Government and the Minister for Health and Children have done nothing to improve secondary care. The Minister has provided a wonderful facility, which does not operate to its full potential because he was unable to obtain the necessary funding from the Minister for Finance.

As a result of the constraints imposed on the South Western Health Board by the Minister for Health and Children and cutbacks by the Minister for Finance, St. Fintan's Hospital in Athy has had to close a 21-bed ward. This reflects the number of beds lost to Naas General Hospital. Patients who might have used St. Fintan's Hospital for secondary care or long-term rehabilitation cannot do so. However, because they are not well enough to go home they must remain in Naas General Hospital. As a result, acutely-ill patients cannot be admitted to Naas General Hospital and must wait on trolleys and chairs in the corridors of this wonderful facility.

The nursing home subvention appears to be a wonderful measure but it is of little value to the ordinary person. The maximum nursing home subvention available to an old age pensioner or a person in receipt of a social welfare payment is €190. An old age pension or social welfare payment will bring the amount up to approximately €400. The famous enhanced nursing home subvention is a figment of the Minister's imagination. A person who has any property is in danger of not receiving the subvention. The subvention is also means tested. This means that most elderly people must join a waiting list for a place in a nursing home near to their own home where they can be visited by their family and friends. They must wait in a general hospital, being pressurised by staff to go home when that is not possible. An elderly person cannot go home to be cared for by an equally elderly wife, sister or brother.

Last week, I saw an 84 year old person sent home to be cared for by her 82 year old brother and her nephew in his 60s, in a house that has neither running water nor electricity. It is shameful that such a case had to be addressed in that manner. Those two elderly people took it upon themselves to care for the woman. When I tried to find secondary care for her in a local geriatric hospital I found they were full or that wards had been closed by this Minister. The nursing home subvention could be used as a means of reducing the bed problem in facilities such as Naas General Hospital.

This afternoon's Exchequer returns, which show tax revenue €514 million ahead of the Minister for Finance's expected revenues and capital spending nearly 25% below target, are an indictment of the Government's callous refusal to commission health service facilities such as James Connolly Memorial Hospital in Blanchardstown. The new €105 million wing at the hospital has remained idle for the ninth months since its completion. In a typically cynical move, the Fianna Fáil rumour machine is suggesting that a decision to fund the opening of the extension is imminent, just in time for the local elections on 11 June. Fianna Fáil and their Progressive Democrats allies are masters of this style of political stroke.

Some €105 million has already been spent on a new wing for the hospital. Despite being ready for more than nine months, the new state-of-the-art accident and emergency unit remains empty while staff work next door in prefabricated buildings that would shame a developing country. The new operating theatres, costing many millions, lie dark and unused as do the intensive care unit and many of the new surgical beds.

Blanchardstown, Dublin 15, and the areas of County Meath served by James Connolly Memorial Hospital are among the fastest growing areas in western Europe. On 9 October 2003, the Minister of State at the Department of Health and Children, Deputy Callely, speaking on behalf of the Minister for Health and Children, promised that the new facilities would be open within a matter of months. Deputy Callely said the ERHA, the Northern Area Health Board and management of James Connolly Memorial Hospital were also finalising arrangements to transfer existing accident and emergency services to the new facility upon its anticipated completion in November and that the completion date would be within four weeks. He also stated it was expected the building would be in use in November. I want the Minister of State to come to the House and apologise to the people of Blanchardstown and Dublin 15 for such a blatant misstatement of the truth.

In a week when the Government acknowledged the waste of €52 million on the e-voting debacle, it is outrageous that elderly people are waiting on trolleys in James Connolly Memorial Hospital and that in yesterday's report of the treatment purchase fund it is listed as one of the four hospital blackspots for waiting lists in the Dublin area.

The dedicated staff, doctors and nurses in James Connolly Hospital have said, over and over again, that many hundreds of new procedures could be performed if the theatres, ICU and surgical beds in the new unit were fully commissioned. Fianna Fáil and the Progressive Democrats have refused to commission these desperately-needed facilities for the sake of a €5 million operating deficit. It is ironic that €1 million of this deficit arises from a fine imposed on the hospital for lack of efficiency in the turnover of patients, particularly elderly patients. We are living in Alice in Wonderland when the Minister for Health and Children can impose a fine of €1 million on an ancient TB hospital campus which is so spread out that it can take an hour to transfer patients from the old TB units to the hospital’s main building. Of course, if we were in wonderland we could demand of this failed Minister, “Off with his head”.

In the context of today's Exchequer figures and the boom in tax receipts, much of it as a consequences of recovering unpaid taxes from the 1970s and 1980s, it is shameful for the Government to withhold funding from James Connolly Memorial Hospital. Many of the elderly people on trolleys, or regularly held in ambulances in the car park, paid their taxes when prominent members of the Fianna Fáil Party were aiding and abetting tax fraud on a massive scale.

Arrogance and incompetence with public funds are the hallmarks of this Government. The electorate will have an opportunity on 11 June to issue a wake-up call to the Minister for Health and Children and to his Ministers of State, Deputies Brian Lenihan and Callely. In casting their votes in Dublin 15 and Meath, the electorate can send a clear message to the Taoiseach to open the new wing in James Connolly Memorial Hospital, to start work on the rest of the hospital and to start to abolish the waiting lists, as was promised.

I am disappointed but not surprised the Minister for Health and Children is not here this evening. As the Minister represents the constituency of Cork South-Central, one might imagine Cork city would be well served in regard to health, which is not the case. Cork has a university hospital which has, for the past four years, been no more than a building site. The accident and emergency unit launched by the Minister has not opened and is unlikely to open in the near future. However, the people of Cork are hopeful it will open for 2007 when the next general election comes around.

My colleague, Deputy Sherlock, outlined the plight of the elderly in Cork city and county. While he dealt mainly with Mallow, a similar situation arises in Cork city where approximately 5,000 elderly people are on an enhanced subvention list. While the Southern Health Board recognises they need urgent and immediate full-time care, there is nowhere to put them.

We sometimes get lost in figures when discussing subjects such as dementia, Parkinson's disease or Alzheimer's disease and this can distance us from the people involved. Therefore, I will deal with the case of a man named John. He is 70 years old and his wife is little younger. When I called to their house following a telephone call from a neighbour, there were four locks on the door because John is inclined to wander. His wife told me that if she hears John stirring during the night she must immediately jump out of bed to make sure he does not fall down the stairs. Their bathroom is upstairs and the wife must take him up and down the stairs all day as he needs to use the toilet regularly. She told me she was exhausted and did not think she could go on any longer. When John had a seizure and was hospitalised, his wife's opinion was that he would at least get the care he needed but that it was not the way she wanted him to be treated. Nonetheless, she considers herself lucky at this stage.

This is the plight of the elderly seeking enhanced subvention in the Southern Health Board region despite the Minister for Health and Children being from Cork. The Minister does not have the courage, stamina or gumption to stand up to the Minister for Finance and demand money, although he will leak all the press releases he can, and leaked another recently. The Minister has more publications than Rupert Murdoch but nothing is done.

His greatest con-job came during the 2002 general election campaign when with great aplomb he told us that BreastCheck was to be rolled out in Munster. The premises were bought and the women of Munster were at long last to have the service Dublin had. We are still waiting. The site brief was only completed three weeks ago and the Department told me it will take approximately 18 months before a decision is made, which brings us close to 2007, just in time for the next general election.

The Minister has announced the roll-out of BreastCheck in Cork three times but it is still not up and running. It is estimated that in Munster alone 37,000 women would be called per year to have a check carried out. As a result of BreastCheck, breast cancer detection is up by 1%. That could be improved upon and detection made possible at an earlier stage but the Minister does not care. Instead, whether breast cancer is detected early depends on where a woman lives.

I presume the Minister will announce this programme again. When the Opposition ask what has happened to it, he will tell us that these things take time. They do not. They take a Minister who knows what he is doing and one who insists on progress. The Minister has not done that.

I am glad to have the opportunity to contribute to this debate and compliment my colleague, Deputy McManus, on tabling the motion. It is a matter which affects all citizens. There is an old saying that one's health is one's wealth. Many would not understand this because in this society the greedy are getting greedier and "me" rather than "we" is the fundamental underlying philosophy of the Government.

At a time when the nation is experiencing unprecedented wealth, it is disgraceful that there was never greater poverty for those who cannot afford access to and equality of treatment in the health service. We boast about the economy, but it is not one which could be compared to any other European economy when one considers access to services. Our two-tiered, under-funded, under-staffed and over-stretched services are akin to what one might expect in a developing country.

Members of the House who take the opportunity to meet constituents and do not seclude themselves in ivory towers will realise the position on the ground, and the frustration of those trying to get access to a hospital bed. It is quite a health service that leaves patients for 48 hours on a hospital trolley, if they are lucky enough to get a trolley. In some cases, patients are left outside hospitals. Such Third World conditions in a supposedly booming economy are disgraceful.

It is time to put a stop to this nonsense. I am fed up listening to hype, bluff, bluster, blather and condescension in the House as the Government tries to ensure that capital gains tax is reduced at the expense of the poor of the country who are trying to get access to the health service. I am fed up with talk of strategies, agendas, forums and achievements, and historical replies about what happened in the mid-1990s. The Government should get on with the job or get out if this is all it has to say. Nobody wants to hear about historical perspectives. The Government now has an extra €500 million it did not expect to have. It should spend it on the health service and not worry about the economy.

The Government might not know much about the plight of the poor. What of those lying on trolleys or waiting for orthodontic treatment, including children with embarrassing dental problems for the treatment of which parents must borrow thousands of euro from credit unions? For the past seven years, the Government has long-fingered the development of the hospital in Mullingar and has been economical with the truth when questioned on it. The previous Government put phase 2A of the hospital in place but what has the current Government done with phase 2B? More than 100 beds are awaited. A sum of €60 million was needed to complete the hospital for the people of counties Longford and Westmeath. Thousands of people are scattered over a geographically dispersed area. It is well known that the proximity of a hospital is vital for patients, especially those without access to public or other transport, but this hospital is still the subject of reports and a tendering process. Over-stretched staff can only look at the decaying four storey building and watch bird droppings fall on it.

I pay tribute to Deputy McGuinness, a member of the Committee of Public Accounts, for always emphasising the need for value for money. He should visit Mullingar and assess the hospital building which has been waiting seven years for completion. The Government wasted €52 million on electronic voting that nobody wanted. It should tell this to the people of Westmeath when €60 million would have completed a hospital there to serve approximately 100,000 people, not including those under the age of 18.

It is a scandal. The Government must get its priorities right because the people are sick of cynicism. This hospital needs 311 beds but has only 203 despite experiencing 130% occupancy in winter. Nurses, staff, consultants and attendants are working flat out while looking at a decaying and unused building. At the same time, there are more consultant's reports, obfuscation and foot-dragging. It is time to stop the messing and give the people the health service they deserve. If we must tax the rich, it should be done to ensure that ordinary people have a health service.

I think it was Professor Walsh of UCD who said the biggest problem in the Irish health service was politics. I am sure if he listened to the debate this evening, it would confirm his view.

Is he a consultant?

He is an authority on health matters.

While the discussion this evening is about hospital waiting lists, there is a marked reluctance on the part of Opposition speakers to discuss the national treatment purchase fund, the key strategic instrument used by the Government to tackle this problem.

Who developed it?

Deputy Burton referred to the long waiting lists, which I acknowledge, at James Connolly Memorial Hospital, an institution close to my heart. What she did not mention was the fact that it was one of the few hospitals in Dublin to extend non-co-operation to the national treatment purchase fund until very recently.

The Minister of State kept the new building closed.

I will be quite happy to discuss the other issues with the Deputy. I took the initiative last year to engage the hospital with the fund. Deputies of all parties will have to face the fact that the operation of such a fund assists in introducing what is so badly needed in the sector. There must be some element of competition and choice for patients. Why are they not being told in sufficient numbers about the existence of this facility, which they should? We are quite satisfied that adequate funding has been provided to deal with waiting lists.

The Deputies opposite appear to find it difficult to accept that significant progress — although not enough — has been made on the length of time patients must wait for treatment in hospital. The national treatment purchase fund has reported on its progress to date. It has a multidisciplinary team working with individual acute hospitals. Deputies can contact the fund to identify those patients who have been waiting longest for treatment. More than 13,000 operations have been arranged since 2002. I had the honour of launching the report last year, which showed a huge level of patient satisfaction with its operation. That is a fact, not spin.

There are still a number of patients waiting for treatment for more than 12 months. As Opposition Deputies highlighted, many of these patients are concentrated in a small number of hospitals in the eastern region. This should not continue, particularly when the national treatment purchase fund has substantial capacity to treat patients. It is an issue which all of us in this House must examine. If funds have been voted to provide for these patients, why are they not being treated? It is a fundamental question which must be tackled. That capacity is available in many specialties, including urology, gynaecology, general surgery, ENT, orthopaedics, plastic surgery, vascular surgery and ophthalmology.

If patients are prepared to exercise choice by travelling outside their local hospital or health board area, they can be treated much quicker in many instances. The national treatment purchase fund has the required capacity. The fact that patients or their general practitioners can contact the fund directly to arrange treatment is very important. The majority do not need to wait for treatment for more than six months. They do not have to wait to be contacted by the fund. They can contact it directly by using the Lo-call number.

Work is proceeding on the implementation of the primary care strategy. There has been substantial progress in the development of the first group of primary care teams. I commend the health professionals involved for their willingness to embrace this new way of delivering primary care services. At this stage, a number of teams are providing new or enhanced primary care services for their target populations.

Additional allocations have been made in revenue to support the implementation of the primary care strategy. I agree that primary care is very important. The whole question of the general spirit and thrust of the Hanly report recommendations is fundamental because pressure on accident and emergency units will not be relieved unless there is a shift to a consultant-delivered service. The debate on the Hanly report has been mired by discussion of a purely local character. As a result, we have not got down to the fundamental issue of how to structure the service as between hospitals. The idea put forward constantly of each local hospital being a one-stop shop is completely outmoded in modern medical and hospital care. It does not apply in any other country. Until we collectively face up to this issue and realise that hospitals must co-operate with one another——

How will the Minister implement the Hanly report——

The Deputy had a good day on it in his time, for which I commend him. Until we face the issue of co-operation, not closures, between hospitals, we will not make progress in this area.

Reference has been made to the Minister for Finance who voted the entire income tax receipts of the State to the Department of Health and Children.

I wish to share time with Deputies O'Shea and Rabbitte.

Is that agreed? Agreed.

The motivation behind the motion tabled by the Labour Party health spokesman, Deputy McManus, whom I commend, is to highlight on this its second anniversary the solemn pledge of the Taoiseach before an election that waiting lists in our hospitals would permanently come to an end within two years. Time is up on this commitment, as it is up on the Government. Instead of permanently bringing an end to waiting lists, as Deputy McManus has ably demonstrated to the House, they are lengthening. The Government has the gall to table an amendment to seek to commend it on the targeted approach being adopted. Some 80% of patients are now only waiting one year. Shame on a Government which so cynically manipulated a general election result with a pot of money and ended up in a situation where the people were beguiled into believing a vote for it last time round would result in the ending permanently of waiting lists.

I want to deal with my own hospital in Wexford. I must make a brief comment on the Minister of State's contribution in which the only thing he could vaunt was the national treatment purchase fund, as if it was a new idea. A version of the fund was operated ten years ago when I was in the Department of Health and Children. Patients were flown for orthopaedic treatment from Cork to the Royal Victoria Hospital in Belfast. Waiting times were halved as a result of that first waiting list initiative. This was recognised as a short-term measure until the capacity of the indigenous hospital service was brought up to standard to deal with Irish patients in Irish hospitals in a reasonable time. A decade later, to talk about exporting patients as a panacea is to deny the fact that we have the capacity within our own hospital system to serve our own people or that we have the money and the will to do so.

Wexford General Hospital is a case in point. Ten years ago, it was promised 90 new beds, an additional operating theatre and a new day ward but nothing has happened in the intervening period. It did not feature in Fianna Fáil's national development plan. Last year, a new day hospital for the elderly was completed but it has lain idle since because not one shilling has been provided to staff the facility. It is now as useful as the electronic voting machines that will be stockpiled somewhere else. What an abject failure of policy when even capital works cannot be brought on line for the want of money. Surely there is planning within the Department to arrange for staffing when capital development projects are completed.

Psychiatric facilities at the hospital are under-developed. I spoke to a consultant psychiatrist in Wexford this evening who is in despair over the lack of development of mental health services. From start to finish, in a time of plenty, the record of the Government and its immediate predecessor is one of abject failure. No litany of mealy-mouthed platitudes in what pretends to be a reasoned amendment will hide its shame, inadequacy and failure.

In the short time available to me, I wish to focus mainly on the waiting lists at Waterford Regional Hospital, the latest figures available on which show a total of 1,135. I stress that these are patients who have been referred by a general practitioner to a consultant, who has placed the patients on an in-patient waiting list. Not included in the figure are the many patients who await an appointment with a consultant having been referred by a general practitioner. These patients are often in pain and distress and their condition is weakened by the uncertainty of not knowing when they will meet the consultant.

On the waiting lists at Waterford Regional Hospital are 97 patients awaiting treatment for pain. The cruelty of these patients being on a waiting list or, worse still, on referral from a GP and waiting to meet the consultant is unacceptable. Surely, ways can be found to provide care for patients who are in pain, often constant and severe, and to do this quickly when the need is identified by the general practitioner. There are 219 patients on the ENT waiting lists at Waterford Regional Hospital, according to the figures I have obtained.

The largest number for those on a waiting list at Waterford Regional Hospital is 544 patients for ophthalmology treatment. Our eyes are so vital to all aspects of our daily lives that a waiting list of 544 people is shameful. Other waiting list figures at the hospital include 130 for endoscopy, 80 for medical care, 28 for dental surgery and 37 for gynaecology. Again, I stress that these figures relate only to those who have been put on a waiting list by a consultant. The figures provide only part of the picture in regard to those who need to have procedures carried out.

The Fianna Fáil election commitment in the 2002 general election to end waiting lists within two years is shown for the cynical, dishonest undertaking that it was. The win-at-all-costs approach may bring short-term gains but the chickens are coming home to roost for Fianna Fáil and the Government. It is clear that there is a massive rejection of the Government among the electorate. How often do those of us on this side of the House hear the phrase: "You will have to get them out"? These words are being delivered in anger and frustration throughout the country. Fianna Fáil and the Progressive Democrats will get their answer in the forthcoming local and European elections. The anger which exists towards the parties will only increase as the election campaign becomes more intense.

The health services are fundamental to everything in our lives. Hospital care for public patients is a real issue and one upon which the Government has failed despite its cynical commitments. There is a real problem in regard to permanent care settings for the elderly and cancer care services need massive upgrading, not least in the provision of radiotherapy for cancer patients for therapeutic or palliative purposes. When women opt for mastectomies rather than travel distances for radiotherapy because they feel they cannot leave their children, it must make us all pause and reflect on this barbaric situation.

The Government's acceptance of the Hollywood report and its recommendations will do little for people with cancer needing radiotherapy and who live far from Dublin, Cork and Galway. Reports on the health services are plentiful but ensuing action is scarce. It is difficult, to say the least, to envisage how any real improvement will take place when we are faced with declining services. The shortage of speech and language therapists leads to intellectually disabled children not getting these vital services, the absence of which impairs their progress at a time when these services can have their most beneficial effect.

The Labour Party tabled this motion not only to highlight the cynicism and dishonesty of the Government but also, most importantly, to pressurise the Government to meet the needs of hospital waiting lists. We live in hope.

I thank all my colleagues in the House who supported this motion in the name of Deputy McManus, our health spokesperson. The primary task of the Opposition is to hold the Government to account. Towards that end, I was greatly amused to watch on the monitor some of the newer Fianna Fáil Deputies accusing the Labour Party of using health as a political football. I cannot think of anything which is of more interest to our people. Anyone who was on demonstrations in Ennis or Nenagh will have seen the passion with which Irish people hold their opinions about the health services. Fianna Fáil Deputies who think we are using this as a political football have obviously not been in the House long enough to have experienced their party in opposition because that is an experience one must live through. Nothing but nothing is sacred when Fianna Fáil is in opposition.

Given that the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, happens to be in the hot seat, I remind him of his recent and much loved father who was dispatched to the United States by the then Taoiseach to oppose the Anglo-Irish Agreement. There was nothing Fianna Fáil would not use if it advantaged it politically, to which I do not object.

However, to have to listen to Deputy Devins and others thinking that somehow the Labour Party is using this issue as a political football prompts me to state that it is not. It was the Taoiseach who stated, "Fianna Fáil if returned to office will permanently end waiting lists in our hospitals within two years through a combination of bed capacity, primary care, secondary care and targeted reform initiatives." That was a powerful promise to the people on the eve of a general election. The people believed in an economy which had experienced a boom since 1993 and believed that the Government could deliver on that promise. The outgoing Taoiseach of an outgoing Government asked the people to return it and within two years it would abolish waiting lists.

It is our obligation to hold the Government to account on a promise like that, particularly when the figures show that 27,318 people — live human beings in varying degrees of pain and need — were on the waiting list at the end of the last quarter of 2003, an increase of more than 100 over the figure three months earlier of 27,212. That is the reality and no amount of massaging of the figures or handing over responsibility to the national treatment purchase fund, something we are increasingly doing, will change it. If we cannot build a road in this country, we set up a quango, namely, the National Roads Authority, to look after the matter. This happens in regard to any area in which we are in trouble. More people are now involved in regulation of the telecommunications industry than are in the Department of Communications, Marine and Natural Resources. The Government's answer is always to set up a new quango.

The Government hands its figures over to the national treatment purchase fund which will massage the figures, just as Fianna Fáil massaged unemployment figures in days gone by. For example, the Government introduced pre-retirement schemes to suggest that people of more than 60 years of age should not be on the unemployment register and that the figures were not as bad as previously thought. The Government cannot conceal the fact that in the health strategy it committed itself to a position in which, by the end of 2002, nobody would be on the waiting list for longer than 12 months. That was a modest promise, unlike the Taoiseach's.

Let us be realistic, nobody would make a promise like the Taoiseach did. Nobody believes waiting lists can be abolished. There will always be waiting lists and we must frankly admit that. The issue is how long it is reasonable for people to have to wait and why we can not tackle the fundamental inequality of our two-tier health system, whereby one patient can be fast-tracked within a matter of days if he or she has private health insurance while other patients are on the waiting list, 20% of whom the Minister of State states have been waiting for longer than 12 months, although our figures are closer to 33%. The Government commitment was to people on the waiting list for longer than 12 months.

A second commitment, which had a profound effect on the outcome of the general election, was the promise to enhance eligibility for medical cards by 200,000. If one looks at the plight of low income workers, and there are many in this economy, the level of eligibility for medical cards means 27% of people get medical cards based on income. We will leave out those over 70 who get the medical card irrespective of how well off they are. That percentage used to be as high as 39%. Low income workers going to a general practitioner must pay €30 or €40 per visit and they are being crucified, but the Government has culled almost 100,000 medical cards from the system, according to the IMO. I did not realise it was that high. I thought it was approximately 55,000. Instead of enhancing eligibility, the Government has culled 100,000 medical cards as part of the turn on the tap, turn off the tap system to suit the electoral cycle.

I have concluded that it is impossible to embarrass the Government. The health services were starved for years because of the extent of tax evasion, but whether it is tax evasion, the abuse of public funds or wasting €52 million on electronic voting machines which could be used to open badly needed beds taken out of the system between 1987 and 1989, one cannot embarrass the Government. Its members come in, reel off statistics and ignore the reality of those suffering.

The Taoiseach said his party in Government would abolish waiting lists within two years. There are 27,318 people on the lists and that is the only yardstick which matters. The purpose of our motion is to hold the Government to account in order that it at least begins to address a problem, which is causing such misery in a wealthy society. Nobody can understand why we have gone back to this situation when revenues in the last quarter exceeded Government targets by €514 million. It is because the Government is using the electoral cycle to dictate spending and it is insensitive to the needs and suffering of those on the waiting lists.

Amendment put.
The Dáil divided: Tá, 66; Níl, 50.

  • Ahern, Dermot.
  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Blaney, Niall.
  • Brady, Johnny.
  • Brady, Martin.
  • Brennan, Seamus.
  • Browne, John.
  • Callanan, Joe.
  • Carey, Pat.
  • Carty, John.
  • Cassidy, Donie.
  • Collins, Michael.
  • Cooper-Flynn, Beverley.
  • Coughlan, Mary.
  • Cregan, John.
  • Curran, John.
  • Davern, Noel.
  • Dempsey, Tony.
  • Devins, Jimmy.
  • Ellis, John.
  • Finneran, Michael.
  • Fitzpatrick, Dermot.
  • Fleming, Seán.
  • Gallagher, Pat The Cope.
  • Glennon, Jim.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Haughey, Seán.
  • Hoctor, Máire.
  • Jacob, Joe.
  • Keaveney, Cecilia.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Killeen, Tony.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • McCreevy, Charlie.
  • McDowell, Michael.
  • McEllistrim, Thomas.
  • McGuinness, John.
  • Moloney, John.
  • Moynihan, Donal.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M.J.
  • Ó Fearghaíl, Seán.
  • O’Connor, Charlie.
  • O’Donnell, Liz.
  • O’Donovan, Denis.
  • O’Flynn, Noel.
  • O’Keeffe, Batt.
  • O’Malley, Fiona.
  • Parlon, Tom.
  • Power, Peter.
  • Power, Seán.
  • Ryan, Eoin.
  • Sexton, Mae.
  • Smith, Brendan.
  • Smith, Michael.
  • Wallace, Mary.
  • Walsh, Joe.
  • Wilkinson, Ollie.
  • Woods, Michael.
  • Wright, G.V.


  • Allen, Bernard.
  • Boyle, Dan.
  • Broughan, Thomas P.
  • Burton, Joan.
  • Connaughton, Paul.
  • Connolly, Paudge.
  • Costello, Joe.
  • Cowley, Jerry.
  • Crawford, Seymour.
  • Crowe, Seán.
  • Deenihan, Jimmy.
  • Enright, Olwyn.
  • Gilmore, Eamon.
  • Gormley, John.
  • Healy, Seamus.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kehoe, Paul.
  • Lynch, Kathleen.
  • McCormack, Padraic.
  • McGinley, Dinny.
  • McGrath, Finian.
  • McGrath, Paul.
  • McHugh, Paddy.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Morgan, Arthur.
  • Murphy, Gerard.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Dowd, Fergus.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Pattison, Seamus.
  • Penrose, Willie.
  • Quinn, Ruairi.
  • Rabbitte, Pat.
  • Ring, Michael.
  • Ryan, Eamon.
  • Ryan, Seán.
  • Sargent, Trevor.
  • Sherlock, Joe.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Upton, Mary.
  • Wall, Jack.
Tellers: Tá, Deputies Hanafin and Kelleher; Níl, Deputies Stagg and Kehoe.
Amendment declared carried.
Motion, as amended, put and declared carried.