Health Services: Motion (Resumed).

The following motion was moved by Deputy James Reilly on Tuesday, 2 October 2007:
That Dáil Éireann,
recalling the promises made by the Taoiseach and the Minister for Health and Children in May 2007 that there would be no cut in frontline health services;
noting the:
deterioration of critical frontline hospital services in recent months, as evidenced by the:
loss of 30 nurses and four consultants from Sligo General Hospital;
cancellation of dental services for children in Inchicore and Bluebell;
dismantling of key services at mid-western regional hospital, Ennis;
immediate closure of breast cancer services at 13 hospitals nationally without alternative services being available;
closure of a 24-bed unit for the rehabilitation of elderly patients at Merlin Park Hospital, Galway,
disuse of a 17-bed surgical ward at mid-western regional hospital, Limerick; and
cancellation of essential suicide prevention training for applied suicide intervention skills training (ASIST);
calls on the Government to:
ensure that frontline health services are not reduced and that any budgetary adjustments necessary are focused on administration and bureaucracy rather than essential frontline services.
Debate resumed on amendment No. 1:
To delete all the words after "Dáil Éireann" and substitute the following:
"acknowledges the continued increase in funding for health services over each year of the last decade and the associated expansion of a wide range of front-line services, including in 2007:
the allocation of over €15 billion across Health Votes in 2007, an increase of 11.35% over the 2006 level;
the increase of €245 million in services for older people, enabling the additional provision of step-down beds, long-term care, home-help hours, home-care packages and nursing home inspections;
the increase of €100 million for services for persons with a disability, including intellectual disability services, physical and sensory services, implementation of Part 2 of the Disability Act 2005 and a range of services within the mental health services remit;
the provision of €70 million additional funding in the acute hospitals sector, allowing for the opening of new acute hospital units, improvements in neurology/neurophysiology services, and a further €10 million for the national treatment purchase fund;
the provision of over €20 million for cancer control, including screening, acute services and research;
the additional €22 million in primary and social cohesion programmes, including funding to continue the investment in primary care teams, sexual assault treatment units and social inclusion initiatives; and
the continued commitment to the personnel management and development programmes with an additional €25 million, including funding for both medical and nursing training and education;
notes the high satisfaction levels with front-line health services shown in Insight 07, the most comprehensive, objective survey of public opinion on health services which was published last week;
reaffirms the statutory requirement that the Executive should manage its budget within the Vote approved by Dáil Éireann and acknowledges that the Executive has taken measures to ensure that it meets this objective in 2007, by means of its Breakeven Plan; and
notes that it is the intention of the Executive that these measures will not impact on planned front-line services, which will be maintained in line with the National Service Plan, and that provision is being made that where critical or essential vacancies arise, they may be filled by re-deployment of existing staff."
—(Minister of State at the Department of Health and Children, Deputy Jimmy Devins)

I welcome the opportunity to speak on this motion. In terms of general principles, it is in everybody's interests that clear accountability be established in health policy. We have all suffered from a lack of definition in the transfer of responsibilities from Parliament to the Health Service Executive. I recall a paper delivered by former EU Commissioner with responsibility for health, Mr. David Byrne, to the Law Society in University College Dublin, in which he discussed the issue of the transfer of responsibilities. Mr. Byrne suggested that democracy and the Constitution required a clear policy envelope on the occasion of the transfer of powers, for which accountability resides in Parliament, to the Health Service Executive.

While it is not my intention to knock people who have been trying their best, the performance of the HSE in delivering accountability in health policy has been insufficient. Professor Drumm recently offered to meet parliamentarians to discuss how the executive could be more accountable. The 8.30 a.m. meetings in the audiovisual room are regarded by all those who attend them as a complete waste of time.

Without seeking to make a party political point, when I raised this issue at the last such meeting during the previous Dáil most Deputies agreed that the meetings were nonsense. It is also nonsense to suggest that the issue at stake is anything more than the presentation of the HSE's image to elected representatives.

It is important to establish principles of policy provision which will be accountable in the Oireachtas. To give an example, universality of access is a principle on which we, as politicians, can differ. There are those who argue, in a dangerous manner, that one can provide for health based on market principles and that the ethos of competition will deliver a service for something as basic as health. I profoundly disagree with this view. Health policy must be structured in accordance with the theory and practice of citizenship. This requires building a model not on notions of co-location, which we have discussed elsewhere, but on principles of universality, namely, that which is required to meet need.

It is interesting that the Taoiseach uses aggregate sums when replying to questions on this matter. The Government amendment lists gross figures for expenditure, which does not answer a single question. It is unhelpful to provide units of cost rather than need because planning in health must entail planning in accordance with need and performance must be measured in terms of how need is addressed.

I have no difficulty in acknowledging the performance of medical practitioners in difficult circumstances. In 2005, I spent a number of weeks in Merlin Park Hospital having been operated on by an excellent team working in a building constructed in 1951. Although it was possible and necessary to modify this building, I later learned that the Health Service Executive failed to spend its full capital budget when it could have enhanced the capacity of health service staff to perform to an excellent standard.

The motion notes that a 24-bed specialist unit for elderly people — unit 4 — at Merlin Park Hospital faces closure. Unit 4 has a small gymnasium and patients are provided services in a single, compact space. Staff are trained in the use of certain types of equipment, assisting people in ambience and so forth. The unit's services and staff will now be scattered across the entire hospital. The public relations people tell us that a new, specialist unit will emerge by 2012. It does not make sense that a body which failed to spend its capital budget can close down a service that is meeting immediate needs on the basis of a nebulous commitment to provide a replacement service at some point in the future.

With regard to the guff about the national treatment purchase fund, performance in this area is uneven. Certain consultants, as their receptionists have informed me, have waiting lists of three and four years which act as a barrier to access to the NTPF. That is a health policy matter. Unfortunately, Deputies no longer receive replies in the House when they ask questions on any health policy issue. Their parliamentary questions are fobbed off to the HSE's parliamentary affairs division. I no longer bother about names and titles because staff and their titles frequently change. When we gather at 8.30 a.m. meetings we are told that the problem lies with Members, that we, the elected representatives, are obtuse and that a new public relations initiative is needed to convince us that the HSE's performance is good rather than poor.

Capital expenditure has proceeded in some areas even though approval for staffing the facilities in question has been withheld. In Indreabhán i gContae na Gaillimhe, beidh eolas ag an Aire Stáit faoin gcaoi go bhfuil an t-airgead ar fáil ach níor tugadh cead na daoine a fhostú. It is interesting to note how we have arrived at the current position of the HSE being told it must live within its budget. It would be useful to examine how the current overrun in the executive's budget occurred. Although the cap on the public service side was instituted, those in charge would freely admit that they have been able to exceed budgets and overspend on privatised services. For example, with regard to the 80 or 120 home care packages in Galway city and county — the figure depends on how the calculation is made — it was possible to exceed the budget if one purchased these services from private providers. Across the entire system of the HSE, privatisation by stealth generated the current overspend. However, in responding to the current circumstances, no attempt is made at analysing how the overspend occurred. The people paying the price for the overspend are those who need the services, those who should be appointed and those who undertook training to meet skill shortages. Be it in respect of home help, home care packages and so on, we must analyse the reason for so much unscrutinised spending in the privatised section.

May I share time with Deputies O'Hanlon, Finneran, Conlon and O'Rourke?

Is that agreed? Agreed.

I welcome the opportunity to discuss health matters for a second week. Notwithstanding a number of comments, it is important to put matters in context. Gross expenditure should be discussed despite the belief of some to the contrary. Many years ago, we underspent on health relative to other countries, but we spend approximately 8.9% of GNP currently. This is on a par with the OECD, comprising the world's 30 richest countries. Some 11% of our population is over 65 years of age whereas the relevant figure for OECD countries is 17%. On a purchasing power parity basis and factoring in inflation, the cost of living and so on, we spend $2,596per capita compared to an OECD average of $2,500. These facts are not unimportant. Some 80% of Ireland’s overall health spending comes from the public purse while the remainder is private funding. Across the OECD, the ratio is approximately 75:25. Our public spending increased from 78% three years ago.

Much is said about privatised medicine. The challenge for the public health care system is to supply services to patients in need. When we discuss waiting lists, we never refer to how 100,000 might be waiting for buses on any given day because the length of time people wait for treatment is the issue, not how many are waiting. The waiting period in respect of 17 of the top 20 procedures has decreased from two to five years to two to five months. Some 17,000 of those in question have been on the list for fewer than three months. We will never reach a stage where the hospital or service provider is waiting for people to appear, as it will be the other way around. In every health care system, there will always be a list of appointments for people seeking treatment. It is an issue of waiting periods, not of being on waiting lists.

Last Friday, Lansdowne Marketing, which is acknowledged as a reputable company in this field, and the public health institute at UCD published the findings of the independent research they carried out on those who had accessed the system rather than the wider population, as the latter gets its impression from the media or what is reported from the House. If we want to listen to those who have used the service, I will cite a number of statistics. Some 76% of inpatients were seen within a month, 11% were seen within three months, 4% were seen within six months and 4% waited longer than six months. This is a significant improvement on the situation a decade ago. In the past year, some 64% of our citizens saw their general practitioners on the day they sought the service, which is not the case in many countries. I could continue with more data. Those who use our hospital, community and GP services report high levels of satisfaction.

If they can get them.

Including the good or very good category, the satisfaction level is more than 90%. It is a positive reflection on the public health care system.

Deputy Higgins referred to accessibility. Until the early 1990s, there was no universality. The VHI was established 50 years ago because 20% of the population were not entitled to hospital services, but everyone has that entitlement today. I am a strong fan of maintaining this position. A hallmark of the new contract of employment for consultants will be access to diagnostics in public hospitals for every citizen on the basis of medical need rather than preference due to health insurance or the ability to pay.

Situations such as the Rosie case, which came to light last year, cannot be allowed. She was told by consultants that she could have her procedure immediately if she had insurance or else be put on a list. She waited six months. Access to publicly funding facilities should only be provided on the basis of medical need rather than a preference for one group over another. This is a fundamental principle in the ongoing negotiations between the Government, the management of the HSE and the consultant bodies. Were we to abandon some of our principles, we could have reached an agreement long ago.

Regarding the co-location of private hospitals, neither I nor the majority of taxpayers and patients care how services are funded. They want excellent services when required and as close as possible to where they live. GP services are a public private partnership of a kind in that the GP sees GMS and private patients without distinction. None of the people in a GP's waiting room knows who has a medical card. I support this system strongly because it works well. Moving more services from hospitals to the primary, community and continuing care sector is a strong feature of future policy.

Many public hospitals are hives of private enterprise. I do not understand why there was a hullabaloo when the previous Government sought to convert private beds funded by the taxpayer into public beds to which all patients have equal access. For many years, 20% of all public hospital beds have been ring-fenced for private patients while the taxpayer paid for the beds' running and capital costs, staff and diagnostics. Why should this be the case? We want to convert the beds for public use and have private beds co-located with public beds so that doctors are on site. Fine Gael has a problem in that regard. While it does not have an objection to private beds, it does not want them on site. Apparently, putting them five miles away is fine.

Concerning the measures taken by the HSE, every organisation, be it a sports club, political party or trade union, has an annual budget within which its management is expected to live. On a monthly basis, the board of the HSE monitors its budget and sends a report to the Government. It is a challenge for the HSE to live within its budget because there is always a large demand for services, but I do not understand the dire consequences predicted by some. Reference was made to the case of an anaesthetist going on holiday from Cavan General Hospital. There are eight consultant anaesthetists and ten registrars in Cavan General Hospital and Monaghan General Hospital. Compared to hospitals elsewhere, this is a considerable resource. I do not know why a team of 18 cannot organise its work in such a way as to prevent the predictions broadcast this morning.

Regarding the 30 nurses at Sligo General Hospital, it has a nurse to bed ratio of 1.8:1 whereas Waterford Regional Hospital has 1.3 nurses per bed. The latter can operate on half a nurse less per bed than the former. Is it acceptable that a hospital with 1.8 nurses per bed can predict such dire consequences when informed that the 30 nursing positions used to cover holiday periods will no longer be available?

Reference was made to consultants earlier in the debate. One locum consultant was appointed to facilitate a consultant to attend the Medical Council. I was not aware until I became Minister for Health and Children that if a consultant is appointed to a body, a locum is appointed to replace him or her in clinical practice. It is a recent development. Another consultant retired and while his replacement was taking up his position, there was a transition period during which a locum was in place. The two locums in question are, therefore, surplus to requirements. I do not understand why we hear the things we do when we seek to point that out.

I heard a doctor speak this morning about 62 beds and 150 procedures per month in Galway, which represents an incredible ratio of beds to procedures. I told the House last week that when Professor Keane was appointed to oversee the reform of cancer services in British Columbia, he had ten inpatient beds for radiotherapy for a population of 4.1 million. There are 179 inpatient beds in this city for a similar population. Professor Keane could do with ten beds in British Columbia what we have 179 beds to do despite the very dispersed population in that part of Canada. Professor Keane made the point that improving services is all about re-organising how things are done.

I made the point to the House last week that the most expensive bed is a hospital bed. Unless a patient needs to be in a hospital bed, alternative hostel-type accommodation must be used as it is everywhere in the world. If we could get all Irish hospitals to perform to the standard of the best hospital in the country, we would greatly reduce the burden we face. If we could get close to the performance in Canada, where twice as many day procedures are performed, it would have an incredible impact on our acute hospital system. If we could go further and introduce best practice in respect of in-hospital stays for basic procedures, we would greatly improve the performance of our hospitals. In Ireland, a simple procedure like an appendectomy can require from three to six and a half days hospitalisation. Many patients are in hospital over weekends when very little tends to happen. We must reform hospitals and acute hospitals in line with best practice in other European countries.

As part of the settlement with the nurses unions in May 2007, we agreed that 2.9 million hours per annum should be taken out of public nursing hours before June. Nurses would reduce their working week from 39 hours to 37.5 hours on a cost-neutral basis and without any diminution of services. If the failure to replace 200 to 300 staff each month to what I acknowledge will probably be the end of the year is to have the kind of consequences of which we are now hearing, I pose the question of whether we have the capacity to take 2.9 million hours out of the public health care system between now and June. I have yet to hear a nurse, doctor or other health care worker from the private health system complain about how awful the service is.

The Minister is not listening.

I have certainly never heard them on the public airwaves saying how terrible it is. We hear such complaints frequently about the public health care system. It is a great pity as we can sometimes undermine confidence in our own system. We have a health care system of which we can generally be very proud. While there are gaps and deficiencies, the challenge of health care reform is to put them right and create a world-class service.

It is important to note on the HSE that for many years we failed as politicians to effect the changes which are normal practice in many other countries. I include myself having been a Member of the Oireachtas for 30 years. We do very poorly in cancer outcomes compared with other European countries, mainly as a result of the fragmentation of services.

The only area of cancer treatment in which we compare favourably is paediatric cancer treatment. The reason we do as well as the best countries in Europe in treating paediatric cancer is that treatment is centrally planned despite being delivered in 16 hospitals nationally. We intend to introduce a similar system to treat adult cancers. We will establish eight cancer centres for surgery. It is not safe for a general surgeon to treat breast cancer. All the evidence nationally and internationally suggests that if a unit does not treat 150 new cases annually, the outcomes are poor. If a surgeon carries out many other types of surgery as well, it greatly reduces the potential for a positive outcome. It is for this reason, the cancer strategy focused on the creation of centres of excellence. Given the choice, a patient will put quality services before geography. If one has a sick child, one will drive anywhere to have him or her treated. We would do the same for ourselves given the option. As most people will acknowledge, it is not possible to have standards of excellence for cancer treatment duplicated in every hospital. Experts are few and far between and we must ensure they work together to facilitate triple assessments and other systems.

Earlier in this debate, Deputy Reilly asked about the 13 centres which are to cease to treat breast cancer. Of these, the three at Cavan, Navan and Roscommon have already ceased to operate. A number of others at Loughlinstown, Naas and Tullamore carried out only one procedure annually and none carried out more than 15 in a given year. The HSE has made provision for patients to be treated for symptomatic breast cancer in the centres of excellence. A great many attacks have been made on the HSE by the Opposition and from this side.

By Government Ministers.

They have attacked from west Galway.

All of the reports which pre-empted health reform, including the Brennan and Prospectus reports, concluded that our system was too fragmented. Greater clarity and accountability was required. Given our small population, only a single organisation is capable of delivering the world-class service to which every Member aspires.

I thank Deputy Finneran for sharing his time. It is important for the people I represent to have the highest level and quality of medical care for any illness from which they may suffer which equates to the level of service provided anywhere else nationally. I recognise the Minister's argument that the necessary level of service cannot always be delivered by the smaller hospitals and that people must travel to receive certain forms of treatment.

Significant changes have taken place over a number of years in the delivery of day-care services and primary care and these have given rise to concern at a number of hospitals including Monaghan General Hospital in my constituency. Monaghan General Hospital provides a very good medical service which is comparable with services available elsewhere and it should continue to be provided there. Day cases in surgery at the hospital are being dealt with very efficiently as are many others. While a new regional hospital is to be provided, it is imperative that existing services continue to be provided in Monaghan. We should be considering opportunities for the development of further services up to the time the regional hospital is provided. A good example is the development of the ear, nose and throat service at Monaghan under the HSE transformation programme.

Adversarial politics does not always serve the best interests of people who are ill. To exaggerate circumstances and provide misleading information frightens patients. I would like those who are constantly critical to look more objectively at the true circumstances and consider how they can contribute to the actions necessary to ensure that everyone has equal access to state-of-the-art health care having regard to developments over the past 25 years.

I am pleased to have an opportunity to speak and compliment the Minister on a clearly focused determination to provide a world-class health service with the help of the HSE. By any standard, things have moved on dramatically. The figures provided by the Minister in this debate are a clear contradiction of the fraudulent figures provided by the Opposition over the past couple of days.

They were provided by the HSE. The Deputy should not mention fraud.

That side knows a lot about fraud.

I am glad the Minister was able to put them on the record tonight so the Irish public can know the exact situation.

The Opposition has played a political game on the issue of private beds and hospital co-location. Everybody knows it is inappropriate for people to have the use of public funds and private beds in public hospitals at the expense of ordinary taxpayers. Somebody had to address the matter and I am glad that the Minister, Deputy Harney, was the person to do so.

With regard to my own patch, I have heard it said that cancer services ceased in Roscommon County Hospital within the past few days. In fact, cancer services were taken away from the hospital more than one and a half years ago. Clearly, people only woke up to that recently.

Was that the Government?

The Minister complimented the staff on the decision and their co-operation with the HSE. It was in the best interest of patients because we no longer had a surgeon who was competent in the area and I do not think the women of County Roscommon would want procedures carried out if they felt those responsible were not competent. In response to the BreastCheck situation, the mobile unit put in place by the Minister since the end of last April has screened 1,300 women from County Roscommon. I have been told the unit will remain until the end of January, at which time everybody in the relevant category will have been screened.

It remains vital to provide 24-hour accident and emergency services in the area. That became even more apparent several nights ago, when a serious car crash occurred outside Roscommon town. Lives were saved as a result of what happened there. We should remember the part that geography plays and I hope the HSE will remember it is not easy to travel 80 miles across a rural area at night. It may take an ambulance 20 minutes to cross a city but it is a different story if one is travelling from Arigna mountains or Roosky.

I am glad to have had the opportunity of making my contribution and I commend the Minister on the fine work she is doing.

Health care provision is an emotive issue. No one disputes that we all want the best health care for our families, our friends and ourselves. That is why I welcome the opportunity to speak on an extremely important issue to me and to the people of counties Cavan and Monaghan. It is appropriate this should be my maiden speech in Dáil Eireann. It is vital this debate deals with the facts because there is no room for myths, presumptions or scaremongering.

For too long in County Monaghan, we have listened to negative spin which can and does dent patients' confidence in using the service. This Government remains committed to providing the best possible acute care to people living in the north east and providing the people of County Monaghan and the north east with the most modern, integrated, safe and patient-focused service ever devised in this country. That service will take at least five to seven years to become fully up and running and will be based around a regional hospital, with Monaghan and other local hospitals and community services providing the majority of health needs locally. International evidence confirms that the more frequently a surgeon performs specialised operations, the more successful the outcome for the patient. If I were having an operation on my gall bladder, I would rather be operated on by a surgeon doing ten procedures each week as opposed to ten each month.

The new integrated health services will be designed around clinical needs, offer better access to specialist services, provide more day care services, which are less invasive and mean less time spent in hospital, have the most up to date technology and equipment, provide improved critical care and have a better working environment for staff, which is important. Central to this new integrated health service is the development of primary care teams across County Monaghan and the north east. Each team will include GPs, nursing staff and other therapists who work together to provide a comprehensive community health service to local communities.

The Government and the HSE have given a clear commitment that as health services in the region are developed, existing services will remain in place until they are replaced with higher quality, safer or more appropriate services. The health service is undergoing the biggest period of investment and reform since the foundation of the State. Monaghan hospital is also undergoing a major period of change, as are other hospitals. However, it will continue to meet the majority of the people's health needs. The regional hospital will provide emergency and trauma services on a 24-hour basis. It will also provide planned specialist procedures which are complex and require the facilities of a large regional hospital. The reality is that due to technological advancements, many procedures which would have required a long stay in hospitals can now be carried out as day procedures, which means patients can receive care in the appropriate setting.

Last night, the Opposition spokesperson on health, Deputy Reilly, referred to the stripping of services at the hospital. Perhaps it was not the Deputy's intention to mislead the house but I would like to clarify the situation nonetheless. This month, Monaghan hospital will open two new state-of-the-art medical wards catering for 50 patients at a cost of €5 million. This investment will allow the hospital to carry out a range of medical and day procedures for the people of County Monaghan. The beds to which Deputy Reilly referred were always surgical beds and were moved to Cavan General Hospital along with the surgical procedures and consultants. These beds were used as medical overflow beds and Monaghan hospital was never told it could increase the commissioning of medical beds. There are now 56 beds, including six additional high care beds. I realise the HSE and patients are facing significant challenges. However, it is important to highlight progress when it is being made. Contrary to local media and Opposition reports, ear, nose and throat services have not been discontinued and there is a proposal to expand these services in conjunction with Northern Ireland. Proposals have also been made to expand urology diagnostics and day procedures and to completely refurbish a dedicated day care services unit on the first floor of Monaghan Hospital. Waiting times for operations in counties Cavan and Monaghan have been dramatically reduced to three months or less, unless by choice or due to a medical condition.

I reaffirm my commitment to Monaghan Hospital. I will continue to fight to ensure appropriate services and to remain confident that any member of my family can avail of high quality services.

Deputy O'Rourke has two and a half minutes left.

I started with five minutes but pirates are everywhere. I congratulate Deputy Conlon on her maiden speech.

I wish her many happy years of representing her constituency.

When the Minister was away from the House last week, I described her as a mighty woman. She should not let them get her down. There lie dragons everywhere, whether in the HSE or elsewhere.

Senator Cassidy knows that.

She can rely on good servants in the Department of Health and Children and good friends. We would all agree that expenditure must be kept within limits but I ask why it went so far before anybody seemed to cop on. Why did nobody ask about galloping expenditure or shout "halt" some months ago? It is somewhat odd.

It is because there was an election.

That was some time ago. The HSE is growing into a massive monolith. It reminds me of Topsy inUncle Tom’s Cabin, who kept growing. I do not know how it is going to be put in shape or curbed.

I welcome the cancer care strategy because it is proper to have centres of excellence. Who would not want to visit such a centre rather than not know the outcome of a treatment? I hope the Hanly report will finally be introduced against a background of common sense. In addition to there being no hospital, the Health Service Executive is to close the death notification office in Athlone within three weeks. I spoke to the registrar in Roscommon today.

It is moving to the Department of Social and Family Affairs.

The registrar said Athlone must be like Edenderry and Birr. They are lovely towns but they are certainly not like Athlone. Poor people tend to prefer to go into their own town to register deaths and they have been told they cannot do so from 5 November because the HSE has instituted this remarkable decision. While I have the Minister for Health and Children, Deputy Mary Harney, captive in the House I ask her to attend to this as it should not be allowed to happen. I wish the Minister well in her endeavours and she may act puzzled if she so wishes but I phoned today and I was told that this would go ahead regardless of what I say before the House. I hope that common sense will prevail.

I wish to share time with Deputies Durkan, Connaughton, McCormack, Ring, Burke and Tom Hayes.

They will barely get two and a half minutes each.

They are lining up.

I wish to deal with the final issue Fine Gael raised and that is the cancellation of essential suicide prevention training for applied suicide intervention training skills. I am disappointed the Minister of State at the Department of Health and Children, Deputy Jimmy Devins, has just left the Chamber because his first act was the cancellation of ASIST suicide prevention training throughout the country as a cost saving measure.

He is listening to the Deputy's contribution.

This sets the tone for the continued neglect by the Government of its commitment to the implementation of the recommendations of Reach Out: A National Strategy for Action on Suicide Prevention. The strategy was published in 2005 and was endorsed by the Taoiseach, Deputy Bertie Ahern, and his Government.

The strategy sought "to deliver on a partnership basis a national training programme for volunteers and staff of voluntary and community groups involved in mental health promotion and suicide prevention". Investment in suicide research and prevention is a continuing disgrace that borders on political immorality. The skills-based community training initiative known as ASIST, which stands for applied suicide intervention skills training, is a two-day skill based workshop that helps prepare individuals of all backgrounds to provide emergency aid and make life-assisting interventions for persons at risk of suicide. The aim of the programme is to enhance the ability to promote the immediate safety of a person at risk of suicide and provide links to further help. Training has been offered to multi-disciplinary and multi-agency personnel throughout the State by suicide resource officers. ASIST prepares care givers of all kinds to provide suicide first aid intervention. Professional volunteers and informal helpers need to know how to help a person with thoughts of suicide in a way that increases suicide safety and to discontinue many such programmes is unacceptable. The Minister should be ashamed of closing these workshops as a cost cutting measure.

The ASIST programme trains the intervention care giver to identify people who have thoughts of suicide, understand how their beliefs and attitudes can affect suicide interventions, seek a shared understanding of the reasons for thoughts of suicide and reasons for living, review the current risk and development plan to increase safety from suicidal behaviour for an agreed amount of time and follow up on all safety commitments while assessing the further help needed.

The people who usually attend these programmes are the bereaved of suicide victims, teachers, parents, gardaí, citizens' information personnel, addiction counsellors and representatives of sporting organisations such as the Gaelic Athletic Association, GAA, Irish Rugby Football Union, IRFU, and Football Association of Ireland, FAI, as well as other organisations. The programmes are also attended by members of the public interested in playing a role in reducing suicide. Up to 40 of these programmes have been cancelled and the preparation work of suicide resource officers over the summer has been frustrated. Some suicide resource officers have been able to obtain community halls free of charge but they are often unsuitable as no facilities are available for people on an intensive two-day course that covers a very delicate subject.

People who volunteer to play a role in reducing suicide should be treated decently and have the chance to obtain a meal or tea, coffee and refreshments. It is very disturbing that when people become upset, as they do when addressing this delicate issue, there is no place in a cold hall to comfort them or offer a cup of coffee. This is no way to treat the trainers who introduce the ASIST programme or the volunteers that seek to reduce suicide in their communities.

To abandon these programmes and force the situation as the Minister of State has done in one of his first acts is a disgrace. The Minister of State should revisit this matter.

Anything I say should not be taken as a personal criticism of the Minister for Health and Children, Deputy Mary Harney, but I strongly disagree with one remark she made. The Minister said people will drive a sick child almost anywhere to obtain treatment but that is not true. People with a child in need of urgent treatment will drive to the nearest hospital wherever it may be. Until the people on the other side of the House, who control these services, recognise this fact they are wasting their time.

We heard this sort of rubbish on countless occasions with regard to the location of the new children's hospital and one of its selling points was that it is on the Luas route and had train services nearby. Nobody brings a child to hospital in an emergency by train, bus or other forms of public transport. In the middle of the night, countless parents are forced to take their children to hospital and in such an emergency they will always choose the nearest hospital available.

In past times, when many hospitals were available around this city, doctors would refer a patient to one hospital, then another and another until he or she found one that could cater for his or her patient. This facility is gone because of economics; it is deemed more efficient to cut back and remove hospitals. This idea of big is beautiful was adopted in the UK and it failed. Big is only beautiful if a selection of alternative services is available and competition exists.

I disagreed with the Minister long ago about the idea of one health board for the entire country and it still will not and cannot work. She may compare ours to any jurisdiction she wishes but the idea will simply never work. Instead the HSE will be subdivided into mini regions with various people fighting turf wars within the system. There is no accountability because although we can put questions to the Minister in the House, she can no longer answer for the health service. Instead when we put a question we receive a reply, sometimes curt, a week later merely stating that it is a matter for the Health Service Executive. The HSE seems not to understand why we ask such questions but we have a right to do so because the public demands to know.

The HSE is a department built on reports — the Minister's predecessor introduced the ten year strategy some years ago, then came the Hanly report and the Brennan report. How many other reports will there be before action is taken? This situation has emerged because the needs of the patient are not central to the health service; no reference is made to the convenience of the patient. Does anyone consider how painful it is to wait three, four or five months for a hip operation? Countless people in my constituency and others are in that situation, although the scoping reports do not seem to pick up on them. In the recent general election we met many such people but we received some fairly curt replies from the HSE when we raised their questions. I want to make it clear that it is a Deputy's job to raise questions in this House when a constituent has raised it with him or her. We have a right to accurate answers.

I believe the health service is best served by an available, accessible, accountable modern and efficient network around the country, but this does not seem to be the direction the Minister is taking. Instead the Minister seems to be applying plasters to the service's wounds. Naas General Hospital was mentioned as the most modern hospital around with its state-of-the-art, clean air theatres. Why are they not being fully utilised and for whose convenience are they being kept empty? It is certainly not for the convenience of the patients as they are ready for treatment.

Why is it necessary to have waiting lists? Is it not as easy to simply perform an operation straight away, within a week of referral? It is surely as easy in the first week as it is six months later. If a procedure must be undergone in any event, what is the benefit of keeping a patient waiting? I compare the waiting time here to the experience I heard some time ago of a patient undergoing a procedure in another jurisdiction. The patient had an X-ray, received the result of the X-ray within two hours and was then referred for the procedure. A person might have to wait three months, six months or even a year to undergo tests here. The issues speak for themselves. We need to get back to basics and deal with patients' needs as opposed to providing for the convenience of an internal system.

I listened to the Taoiseach today when he was trying to explain what has gone wrong with the health service. Many of the matters of which he spoke are not the services that I have grown to accept in the part of the world from which I come, but that is not the message I want to get across.

Many aspects of the health service are extraordinarily wrong but they are not highlighted as they should be. I speak about an area of the country that the Minister knows well. I refer to the services centred in the Ballinasloe health centre. Does the Minister realise that almost 2,000 children throughout the country have been denied ophthalmic services? The Ballinasloe health centre serves an area stretching from Creggs on the Roscommon border to Derrybrien near Gort. The consultant in this area retired a number of years ago and was never replaced. In addition, there is no area medical officer. The person who held that position has gone on to greater things and was not replaced.

I wish to refer to the provision of audiology and orthodontic services for children in schools. The Minister will be aware that under the Health Act a guarantee was given to every child under 16 years of age, irrespective of his or her parents' incomes, that he or she would be looked after at school level in terms of the provision of those services. That did not happen and it is not happening. That is nothing short of a disgrace.

I have often heard the Minister and Professor Brendan Drumm talk about the necessity to ensure that treatments are available at the earliest possible time and I agree. Will the Minister agree that it is important for a child with an eyesight problem to have it rectified when he or she is a child? One can imagine the problems a child would face in later years if he or she did not receive treatment? These services are not being provided in the Ballinasloe health centre. It is a disgrace that the failure to do so is silently being brushed under the carpet.

The Minister spoke of what has happened in terms of cancer care services and I do not have time to address that in regard to Ballinasloe. We all know what is happening. Unfortunately for the people of Ballinasloe, the cancer care services in place are being removed for the reasons outlined by the Minister. Everybody in the area is talking about the centre of excellence in Galway. That is an excellent centre but when I tried to visit a patient there last Monday I could not get in because there was a traffic jam for half a mile around the centre.

The Minister needs to open a private hospital.

One can imagine what will happen when services are concentrated in the one hospital if proper access is not provided. That is an issue of which the Minister should take notice.

Another major issue is that of old people's homes. I refer to what were known as geriatric homes. I understand there was talk in Galway city and county in recent days, about which I assume we will hear more tonight, about unit 4 in Merlin Park Regional Hospital. I have been advised that four beds have been available in the main sector of St. Brendan's in Loughrea that were not used for the past month. I have heard many times in the Dáil of the long waiting lists. Where are the people who sought access to that service? What is happening in regard to that service? I am glad the Minister is present to hear what I have to say.

The purpose of this Fine Gael motion is to highlight the serious situation that has arisen in the health sector as a result of Government cutbacks and the embargo on the recruitment of staff. I wish to put some questions to the Minister for Health and Children, Deputy Harney. How can she and the Taoiseach, who spoke on this issue in the House this morning, say that cutbacks are not having any effect on the health service? How can they say that closing 24 beds in unit 4 in Merlin Park Regional Hospital will have no effect on the health of elderly patients who are all aged over 65? Some of these patients are in their 70s and 80s, and one is aged over 90. This unit was a highly specialised one, catering for the elderly with specialised facilities and the necessary support. The patients will now be dispersed to various wards which are already understaffed and that will naturally have a serious effect of them.

I understand that hospital 2, Merlin Park, which has over 20 orthopaedic beds in a rehabilitation unit, is also threatened with closure. I read this as a deliberate attempt to run down Merlin Park Hospital, perhaps with a view to selling off some of the land, as was promoted a few years ago but resisted by myself and the people of Galway.

How can the Minister say that the Government cutbacks will have no effect when the service for breast cancer patients has been cut from five to two days at University College Hospital, Galway? How can the Minister and the Taoiseach say that patient services will not be affected when 40,000 people are on waiting lists for hospital treatment and thousands of people, the number of whom are unknown, are waiting for appointments to get on waiting lists. Currently, 12,000 adults are more than six months on waiting lists and 2,200 children are more than three months on waiting lists, all this despite promises before the general election that no one would be more than three months on a waiting list.

I will confine my questions to examples of how the cutbacks and embargoes are affecting services for elderly people in Galway, but these examples apply to any part of the country. I will give the Minister one more example of how people are suffering and I would like an answer in response. I dealt with a case recently of a man in County Galway who is looking after his mother in her own home. This woman is in her 80s. He had the benefit of a home help service for eight hours per week. One of the home helpers retired so his service was cut to four hours per week. Despite my best efforts and unbeknown to HSE personnel dealing with this case, I was told last week that a home help could not be recruited and that the woman need not bother coming in for an interview because there was an embargo on the recruitment of staff. This elderly woman may now have to go into residential care, all for the saving of €40 or €50 per week. The members of the Government should be ashamed of themselves. How can I explain to this man that a saving of €40 or €50 a week is denying him four hours per week of home help to enable him care for his mother?

The Taoiseach said this morning that the expenditure in the HSE must be cut back. How can the HSE book a hotel for interviews for middle management staff and interview 200 applicants when it cannot interview one person to provide a home help service for four hours per week? I am sure the Minister does not have a answer to that.

How can the Minister justify this situation when the Government has wasted so much taxpayers' money? The Taoiseach said we must save money. We wasted €50 million on e-voting machines over the past four years and it costs us €700,000 a year to store them. How could the Department of Health and Children spend €150 million in 2005 on the PPARS computer system, which was estimated to cost €8.8 million but ended up costing €150 million before the project was suspended? How can the Taoiseach spend €600,000 per year on special advisers? Is it true that they are hired to write positive spin for the Taoiseach every Sunday in theSunday Independent?

How do I explain to the man who is seeking a home help for four hours a week to care for his mother that the Taoiseach spends €12,000 a year on make-up? Can the Minister answer that question when this man cannot get a home help for four hours a week to care for his mother in his home rather than send her into institutional care? The members of the Government ought to be ashamed of themselves.

I wish to ask the Minister a straightforward question. How can we pay Professor Drumm a bonus of €80,000 when the health service is in disarray? The only other person who received an award such as that was Eddie O'Sullivan when he got his contract before the team played in the Rugby World Cup. How can we pay a man a bonus of €80,000 when the health service is in disarray? I want the Minister to answer that question when she responds. It is a disgrace. I would pay the man €2 million a year if he got it right, but he has not got it right.

I visited a man the other day who was very sick. When the doctor told him he had to go to hospital, he cried and pleaded with his son and daughter not to send him. He said if they sent him into hospital, he would come out with MRSA or might not come out at all. Is it not a disgrace that people are afraid to go into hospital because of MRSA and that we cannot even get the matter of basic cleanliness right? Is it not a disgrace that some people go into hospital and come out worse than they went in with MRSA? Something must be done to improve our health service.

I agree some people who get a hospital bed are happy they have got a good service. However, other people are waiting for hip operations, cancer treatment and back operations. It is not right they must wait. Most of these people waiting for operations are elderly and have paid their taxes to the State. The Taoiseach and the Minister tell us daily the Government has never put as much money into the health service. If we have never put as much money into it, why is it in such disarray? Why are so many people pleading with us politicians in an effort to get beds or appointments in hospitals in Dublin and their own towns and cities? The situation is disgraceful and something must be done to deal with it once and for all.

The Minister for Health and Children has talked about centres of excellence for each region, yet currently we cannot get people to hospital appointments, particularly people from areas like north, south and east Mayo. They need to travel distances of 70, 80 or 150 miles but they cannot get to their appointments because the HSE will not transport sick people to them. This is a disgrace when such a small budget is required for it.

I visited the HSE the other day and saw a jeep parked outside. The jeep is equipped for the man in charge with a mobile phone and every kind of equipment he could need. There is even a place for him to rest if he gets tired travelling from Mayo to Castlebar or Roscommon to visit the ambulance service. We have too many bosses, but not enough doctors and nurses. We do not have enough people dealing with those who are sick.

I attended a meeting the other day where I heard every excuse as to why the HSE could not bring patients to hospital appointments. What would it take to bring them? In the context of the overall budget of the HSE it would not cost €1 million to bring them to their appointments. The other day I referred the case of a woman who has not been able to take up her appointment with Merlin Park Hospital for 12 months to the Ombudsman. I hope his office will act on the matter because there is no point in referring it the Minister because she would transfer it to the HSE which could take up to six months to reply, by which time the woman may be dead.

The Minister mentioned earlier that when she heard on "Morning Ireland" this morning that 150 orthopaedic procedures were carried out in two units of Merlin Park Hospital she thought it was incredible.

I said the bed rate to procedures was very high.

The Minister was selective in what she said, or else she does not understand what is happening on the ground. The reality is that the HSE, under the Minister's jurisdiction, proposes to close 27 of the 62 beds available that allow that incredible number of procedures to be carried out per month in Merlin Park Hospital. The Minister is presiding over that proposal. We welcome her issue of the report of the number of procedures done, but the reality is she proposes to cut that number.

The Minister's amendment to the motion states there is associated expansion in the area of step-down beds in the HSE. The Minister visited St. Brendan's Hospital in Loughrea recently, before the election, and declared she would provide ——

I visited it two years ago.

More recently.

Well, the Deputy's former leader visited it and uttered the Minister's words in her absence.

Was he in drag?

The situation then was that a 40-bed unit would be provided. However, in the past two years since Deputy Harney's visit, the hospital has gone from 187 beds to 72 beds for the elderly in this public hospital in County Galway. The only stroke unit we have in the west of Ireland, in Merlin Park Hospital, is now also under threat despite the great attention of the medical personnel there who developed it into an important unit from nothing through their own endeavour. Now the Minister, over the HSE, has decided to disband the unit and it will take years to redevelop the facility.

Deputy Pádraic McCormack mentioned the home help service. The Minister has no idea of what is happening on the ground in this regard. I will tell her. If someone in the west phones the HSE and informs it for example that someone aged 93 or over has come out of hospital and needs home help to be provided, the response will be "No" because the HSE cannot employ any more home helps. It may be able to give the person one hour's help if it takes that hour from somebody else or it will offer €200 for the person to employ someone, but they must provide PRSI and all other tax details on the person they employ. A person of 93 years should not have to deal with such details to avail of the €200 for such help, but that is the reality of the service over which the Minister presides. Is it any wonder the Minister's colleague says dealing with the HSE is infuriating? He knows about it and I presume he was trying to do something for his constituency when he found it so infuriating.

Furthermore, the Minister is removing funding from Portiuncula Hospital's breast cancer services and bringing it to the centre of excellence which cannot do the procedures done in Portiuncula. That is what the Minister is doing. The HSE is disintegrating in front of her eyes, but she is doing nothing about it.

I congratulate my county colleague, Deputy Hoctor, Minister of State at the Department of Health and Children, and wish her the best of luck on her new appointment.

I welcome the opportunity to speak on this crucial issue at this time of crisis in the health service. Where should one start in convincing the Government of the seriousness of this issue? Just a few months ago the Government promised the health services would develop and be fully supported over the coming years, but these empty promises have been broken. In the past few weeks we have seen a recruitment freeze and the closing down of spending by the HSE. Despite questions on behalf of constituents, the Opposition is still in the dark about how long this will continue——

It will go on for the rest of the year.

——and how it will impact on local services. It has already had a significant impact in south Tipperary over the past three weeks, particularly in the hospital in Clonmel which has seen the closure of one operating theatre and six surgical beds. There has also been a reduction in operations and elective procedures and a restriction on day cases to essential day case gynaecological procedures only. These changes have been brought about after only three weeks of a so-called temporary freeze which the Minister has tried to convince us would not compromise patient care.

I urge the Minister to listen to what we are saying and inform us how increased pressure on already short-staffed wards does not impact on patient care. How does the cancellation of psychological services, physiotherapy, respite care and home help services for patients with debilitating neurological disorders not adversely affect patient care? How does cancelling dental treatment for children in Dublin not adversely affect patient care? What level of care is the Minister using to assess patient care when she makes that statement?

The Minister should leave the nurses alone and tackle management. That is where we have failed in every debate since we started discussing health services. In the old health boards and in the present structure, we have failed to tackle mismanagement in the health service, and I beg the Minister to do something constructive about that.

The Government's motion is based on a recognition of the continued increase in funding for health services over each year of the last decade and the associated expansion of a wide range of frontline services and the high satisfaction levels with frontline health services shown in Insight 07, the most comprehensive, objective survey of public opinion on health services which was published last week. The Government motion also reaffirms the statutory requirement that the executive should manage its budget within the Vote approved by Dáil Éireann and acknowledges that the executive has taken measures to ensure that it meets this objective in 2007 by means of its break-even plan; and that it is the intention of the executive that these measures will not impact on planned frontline services, which will be maintained in line with the national service plan, and that provision is being made that where critical or essential vacancies arise, they may be filled by redeployment of existing staff.

As the Minister of State, Deputy Devins, noted in his contribution last evening, there are some very positive aspects of our current health service which are worth reiterating. Life expectancy in Ireland has increased steeply since 1999 and the 2005 figures show that life expectancy at birth is 79.59, an increase of 3.5 years. As a result our life expectancy is now considerably higher than the new EU27 average.

It is also important to acknowledge some of the key results of Insight 07, the recent customer service satisfaction survey undertaken by the HSE. Of particular note are the overall ratings with regard to quality of care, where 64% of inpatients, 58% of outpatients, 84% of GP patients and 76% of other community services rated their experience as excellent or very good.

My area of responsibility is services for older people and over the last two budgets, we provided the largest expansion ever in health services for older people, with €400 million additional current funding. Budget 2007 provided an additional €82 million for community services, 2,000 extra home care packages, benefiting 4,000 people at a cost of €55 million, 780,000 additional home help hours at a cost of €18 million, 1,100 more day places at a cost of €3.5 million, €5 million for expanded palliative care services and €500,000 for sheltered housing.

We have now increased the nursing home subvention from €190 maximum to €300 per week. We also provided €30 million for enhanced subvention. We are overhauling the way nursing home care is financed to remove the unfairness of the present system. No person in the care or his or her spouse will ever be forced to sell or mortgage their house to pay for care. Legislation to underpin the scheme is being prepared with a view to commencing the scheme in January 2008.

The Health Act 2007 established the Health Information and Quality Authority on a statutory basis. It also provides for the registration and inspection of all nursing homes, public, private and voluntary. Inspections will be carried out by the social services inspectorate, part of HIQA. New standards are being finalised and, for the first time, a care plan for each patient will be required.

The Health Service Executive has initiated an independent review of all acute hospital services in the mid-west region and how they can be developed in accordance with best practice. The consulting group Horwath Consulting Ireland, in association with Teamwork Management Services, is finalising the report on the review of acute services in the mid-west which is expected to be to be submitted to the HSE board by year end. Recommendations for the future configuration of clinical services, including accident and emergency, critical care, acute medicine and surgery, together with diagnostic services such as X-ray, for each of the hospitals in the mid-west area will also be set out in the report.

A cardiac clinical nurse specialist was redeployed in Ennis General Hospital on one day only to theatre recovery. It was imperative to the service and she has not been redeployed since and no other nurse has been redeployed. It is logical that staff would be redeployed to the areas of greatest need in the best interests of patient care and safety.

An internal staffing review was conducted in Ennis General Hospital. Unions were told in advance that any recommendations for staffing increases would have to be processed through the service planning process. This review recommended an increase of 26 staff, nurses and health care assistants. The matter is under consideration as part of the Estimates process for 2008.

The record shows that this year our health services and indeed in every year since 1997 have seen significant increases in funding, staffing and patient services. The HSE is managing services with the objective of avoiding any impact on frontline services and patient care and maintaining them in line with the national service plan for 2007.

The Minister for Health and Children stands indicted by the state of the health service. In my constituency, Limerick East, for the past ten days 50 beds have been idle, with a 17-bed general surgical ward in Limerick Regional Hospital and 35 beds in St. John's Hospital remaining unopened since the start of the summer. That happened because every summer the ground floor ward in St. John's is closed as result of budgetary constraints but when it was to reopen in September, the hospital found an embargo had been put in place. The Minister talks about co-location but that is a joke because we cannot even use the existing beds. There was no cost benefit analysis of the co-location system.

The HSE has clearly failed in the three years since its formation. In the report of the Comptroller and Auditor General for 2006, the financial systems within the HSE are damned on page 136 and on page 141 this stance is supported by the Department of Finance. The Comptroller and Auditor General stated that the Accounting Officer said he was aware of the difficulties caused by the lack of a proper financial management system and he shares the Comptroller and Auditor General's concerns in this regard. The HSE is a €14 billion business organisation with a manual system in place in certain areas. That is one of the reasons for the mess in which it finds itself. Its reporting is chronic, it did not flag the €200 million early on. Professor Drumm should be handing money back from his salary, not taking an €80,000 bonus. It is a disgrace.

The Comptroller and Auditor General's report features another interesting statement. For the former Mid-Western Health Board area, the underspend was €32 million in 2006 but in corporate services and management in the HSE there was an overspend of €17 million. It was supposed to spend €27 million but spent €45 million, almost 70% above the original target.

I am interested in the Disability Act passed in 2005. Section 8 in Part 2 of the Act dealt with an assessment of needs for children up to five years of age. They are entitled to an assessment after three months and legally to a report after a further three months. Where does that stand while the embargo is in place? Existing therapy service staff, not new staff, are being used to carry out assessments.

I call on the Minister to demand of the HSE that there are no further embargoes on frontline staff, to stop all bonus payments to management and to implement the review of the HSE reporting system, which is an absolute disgrace.

My colleagues may not be aware of what is happening in County Kerry. In Kerry General Hospital we are on our third locum accident and emergency consultant. The post has been advertised by the HSE but no one is willing to take up the position because they do not have the registrars, SHOs or junior doctors. Why would anyone take a senior post when the support is not there for them? This has been going on for a number of years and it is about time to remedy the situation. The last resident accident and emergency consultant in Kerry General Hospital left for Tullamore and is now a member of a team of three accident and emergency consultants there. There are five registrars and ten HSOs at a hospital with the same output of 39,000 patients as Kerry General Hospital. I am calling on the Minister to take action. My colleagues have referred to cutbacks, but we have been suffering from this for years in Kerry. We have sought a specialist nurse to treat the 300 patients suffering from Parkinson's disease in Kerry, but it has proved impossible to get one. That situation needs to be addressed.

I was contacted by a man recently whose 86 year old mother is suffering from Alzheimer's. He is keeping her at home for the sake of her dignity. He was refused the respite care grant because he works more than 15 hours on his farm. If he was not working more than 15 hours on his farm he would not be able to keep himself, never mind keeping his mother at home.

I am glad the Minister is here and I welcome that valuable change in a health debate. I also welcome the fact that Deputy O'Rourke pointed out the Minister's failure to control spending on the HSE. The Minister is in control and must take responsibility. The original motion did not include the new cutbacks in Monaghan Hospital. The reopening of two reconstructed wards at a cost of approximately €5 million should have been a good news story for the people of Monaghan, but the Government and the HSE have introduced further cutbacks. The HSE says it only involves a cutback of ten to 12 beds, from what was available during the refurbishment process whereas, in fact, it means that a modern, recently upgraded 25-bed ward is being decommissioned. Ten years ago there were over 140 beds in Monaghan General Hospital with a full service. What is being done to the consultants and staff of the hospital through simple e-mails from the backroom boys is completely unacceptable. There was no forewarning or prior discussion and clearly no care for patients and their families.

The Fianna Fáil-led Government promised so much just weeks before the election, not just for Ennis and other hospitals but also a new ENT, ear, nose and throat, service for Monaghan. While I welcome my colleague Deputy Conlon's contribution, she failed to mention the fact that the service she offered people before the election is now gone.

The Minister of State, Deputy Smith, and his colleagues who represent the Cavan-Monaghan area, should realise what is being done in the name of progress and what is clearly planned. We all have a duty to take political responsibility on behalf of those we represent, rather than simply handing over patients' lives to advisers from a failed British system.

The last time Monaghan General Hospital was off call, up to 17 lives were lost because people were not allowed through the door. Mr. McCullough, who lived only 500 yd. away, was refused admission to the hospital where he would have obtained relief and care. He died on the way to Cavan. Perhaps the Minister can meet the people in the Gallery tonight. They have travelled from Monaghan and now expect their public representatives to stand together and fight for hospital services there.

In Scotland, which is only now seeking independence, they are building new local hospitals rather than dismantling high quality buildings containing beds and theatres, which is wanton waste. How can any Minister stand over the fact that patients who should be dealt with in the Cavan-Monaghan hospital structure are either going through the VHI or the National Treatment Purchase Fund to private hospitals in Mullingar and Galway? They will be dealt with by the same personnel who left the Cavan-Monaghan hospital system because of the then health board management's failure to deal with them.

The situation in Monaghan General Hospital is dire. For my colleagues on the Government benches to have said that there would be no changes and that the service would be retained was not true, to put it mildly.

I am asking the Minister at this late stage to at least consult with the people of Monaghan. She should meet them here or elsewhere, but she should meet with them before it is too late and more lives are lost. HSE personnel intend to take away further services. The special treatment room does a marvellous job, better than anywhere else in the country. It is working well so why withdraw it? Why is the high care unit being taken away? That should not be done either. The Minister should ensure that, at least until better services are put in place, they should be retained there, yet she will not do so.

I wish to start on a positive note. I see my old friend, Mr. Tom Mooney, there from the Department of Health and Children. He knows that I always try to see the positive side of things. I welcome the fact that Fine Gael pressure has resulted in the cuts in surgeons at Sligo General Hospital being forestalled for three months at least. We have also stimulated the resumption of dental services at Bluebell and Inchicore, although this will not happen until November. This shows that the Government can act when it has the political will to do so. The Taoiseach and the Minister for Health and Children now believe that if they say something often enough, then it is so. We are back to the good old days. "There will be no cuts" was the mantra of the Taoiseach and the Minister on Newstalk before the election a few short months ago. Now we see the truth, however, which involves cuts of frontline patient services all over the country. They say the cuts will not affect patient care, but operations have been cancelled at Cavan. In addition, reduced bed availability means more patients are on trolleys in accident and emergency in Galway. Cardiology clinics in Crumlin for small babies and sick children are under threat in October and November.

What about the new cancer strategy for the future? We dismantled the existing service with immediate effect, only to find a week later that the western HSE has deferred 184 posts, which will reduce breast cancer services from five to three days a week at its proposed designated centre of excellence. What provision has the Government made for transport services from the hospitals that are closing down their services and transferring them to centres of excellence? I am told that little or no such provision has been made as the transport budget has actually been cut. The Minister refuses to listen to her own colleagues. Deputy O'Rourke said she does not support the PPP process or bilocation, which she believes cannot deliver the cancer strategy. The Minister's Cabinet colleague, Deputy Ó Cuív, cannot make head nor tail of it. He said the HSE was impossible to deal with. In deference to the Minister I will not mention Tallaght. Deputy O'Connor, who is always a reasonable man, tells the Minister that the HSE should get its act together. The Minister of State, Deputy Devins, expresses concerns regarding HSE cuts in Sligo General Hospital.

Why is there no health committee in this Dáil four months into the new term? Is this an example of how seriously the Government treats health issues? Why have we had nine months of mismanagement of the HSE budget? As the Minister's own Government colleague asked, what happened to the monthly control to which the Minister alluded earlier? Why after nine months do we find panic stations with frontline services being cut? We have seen operations cancelled at Cavan-Monaghan hospital. I welcome the representatives of the Cavan-Monaghan action group here. Deputy Crawford and the Monaghan hospital action committee have been fighting tooth and nail to hold on to existing services, and who would blame them?

This is a case of live horse eat grass — you can have it tomorrow but we are taking away what you have today. Anybody who buys into that is surely naive. Serious operations are being cancelled and some people are waiting up to two years for their operations. It is objectionable that a HSE spokesman on the radio describes these as minor operations. Everyone waiting for the operations would require a general anaesthetic, a serious event in itself carrying its own risks and morbidity. These people, and their families, suffer stress and worry as they prepare for their operations and it is not good enough that they should be cancelled on a whim. This does not serve the people.

A total of 41,000 people are on waiting lists and one of the longest lists is at Beaumont Hospital. For the Minister and the Taoiseach, wherever he is tonight, the reality is that today at Beaumont nine ambulances were tied up waiting for patients to vacate trolleys. One patient collapsed and had to be treated on the floor of the accident and emergency unit. What happened to my parliamentary question asking that spare trolleys be left for ambulances?

Under Charles Haughey Fianna Fáil had a campaign slogan, "Health cuts hurt the old, the sick and the handicapped". That is particularly applicable in the current climate of swinging cuts to frontline services. Another phrase from that era sums up the Government's attitude to the health services, "GUBU" : it is "grotesque" that patient care is sacrificed for supposed fiscal rectitude when there is an alternative available in the form of delivering efficiencies from the burgeoning bureaucracy in the health service. It is "unbelievable" that Ministers persist in denying that patient care will be affected by cutbacks when it is clear that an attack on frontline delivery affects patient care. It is "bizarre" that the Government can announce a strategy on cancer one week and cut the delivery of cancer services the next. It is "unprecedented" that a Minister and architect of the Health Service Executive should now abdicate responsibility for its functions saying it is impossible to deal with.

The Government's attitude to the HSE is that of Frankenstein to his monster, it is prepared to reject it or use it as a shield when it suits. It is not unprecedented, however, that severe cutbacks should closely follow the return of Fianna Fáil and the Progressive Democrats to Government. Despite all the defences they have put up it cannot be denied that patients are being punished for the overspending of a Government agency. I ask the Minister again to put the patient first and ensure that frontline services are not affected by these cutbacks.

Deputies

Hear, hear.

Amendment put.
The Dáil divided: Tá, 80; Níl, 66.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Behan, Joe.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Cyprian.
  • Brady, Johnny.
  • Browne, John.
  • Byrne, Thomas.
  • Calleary, Dara.
  • Carey, Pat.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Cuffe, Ciarán.
  • Cullen, Martin.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gallagher, Pat The Cope.
  • Gogarty, Paul.
  • Gormley, John.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • Lowry, Michael.
  • Mansergh, Martin.
  • McEllistrim, Thomas.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Brien, Darragh.
  • O’Connor, Charlie.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Keeffe, Batt.
  • O’Keeffe, Edward.
  • O’Rourke, Mary.
  • O’Sullivan, Christy.
  • Power, Peter.
  • Roche, Dick.
  • Ryan, Eamon.
  • Sargent, Trevor.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.

Níl

  • Bannon, James.
  • Barrett, Seán.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burke, Ulick.
  • Byrne, Catherine.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Coveney, Simon.
  • Crawford, Seymour.
  • Creed, Michael.
  • Creighton, Lucinda.
  • D’Arcy, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Hayes, Brian.
  • Hayes, Tom.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kenny, Enda.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McHugh, Joe.
  • McManus, Liz.
  • Mitchell, Olivia.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Keeffe, Jim.
  • O’Mahony, John.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ring, Michael.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P. J.
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Varadkar, Leo.
  • Wall, Jack.
Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Dan Neville and Emmet Stagg.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided by electronic means.

Given this vital issue and in view of the non-co-operation in certain areas, I demand a vote through the lobby.

The vote will proceed.

Question again put, "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 80; Níl, 65.

  • Ahern, Michael.
  • Ahern, Noel.
  • Andrews, Barry.
  • Andrews, Chris.
  • Ardagh, Seán.
  • Aylward, Bobby.
  • Behan, Joe.
  • Blaney, Niall.
  • Brady, Áine.
  • Brady, Cyprian.
  • Brady, Johnny.
  • Browne, John.
  • Byrne, Thomas.
  • Calleary, Dara.
  • Carey, Pat.
  • Collins, Niall.
  • Conlon, Margaret.
  • Connick, Seán.
  • Coughlan, Mary.
  • Cowen, Brian.
  • Cregan, John.
  • Cuffe, Ciarán.
  • Cullen, Martin.
  • Curran, John.
  • Dempsey, Noel.
  • Devins, Jimmy.
  • Dooley, Timmy.
  • Fahey, Frank.
  • Finneran, Michael.
  • Fitzpatrick, Michael.
  • Fleming, Seán.
  • Flynn, Beverley.
  • Gallagher, Pat The Cope.
  • Gogarty, Paul.
  • Gormley, John.
  • Grealish, Noel.
  • Hanafin, Mary.
  • Harney, Mary.
  • Haughey, Seán.
  • Healy-Rae, Jackie.
  • Hoctor, Máire.
  • Kelleher, Billy.
  • Kelly, Peter.
  • Kenneally, Brendan.
  • Kennedy, Michael.
  • Kirk, Seamus.
  • Kitt, Michael P.
  • Kitt, Tom.
  • Lenihan, Brian.
  • Lenihan, Conor.
  • Lowry, Michael.
  • Mansergh, Martin.
  • McEllistrim, Thomas.
  • McGrath, Finian.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • Moynihan, Michael.
  • Mulcahy, Michael.
  • Nolan, M. J.
  • Ó Cuív, Éamon.
  • Ó Fearghaíl, Seán.
  • O’Brien, Darragh.
  • O’Connor, Charlie.
  • O’Flynn, Noel.
  • O’Hanlon, Rory.
  • O’Keeffe, Batt.
  • O’Keeffe, Edward.
  • O’Rourke, Mary.
  • O’Sullivan, Christy.
  • Power, Peter.
  • Roche, Dick.
  • Ryan, Eamon.
  • Sargent, Trevor.
  • Scanlon, Eamon.
  • Smith, Brendan.
  • Treacy, Noel.
  • Wallace, Mary.
  • White, Mary Alexandra.
  • Woods, Michael.

Níl

  • Bannon, James.
  • Barrett, Seán.
  • Broughan, Thomas P.
  • Bruton, Richard.
  • Burke, Ulick.
  • Byrne, Catherine.
  • Carey, Joe.
  • Clune, Deirdre.
  • Connaughton, Paul.
  • Coonan, Noel J.
  • Costello, Joe.
  • Coveney, Simon.
  • Crawford, Seymour.
  • Creed, Michael.
  • Creighton, Lucinda.
  • D’Arcy, Michael.
  • Deasy, John.
  • Deenihan, Jimmy.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Enright, Olwyn.
  • Feighan, Frank.
  • Ferris, Martin.
  • Flanagan, Charles.
  • Flanagan, Terence.
  • Gilmore, Eamon.
  • Hayes, Brian.
  • Hayes, Tom.
  • Higgins, Michael D.
  • Hogan, Phil.
  • Howlin, Brendan.
  • Kenny, Enda.
  • Lynch, Ciarán.
  • Lynch, Kathleen.
  • McCormack, Pádraic.
  • McEntee, Shane.
  • McHugh, Joe.
  • Mitchell, Olivia.
  • Naughten, Denis.
  • Neville, Dan.
  • Ó Caoláin, Caoimhghín.
  • Ó Snodaigh, Aengus.
  • O’Donnell, Kieran.
  • O’Keeffe, Jim.
  • O’Mahony, John.
  • O’Shea, Brian.
  • O’Sullivan, Jan.
  • Penrose, Willie.
  • Perry, John.
  • Rabbitte, Pat.
  • Reilly, James.
  • Ring, Michael.
  • Shatter, Alan.
  • Sheahan, Tom.
  • Sheehan, P. J.
  • Sherlock, Seán.
  • Shortall, Róisín.
  • Stagg, Emmet.
  • Stanton, David.
  • Timmins, Billy.
  • Tuffy, Joanna.
  • Upton, Mary.
  • Varadkar, Leo.
  • Wall, Jack.
Tellers: Tá, Deputies Tom Kitt and John Curran; Níl, Deputies Dan Neville and Emmet Stagg.
Question declared carried.