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Dáil Éireann díospóireacht -
Tuesday, 5 Oct 2010

Vol. 717 No. 2

Health Services: Motion

I move:

That Dáil Éireann, noting with concern:

that there are more than 46,000 adults and children on hospital waiting lists across the country, which is 5,400 patients more than last year;

that over 272,000 bed days were lost in 2009 due to the delayed discharge of patients;

that 50,000 operations have been cancelled since 2007, leaving many patients waiting in pain;

the anguish that continues in hospital accident and emergency departments, with an average of 300 patients on trolleys each day; and

that no further loss of capacity can be sustained;

calls on the Government to:

ensure that there are no further reductions to front line staff or services;

suspend the loss of front line health services and capacity at hospitals, for example, at Clonmel, Merlin Park, Nenagh, Roscommon, Navan, Sligo, Letterkenny, Portiuncula, Wexford, Monaghan, Ennis and Louth county; and

immediately open the €16 million community hospital facility in Dingle, County Kerry.

I wish to share time with Deputies Catherine Byrne, Ulick Burke, John Perry, Paul Kehoe, Tom Sheahan, Pádraic McCormack, John O'Mahony and Damien English.

The motion is self-explanatory as it seeks to ensure there are no further reductions to front line staff or services and to consider other methods to meet the budgetary constraints faced by the HSE. I refer to the Government's amendment. Mention is made of increased life expectancy but an eminent epidemiologist has stated that less than 10% of longevity over the past 20 years can be attributed to health care, if vaccinations are excluded. The amendment notes the decrease in hospital infection rates, yet they remain unacceptably high, while it welcomes the EU's endorsement for being ranked second in quality palliative care, although many parts of the country are without a hospice. The Minister should tell that to the terminally ill who cannot obtain a medical card.

The amendment also notes progress in cancer screening, particularly cervical cancer screening, but there has been a significant drop off in women attending for screening since the methodology was changed to a letter of invitation, thus putting a barrier between them and the service. Where is the bowel cancer programme? Why has it taken so long to get cancer screening up and running? The Government parties welcome the fact that data indicate that a significant majority of patients attending accident and emergency departments are treated and discharged or admitted within the maximum waiting target of six hours. That is a clever statement. What percentage of those needing admission are admitted within six hours? It is laughable for the Minister to suggest that a substantial number of operations are cancelled by the patients themselves. I challenge her to produce the figures in this regard. I warrant is it less than 5% and probably less than 1%.

This motion is about protecting patients from cutbacks necessitated by mismanagement and waste in the HSE, presided over by this Minister. It intends to demonstrate clearly that there is a third way by changing the bizarre working practices and bloated bureaucracy at the root of the waste in our service. The Government, through a series of policy failures, continues to undermine the provision of fair and equitable health services to our citizens. Current health policy, particularly as outlined in the amendment to the motion, sends a clear statement that the Government does not view health as a priority. It has consistently ignored the concerns of local people, medical professionals and service users when stripping hospitals of their services. Nobody in the House opposes excellence in clinical care or denies the need for change in the provision of hospital services but when the Government's immediate reaction is to close theatres and wards or to withdraw front line services to save money, we do have a problem, as this is a lazy way to attack our difficult situation.

Let us examine the reality. More than 46,000 adults and children are on hospital waiting lists across the country, which is 5,400 patients more than last year. More than 272,000 bed days were lost in 2009 at very significant cost to the system, due to the delayed discharge of patients. A total of 50,000 operations have been cancelled since 2007, leaving many patients waiting in pain and distress while an average of 300 patients are on trolleys each day with 420 patients on trolleys today alone. A total of 332 service users of St. Michael's House are on a priority list waiting for care.

The Government parties have spent vast sums over the past ten years but billions of euro have been wasted on a health service that has not reformed. As a result, our health system is ranked 13th in Europe for quality and 25th for value for money. We are facing a massive economic crisis with €34 billion going into a dead bank that will never lend again, yet the Minister is planning to cut health spending next year by another €600 million without introducing any meaningful reform. Last week, we learned that the HSE has to significantly cut back health services right across the HSE west area to meet its budget deficit. These cuts mean that patients will wait longer on trolleys in accident and emergency departments for treatment and care. HSE west has informed us €5 million was lost last year through absenteeism and payments from insurers on behalf of patients in this area totalling €10 million are outstanding for more than 12 months.

People are feeling pain but HSE administrators have taken the soft option of cutting front line staff and services. Navan hospital is a case in point. The Minister alluded to it being shut because of economic considerations, given all hospitals must stay within budget, but Navan hospital is operating within budget. This is more nonsense from the Minister. The HSE had six grade 8 senior managers earning between €80,000 and €90,000 a year in 2000 but there are now 700, a 10,000% increase. Professor Drumm, the former chief executive officer of the HSE stated that he had "no doubt" that he could reduce backroom staff by "at least 30%". In 2005, some €1 million was spent on consultants to advise on how to deconstruct the executive while more than €100 million has been spent on reports over the past ten years, most of which lie unpublished, unimplemented and gathering dust.

The HSE has spent more than €121 million on taxis since 2006. Legislation on the introduction of drugs reference pricing has been deferred until late next year but it could save a few hundred million euro. Meanwhile, the Minister introduced a prescription charge, which is a measure that will cost more in terms of human misery and hospitalisations as a result of people not taking their medication. The moratorium on recruitment is forcing hospitals to hire expensive premium rate agency staff who are believed to cost 36% more than health service staff. Other inefficiencies include banking and payroll practices which are costing the HSE €20 million a year in potential savings. The executive has paid more than €11 million to people on sick leave for more than 12 months, with more than €100 million spent on agency staff every year. More than €2.3 million of taxpayers' money ended up in a bank account with no knowledge of where it was spent while RTE reported a catalogue of waste within the HSE this evening. Equipment such as crutches and Zimmer frames are not reused even though there is no reason that they cannot be sterilised and reused as is the case in other countries. We cannot reuse them and they are thrown out. The Minister alluded to the significant increase in the bills for hospital cleaning with a 54% increase on the 2005 figure.

All this waste and expenditure must stop but instead the HSE under her guidance chooses to close 32 beds in the Mater Hospital. Some 62 beds are closed in Beaumont and 24 beds are closed in Blanchardstown while Professor Drumm said earlier this year that there were plans to close another 1,100 beds. Home help hours have been frozen. Deputy Catherine Byrne instanced the case of a 97 year old woman who went into hospital for a week and returned home to find her home help had been discontinued. She want back to a cold, empty house. This is a false economy and the Government has its priorities upside down.

I want the Minister to tackle waste, take hard decisions, change work practices and stop talking about it. She has had six years to do so. Fine Gael intends to do this under its FairCare proposals. The National Treatment Purchase Fund, NTPF, spent almost €100 million last year to treat 28,000 patients and €300 million over past three years. The Northern Ireland authorities adopted a waiting list initiative that reduced a waiting list of 57,000 patients at a cost of £36 million over 18 months. That is what we need to do. We also need to examine systems in other countries where the money follows the patient model was used to make a saving of between 10% and 19%. This would allow at least €500 million more to be invested in our health services. The countries to which I refer are Canada, Holland and Taiwan. I congratulate Taiwan on its national day today. I hope to travel to speak there shortly. Taiwan introduced universal health insurance in 1995. It works extremely well and spending on health is only 6.4% of GDP. We need to deliver universal health insurance so that all our people are treated equally and so that we lose this focus on private, co-located hospitals.

The National Treatment Purchase Fund is the prime example of the Band-Aid to cover the cracks rather than any meaningful reform. We need a Minister who will put the patient first, take on all comers who stand in the way of that goal and do more than pay lip-service to it by implementing policies to ensure the patient is put first, as in the policy of the money follows the patient. Simply put, if there is no patient there will be no payment.

I commend the motion to the House.

I thank Deputy Reilly for tabling this motion. I thank the Minister for her attendance as it is important that she hears the contributions from this side of the House.

It is difficult to know where to begin when talking about the cuts in the health service. Deputy Reilly has already alluded to some of them and I will give some examples. A 97 year old woman's home help service was cancelled because she had overstayed her time in hospital while having a surgical procedure. The community nursing home, Brú Chaoimhghín in Cork Street, is to close. The 50-bed unit in Inchicore was to provide new beds for new patients but we have been informed that the patients from Brú Chaoimhghín will be moved to that unit. These will not be an extra 50 beds as they will be used for those existing patients from Brú Chaoimhghín. The ward closures in Cherry Orchard mean that patients have been pushed in together in the St. Laurence unit. The moratorium on staff recruitment means there are no staff to open up the ward. This has been a cruel three months for many of the patients there and for their families. Many of these patients suffer from dementia and other illnesses and they have to deal with the upset of being moved from one area to another. This is a significant concern.

To illustrate the long hospital waiting lists, I will relate a personal story. I was given a doctor's appointment for May next year. This would be very far into the future for some people. With regard to the extra charges for chiropody, it is true that many of us do not appreciate our feet. We all stand on them and do lots of things on them but some people cannot use their feet as well as us. These include many elderly people who find they must pay an extra €10 for chiropody services, or even more in some cases. I am concerned about these people. They do not have anyone at home to help them care for their feet or to help them with clipping toenails or to give them a pedicure so they depend on the chiropody service. The 50 cent prescription charge is outrageous. People in this country have paid for years for their medication. Elderly people in particular are being further challenged to add an extra 50 cent to each prescription. The Minister and I know the problem does not lie solely with the people who need the prescriptions; the problem lies with the way in which the service is delivered through the doctors' offices and pharmacies and there needs to be action in these areas.

My mother-in-law has attended a doctor for a very long time — I will not say his name. One evening I had a headache while in her house. I asked if she had a Panadol. When I opened her press I found 600 Panadol. I was shocked and horrified that any doctor would continue to write her prescriptions.

The cuts in the dental treatment service have had an impact on young schoolchildren and older people who do not have the means to pay for dental treatment on a regular basis. They attend rarely and only when they need care and attention.

I refer to an important issue which may not affect people living in Dublin but which certainly affects those living in country areas, which is the issue of transport. My father-in-law met a man in hospital who told him he had come all the way from Sligo for a chemotherapy appointment. He said he had been taken by taxi that morning and the taxi man was waiting outside to bring him back home that afternoon. The procedure took three hours and he then returned to Sligo. It is a waste of money to hire a taxi to bring a man to Dublin for hospital service.

My daughter had a baby a few weeks' ago. The baby was very distressed during the week and we decided to ring the Coombe hospital to avail of the mother and child clinic. We were informed the service opened at 9 a.m. and ended at 5 p.m. and we were advised to go to Crumlin children's hospital. Thank God, I only live five minutes from Crumlin hospital. I hope in years to come when we have to travel across the city to a new hospital that has no parking spaces we will have a service for young women that does not end at 5 p.m.

Deputy Reilly has already alluded to the issue of wheelchairs and other equipment. The HSE provides wheelchairs. A neighbour of mine needed a wheelchair following an operation on her two feet. She was informed at Beaumont Hospital that the hospital did not supply wheelchairs and she was referred to the HSE service. We went to every HSE service and could not get her a wheelchair. Every day of the week, dozens of crutches, wheelchairs and Zimmer frames are left in houses because the HSE will not take them back. This is a real waste of money and it is an issue that should be identified and dealt with. If they cannot be used in this country we should at least, for God's sake, send them to other countries where they can be used.

I commend Deputy Reilly on bringing this timely motion before the House and I thank him for sharing his time with me.

The Health Service Executive has recently been described as inefficient and not fit for purpose by the Irish Hospital Consultants' Association. It has accused the HSE of being dysfunctional and disconnected from staff who provide the care. It said the State organisation was not just cutting the cost of providing care but cruelly cutting the amount of care. It said that when the HSE was set up, not a single job was lost and no efficiencies have been introduced to date. This is an indictment of a very important agency charged with the delivery of health in this country. It cannot be allowed to carry on in this fashion. It is incumbent on the Minister to take responsibility at this stage to redress the many faults in the organisation.

At a recent health forum, Dr. John Barton, cardiologist at Portiuncula Hospital, Ballinasloe, said that research in 21 OECD countries found that Ireland had the third most inequitable system in terms of access to hospital care. Two factors contributing most to this imbalance are private health insurance and medical cards. A total of 50% of the Irish population now pay health insurance. Many of these pay out of fear of the public system.

Within the past few days, a young mother in County Galway, who had a planned admission for ongoing chemotherapy at University College Hospital Galway, was refused admission and her treatment postponed. She was to have a re-appointment in nine weeks but received a letter stating the appointment would be in nine months' time. This is the Minister's centre of excellence. She has withdrawn cancer services from other centres throughout the HSE west region and given assurances on numerous occasions that all cancer needs for the HSE west region could be provided at University College Hospital Galway. This is another scandal to add to those already on the record of this House. Are we going to have another Susie Long case in the making?

This incompetence is unbelievable at a time when the HSE west employs the highest proportion of corporate staff compared to any other HSE region. A total of 813, or 3.03% of the 26,000 staff is corporate. The HSE west is imposing cuts of approximately €7 million on services at Portiuncula Hospital, Ballinasloe, before the end of this year and approximately €12 million in Galway hospitals. The management of HSE west is calling for reconfiguration of the health system, which will affect these front line services, but there has been little or no reconfiguration of the management in the HSE. Furthermore, the HSE has indicated that a pilot scheme will be trialled in Dublin hospitals next year, whereby budgets will be allocated on the basis of how many patients the hospitals treat rather than the block grant associations we have had heretofore. This will wipe out hospitals where the Minister has sanctioned and the HSE has implemented cutbacks in front line services. The reconfiguration of hospital services under this proposal, albeit a pilot scheme, will lead to the downgrading of hospitals such as Portiuncula and probably Roscommon hospital in the Galway network. I ask the Minister to take control of the HSE to avoid situations like this.

I congratulate Deputy James Reilly on tabling this Fine Gael motion, which is simple and clear. It calls a halt to the unfair and unjustified health cuts in the Sligo-Leitrim region. Breast cancer and mammography services have been removed from Sligo. This decision ignored the proven track record of the cancer care team at the hospital. The comments of Deputy Ulick Burke confirmed this. The team was producing results exceeding those achieved at top cancer clinics in the US and elsewhere. This month the HSE is imposing a further €12 million cut, bringing the total to €24 million in one hospital alone. Over 200 members of staff have gone, including over 100 nurses. All agency nursing staff are gone and there are restrictions on consultant locum cover and reductions in overtime. There have been cancellations to elective surgery and restrictions on theatre time due to staff shortages. Emergency equipment is barely maintained rather than replaced. There have been 60 bed closures and cutbacks in orthopaedic services from 48 beds to 12 beds, as well as cutbacks in angiography and cardiac services.

At present, Sligo hospital offers a premier cardiology and angiography service, with a three-week turnaround time for cardiac patients. With the proposed cutbacks, the service will be severely curtailed, resulting in patients being transferred to Dublin, where waiting times are up to six months. Lives will be lost.

It is clear that this Fianna Fáil-led Government and the Minister for Health and Children, Deputy Mary Harney, are determined to reduce the services and the status of Sligo General Hospital to a local district hospital. I am calling for no further reductions to front line staff or services. The scheduled loss of front line health services at Sligo General Hospital must be halted. High quality, highly specialised existing services are being removed and curtailed. The time has come for the people of this region to say to the Government and the Minister that enough is enough. The Fianna Fáil Deputies of Sligo-Leitrim chose to vote with the Government to remove cancer services from Sligo. This motion gives them a second chance to show where they really stand on health care services in Sligo-Leitrim. With this motion they have the opportunity to vote for the suspension of unsustainable cutbacks to front line health services in this region. With this motion they have a clear opportunity to send a message to the Government that the cutbacks are unjustified and must stop.

In their defence, local Deputies speak of Government promises to build a new 90-room unit and that Sligo General Hospital is shortlisted for a regional colonoscopy service. These are Fianna Fáil promises. They will carry the local Fianna Fáil politicians up to and past the next election. We will not know about actual delivery until after the next election. Actions here will be louder than any words.

I am determined that Sligo General Hospital will have its cancer services restored and will maintain its current regional hospital status, with the full range of specialised medical services. I am committed to the delivery of the new 90-bed unit, which is currently in the capital plan and at the pre-planning stage. I demand that the Minister approves Sligo General Hospital as the location of the regional colonoscopy service. That is confirmation of the calibre and confidence of the medical team at Sligo General Hospital. People all over the country are feeling the effects of health cutbacks to front line services and they want the cutbacks to stop. Any Deputy with a genuine interest in maintaining our standard of health care in a region serving 250,000 people must vote for this motion. Money can be saved and front line services can continue. The former Minister of State, Deputy Jimmy Devins, and Deputy Eamon Scanlon have an opportunity here as they are not members of the Fianna Fáil Parliamentary Party. They must vote with people and they have this opportunity.

Services in Wexford General Hospital and St. Senan's Hospital, Enniscorthy, are severely threatened. St. Senan's Hospital is threatened with closure and Wexford General Hospital is threatened with the removal of front line services. The Leas-Cheann Comhairle is well aware of what is under threat in County Wexford. I am not sure if the Minister is instructing the HSE and if it is doing spadework for the Minister, but she must examine what is happening on the ground. The HSE is a monster in the Department of Health and Children and the Minister is wholly responsible for it.

Maternity services in Wexford are under threat. In 2008, there were 2,399 births in Wexford General Hospital and over 2,500 births in 2009. That is a very significant number of babies being born in one county. There are proposals to remove the services from Wexford. There are continually people on trolleys and overcrowding in the accident and emergency units. I commend the Wexford alliance that was set up to protect services at Wexford General Hospital. I plead with the Minister and my Oireachtas colleagues from Wexford and I call on my Oireachtas colleagues who are part of the decision-making process to ensure future services at Wexford General Hospital and at St. Senan's are retained for the people of County Wexford. There should be no further reductions in front line services.

The people of County Wexford have been very generous in fundraising for Wexford General Hospital over a number of years. A cancer care unit was built recently at a cost of €1 million. I am not sure the Minister is aware of this; I am not sure she or the HSE appreciates it. Only for the generosity of people across the country, our health services would be in dire straits. The Minister must take heed of this and of the millions of euro raised in County Wexford and across the country to keep health services afloat. Only for the generosity of many people, we would be in severe trouble. I give the Minister the message that she should keep her hands, Government hands and HSE hands off the services in Wexford, including psychiatric services and vital services in Wexford General Hospital.

I refer specifically and directly to the new community hospital in Dingle, which remains closed. The old hospital, St. Elizabeth's, is in existence since the time of the Famine and comprises 43 beds with very limited shower and bathroom facilities. It is a three-storey building that is not suitable for people with mobility difficulties. The new community hospital was built at a cost of €16 million on lands kindly made available for a nominal fee by the O'Connor family from Dingle. Construction finished on this facility in December 2008. As we approach December 2010, it remains unopened. At last month's regional health forum, Members were advised that the facility costs €4,000 per week between security, lighting and heating and it remains closed.

The HIQA registration process was initiated in February 2010 and I wonder why it was left until that point. It has not been completed due to the fact that the facility is not meeting the standards required by HIQA. There was a communication from the HSE on 23 September.

The direction the Health Service Executive gave to members of the forum was that they had to communicate with HIQA on a way forward. I can give them the way forward. The Minister could have directed them and given them the way forward. She should invoke the grandfather clause. If they had opened the facility in Dingle, the HIQA grandfather clause would allow the Health Service Executive three years to bring standards up to date.

I commend Deputy Reilly on tabling the motion but, equally, I call on my colleagues, the Independent Member, Deputy Healy-Rae, and Deputy O'Donoghue to vote in favour of the motion and to have Dingle hospital opened immediately. If that is not done I ask the Minister to invoke the grandfather clause and to have to have Dingle community hospital opened immediately.

The motion gives every Member of the Dáil an opportunity to vote tomorrow night for the suspension of the unsustainable cutbacks to front line health services. We in Fine Gael believe that there are significant savings in the manner in which the Health Service Executive is run. I will return to that later if I have time.

First, I will deal with the situation in Galway with which I am most familiar. Does the Minister realise the hardship and suffering her policies, implemented through the Health Service Executive, is causing to the people waiting in vain for treatment? Does she know or care that 140 bed places are closed in the Galway hospitals, University College Hospital, Galway, and Merlin Park University Hospital? Does she know that there are 29,402 people on the outpatient waiting list in Galway? They would half-fill Croke Park on a good day, perhaps a Leinster final or semi-final. The figure last year was 23,000 indicating an increase of 9,400 in one year. A breakdown of the waiting list shows that 4,755 people are on the waiting list for ear, nose and throat operations. Some patients have been waiting four years for an operation. A total of 4,224 people are waiting for approximately four years suffering in vain and in pain. There are 3,214 people on the waiting list for dermatology operations. A total of 2,337 people are waiting for neurology operations. There are 1,900 people on the waiting list for general surgery. I could give more statistics. The figures I have were provided in response to a question asked by Councillor Pádraig Conneely, chairman of the board of Health Service Executive west. There are several other minor waiting lists as well.

The Minister must establish her moral authority in this matter. In our FairCare proposals we will pay hospitals per procedure carried out rather than the current system of a block grant no matter what work is done. There should be accountability.

A total of €10 million is outstanding to Galway hospitals from insurance companies. A further €5 million has been lost through absenteeism. Does the Minister realise that a 1% reduction in absenteeism would save €1 million? There are 460 personnel in the Department of Health and Children. What are they doing and how many of them are rewarded with bonuses on top of their generous salaries? The Minister must address the culture that has grown up in the Health Service Executive. She cannot put wine into an old wineskin.

I wish to be as balanced as I can in the comments I make. I thank Deputy Reilly for tabling the motion. I will confine myself to the Health Service Executive west area and Mayo hospitals in particular. The Health Service Executive west has overruns of €50 million but I understand that Mayo General Hospital has an overrun of just €1 million and further efficiencies have been agreed. All we hear about is further cutbacks to hours of temporary nurses and front-line services. Mayo General Hospital is an efficient hospital. It was recently judged the fifth most efficient in the country. Its budget was reduced from €85 million in 2009 to €77 million this year. I wish to set down a marker. The hospital should be rewarded for its efficiency rather than penalised by further reductions in future budgets. The hospital is to be commended for choosing such measures as ring-fenced beds for surgery so as to allow it to continue to function.

There was much discussion in recent years about cancer services in the west. I do not wish to return to the debate. I am sure patients are receiving good care in University College Hospital, Galway. Due to the rotating closure of operating theatres in Galway because of the chronic financial situation there, the service provided in the centre of excellence is not as good as it was previously in the old system in Mayo General Hospital when the service was being provided there.

It is a different story altogether with the home help service, mental health services and the funding of voluntary services in the county. Following reviews, the home help service in County Mayo has been decimated. It used to be known as home help hours but it is now better described as home help minutes. The policy of the Government is to care for as many elderly as possible in the home. People are doing a wonderful job which is a social service as well as a medical service. The home help service is saving the State money, yet it has been cut by more than €500,000 again this year. Mental health services in County Mayo have been decimated. A total of 60 experienced mental health nurses have retired and were not replaced. Thousands of euro were spent a few years ago on the O'Hara Home in Kiltimagh, a day care centre, and it is now closed. I understand the closure of bungalows at Áras Attracta is being contemplated. This is very hard to take when we discover that in the Health Service Executive west area there is one administrator for every two nurses. Approximately €2.4 million in grants to the voluntary services have been cut. The demand for help from Western Alzheimer's has increased by 40% but its funding has been reduced by 30%. I commend the motion to the House.

I thank my colleague, Deputy Reilly, for sharing time with me. When I look at the counter-motion all I can say is that it is time to get real. Before one can fix a problem one must admit that there is a problem. The dogs on the street know there is a problem with the health service, yet the motion is about clapping each other on the back. Reference is made to the affordability of nursing home care for 15,500 people. One can ask how many people have got it. A total of 15,500 people have applied for it but many of them have been waiting a long time for an answer. Many of the items referred to on the list in the counter-motion are in serious doubt and ignore the reality of the serious problems in the health service. We want them to be dealt with. We are not making them up. They are real. The Minister can say the average time on the waiting list is 2.6 months but she is aware that people come to our offices who are waiting 12 or 18 months.

People are waiting for four years.

They are not statistics; they are real stories. Until the system is fixed, the Minister and her colleagues should not come into the House and clap themselves on the back. No one deserves that when people are still suffering. It is time we got real. Let us be honest and have a proper discussion. In most people's eyes the health service is not working. Perhaps it is working in the Minister's eyes. Perhaps it is her philosophy and the aim of a Fianna Fáil Government with the support of the Green Party and Independents with some Progressive Democrats history to drive people to a private health service.

Perhaps the Minister thinks the system is working. If that is the case she should be honest about it. She should let people know what they are going to get from the Government; what the Government intends to give them. Usually when there is debate about public health service cutbacks on the national airwaves the first advertisement seems to be about private health care. I wonder how that happens.

The Minister referred earlier to Navan General Hospital. My major concern tonight is the capacity issue. She said that elective surgery in Navan General Hospital was cut because of budgets. I have three questions for the Minister. Will she confirm who is responsible for the closure of services in Navan General Hospital? Is it the Minister, the Government or the Health Service Executive? According to the Health Act which set up the Health Service Executive, it is responsible to the Minister. Its job is to implement her policy. Who is closing the hospital and the services? We were not told the closure was due budgets, but we were told it was due to issues of concern. We all understand that concerns can arise and they should be investigated and dealt with. I would prefer a public independent inquiry on the matter. If there are concerns they should be sorted out.

We are being told that the reason elective and emergency surgery are being moved from the hospital is for those reasons. The Minister said today the reason is budgetary. We are all aware there is an issue with emergency surgery. I will not debate that issue with the Minister as there is proper health data on the matter. However, that is not the case with elective surgery. The HSE has said in meetings and on the airwaves that the reason is due to patient care. The Minister confirmed today that the reason is budgetary. Which is it? If the reason is budgetary, will the Minister deal with the staff who have told us lies on the airwaves in recent months about the real reasons for removing surgical services from Navan General Hospital. The Minister should deal with the issue if she is in charge.

Will the Minister tell the people of the north east exactly what health service she plans for them? Will she tell them what she believes they should have? Will she reverse this crazy policy for Navan? There will be a massive domino effect if she removes elective surgery because the other services will go. Will the Minister give the hospital a chance to thrive? It is a good hospital and — I am not just acting as a local Deputy in this respect — it is a national asset giving a good service. If the Minister or the HSE have their way, it will be gone, which will increase the waiting lists because the capacity is not available in the north east to absorb the number of patients currently going through, as the Minister knows.

I move amendment No. 1:

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

"in the context of the current economic challenges facing the country and the need for all regions in the Health Service Executive to operate efficiently within their 2010 budget provision:

notes the huge improvements in recent years in the health of the Irish population, including the increase in life expectancy to 76.8 years for males and 81.6 years for females, increased survival rates for conditions such as breast and prostate cancer and reduced mortality from cardiovascular diseases, including strokes;

notes the decrease in hospital infection rates of over 40% between 2006 and 2009;

recognises that Ireland has one of the lowest infant mortality rates in the world;

welcomes the endorsement from the European Union on being ranked second in Europe in quality palliative care;

notes the very real progress in cancer screening and the fact that 122,000 women were given free breast cancer screening and 285,000 women had free cervical cancer screening last year;

welcomes the fact that the HSE will deliver fully on the key areas of activity promised in its service plan for 2010, including 540,000 inpatient treatments, 689,000 day cases and 3.4 million outpatient attendances, 1.1 million emergency department attendances, over 9,500 home care packages and home help to 54,500 people;

notes that the number of patients treated is a better indicator of the level of service provided than the number of beds available;

welcomes the very positive impact of the fair deal scheme on the affordability of nursing home care for the 15,500 people who have applied for it and its positive impact on the problem of delayed discharges which has decreased by 30% since last year;

welcomes the fact that data indicate that a significant majority of patients attending emergency departments are treated and discharged or admitted within the maximum waiting target of six hours;

recognises that in these challenging times, the opportunity through the Croke Park agreement of introducing modern work practices, flexibility and deployment maximises the care available to patients;

rejects misleading claims about the cancellation of operations which take no account of normal postponements for clinical reasons and the fact that hospitals arrange to reschedule patients' admissions for the earliest possible date;

welcomes the appointment of national clinical leaders in many medical specialties such as neurology, diabetes and stroke, who will determine how best to provide services which will give patients the best chance of a good outcome;

rejects inaccurate claims about inpatient waiting lists and welcomes the fact that the average waiting time for elective treatment is now just 2.6 months, down from between two and five years in 2002; and

pledges its continuing support to the Government in its work to provide a safe, fair and cost effective service for all."

I wish to share time with the Minister of State, Deputy Áine Brady, and Deputies Cregan and Dooley.

Is that agreed? Agreed.

We heard the leader of Fine Gael today talk about black Thursday and the economic challenges this country confronts, which are immense, and about the role Fine Gael will play in addressing those challenges. Notwithstanding that fact, at 3.15 p.m. last Friday this motion was submitted in the name of the deputy leader of Fine Gael. The health service at present consumes 133% of all the income tax we raise in this country, which is unique in the developed world. It consumes 27 cent out of every €1 we spend or 11.8% of our national income, which again is very high and much higher than the OECD average or European average, and, given that our population is young, is very high in comparison with those countries that have a young population. In the good years, health spending increased by 8.8%. Notwithstanding all those facts and the need to confront the economic challenges in an honest and real fashion, Fine Gael tabled this motion.

Interestingly, the motion relates to hospitals in ten counties and does not relate to hospitals in Cork, Dublin, Limerick, Kilkenny or Waterford.

It does. It uses the term "for example".

With regard to those hospitals, Fine Gael proposes to increase funding in Clonmel by €300,000, in Merlin Park by €28 million, in Nenagh by €6.9 million, in Roscommon by €600,000, in Navan by €5.7 million, in Sligo by €18 million, in Letterkenny by €11.1 million, in Wexford by €11.4 million and in Ennis by €10.2 million. That makes €97.9 million on top of the €800 million those hospitals receive.

Who caused the problem? It was bad management by the Minister's Department.

We are not told from where that additional money will come. We are simply asked to provide it.

I just gave the Minister the figures.

Deputies should allow the Minister to speak.

I listened to Deputy Reilly, with respect. I know he is going to the Taiwanese reception, although I thought Fine Gael policy was the one China policy, which is interesting. That is the Deputy's entitlement, however, and I will not take issue with him on that except to note that I understood his party's policy was the one China policy.

I would correct Deputy Reilly by noting it is not the case that 10% of increased life expectancy is due to health care, it is 50%.

I dispute that with the Minister.

Deputy Reilly would dispute it. He disputes everything with me.

Deputies should allow other Deputies to be heard in the House without interruption, as they were heard.

No matter how much rubbish she speaks.

Deputy McCormack should have some respect for the House.

The fact is that 50% of the increased life expectancy in Ireland is due to better health interventions and 50% is due to our enhanced prosperity over the years since we joined the European Union. At that stage, we were below the EU average by more than a year and we have substantially increased life expectancy in the intervening years, which is a good news story.

Deputy Reilly criticised me for some of the data in the amending motion. If we are to have real debates in the country and in context, we must recognise that in the health area there will always be people looking for services that cannot be provided immediately. There is no doubt about that and there is no health system in the world where that is not the case. Fine Gael proposes in its fair care plan that there will be free general practitioner access for everyone in the country at a cost of at least €1 billion, yet we are told it will not cost any more money. Fine Gael proposes that there will be private health insurance for every citizen in the country who will get unlimited health provision in a timely fashion. That is not supposed to cost us any money either. Deputy Reilly has accused me of madcap policies and mythical mathematics, but if ever there was mythical mathematics, it is that we will increase GP service to the two thirds of the population that do not have it and it will not cost an extra penny, and that we will provide private health insurance yet individuals will not have to pay more and it will not cost taxpayers more.

Fine Gael's new finance spokesperson said at the start of the summer that he would revisit these policies, although I do not know if that has yet happened. If we are to have a real debate in this House about an alternative approach, we must at least be honest about costings and about the financial situation in which this country finds itself.

That the Government put it in.

The allegation from the Opposition is that there is a closure of beds. There are 1,000 or 1,100 beds closed and to open them would require €300 million. Notwithstanding the fact those beds are closed, just as many patients will be treated this year as last year. That is a fact. I imagine this will be saluted.

Central to changing work practices within the HSE, which is a very important agenda item for me, is the recent Croke Park agreement. Central to that agreement is flexibility and redeployment. In Clare recently, when the HSE was moving nurses from Ennis, where they were not required, to Limerick, a Fine Gael Deputy opposed this. We are told money should follow the patients, but surely staff should follow the patients as well. Where does Fine Gael stand on the Croke Park agreement? At the first opportunity to implement what is at the heart of that agreement, Fine Gael baulked when Deputy Breen strongly opposed the nurses moving from Ennis to Limerick, where they are required.

Let us be clear. If we are to continue to provide a high quality service for our patients and to provide as much service as we possibly can, this will require a considerable reduction in public spending this year, next year and until at least 2014, because we must work until then to reduce the Government general balance from the underlying position this year of 11.9%, excluding the once-off EUROSTAT requirement for the promissory notes to be added in. This reduction will have to take place in areas such health which accounts for a large proportion of public spending. That will be the story no matter who is Minister or what parties make up the Government. We must be clear on that. This is why there will have to be greater emphasis on work practices, staff ratios, flexibility, longer working days, five-day week wards and more same-day admission for surgery. Thankfully, we have greatly increased day case activity in most hospitals and it now exceeds 70% in many hospitals whereas it was 50% just a couple of years ago. That said, we must do more.

In some of the hospitals, and this applies to University College Hospital Galway, the level of absenteeism is at 7%, which is twice what it should be. It is extraordinary that if one works in the public services generally, one is more likely to be out sick than if one works in the private sector. I do not know why this should be the case. Absenteeism in that hospital alone costs more than €140,000 a week and this issue must be addressed within the hospital and within the country. That hospital——

What is the Minister doing about it?

I would expect that when people come to the Deputy to leverage political support for challenges they face, at the least he would confront them with the challenges they can address. There was a litany of examples, especially in the west during the time of the Western Health Board, when year after year it ran over budget and the political system was leveraged to rescue the health board. That leverage no longer exists because the money does not exist to do that. All we expect every region to do is to live within the budget allocation given to it for 2010. No one is asking for a cutback in that budget, we are not having a supplementary budget and there is no emergency budget. We are asking that the budget allocated, the €15.3 billion we allocated to the public health service this year, which is 27% of Government spending, would be lived within in every region. Where that cannot happen, issues must be addressed, hospital by hospital or community care area by community care area.

The budget for the health service in the west, which was the focus of a number of contributions, is more than €2 billion this year. To put that in context, it is the amount we spent on the whole health service in Ireland in 1994-95, which is a considerable amount. Perhaps we could do with more money, and we would love to have more, but we do not have the luxury of having more given the financial challenges this country faces. That budget should be able to deliver for the west and its citizens what was planned in the service plan. I expect to see the plan's targets adhered to in the west during 2010 as much as I do for the entire country.

Regarding home help in the west specifically, 16,000 families will get home help services. Of course they could do with more and I wish we could have more, but we have maintained the budget for home help services this year. An extra €10 million went into home care packages and home help services in 2010, notwithstanding——

Are they being delivered?

——our financial challenges. Of course we could always do with more. Could we do with more hours for the individuals who have a service? The answer to that is clearly "Yes".

No accountability.

Unfortunately, we do not have the resources to do it. What we were able to do was put an extra €10 million into home care packages and home help services. Some 54,000 people in the country get home help services and just under 10,000 people are in receipt of home care packages. My priority and that of the Government is to continue to support people in living at home.

Deputy Burke mentioned the reference in the Government's amendment to the motion to the fair deal. Some 39 applications to the fair deal have been refused and just under 11,000 have been approved. Some 4,000 are currently in application. Of almost 11,000 that have been granted, 39 have been refused.

Over one third of applications are waiting for an answer.

They are recent applications. The responses are made in a timely fashion and money is not an issue in that respect.

The Minister should not give the impression that——

Please, allow the Minister to continue.

As a result, the number of late discharges from our acute hospital system has decreased by 30%.

This is an improvement and I wish the overall figure was zero, but the figure is going in the right direction, just like that pertaining to hospital infections and some of the other issues mentioned in our amendment.

Deputy Perry mentioned Sligo General Hospital, where the absentee rate is just under 5%, or 9,222 hours per month. In Navan hospital, the relevant figure is 4.74%, or 3,549 hours per month. In Letterkenny General Hospital, the figure is 10,392 hours per month. In Portiuncula Hospital, the figure is 4,982 hours per month. The HSE is working with those hospitals to address the absentee issue but we must all be at one, in that these rates of absenteeism in our health service cannot be justified.

What is the Minister doing about them?

I would like to know what the Deputy is trying to do about it instead of putting pressure here.

We have not had six years in office.

Allow the Minister. I ask her not to invite crossfire.

I am trying to respond.

I want to answer, given the short time I have left.

The Minister has two and a half minutes left.

I want to answer some of the questions put. No one in the Department of Health and Children gets a bonus. Deputy English or one of his colleagues asked how many people got bonuses.

I did not ask that.

Maybe it was Deputy McCormack. Two Deputies mentioned crutches. First, there are litigation issues. Second, it is cheaper to buy new crutches than to sterilise old ones. This is an issue in which I have been involved for the past year and I want to put the record straight.

There are many examples of medical appliances that can be reused and a greater effort is being made to do so. That programme has been accelerated recently.

What has been moved at Navan hospital is acute emergency surgery. One——

And elective surgery.

No. If the Deputy just listened. I tried to deal with this issue during Question Time.

Please, allow the Minister to reply to the questions put.

On average, one acute emergency surgery is admitted to Navan hospital every 24 hours. For patient safety reasons, that person will no longer go to Navan, but instead go to Drogheda. That is what has been cut for reasons of patient safety.

With respect, that is not the case.

Regarding orthopaedic surgery, which was the purpose of the question——

No, elective surgeries.

Yes, elective surgeries. It is a centre for orthopaedic services. Those will remain in Navan but, from the middle of this month——

(Interruptions).

Please, let the Minister put her speech on the record. The Deputies will have an opportunity to reply.

On a point of information——

The Deputy knows there is no such thing in our Standing Orders as a point of information.

Then a point of clarification or a point of order.

A point of order, if you please.

On a point of order, the Minister is trying to tell the House that orthopaedic surgery is the only elective surgery.

That is not a point of order.

The general elective surgery of general surgery has been taken away.

She did not say that.

We are discussing 1,800 cases per year, which cannot——

She was referring to orthopaedic surgery that was elective.

The Minister should get with the programme.

I ask Deputy Reilly to resume his seat. If the Minister and Deputies will allow, I will say something. Deputy Reilly will have the right to reply to this debate because it is Private Members' business. We will get much further if people would just listen. If they want to rebut points made, they will have ample time to do it, but we do not shout people down. That is not how a Parliament works. The Minister to conclude.

Is that how it works? That is not how the HSE works.

If Deputy McCormack wants to continue interrupting, I will ask him to leave the House.

From the middle of October to the end of this year, elective orthopaedic surgery will be suspended for cost reasons. That is what I stated. It will remain in Navan, as that hospital has been identified as a centre where orthopaedic surgery will and can continue.

During that period, I hope the orthopaedic surgeons will deal with the outpatient list. Many of the people on it will never require surgery and could have physiotherapy services instead or might not require further expertise.

It is elective surgery.

Clearly, Fine Gael's motion relates to ten counties. It is about seats in those ten counties.

I do not know what Fine Gael's answer is to the other counties. At a time when the country faces its greatest financial challenge ever,——

By whom was it caused?

——that the main party in the Opposition and its deputy leader are advocating additional money for the public health service is not acceptable.

No. We want better use of public money.

Have cutbacks been approved?

I am surprised that Deputy Reilly should continue to pursue these policies in his new role as deputy leader of Fine Gael.

Deputy Cregan has five minutes.

The Minister is in the wrong parliamentary——

Please, allow Deputy Cregan to make his contribution.

I welcome the opportunity to speak on this important debate. Given that I have heard few contributions relating waiting lists, matters are not that bad. We all have an obligation to ensure the public is treated for elective surgery in particular in as quick and efficient a manner as possible. I commend the National Treatment Purchase Fund, NTPF, which has reduced the average waiting time substantially from between two to five years to two and a half or three months in some cases. This is progress and the Minister should be commended for the significant part she played in it.

As the Minister stated, many Members on the far side of the House have used the opportunity to mention parochial issues. That is human nature and we all take liberties at times. However, now is the time to be serious about the situation this country faces. From time to time, the HSE comes in for a great deal of criticism from us all. Some of that is merited, but much is not. It is unfair that we often point the finger at administrative staff, management and so on. The HSE is the largest employer in the country. Its 100,000 employees comprise many different stakeholders. Human nature being what it is, each stakeholder wants to hold his or her own ground and to get the best for the people he or she represents. While this can be commendable, the time has come for each stakeholder within the HSE to buy into creating the efficiencies mentioned by the Minister and Deputy Reilly. It is fair to say they were in agreement on some of their points, which was sensible and responsible of them. Where HSE west is concerned, both Members pointed out where further efficiencies and savings could be made, whether through dealing with absenteeism, collecting additional insurance money or so on.

My area forms part of HSE west and is facing a situation similar to that faced by all of HSE west. I commend the stakeholders for the responsible manner in which they have behaved in recent weeks. Deputy Jan O'Sullivan on the Labour Party benches convened a meeting between public representatives and trade unions. It is only fair to commend the trade unions involved on the responsible way in which they played their role.

A theatre was to close down in Croom but I received a call from an orthopaedic surgeon who told me there was a better way to make the same saving. The HSE asked what the other way was and sat down in a dialogue. The theatre will not now close. This was a sensible and responsible approach. Another issue arose when staff in the orthopaedic hospital in Croom were to be redeployed to the regional hospital in Limerick. The trade unions sat down and agreed to allow it.

It is not all bad. There are ways in which we can create further efficiencies. At present, the total spend on health amounts to all our income tax moneys plus one third of other income to the State. We cannot have it every way. Of course, we want the best health service possible for the people in our country but we also want the best justice and law and order system, the best education system and every other kind of system. We must be fair and reasonable. The sum available is €14.6 billion and we have to bring in efficiencies and work within the budget. We did that successfully in many of the health boards throughout the country and I believe we will do so again, certainly in HSE mid-west. It is important that we should have at least the same level of successful outcomes, enhance that where and if we can and continue to work in that fashion.

I commend the Minister for Health and Children, Deputy Mary Harney, for her stewardship in recent years. Like the Taoiseach, she has been the subject of personalised attacks on many occasions by Members both inside and outside the House. That is despicable. If we want to criticise a person we should do so on his or her performance, but that is not possible in this case because the Minister has performed exceptionally well.

I welcome the opportunity to contribute to this debate and I echo the sentiments expressed by Deputy Cregan in regard to the Minister, Deputy Harney, who I have found, in the years I have been in this House, to be extremely open to new ideas and prepared to engage and deal with difficult situations where they arise. That is not how she is characterised outside the House. Like the previous speaker, I find it difficult to understand how she can deal with some of the slurs and insults that are thrown her way. I suppose it is a test of her character and she has won it well.

We all accept that the protection of front line services is of the greatest importance and the Minister and the Government are striving to deal with this, especially in the current difficult economic climate. There is a requirement for all of us to show leadership and to try to bring the people with us. To some extent, I was taken by how Deputy Reilly put forward the Fine Gael proposal. He spoke about the necessity for money to follow the patient and set the overall framework of how his party would deal with the health service. That is fine and the Minister responded to some areas where she found inaccuracies. At least the Deputy was talking about a co-ordinated plan but speaker after speaker who followed him complimented the Deputy for his proposal and then sought to undermine what he had said by considering local issues and discussing services rather than patients. Deputy Reilly clearly stated that money should follow the patient and I respect him for that. He said that, in so far as one can, one must focus delivery of the health service on the patient. That is clearly set out in the way reconfiguration works.

I will not go over the same ground again but the Minister referred to a situation where a Deputy in County Clare sought to undermine what is being done, although it had been agreed by the unions in the Croke Park deal. I find it difficult when a nurse comes to me and complains in a clear way that she does not want to move to another hospital. On a personal basis I can understand that but if the matter has been agreed by the unions and is in the best interests of the patients concerned, what end are all of us here to serve? We must be careful and stop fanning that flame, undermining the health service and the majority of its people who deliver a fantastic service. We have to get behind them and their union leadership and work towards a reconfiguration process which is based absolutely on patient safety. That must be central to the delivery of our health service. People must have confidence in the care they receive and have the best possible outcomes. I have seen this with the reconfiguration process as it has developed in Ennis. It was very difficult at the outset because there were certain political people on the other side who had local interests at heart. Using fear, some put forward the notion that if the reconfiguration process were to take place as outlined by the Minister and the HSE in the region of 20 people per year would die. That did not happen and, of course, there are no headlines when something does not happen. It is very hard to propose the notion that people's lives have been saved as a result of configuration.

We must continue with that work. It is not only about saving money but in the financial position in which we find ourselves, as the Minister set out, the incremental increases that had been occurring year on year are no longer there. This will force change. I am concerned that certain people on the other side have told Deputy Reilly that they are not prepared to accept that change. They have said as much in his company albeit behind his back. They are not prepared to accept that change which is necessary. If the extra money does not exist, it is clear we must do more for patients with less money but only if we work differently. The unions recognised this in the Croke Park agreement. Deputies in this House must show leadership and find ways to do this. Deputy Cregan identified ways in which it has been done and I have seen other examples in the county I know best. It is possible to move forward, holding the views of workers and management to hand, and to develop a proper model that can be worked more efficiently from both a cost and a labour-intensive point of view.

I thank Deputies for raising the issue of Dingle Community Hospital as it provides me with an opportunity to address this issue and reaffirm the Government's commitment to providing quality residential care for older people. The Government's policy is to support older people to live independently and with dignity in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to quality long-term residential care where this is appropriate. We continue to develop and improve health services in all regions of the country and to ensure quality and patient safety.

It is important that we have effective mechanisms in place to maintain and enhance public confidence in the delivery of quality services. The well-being and safety of the individual resident guides us in reforming the health service. This Government places great importance on the policies, standards and legislation we are implementing to achieve this end.

Older people deserve the highest quality of care in both public and private settings. Formal standards are a key requirement for inspection and registration. They set a benchmark for service providers to deliver a service that promotes health, well-being and quality of life. With this in mind, my colleague, the Minister for Health and Children, Deputy Mary Harney, approved national quality standards for residential care settings for older people in February 2009. As Deputies are aware, there are 32 standards under seven groupings, namely, rights, protection, health and social needs, quality of life, staffing, the care environment and governance and management. These standards set the benchmark for residential care settings for older people in Ireland and deal with, among other issues, their physical environment. Standard No. 25 states: "...the location, design and layout of the residential care setting are suitable for its stated purpose. It is accessible, safe, hygienic, spacious and well maintained and meets residents' individual and collective needs in a comfortable and homely way."

However, the standards are about much more than infrastructure. They are resident-centred and provide a blueprint for the provision of a higher standard of care, delivered against a set of understood and developed criteria, designed to improve and enhance care and recognise good practice. They are evidence-based and identify whether the best services possible are being delivered in an effective and appropriate way.

Older people, their families and the public must have confidence that quality standards are being implemented across the system. These standards will play a pivotal role in driving improvements in the quality and safety of residential care for older people in the years ahead. The standards are underpinned by both the care and welfare and the registration regulations. They provide the chief inspector of social services, who is part of HIQA, with a regulatory framework applicable to all nursing homes. The chief inspector is responsible for the registration and inspection of nursing homes and for ensuring they continue to meet the standards.

As Deputies are aware, the new community nursing unit in Dingle and the time it is taking to open it have attracted media attention, locally and nationally. I understand planning permission was granted by Kerry County Council in early 2007. The original design had to be modified due to the compulsory purchase by the council of some of the site for an inner relief road. Work on site started in October 2007 and was completed in December 2008. The HSE equipped the new unit over the course of 2009 and submitted the completed registration pack to HIQA in April 2010 to enable the centre to be registered and to open. HIQA inspected the unit in June and the chief inspector issued the notice of proposed decision on registration on 15 September. Under section 54 of the Health Act 2007, the HSE has 28 days to make representations concerning the proposed decision. I understand discussions are ongoing between the HSE and HIQA on the proposed decision and I am confident the issue will be resolved.

It will be clear to the House from this outline that this Government's commitment to ensuring the safety and well-being of residents in nursing homes is undeniable and we will continue to work with all relevant stakeholders in this sector.

I wish to share my time with Deputies Caoimhghín Ó Caoláin, Brendan Howlin and Seán Sherlock.

I commend Deputy Reilly and his Fine Gael colleagues. It is very important for us to debate this motion tonight. There is a great deal of pain, suffering pain and concern within communities around the country because of the numbers of people on trolleys, waiting for operations and because of the numbers losing their services, including those with disabilities and the elderly who are losing the home help hours and the aids and appliances they need to live their daily lives in some type of comfort.

This is not a mirage, rather it is the reality we all know as public representatives, because people come into us every day with these issues. People are waiting in some cases, years, to have procedures carried out. Admittedly some of them are not on the waiting lists about which we have statistics, because they are waiting to get from the GP to the outpatients' department before they see a consultant who will then put them on the list. Some three months after that they start to be counted.

There are many problems in the health service and that is not accidental. I have a reply here from the new head of the HSE, Mr. Cathal McGee, which acknowledges that €1.3 billion was cut from the Executive's allocation in 2010. That has to come from somewhere. As the HSE is such a cumbersome organisation, the way in which it implements such cuts is to bludgeon. It is literally a question of cutting front line services, by and large. We have not seen the backroom reforms and other measures that might have alleviated some of the pain.

I am sorry the Minister is no longer here, but she read out a list of costs that the Fine Gael motion would embrace. However, all Fine Gael is doing is seeking to maintain front line services in the various hospitals that are listed as examples and ensure there are no further reductions. The Minister has effectively conceded that all that money has actually been taken out of the service. The motion is simply asking that the existing front line services be maintained. Therefore the Minister, in her contribution, has effectively made the case for the fact that this is a very important motion and that real pain is being experienced.

She also made the argument very strongly for the type of reform the Labour Party has been talking about since 2001. She referred to the figure of £2 billion that was being spent on the health service in 1995, I believe. In the Labour Party document for 2001, we had a figure of £5.5 billion as the amount being spent on the health service at the time. We said that to produce the universal health insurance reform we were proposing the cost would go up to £7 billion. The present figure is around €15 billion — it went up more or less to €16 billion, but has come back down yet we have not had the reforms. Therefore we have this loss of service, and all these waiting times because we have not had reform.

All we had was the setting up of the HSE, which was a setback to reform, in my opinion, rather than an improvement. It is such a centralised monolithic organisation that it makes it very difficult for anybody to achieve reform in that context. The Minister has effectively admitted defeat in what she said in her speech. The cost of the health services are not high relative to other European countries, although it represents a high proportion of the amount of tax being taken in. However, we have not had the reforms to allow the money to be spent efficiently to provide the front line services that other European countries can achieve on similar GDP percentages.

The Minister has therefore acknowledged that she has not reformed the health service and that we are spending a considerable amount on it but are not getting value for our money. I am particularly concerned, on reading today that the number of people on trolleys is 420. I have the figures here for the various hospitals all over the country, and it is 33 in the Mid-west Regional Hospital, in my constituency. Our region is supposed to be the shining light as regards configuration for the rest of the country, yet our main hospital has 33 people on trolleys today.

The highly respected former Fianna Fáil councillor for many years and former chairman of the health board, Mr. Jack Bourke, with whom I served on Limerick City Council, was quoted recently in the media as being appalled at the whole situation when a family member attended the hospital's accident and emergency department. He was not complaining over the treatment but about the conditions in the accident and emergency department in Limerick and the number of people waiting. The attempt to reconfigure in Limerick was meant to include a critical care block, which has not yet started. It was meant to include many day services in Ennis, Nenagh and St. John's as well as other diagnostics and services in the smaller hospitals. On paper it looked quite good, but unfortunately it has not been delivered. One of the results of this is that 33 people are on trolleys.

I should like to quote Mr. Paul Burke, the person who is implementing reconfiguration and who is very committed. He is a very fine clinician, somebody I respect enormously, and I know he has tried very hard to make reconfiguration work. I am quoting from the most recent edition of the Medical Independent, where he says:

One area of agreement that is common to all sides of the debate is the impact of the staff moratorium.

A 1.8 per cent decrease in the numbers of people with private health insurance — equivalent to 42,000 people — in the 12 months to June 2010 has increased the demand on public health services, including acute care.

Combined with the moratorium, this leaves consultants in a difficult position when trying to deliver a workable process of reconfiguration.

"More than the funding itself, the big difficulty has been the moratorium and our resulting ability to effect change," said Mr. Burke.

"We could have done a lot more, much more quickly, even if we were working in a budget-neutral situation. But for example, when we closed the in-patient surgical wards in Ennis and Nenagh, there were a number of staff there who were either redeployed or took early retirement and under the moratorium, we didn't get those retirees WTE.

"So then when I said, ‘We want to develop things more quickly here' in terms of getting more nurses and a greater pool to draw from, when I went looking for these people they were gone, thanks to the moratorium.

"So yes, this hospital [Limerick] has become busier and there is greater pressure on staff."

Mr. Burke explained that Limerick has taken a "double-hit" in terms of staffing pressures because of the moratorium.

"There would be the usual, natural loss of jobs because of retirement and so on, but because a number of people said, ‘Well, I'm not going to move to Limerick at this stage' and took early retirement, there were a large number of people in our region who would have made that decision, rather than somewhere where there were no changes occurring, and in that sense, we took a double-hit because of the moratorium."

I read that out because I wanted to make a case this evening for the moratorium to be substantially reviewed. It is causing untold problems and that is an example of somebody who is genuinely committed to reconfiguration, and who is finding the moratorium is making it almost impossible to achieve the Government's policy in this regard.

We also saw reports during the summer whereby HSE west and other regions found themselves in the ridiculous position of having to take on agency nurses in particular along with other health care professionals, at an extra 40% to 50% of the cost they would otherwise have had to pay. I strongly argue that this needs to be addressed.

Another point I wanted to make relates to the insurers. I got a reply to a parliamentary question which said that by the end of 2009 some €41 million was owed in insurance charges to HSE west, and a further €2.5 million was owed to St. John's Hospital in Limerick.. That is appalling inefficiency and if collected would make up the kind of money that is needed. My final point is about those crutches. I do not accept the argument to the effect that it is not cheaper to reuse crutches. There are plenty of materials that can hygienically clean articles such as crutches. I urge the Minister to rubbish whoever told her it was not cost effective to reuse crutches.

Ba mhaith liom mo bhuíochas a ghabháil don Teachta Uí Shúilleabháin.

I support the motion in the name of the Fine Gael Deputies and I urge all Deputies of every party and none to support the motion. A major price is being paid for the misgovernment of this State over the past 13 years, and among those paying heavily are public patients in our health services. They are now subject to savage cutbacks that are closing hospital services, shutting down beds and wards, increasing waiting lists and waiting times, worsening the overcrowding in accident and emergency departments and slashing a whole range of services in the community.

Last Friday, 1 October, the Fianna Fáil-Green Party Government began the imposition of prescription charges on medical card holders. The Government claims that these charges are being imposed in order to save money on the State's drugs bill. In fact, the charges typify the perverse economics of this Government, placing a further burden on those least able to afford it rather than tackling the real problem. The real savings are to be made by reducing the profiteering of manufacturers and distributors of drugs and tackling over-prescription and wastage. In addition, the charges are causing confusion and creating another costly bureaucratic nightmare for patients, pharmacists and the HSE.

The so-called rebel backbenchers who have been raising health issues over the summer were happy to trip in behind the Minister, Deputy Harney, and her Cabinet colleagues to vote for the prescription charges Bill on the day before the summer recess, and they have voted for every health cut in every budget since 2007. This week they have a chance to redeem themselves and demonstrate their sincerity in raising the health service crisis in their regions. Then it will be up to the voters to decide whether the real concern of these backbenchers is hospital beds and health services, or Dáil seats.

One of the hospitals mentioned in the motion is Monaghan General Hospital. The removal of services from this hospital, culminating in the ending of acute services on 22 July 2009, has been used as a template for the downgrading of other hospitals. Government and HSE centralisation policy, as well as the tightening regime of cutbacks, including the recruitment embargo, sees hospitals across the State under threat. The latest to fall victim were also in the north-east region — Louth County Hospital in Dundalk and Our Lady's Hospital in Navan. The cumulative effect is to greatly increase the burden on Cavan General Hospital and Our Lady of Lourdes Hospital, Drogheda.

The north-east region is now the least well equipped to deal with the further savage cuts coming down the line courtesy of this Government. In June we had the closure of the emergency department at Louth County Hospital, Dundalk, and the removal of both the rapid response vehicle and the patient transport ambulance from Monaghan to Castleblaney. In a meeting between union officials and HSE administrators yesterday, it became apparent that the HSE intends to further cut services at Our Lady's Hospital, Navan. Some 13 surgical beds at the hospital are closed from this morning, while the whole of St. Pius's ward is also being closed. The HSE has said there will be redeployment of staff and there may be redundancies.

The Save Navan Hospital campaign is organising a major rally in the town of Navan on 30 October. More than 100 staff on fixed-term contracts in Letterkenny General Hospital have received notice that their hours will be cut by seven hours per week. This is at a time when front line staff and users both say the hospital is full to capacity. The HSE's plan for Letterkenny also includes the following proposals: the closure of one intensive care unit bed — a 20% cut; the closure of the pharmacy; the cessation of all elective surgery until the end of 2010; and the closure of the mortuary at weekends. In the context of recent road tragedies in County Donegal, how would Letterkenny hospital cope in the event of — God forbid — any recurrence?

This is all happening at a time when we have already seen significant bed closures in Letterkenny and Sligo General Hospital over the last 18 months. The so-called overspend at Letterkenny General Hospital is directly related to the cuts in funding to that hospital following budget 2010. Today we also learned that the HSE is to cut its funding scheme which assists 250 cancer patients from Donegal annually with the cost of flights to Dublin for treatment. This project was initiated by the community in Donegal in 1996 and is now in jeopardy due to these heartless cuts. Hospitals across the State, including excellent hospitals such as South Tipperary General Hospital in Clonmel, which I visited a year ago on 12 October, continue to be under threat from the centralisation policy and cutbacks of the Fianna Fáil-Green Party Government.

It is not only acute hospitals that are being targeted. On several occasions I have raised the case of the public nursing home at Loughloe House in Athlone, which the HSE tried to close earlier this year. Thankfully, due to a campaign by the local community, this facility remains open, but it is still under threat. It is feared by people in Wicklow town that Wicklow District Hospital, which provides long-term and respite care for older people, faces the same fate. Respite beds have already been cut. The community has received information indicating that the HSE is planning the closure of the hospital and, as in Navan, a protest march has been organised for this coming Saturday in that town.

The Members on the Government side have repeatedly voted confidence in the Minister for Health and Children, Deputy Harney. This is the Minister who said recently that there was no more money for health care in the west while opening a €100 million extension to the private, for-profit Blackrock Clinic, part of the private health care industry that she and her Government colleagues of all hues heavily subsidise at the expense of the public system. It is incredible. We are living through a nightmare in terms of health care provision and delivery systems. If someone had written this in different times we would never have believed it possible. However, that is the way it is, and the dark clouds that descended over the community I am proud to be part of and to represent in the House have now spread to many other locations across the State, just as we forecast at the time. My sympathy goes out to each one of those people, those families, and those communities at this time. Something must be done.

I commend hospital and health campaigners across the country, and I urge people campaigning on health issues in the regions and nationally to keep up the pressure, particularly on Government-supporting Deputies, not least those who have allegedly taken a stand of concern for their communities with regard to the ever-diminishing delivery of hospital and health services. I hope this people-led effort will help to hasten the departure of a regime that has caused major hardship in our public health services and great distress for people across the State.

Debate adjourned.
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