Wednesday, 26 April 1995
Dáil Éireann Debate
That Dáil Éireann, mindful of the unacceptable hardship being caused to hospital patients and their families due to appointment and admission cancellations, long waiting lists and continuing overcrowding in hospitals and also erosion of morale among hospital staff, condemns the Government for its failure to recognise the crisis and to adequately address the problems.
Mr. L. Fitzgerald: I heartily support the Private Members' motion in the name of our spokesperson, Deputy Geoghegan-Quinn. I regret the Minister is not present but I am pleased the Minister of State has arrived. I was amazed at the incredulity of the Minister at our putting down this motion. Both he and I are long in the tooth politically — we came into the House together a number of years ago — and we have seen many Governments and many political parties, including our respective parties, come into Government and go into Opposition. The records show that when parties go into Opposition they have to be vigorous and robust in their critical analysis of Government performance, even though the Government may be in office only a short time. Sometimes the zeal of both our parties was, perhaps, in excess and at the expense of constructive criticism. Indeed, all parties in the House occasionally stand condemned on that score. I am not excluding my own party from that criticism because that is in the nature of Opposition. We have made it clear that while we intend to be a vigorous, robust Opposition and to analyse all issues on an ongoing basis, for the short time we will be in Opposition——
The Minister tried to convey the impression that there is not a crisis in the health service. I will confine my  remarks to the Dublin area, I have a few examples to illustrate the crisis. I am not saying it all happened over night or over the last three or four months but there is a crisis and it must be addressed.
The central question in the Private Members' motion is whether there is a crisis. The Dublin hospital scene is rapidly approaching crisis, if not already in crisis. The symptoms that demonstrate the problem have been succinctly articulated in Deputy Geoghegan-Quinn's motion, in her contribution to the House last night and by my other colleagues. I wish to refer to my constituency of Dublin North-East where the problems are ongoing. They did not commence yesterday, 1 January 1995 or when this Government took over but, having spoken with professionals who work at the coalface and people in the health board, the problems relating to casualty in the Mater and Beaumont hospitals have worsened.
Patients are unable to obtain beds. They have to remain on trolleys for too long and there is queue jumping. I understand a trolley is a short stay bed. Some of my constitutents have spent between 24 and 48 hours on trolleys in the Mater and Beaumont hospitals. That has been refuted by hospital managers but it is true. I believe the people who have told me. I have also been in debate with constituents who have used the accident and emergency departments for queue jumping. They explained the reason they were concerned and the reason they felt under pressure to do that. I pointed out it is not right but the problem exists and it must be addressed.
There are solutions. In the Dublin area three hospitals are to be closed. I suggest one should be kept open either to deal full time with accident and emergency or, alternatively to deal with the step down category. That would have much merit. There is much discussion on that issue and I ask the Minister to consider it seriously within his Department.
Mr. Foxe: I appreciate the generosity of the Fianna Fáil Party in sharing time with me. It is unfortunate for the Government that this motion has been tabled so early in its reign. The Government is in office only four months. Many of the problems which face the health services, particularly the hospitals, have not grown up over the last four months, they have been growing for a number of years.
In the late seventies and eighties the idea was that the smaller hospitals would be closed and that we would end up with a few bigger and better hospitals. The thinking was that bigger meant better which it does not. That policy was exercised by the Fianna Fáil led Government of the day and also by the Fine Gael led Government of the day. Roscommon Hospital was no exception. Fortunately towards the end of 1989 and 1990 the thinking changed somewhat in connection with that hospital. Instead of being downgraded it has played a major part in the health services not only of Roscommon but of the surrounding counties, some in the North-Western Health Board area and one Mid-Eastern Health Board area — Longford and Leitrim. Instead of being downgraded, money was allocated and the position was reversed. Since then the hospital has grown and new services have been developed.
In 1991 the number of patients discharged from Roscommon Hospital was 3,350. In 1994, three years later, that figure had grown to 4,500, an increase in excess of 30 per cent. With the increase in patient turnover there were further increases in drugs, food, x-rays and general administration. Unfortunately there was no extra allocation of funds for the continuation of the hospital services. In 1994 the number of patients had increased by 14 per cent but still no extra funds had been provided. The shortfall last year amounted to £250,000. Unless that shortfall is made up the services cannot be maintained at their present very high level. That would result in downgrading the hospital, lowering morale among the staff and  confidence among the local people in their hospital. That would be to the detriment of the health services in that area.
Most of the admissions to the hospital are emergency admissions and there is no fall back position for when an emergency arises when elective patients could be sent away because their condition was not serious. It is, imperative that there be no further cutbacks. Any attempt to pare expenditure further would make a bad situation worse. A partial answer might be to provide a day care centre in some hospitals where patients who are no longer termed acute could be treated.
Mr. Crawford: I wish to share my time with Deputies Boylan, Frances Fitzgerald, Breda Moynihan-Cronin, Eric Byrne and Kathleen Lynch. This obviously limits my time, but I wish to support the Minister's amendment to the proposal we are now debating. The Minister has done an extremely good job in some very delicate situations, for example, in regard to the Blood Transfusion Services Board, the travel Bill and other issues which had been put to one side for many years.
As a relative newcomer to this House it surprises me that the Opposition can in a few months try to make out that they are not responsible for any of the problems, the potholes, unemployment, housing or even the beef tribunal and its costs. This Minister has gone about his job in the best possible way, utilising the funds provided to him. I pay tribute to his predecessor who reduced the waiting lists in many acute hospitals. The Minister for Finance also played a role by providing an extra £8 million in the budget.
In a few months this Minister has made every effort to consult many groups. He has begun a tour of the health boards to meet personnel and  deal with problems. He has made tremendous strides in a very short time.
In my area he has provided much needed funds for the appointment of ten joint consultants to the hospitals that most concern Deputy Boylan and me. There had been talk of appointing consultants but this Minister provided £810,000 in this year's budget to make those appointments. He has also provided funds for CT scanning unit in Cavan Hospital. There is a financial allocation for the development of a satellite dialysis unit in the North-Eastern Health Board which also services Cavan-Monaghan and I have no doubt that the Minister will shortly open the cardiac unit in Monaghan.
In my area there is a problem with the hospital waiting lists. I want to make the Minister fully aware that there are still people on waiting lists. However, to try to blame him for the problem is unrealistic.
The Minister allocated an extra £585,000 for the dental services in my region and £800,000 for child care in the North-Eastern Health Board region. In my immediate area of Monaghan the Minister has given £450,000 for the mentally handicapped.
We want many more things and I am satisfied this Minister will do everything in his power to ensure that waiting lists are cut and much needed day care services are provided in Monaghan Town, the biggest town in my constituency. These have been promised for many years and will become a reality.
Last night the Minister showed a realistic and detailed grasp of the difficulties facing the health service, particularly in Dublin. I am glad the Opposition parties acknowledge that these problems did not begin in the last four months but have a long history. In the last four months the Minister grasped  the nettle and started to take action to put in place a good plan to deal with the difficulties.
I am concious of the difficulties facing the Dublin hospitals and I acknowledge what the Minister has done in those hospitals. These are not the actions of a man who is not in touch with what is going on in hospitals. In my constituency the Meath Hospital has been supported. The Adelaide Hospital got £230,000 for development this year. The National Children's Hospital in Harcourt Street got £100,000. The Coombe Women's Hospital got a welcome £125,000. Millions of pounds have gone to St. Luke's and St. Anne's in my constituency and also St. Vincent's Hospital just outside my constituency where a major programme is being put in place. I see real efforts to solve the problems facing those hospitals.
There has been an acute problem in the last few weeks and months, not just in Dublin but in other European capitals where there has been a huge demand on accident and emergency services. Because of the harsh winter elderly people have made more demands on hospital services. It is important to realise that we need an integrated plan and a complex reaction to solve the problem.
How we develop the appropriate use of GP services is critical. It will not be easy because there is a culture and tradition of going to the accident and emergency services. People, when they are upset, frightened and in crisis, want to know they can walk into an accident and emergency service that can receive them well. However, we must examine the supports we give to GPs to provide appropriate cover, particularly outside working hours and at weekends, so that people are not put under pressure to attend inappropriately at accident and emergency services. I look forward to hearing the results of the project work being done at the moment because that is extremely important and part of solving the pressure put on our hospitals.
We must also examine the integration  between the services offered by the health board in Dublin and the voluntary hospitals. We should ensure there is co-operation and that management structures are put in place. I welcome the important decision announced by the Minister last night to allow nursing staff to be represented on the management committee which monitors the needs of the Dublin hospitals and considers the various management issues which arise.
The Minister has made money available to reduce waiting lists. Some of the waiting times outlined are unacceptable. In a number of areas the waiting lists are too long but there have been dramatic improvements in recent times — some have been reduced by 47 per cent and others by 57 per cent, progress by any standard.
It is not helpful to the general public to engage in scaremongering about the health services as people's health is far too precious. There is a need for a quality debate on the problems facing the acute services which will not be easy to solve. An integrated approach is required. It is not just a question of providing money for the services although this forms an important part and is being done. The amounts quoted last night are impressive. An additional £17 million is being provided for the acute hospital services in one area and an additional £70 million in capital funding. We need to address a variety of areas, including management issues, access to general practitioners, hospital structures and how hospitals are coping with the heavy demands on them.
Mr. Boylan: I thank my colleagues for sharing their time and giving me this brief opportunity to publicly endorse the amendment to the resolution tabled by the main Opposition party. I am disappointed but not surprised that it has moved this motion. The Minister, who has been in office for less than three months, should be given an opportunity to correct the faults in the service.
The waiting lists did not appear during the past three months; I have  received much correspondence from constituents about them and although they were getting longer and longer the main Opposition party did not bother trying to reduce them. Its attitude was “come day, go day, God send Sunday” but that was no way to run the country or the health service. The Minister, Deputy Noonan, is only one of the fine men and women in the Government who are tackling the issues and coming to grips with the problems.
I thank the Minister for the many services he has provided in the North-Eastern Health Board area, including the dialysis unit in Cavan General Hospital to which my colleague, Deputy Crawford, referred. Prior to this unit being established patients from County Cavan had to travel to Dublin twice weekly. This was allowed to continue year after year without any attempt being made to rectify the problem.
I also compliment the North-Eastern Health Board for the approach it has adopted towards the care of the elderly. I do not want to be too critical as the doctors, nurses and general staff are trying to provide the best service possible in the conditions under which they have to operate but St. Felim's Hospital in Cavan is outdated. Despite this an excellent service is being provided for over 400 elderly patients.
The elderly like to be cared for at home or as close as possible to it but in many cases this is not possible. With finance provided by the Minister the  North-Eastern Health Board is now setting up small nursing homes. To an elderly person 30 miles is a long distance but they will now have an opportunity to be cared for within their own locality. This is a marvellous development and I publicly thank the Minister and the health board for providing these facilities which will come on stream before the end of the year.
There have been many other developments and people can rest assured that the long waiting lists for cataract and hip replacement operations and for orthodontic treatment will be reduced. In the case of children it is essential that they receive this treatment before the problem becomes difficult to correct. The waiting lists are being cut and children and the elderly are now being operated on in a matter of months rather than years. This is a major step forward.
Mrs. Moynihan-Cronin: When I was elected in 1992 the health services were in crisis. There was no overall health strategy, hospital waiting lists were getting longer and longer, the health boards had huge debts, the dental services were inadequately funded and many building projects were still on the drawing board. I compliment the previous Minister for Health, Deputy Howlin, for taking action to deal with the matter. In 1993 he made £20 million available to the health boards for the waiting list initiative to reduce in-patient waiting lists. It was the first of its  kind and proved highly successful as there was a dramatic reduction in waiting lists. I am glad that the Minister, Deputy Noonan, is providing £17 million to tackle the problem.
It is important that there are preventive services and in this regard the dental and orthodontic services were badly nelgected. The Minister is providing £9.5 million this year to allow the health boards to extend eligibility for services to children up to the age of 14 years. Many of my constituents have complained that because their children did not receive treatment at an early age they ended up in hospital. Services for the mentally handicapped were also neglected.
Under the Child Care Act an additional £10 million is being provided this year for preventive services. With these funds new services and facilities for abused and neglected children will be provided. There is a need for improved monitoring of children in residential care and an expansion of facilities for homeless young people. Most importantly, there is a need to strengthen the preventive services. The incidence of child abuse in the past three years is frightening. If these could have been prevented the waiting lists for these services would not be as long.
We now have a dialysis unit at Tralee General Hospital. For many years patients had to travel to Cork two or three times each week to receive renal dialysis treatment. Many of these people now have to travel only 25 or 30 miles to Tralee where that service is provided and the cost and hardship for the families concerned is drastically reduced.
Another matter of concern to me relates to the rape crisis centres. I am glad the previous Minister and the present Minister have dealt with this matter. In 1992 the Rape Crisis Centre in Tralee was glad to receive £300, but it is now receiving £45,000 per year. The extension of this service results in fewer people needing hospital care. I compliment both Ministers for providing funding in this area.
 Because the health services were neglected for many years, waiting lists are long, but this problem cannot be dealt with overnight. Deputies on the Opposition benches have very short memories. It was only when Deputy Brendan Howlin became Minister for Health that this issue was tackled.
Mrs. Moynihan-Cronin: Fianna Fáil was in power for many years but its various Ministers for Health did not take the initiative in this area. Deputy Howlin must be complimented in this regard, and I am delighted the present Minister is following in his footsteps.
Mr. E. Byrne: When I listen to Fianna Fáil Deputies and read their Private Members' motions I wonder whether they squirm at the notion that they condemn everything, the health service, the education service, the budget and so on. How long has this Government been in office?
Mr. E. Byrne: The facts speak for themselves. The issue of hospitals and medical care is a very serious one, an issue of life and death. As a Democratic Left Deputy there is no point in me standing up and saying something that is not factual. The reality is there are difficulties and crises in certain areas of the health service and it would be a foolish politican who would beat his breast and say that everything is rosy in the garden when we know that is not the case. I will be happy if in the next two years the Government attempts to put right the mess Fianna Fáil left behind.
Like my colleague, the Minister of State, Deputy Durkan, I shared responsibility in the past for the health services in the Eastern Health Board region. We are aware of the problems in the delivery of the health service, particularly the difficulties in accident and emergency departments. Fianna Fáil's attempt in the past to resolve that problem was to close half the hospitals on alternative nights, but it quickly had to reverse that policy because it was unworkable.
An increasing number of elderly people who are admitted to hospitals through accident and emergency departments are inappropriately placed. These people should be placed in appropriate accommodation such as nursing homes or other facilities provided by health boards, thereby alleviating the problems of acute general hospitals. This is a problem that must be addressed because it is causing tremendous difficulties in the delivery of the health service. For example, patients often have to undergo rigorous fasting before attending hospital for an operation, but when they arrive at the hospital they may be told the bed is occupied by a person who was admitted through the accident and emergency unit. This is a complex area and I am not sure where the problem lies but I hope it will be addressed by the Minister. Successive Governments are to blame for the reduction in bed numbers — perhaps in amalgamating hospitals  the total number of beds was not maintained. I appeal to the Minister to address the inappropriate admission of elderly people to acute general hospitals. He should use his good offices to facilitate the Eastern Health Board in developing a facility to which elderly patients may be transferred.
Kathleen Lynch: The motion refers to the unacceptable hardship being caused to hospital patients and their families due to appointment and admission cancellations, long waiting lists and continuing overcrowding in hospitals and also erosion of morale among hospital staff, but I take it these appointments were made some time last year when Fianna Fáil was in office. I take a middle line on most issues and if I were in Fianna Fáil I would be extremely concerned about the health service and about one matter in particular, that is, schizophrenia, because that appears to be what Fianna Fáil Deputies are suffering from. They are giddy and nauseous from the continuous twirling——
Kathleen Lynch: I come from Cork city where we witnessed the closure of the North Infirmary under a Fianna Fáil Government. In dealing with the health cuts we must consider Fianna Fáil's position at the time the cuts were made. In politics we are inclined to have short memories, but at that time Fianna Fáil was in Government with the Progressive Democrats. That Government, which was driven by the Progressive Democrats, promoted cuts in the public service, but now that Fianna Fáil is on its own it is floundering and has forgotten entirely what happened at that stage. For the past seven years Fianna Fáil has been known as the party of cuts, particularly in health care — Fianna Fáil knows that, we know it and the public knows it. It is shameful for that party to introduce this transparent motion and the public will quickly see through it. If  there are shortcomings in the health service, they are there because of Fianna Fáil's actions when in Government.
Kathleen Lynch: When I spoke to the matron of one hospital in Cork, the problem she raised was not the shortage of beds, which was chronic, but the shortage of cutlery. That shows how bad the position was under a Fianna Fáil Government. That party should look at the newspapers of that time to see the state in which it left the health service. The Minister for Health recently announced in Cork the extension of a hospital which has been grossly overcrowded for the past few years.
Mr. B. Smith: I welcome the opportunity to speak on this important motion on the health services tabled by Fianna Fáil. All of us as public representatives are very conscious of the need to provide the maximum level of health care for our citizens. Not a day passes that we do not receive letters or telephone calls from anxious constituents who are generally concerned about the delay in obtaining some particular health care.
Over many years the range of health care has been extended considerably at major national centres in Dublin and in  general and regional hospitals. Nobody can minimise the large annual financial investment needed in our health services. I am aware that in my health board area the health board's non-capital allocation in 1995 is more than £95 million. I compliment the chief executive officer of the North Eastern Health Board, the deputy chief executive officer and their colleagues for their work, particularly over the past few years, in expanding and consolidating the range of services available in Cavan and Monaghan. Alongside those developments and additional services the board has been extremely prudent in managing its income. That is borne out by the fact that the audited 1993 accounts show a negligible excess in an expenditure that almost totalled £100 million. I understand the same position will pertain regarding the audited 1994 accounts.
I am glad that the General Hospital in Cavan, established by Fianna Fáil in Government, is a noted medical centre and that the range of services provided there continues to expand. We have been fortunate that excellent specialists have taken up senior positions in the hospital and I am glad that more newly appointed consultants will take up positions at an early date. Those appointments were approved in early 1994. The provision of a dialysis unit and the future commissioning of a CAT scan machine will add considerably to the status of the hospital and such services provided locally eliminate long, tedious and difficult journeys for many people who are ill.
For the information of my colleagues Deputies Crawford and Boylan, I recall that on 8 February 1994 the then Fianna Fáil-Labour Government approved the provision of a dialysis unit in Cavan General Hospital and in May 1994 the same Government approved the provision of a CAT scan at that hospital. The letter I received from the then Minister for Health, Deputy Howlin, pointed out that I had been in touch with him regarding the development of a satellite kidney dialysis unit in my area  and that he was glad to inform me that this year he will be providing funds for the development of a dialysis unit in Cavan General Hospital.
Reference has been correctly made to the extreme pressure exerted on accident and emergency departments basically of the shortages of beds. The difficulties arising from that overcrowding caused strikes at two hospitals in this city and I am certain that the nursing staff who took that industrial action did not do so lightly, they were forced into it. I hope all the parties involved, including hospital management, consultants, the Department of Health, doctors and nurses can address those issues together and put the days of overcrowded, unsuitable and dangerous casualty departments behind us.
It is well accepted that the shortage of acute hospital beds is one of the major contributory factors to the difficulties experienced in casualty departments. It must be borne in mind that a sizeable percentage of those beds are occupied by patients who could obtain sufficient medical care in district hospitals or nursing homes. There is an urgent need to provide step down facilities and an adequate community support service throughout the country.
The fact that a sizeable proportion of acute beds are used for non-critical patients in hospitals, such as the Mater, Beaumont or St. James's, has a multiplier effect in causing delays at regional or general hospitals dependent on the referral of some patients to those major hospitals for specialist medical or surgical care.
I appeal to the Minister, and his Department, to change the criteria for deciding on the number of hospital beds to be provided at a general hospital such as Cavan. I understand that the Department used the criterion of 0.8 per thousand of the population per medical bed, but I believe there is no factoring in of the medical needs arising in an area where there is a higher than average elderly population. In Britain and in Northern Ireland such a criterion exists  and the Minister should give urgent consideration to a better medical bed allocation to an area, such as Cavan, which has a unique density of an elderly population. The allocation of beds under the present criterion poses serious problems for Cavan General Hospital due to the density of an elderly population, attendant medical needs and lack of non-acute hospital beds, nursing homes and community support services.
Allied to that, problems also arise due to delays in having patients referred to Dublin hospitals for coronary angiograms, MRI or CAT scans and other medical and surgical attention. Many problems arise from delays in having people referred for non-life-threatening treatment whether medical or surgical. There is an urgent need to develop nursing units in west and east Cavan and I hope the Department will give favourable consideration to the health board's proposals in this regard and that it will be possible for the work to commence on those projects before the end of 1995.
The respite care programme is beneficial and I hope that service, along with the convalescent care programme, will be expanded further by the Department. Such developments facilitate the discharge of patients from the acute hospital system.
I am conscious of the benefits of the provision of extra services and facilities at hospitals throughout the country. A dialysis unit has been established in Cavan and a CAT scan is to be commissioned at an early date. Both those services are available due to the generosity of the people in Cavan-Monaghan and the voluntary organisations involved in raising hundreds of thousands of pounds to buy the necessary equipment.
I understand that the Irish Society of Medical Oncology prepared a major report on the delivery of services in the oncology area. Among the many proposals in its report, it recommends the establishment of cancer units at a number of centres including Cavan. It is proposed that such a centre should have  one medical oncologist and a linked haematology post in each centre. I hope the Minister gives that report urgent consideration and puts in place at regional level the appropriate medical service for people suffering from cancer.
I am glad co-operation exists in the health area between North and South. Ear, nose and throat outpatient services and day procedures are provided for the Cavan-Monaghan catchment area by the Western Health and Social Services Board at the South Tyrone Hospital in Omagh. There is obvious potential for further cross-Border co-operation and I hope the hospital facilities on this island will be made available to all citizens.
Mr. M. Ahern: I am glad to have the opportunity to contribute to this debate on this important motion. It is one which all of us on this side of the House would support. The motion condemns the Government's failure to recognise the crisis in the hospital system and to adequately address the problems facing all those involved in operating the system and the patients who have to depend on it.
The former Labour Minister for Health, Deputy Howlin, now Minister for the Environment, recognised that there were going to be problems in the health services in this and coming years and he successfully extricated himself from the Department and has left Minister Noonan to face the problems. That is, of course, the action of a caring Labour Party. Since the beginning of this year, the crisis has led to industrial action by nurses, a group of caring workers, who seldom take to the streets without serious cause. This was highlighted in The Cork Examiner yesterday by a member of the Labour Party who drew attention to the fact that strikes were looming at St. Stephen's Psychiatric Hospital in Sarsfield's Court and Our Lady's Hospital on the Lee Road caused by a shortage of staff, utterly unacceptable in this day and age. I wonder what the person was doing to ensure sufficient moneys were made available  to the Southern Health Board to recruit many available, well-equipped people into the workforce. It is unacceptable for members of a Government party to be clamouring in the media for extra funds for this and that project when they should be talking to their Ministers on the issue.
A problem becoming ever more common in all our hospitals is the clogging up of our accident and emergency departments especially in Cork hospitals, through general practitioners being unable to have their patients admitted to hospital through the normal channels. In fairness one has to acknowledge that the weather was so inclement over the past year or so that people's health was adversely affected. More beds should have been made available but the accident and emergency departments were resorted to as a source of entry to hospital.
Another problem becoming ever more prevalent in those accident and emergency departments is that of violence by people entering at night. Doctors, nurses and other staff are being physically threatened, beaten and abused resulting in hospitals being forced to employ extra security staff to protect their workforce. The Minister must allocate funding for such security personnel to protect doctors, nurses and patients. One of the main reasons for this increase in violence is the greater abuse of drugs, especially ecstasy.
The North Infirmary in Cork city was closed some years ago and the Mercy Hospital which catered mainly for people residing in the county is now being associated with the population on the north side of Cork city. The Mercy Hospital throughput multiplied out of all proportion to its ability to cater for the number of patients presenting, the pressure on its staff being tremendous, forcing many almost to breaking point. The then Minister for Health, Deputy O'Hanlon, recognised the problem and commenced the process of upgrading and enlargement of that hospital. The former Minister for Health, Deputy Howlin, allocated funding for a new  building and, thankfully, the present Minister confirmed that funding recently. That will be of tremendous benefit to Cork city and county and the needs of the people.
Nonetheless there are other needs in County Cork. For example, in Fermoy local funding of approximately £500,000 is available for an old folk's home, St. Patrick's, an old hospital, for the provision of a new building to replace the former which has been condemned. Plans were submitted to the Department by the Southern Health Board some time ago, seeking additional funding of £100,000 to £200,000 to complete the work on this building. It would be a crying shame if the Minister's Department did not match the very considerable local funding being made available. In Midleton a collection is being taken up for a day care centre in respect of which I hope the Minister will also provide between £100,000 and £200,000, as he did in his constituency in recent days. There is no other day care centre in the east Cork area to cater for its large elderly population.
Democratic Left, through their spokesperson, Deputy McManus, was a very vociferous contributor to the debate held on health charges imposed in March 1993, contending that there had been a huge decline in spending on health care. She wanted our health services to be improved, to be more equitable and, at the same time, to provide jobs for more highly trained young people. It would appear that that same Member, now a Minister of State, and her Democratic Left colleagues, have forgotten the crisis in our hospitals, in their accident and emergency departments and in other aspects of health care.
In the past two years money was made available through the yield from the tax amnesty and the improved overall national finances wrought by the Fianna Fáil Government in office since 1987, helped for a short period by the Progressive Democrats, which was untilised on the improvement of health services. This Government has foregone  moneys needed and available for the improvement of our health services, as in many other areas. For example, it abolished the bank levy of £12 million, which would have been available, and proposed a 2 per cent cut in corporation tax to benefit large corporations and multinationals already making massive profits. It was from such sources the Government would have received the requisite funds to improve our health services. This Government, including Democratic Left, knows how to look after big business but has forgotten those dependent on our health services. The claim of the former Fine Gael spokesperson on health, Deputy Owen, now Minister for Justice, that the most important individual is the patient rings hollow against current Government action.
Ms O'Donnell: It is now generally recognised worldwide that health budgets in all modern economies constitute big spenders; health and possibly social welfare are the continuing, progressively big spenders in all administrations, having an insatiable need for more resources.
Rather than engage in routine political condemnation of the Government, it would be more helpful and practical to ascertain how existing resources allocated to health and social services are being expended, how they could be better utilised within the health services.
On the matter of overcrowding in hospitals, especially within their accident and emergency departments, should there not be instituted an assessment procedure so that, rather than patients having to wait three and four hours, it could be established quickly whether they might not more appropriately be treated by their general practitioner. Are there any statistics available from consultants in casualty departments on how many patients presenting themselves would be better served going to their general practitioner, in terms of their comfort, time and overall cost to the Exchequer? It  must be remembered also that such patients tend to take up acute hospital beds whereas they might well have been properly treated at primary level by their general practitioner. The Minister must examine the possibility in a broad strategic way of enhancing primary care. With better general practices, treatment nurses within the community, many people would receive better treatment at primary level rather than attending accident and emergency departments and occupying acute hospital beds. We must divert more of our resources to enhancing primary care at all levels within our community, thereby reducing the insatiable rush for high-tech expensive treatment, resulting in better deployment of our available resources.
Even though there are inefficiencies in the system if we properly managed the money ploughed into hospitals and insisted on good management practices then the overall level of service could be improved. What is the status of the strategy for health care published by the former Minister for Health? This glossy document contained a four-year plan for health care and a specific promise in regard to women's health, where a plan is urgently required, particularly in the area of cervical and breast cancer. We have a very high level of breast cancer compared to other European countries, and the Eccles Street pilot project was set up to examine the results of the screening process. I understand the plan is on the Minister's desk and that a decision is awaited from him on a national screening policy. It is worth repeating that every year 70 women die needlessly from cervical cancer. Many of these women were never screened and we should be doing everything we can to put in place a screening programme for women.
The hepatitis C disaster may turn out to be dynamite in terms of its cost to the Exchequer. The tribunal will decide the  level of compensation to be paid to the women affected by anti-D. There are also the men and women who were tragically affected as a result of blood transfusions. The Hederman report did not deal specifically with this issue and all of us — it is our money — will have to face up to the fact that there is another unquantified category of women and men who have been affected as a result of blood transfusions. This disaster will also pose a headache for the Exchequer. Many people were surprised that criminal proceedings were not initiated as a result of the revelations of that excellent, courageous and open report. Some people feel that justice has not been done in this case and I would like to know if the Minister has referred the matter to the Director of Public Prosecutions or whether it is open to someone else to refer it to him.
Little attention has been paid to the area of preventative medicine. Successive Governments have let this area of medicine slip down their list of priorities. They have adopted a sympathetic approach to preventative medicine, yet a very small portion of the health budget is directed towards early intervention to try to keep people healthy and to teach people, particularly young parents, how to lead healthy lifestyles. Given the decrease in extended family support structures, young parents are in danger of not properly feeding or looking after their children. The Minister must give further consideration to the use of existing funds. Much of the funding is directed towards acute hospital care and high technology techniques and there is a definite imbalance in the level of funding directed towards alternative health care. Consideration must be given to the fact that many people have opted out of traditional medicine and now use alternative medicine. As in the case of the green agenda, many people are way ahead of the policymakers in the health area.
Reference has been made to the delays in hospitals and the shortage of beds. These problems are mainly caused  by the allocation of beds to elderly people who could be much better looked after in low cost nursing home accommodation in their communities. Many elderly people do not require acute hospital care; rather they need management, therapy services, etc., which are also available in nursing homes. Consideration must be given to the use of existing beds and the formulation of a strategy to deal with our ageing population. Many elderly people who have had strokes do not need to be in hospital and they could be look after sympathetically and compassionately in small nursing homes in their communities. Reference has been made to an initiative in this area.
I have particular interest in the Child Care Act, 1991, and it is worth noting that this splendid Act has a gestation period of 20 years. If we implemented all of its provisions we would be going a long way towards putting in place very good standards of care for children. However, four years after its enactment only 17 of the 79 sections of that Act have been signed into law. This is a terrible indictment of successive Governments who have failed to put children first in terms of using resources. Budgets are about choices but unfortunately, unless it is a high profile child abuse case, child care is at the bottom of the budgetary and political agenda. My party would support the implementation of the remaining sections of the Child Care Act. Given that only 17 of the 79 sections have been implemented, we cannot say that we have even minimum standards of care for children, the most vulnerable of our citizens. What preventative strategies does the Department have to deal with the very high suicide rate?
Minister of State at the Department of Health (Mr. O'Shea): Deputy O'Donnell referred to people who present themselves at casualty departments rather than attending their GPs. St. James's Hospital has set up an innovative pilot project under which GPs are employed in casualty departments to  screen patients. The Department is examining the possibility of extending this project.
In the course of this debate we have heard Opposition speakers raise a great many issues and without doubt many of them need to be addressed; none of us would claim that the health service is perfect. However, it is also fair to say that many of these issues date from a time when those now on the other side of the House were in Government and had an opportunity to deal with the issues they now complain about. It is, therefore, a matter of regret that Opposition speakers could not have taken some of the time which has been spent outlining in great detail the shortcomings of the health service to give us their views on how they would go about solving these problems.
The Opposition contributions have been long on criticisms of our health service, but lamentably short on constructive debate about how we can go about making improvements. We are well aware that there are infinite demands for the limited available resources. It is, however, misleading in the extreme to suggest, as some Opposition speakers have done, that nothing is being done to remedy the deficiencies. An additional £17 million revenue and £70 million capital funding is being provided for the hospital service this year.
The issue of providing appropriate care for patients who no longer require an acute hospital bed has been raised by a number of Opposition speakers. This is an important element of the health service, particularly as our population begins to age and we find ourselves more and more in need of such facilities for elderly patients who are not ready for discharge into the community. I am glad of this opportunity to highlight the importance of such services. As Deputy Callely mentioned last night, the need for such facilities, particularly in the Dublin area, has been acknowledged for some time. However, I have to take issue with the Deputy's contention that nothing has been done in this area. Over  the past few years, the development of appropriate services for the elderly has been one of the Eastern Health Board's top priorities and significant progress has been made in this area.
I would now like to deal with the allegations, which were so callously thrown out to this House, concerning the lack of facilities for the elderly and the allegations that things had become stagnant. The Opposition tried to suggest that very little had happened in the Eastern Health Board in the last few years, but when we come back to reality we see that the situation is quite the opposite. For example, I have been informed by the Eastern Health Board that in the past five years a number of developments in services for the elderly have taken place. An additional 667 places for intermittent-respite, rehabilitation and extended care have been put in place. In 1994 in excess of 500 elderly people who were medically assessed as requiring long term care, and who had completed the acute phase of treatment, were discharged from acute general hospitals to step down facilities. There additional consultant physicians in medicine for the elderly have been appointed in Dublin north, Dublin south and Kildare-West Wicklow. A fourth post is currently being processed in respect of Dublin South East-East Wicklow.
New departments of medicine for the elderly have been developed at the Mater and the Meath hospitals. These developments interlink between accident and emergency services and services for the elderly in those hospitals and are in line with the requirements set down in the health strategy document. Shaping a Healthier Future, in that each acute general hospital in the Eastern Health Board area will have a designated department of medicine for the elderly. Day hospitals, which are an integral part of departments of medicine for the elderly, have been developed at St. Columcille's, Beaumont and the Mater hospitals. Further such facilities are currently being planned for Naas  General, St. Vincent's and St. Michael's hospitals.
District care units have been developed in each community care area to provide outreach care services for the elderly in their homes. In excess of 200 additional staff of various disciplines including staff nurses, care assistants and paramedical personnel have been employed in this area. This cannot be bad for staff morale.
Also, in 1994, in excess of 5,000 elderly patients were admitted into the district care units from the acute hospitals and general practitioners. This facilitated earlier discharge of patients from the acute hospital service and negated the need for referral of patients by general practitioners to hospitals in the first instance, with the obvious significant impact on the appropriate use of acute hospital beds. It will be seen, therefore, that a system of relieving the acute accident and emergency hospitals was in place before the Opposition raised it during this debate.
A register of elderly at risk has been established throughout the Eastern Health Board's community care areas and multidisciplinary care teams have been developed in each community care area to ensure that the needs of the elderly are identified and addressed.
Miss de Valera: I listened with interest to the Minister's contribution tonight but, unfortunately, I heard only references to the Eastern Health Board area, the Dublin area and its surrounds. There are many problems in the health area outside of Dublin. While I wish those in the Eastern Health Board well, I must underline the many difficulties  that face the Mid-Western Health Board.
As one of their public representatives, a number of people from that area contacted me concerning their elderly relatives who have difficulty getting a bed in St. Joseph's Geriatric Hospital in Ennis. There appears to be a shortage of beds in that hospital and when patients are not accommodated there, their families are forced to pay for them in private nursing homes, often with very little subvention to back up costs. Subvention should be increased to ease the hardship on sons and daughters who are forced to pay for the care of their elderly relatives while providing for their young families and paying mortgages and other financial responsibilities.
The elderly in my area do not wish to burden their families and their feeling of helplessness is merely exacerbated by the fact that they believe, having worked hard all their lives, that they should have access to St. Joseph's Geriatric Hospital and not have to pay for private accommodation. There is now a waiting list for St. Joseph's, something which was not heard of up to now. I would be interested to hear the Minister's comments on statements made recently by a Member of the House about the ill treatment of elderly patients. That caused much anxiety among the elderly population. I want to know the Government's position on those unfortunate remarks.
Last night Ennis General Hospital was full to capacity, one patient had to be accommodated in casualty, there was no bed for him. There is also an immediate need to provide funding for a specialised unit to care for Alzheimer patients in Carrigoran Nursing Home in County Clare. The staff in Carrigoran are waiting to hear from the Department in this respect and I take this opportunity to impress on the Minister the need for him to allocate funds immediately for the provision of such a service. I am sure the Minister would admit that those suffering from mental  handicap need more sheltered workshop facilities in County Clare. We are grateful for the improved facilities in Kilrush, but many more places in sheltered workshops need to be provided, not least in the Dulick centre in Ennis.
I am sure the Minister is aware of the continuing good work of the Brothers of Charity at Gort Road, Ennis but their efforts need ongoing financing. I look on their position sometimes with despair when the moneys I would like to see allocated to the institution are not provided to assist it in its very necessary work.
The dispensary in Kilmaley, County Clare, does not have toilet facilities or a heating system. Together with other representatives I have made renewed representations to the Minister in the hope that this issue can be addressed immediately. It is ridiculous in 1995 to ask patients to attend that dispensary and endure what could be described as Third World conditions. I hope this debate encourages the Minister to make further progress on this matter and the other matters I referred to in my contribution. I wish to share the remainder of my time with my colleague, Deputy Geoghegan-Quinn.
Mrs. Geoghegan-Quinn: Deputy de Valera raised an important point when she asked the Minister to clarify whether he, or the Minister of State in this case, supported the comments by a Member of this House in regard to the treatment of geriatric patients in the Mid-Western Health Board. It is important to clarify that the Member who made the remarks is a member of the party of the Minister of State and employed by the Mid-Western Health Board as a consultant psychiatrist. Perhaps when the clarification is being made all those issues will be taken into account.
There will be an important meeting in Dublin tomorrow. A summit has been called to examine the crisis in the capital's accident and emergency departments. At that meeting there will be hospital managers, representatives of  trade unions and consultants and the Eastern Health Board will also be represented. However, even though the serious crisis at the city's hospital accident and emergency units will be under discussion, representatives of the Department of Health will not be present. The other parties have been told that the Department will not be represented as it does not see any role for itself. It appears that the Minister for Health believes that the crisis is not his Department's responsibility and is a simple inter-hospital problem.
With the summit, the Minister, and indeed the hospitals, have been given an important opportunity — a last shot that should not be missed. If it is missed, I believe we face a summer of unrest. Nurses have said that enough is enough. They are not taking action for pay; they just will not tolerate the constant overcrowding and overwork. They want to provide a quality service to patients and want to do their work without being constantly abused about overcrowding.
There could be industrial unrest quickly if tomorrow's summit does not find a resolution to the crisis in hospitals. Already there have been days of action in Beaumont and the Mater Hospitals. This will spread to the Meath and St. James's Hospitals and other Dublin hospitals unless results are achieved. There could also be further action at Beaumont and the Mater Hospitals.
There are also serious problems in the health services in other areas, which was referred to by Deputy de Valera. Strike notice has been served at St. Stephen's Psychiatric Hospital in Cork. There is a dispute over the redeployment of staff at Our Lady's Hospital also in Cork. In County Wexford, protests are planned for St. John's Hospital in Enniscorthy and in St. Fintan's Hospital in Portlaoise strike action has been threatened over assaults. There are many other disputes brewing but the Government is failing to recognise the crisis in the health services. I blame the Minister for not insisting that representatives of the  Department of Health are present at tomorrow's meeting.
Regardless of what Minister Noonan might think, the Department of Health has a role in the crisis and the Department also believes it has a role. If the Minister will not accept that his Department has a role at the micro level involving hospital managements, the Department certainly has a crucial role at the macro level. There is a need for the formulation of a cohesive plan to deal with overcrowding in emergency departments in major Dublin hospitals. There is a need also for the co-ordination of the city's two ambulance services. The lessons learned at tomorrow's summit could then be implemented in macro form in other parts of the country if the Department of Health representatives were allowed to participate by their Minister.
As I emphasised last night, there is also another reason for the Department of Health to participate in the summit. At present, while the Department of Finance, in continuation of the policy implemented by the last Government, has provided money to deal with people on hospital waiting lists, separate new waiting lists are now developing because local hospital managements around the country are cancelling elective admissions and operations because of overcrowding and bed shortages. These patients go on a new queue or return to the same hospitals as emergencies. The Minister, with his Department, must address this issue.
Last night, and again tonight, Members of the House, including the Minister, expressed surprise that Fianna Fáil raised the crisis in hospitals in the Dáil because we had been in Government up to recently. When we were in Government we supported the Labour Minister for Health in tackling the problems in the health services head on and in recognising the crisis and difficulties associated with it. The Government took action. We did not shirk responsibility and hope that the problem might go away.
 I am glad that Minister Noonan, in his address to the House yesterday evening, recognised and acknowledged that the last Government led by Fianna Fáil provided £30 million to tackle waiting lists in 1993 and 1994. As we know, that action programme led to the most dramatic reductions in waiting times for treatment and reduced waiting lists. In 1994, the Fianna Fáil-Labour Government action led to an additional 16,669 procedures being performed. These were in addition to the normal levels of activity. By December 1994 the waiting list for specialties had been cut to 23,835 from over 40,000 in 1993. This was a cut of 41 per cent and it was achieved by Government action. Real progress was made on children's waiting lists because of a commitment and a recognition of problems by the last Government. With the Minister, I also compliment and congratulate medical and nursing staff for their tremendous efforts during the period of action.
All this is in complete contrast to the response by the Government. Minister Noonan is trying to hide behind his short service at the Department. That is his excuse for lack of action. He also tried to say that some of the problems arose because of the lack of co-ordination of services in Dublin and the lack of accountability of health boards. He was very critical last night. He told me that it was most unfair of me to criticise his Department and he seemed to be particularly sensitive about that — I am not sure that his Department officials were as sensitive to the criticism.
The Minister said that the management of hospitals — with a few exceptions — in the Eastern Health Board area is outside the remit of the Eastern Health Board and that because the hospital management had been devolved, responsibility went with that devolution. If the Minister is unhappy, as he seems to be, why is the Bill dealing with organisational structures of health boards not even on the list the Government published this week of Bills expected to be published this session? If  the Minister feels there is a problem and a difficulty with accountability, why did that legislation, which is intended to reorganise the health services, including the replacement of the Eastern Health Board, not appear on the list published by the Government? There does not seem to be any urgency in relation to this matter.
The Minister also insisted on defending the Department of Health in this crisis. The Department stands accused of contributing to the crisis because it failed to look at the recurring problem of high admissions at the beginning of each year. The only strategy appears to be to ignore the crisis and to hope that things will return to normal. That is not good enough. It is also unacceptable, as I said last night, that patients have been blamed for somehow causing the problem by getting themselves improperly admitted through accident and emergency departments.
If the Department had any sense of responsibility it would have taken two kinds of action within the past three months. First, it would have allocated emergency funding to the hospitals under pressure to allow for the opening of more beds and, second, it would have moved quickly to examine the problem and develop new systems to cope with it. There is a need to increase the level of funding to address the problems and this could be done by the Government giving priority to health care instead of giving breaks to the banks in its budget each year.
It is a serious mistake for the Department of Health not to be represented at tomorrow's health summit meeting as it has an important role to play in this crisis. I appeal to the Minister for Health. Deputy Noonan on the eve of this very important summit to allow his Department's representatives be present at tomorrow's meeting. All other parties will attend the meeting in good faith and the trade unions involved have suspended industrial action pending the outcome. It is imperative that  the Department of Health is represented in the interests of actively supporting a resolution to the problems of the “first quarter curve”, as I referred to it last night. The resolution blueprint  could then be implemented in each of the other health board areas that have similar problems.
Browne, John (Carlow-Kilkenny).
Dukes, Alan M.
Durkan, Bernard J.
|Gallagher, Pat (Laoighis-Offaly).
Higgins, Michael D.
Noonan, Michael (Limerick East).
Sheehan, P. J.
de Valera, Síle.
Haughey, Seán. O'Donoghue, John.
|Hilliard, Colm M.
Morley, P. J.
Nolan, M. J.
Noonan, Michael (Limerick West).
Ó Cuív, Éamon.
O'Donnell, Liz. Quill, Máirín.
Question declared carried.
Motion, as amended, put and declared carried.
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