Tuesday, 16 February 1999
Dáil Éireann Debate
Ms McManus: I propose a vote of ‘no confidence' in the Minister for Health and Children, Deputy Cowen. I do not do so lightly but because we, in the Labour Party, are seeking the approval of the House for a fresh start in the area of health. It is clear this Minister has failed abysmally to live up to the rigours of his office and that those who depend on health care and those who provide it have increasingly lost faith in him.
Our motion is grounded not on some abstract political expediency but on the reality that too many sick and vulnerable people have suffered needlessly – some have even died needlessly – and will continue to do so into the future unless the Taoiseach seizes the initiative and establishes a new  basis for our health care system under different leadership.
Everyone understands that Ministers are constrained by the general economic climate within which they operate and the competing and conflicting demands for resources. Nowhere is this more true than in the area of health care. Each Minister must be able to make choices in order to resolve immediate problems while, at the same time, creating a vision for the future. Ministerial leadership has been described as the place where the dream starts and the buck stops. The Minister, Deputy Cowen, has proved himself gravely lacking on both counts. His focus is more on accountancy than on accountability, more on financial management than on medical care. His role is part of the problem rather than part of the solution at a time, when, for the first time ever in the history of the State, the country's prosperity offers us a real opportunity to address the inequities and failings of our health care system. With this Minister, leadership has become the place where the buck starts and the dream dies.
In June 1997, the people were given a commitment by the Fianna Fáil Party. We were told that if Fianna Fáil was returned to power, the party would tackle hospital waiting lists as a priority. People before politics and tackling hospital waiting lists as a priority – that was the message. The Fianna Fáil election manifesto stated it clearly and even went further. It is worth recalling the basis on which this Government was elected.
Our aim will be to eliminate waiting lists of over 12 months in orthopaedic surgery – especially hip replacements, ophthalmology, ear, nose and throat surgery, cardiac surgery, vascular surgery and plastic surgery. We will set a maximum period of six months for children awaiting ENT or eye treatment. We will ensure that quiet hospital periods such as the summer months are used to make inroads into the lists.
Tonight, as we debate this motion, there are literally thousands of sick and vulnerable people who, almost two years later, have been waiting more than 12 months on waiting lists and thousands of children who have been waiting more than six months. When the public went out to vote, it was on the basis that a vote for Fianna Fáil was a vote to change their lives. Even after the general election, the commitment was repeated in the Government programme drawn up jointly with the Progressive Democrats which said: “The hospital waiting lists will be tackled as a priority.”
The question the sick and vulnerable can legitimately ask is “what has happened in our acute hospital services since this Government took office?”. I will let the record speak for itself. Far from tackling the hospital waiting lists, this Government has presided over a steeply escalating rise in the number of patients waiting for hospital procedures. In some cases, patients have literally died for want of a hospital bed. Those who can, have gone into debt to raise a loan to  access treatment. The remainder are still waiting in ever increasing numbers.
In May 1997, when hospital waiting lists were well below the 30,000 figure, Deputy Brian Cowen, then in Opposition, described them as being “ out of control”. In June of that year, he was made Minister for Health and Children and has made strenuous efforts ever since to massage the figures and rejig the numbers. Yet, in spite of his best efforts, the number of patients has grown consistently. The latest figures, which are already out of date, show an inexorable rise to the most recent official figure, which dates back to September 1998, to 35,405 people. That latest total is almost 20 per cent higher that the total estimated on the date when this Government of such promise came to power.
I can say with some certainty that when the Minister for Health stands up to speak, he will reel off his set piece for yet another time about what the Rainbow Government did or did not do. I acknowledge he has put more money into the system so the real question is “why is he not more successful when he has all this money to spend; why is he not doing the business?”. He is unlikely to mention that the last time there was a Labour Minister for Health, waiting lists were slashed by 37 per cent in one year alone.
This Minister will stick to his mantra, as he does every time he is called to account. We know the script because we have heard it so often from him but the facts are incontrovertible and speak louder than any Government bluster. The facts are that 1 per cent of the Irish population is awaiting essential hospital treatment, and more people are on a shadow waiting list which is not recorded but is made up of those waiting to see a consultant. We have always had hospital waiting lists but there is a new development under this Government's tenure, namely that some of those who need to attend a consultant have even been refused the opportunity to have their names put on a waiting list because of the pressure on consultants' time. In effect, these sick people are waiting to go on to a waiting list which would enable them to access a hospital waiting list. For the first time ever in my experience, patients needing emergency procedures are being left for months before gaining access to hospital. Their tragedy is that if they had enough money to pay for private care, they would have no waiting time at all. It is because they are poor that they suffer. This affront to decency will continue on an ever greater scale unless real and fundamental change is brought about by a Minister genuinely committed to equality of care.
In June 1997, 30,453 patients were on public hospital waiting lists. That figure has increased exponentially ever since. In 18 months of Government, Fianna Fáil and the Progressive Democrats have succeeded in expanding the waiting lists by more than 5,000 people, although we do not have the exact figure. While the figure is still climbing, we can only guess at the extent of the increase.
 Far from using quiet times of the year to make inroads into the waiting lists, the record shows that hospital beds were closed in many cases as a budgetary safety valve in flat contradiction of the promises in the programme for Government. We all remember the brave fight put up by staff in the University College Hospital Galway last summer. What the public may not be aware of is that the total extent of bed closures in 1998 resulted in the loss of 7,704 bed days on average per month. Remarkably, at the time of year when there is greatest demand on our acute health services, bed closures were a major feature in our hospitals. In December 1998, 9 per cent of all beds were closed which led to 16,399 bed days lost. It is remarkable the Government that claims to deal with the issue of hospital waiting lists should have this record.
When things got busy in 1998, it was clear that neither the Minister nor the Department had prepared for the pressures that built up in accident and emergency units and which led to extreme overcrowding. Patients were left on stretchers and slept on trolleys, some of them for literally days on end. In one case an elderly man died just five days after he had been left on a trolley for 56 hours.
Plans were not made by the Department in time to enable hospitals to cope in terms of keeping beds open and providing step down beds in nursing homes which, according to hospital consultants, had spare capacity of approximately 500 beds at that time. Instead, when the going got tough, the tough got going. The Minister for Health and Children went into purdah down in Offaly and took an uncharacteristic vow of silence leaving the Eastern Health Board, in particular, struggling to cope with the deluge.
Yet again, as that crisis receded the Minister has not given any indication that any lessons have been learned from the experience nor that, given increasing hospital waiting lists, we are not facing another year of excessive bed closures at the quiet time of the year and excessive overload in our accident and emergency departments in the winter. I want to be fair to the Minister. I know that pressures exist within the health system that can swallow up infinite resources without a return, but I also know that unless the Minister commits himself to significant structural reforms the position will not change.
I want to put the Government's record in context. A previous Minister for Health has not ever been in the position in which the current one finds himself. No previous Minister operated in a climate of such extraordinary economic growth and prosperity. There are unprecedented opportunities now to bring about the necessary structural changes that can deliver a new health service based on the principles of quality and equality, yet we continue to have a health service in which there are incentives to deepen the gulf between the care of the private patient over the public one.
The Minister will no doubt argue that structural changes are needed which take time to be  achieved and I agree with him as far as he goes, but he does not go far enough. It appears he has no intention of even attempting to tackle the core inequity between private and public health care which distorts our acute hospital services and leads to inefficiency and to injustice. Instead, the opportunity is being squandered and the chasm between those who are sick and can afford to jump the queue and those who are sick and cannot is deepening all the time.
It is worth noting that in 1996 the percentage spend on health care in Ireland was 7 per cent, well below the EU and OECD average levels of 8 per cent and 7.7 per cent respectively and well down the European league table. More recent figures indicate that our spend is slipping with public capital expenditure in 1999 at 0.26 per cent of GDP compared to 0.28 per cent in 1996.
For the first time in Ireland we have the conditions within which an acute hospital service can be constructed that is based on provision for those who need the service most rather than those who can afford to pay for it, but sadly we have a Minister who is unable to provide the vision necessary to the task. This is not simply a matter of money. It is about steering our acute hospital services into a new relationship with the health needs of patients made central to treatment rather than, as now, made dependent on an ability to pay.
That is not to say that generally our health services are not good. They are good and are staffed in the main by people of great dedication and professionalism, but the structural deficiencies in terms of manpower and resources militate against fairness and excellence. For the first time we are living in an economic climate that offers a chance of realizing that new relationship.
Nowhere is that more true than in the situation now pertaining at Tallaght Hospital. The crunch issue, the catalyst that has forced this debate now, is the role the Minister for Health and Children has played in creating the impending crisis there.
Let us be clear what has happened at Tallaght Hospital in case any spin or twist is put into this debate at a later stage. The opening of the hospital last June was a result of the great dedication, skill, determination and professionalism of the staff and management of the three base hospitals. It was an unprecedented achievement for all concerned.
Those same members of staff who put such trust and energy into the project are, this week, voting in overwhelming numbers for strike action. It is not that their commitment has diminished. Paradoxically, it is the same spirit that is driving them to take a step which, generally speaking, is at variance with the ethos of the staff of any hospital. Their determination is to protect Tallaght Hospital from being down graded and starved into submission. They refuse to stand by and allow the cutbacks in services and job losses in a hospital that is already understaffed and operating at only 60 per cent capacity.
Services have not been established, notably in  relation to the elderly day care centre. I am pleased the Minister of State with responsibility for the elderly is present. He is a member of a Government that openly declared it would look after the elderly. Neither have services been established in cardiac catherization facilities. Morale among the staff has plummeted. High tech equipment is lying idle while patients are unnecessarily shipped over to St James's Hospital for tests, which involves a potential danger, because of a failure by the Minister to appreciate the requirements at Tallaght.
Just keeping the hospital operating as it currently stands will be impossible for the board unless the Minister acts to avert the pending crisis. This crisis is of the Minister's making; the faultline leads straight back to original miscalculations made in the Department of Health and Children. This is not only my view. It is the considered conclusion of the consultants who were sent in at the Minister's bidding.
On page 26 of the Deloitte & Touche Report the consultants state “In our view the decision to base the 1998 Determination on the cost structure of the three base hospitals plus certain additional monies was inappropriate.” The report goes on to state “The Determination process does not lend itself well to a situation of major change; such as the opening of a new hospital.” Earlier it is described as a “relatively blunt instrument.” Today I received further confirmation of this and this point needs to be stated. The Deloitte & Touche Report shows that from the Department's notes it knew in March 1998 the amount set was not enough. The notes record that it thought it had put enough funds aside. While it does not look like that now, the amount is set and it is a case of “tough luck, Tallaght”.
Tallaght Hospital is a state of the art, modern, technologically superb hospital. It is a Rolls Royce of a hospital, yet it is being forced to manage on a Morris Minor budget. The report pinpoints many other failures which the board has accepted without hesitation and is working conscientiously to address with the troika established on foot of the report. Its response is in stark contrast to that of the Minister who has not once accepted his responsibility or his culpability for a Department that could neither get its sums right nor use a mechanism appropriate to the task. Not only has the Minister refused to make this admission although he makes heavy demands on everyone else to be accountable, he has compounded his error yet again by leaving a shortfall in funding in the 1999 determination. Now he is reaping the whirlwind in the anger and frustration of staff members whose only desire is to continue to serve their patients and the community at large.
The Minister is reported in today's newspapers as saying he will not make up that shortfall. Even at this eleventh hour he persists in his obduracy, yet he has the statutory authority to make it up without any difficulty. The Health Amendment Act provides for a Minister of health to make a variation in the determination. We all know the  Exchequer is awash with money. At the end of last year an extra £80 million was magically found to pay for the Garda pay deal, yet the Minister is saying he cannot find a paltry £5 million for a unique hospital project that has no parallel in the country and, therefore, cannot provide a precedent for any other hospital.
It is almost as if there is a war of attrition against Tallaght Hospital. Many people believe there is a hidden agenda within the Department to bring Tallaght under its control, to clip its wings in a way that undermines the ethos and traditions of the three base hospitals. I hope that is not the case, but I am placing on record the fact that it is a widespread view. I hope when the Minister for Health and Children speaks, he will address the real funding deficit for this year and last year, something he has singularly failed to do until now.
He might also explain why the expert advice he is hiding behind in making his decision to downgrade the paediatric haematology unit is not sufficiently well thought out to answer the points articulated so clearly by the parents of children with leukaemia who are appalled at the prospect of further unnecessary disruption to the service being provided at Tallaght for their children. Why, for example, should he make this decision which impacts severely on the only accredited paediatric haematology unit in Ireland, a brand new, purpose built unit which is the only externally audited diagnostic unit in Ireland and which has three fully qualified diagnosticians while the hospital being allocated the task of diagnosis has only one, and where there is uniquely a seamless transition for the patient from childhood through adolescence to adult care?
In November an all-party motion was debated in the House on the needs of the mentally handicapped. I want to briefly refer to that issue again because these are the people who always lose out in the battle for resources. Despite that debate the situation has not improved. The most recent figures from the Mid-Western Health Board, for example, clearly show that the case made not just by Opposition Members but also by Fianna Fáil Members, has not been listened to. In the Mid-Western Health Board alone there is an urgent need for 76 new residential places and 81 day care units. The allocation received by the board will only provide for 19 residential and 17 day places, and at a reduced level. This is a pitiful response at a time when there are funds going a begging to meet the urgent needs in our communities.
Ms McManus: The Minister should listen as he might be interested in what I have to say. The impression one gets is that the Minister for Health and Children would shed no tears if he  was moved elsewhere. He is a man of undoubted ability and intelligence with an unprecedented amount of money at his disposal, which raises an obvious question, namely, why is he unsuccessful in meeting the requirements of his brief when all the circumstances are such that his position should be absolutely secure. No Minister in recent times has received so much criticism, in a whole area of concerns, as the Minister, Deputy Cowen. Yet the circumstances in which he is operating, economically and in other ways, have never been so good.
The Minister's track record reveals the lack of serious commitment required for the task. His lethargy, combined with the clear breakdown of relations between senior officials in his Department, a case which has ended up in court, has resulted in a failure of governance of our health service. What is required now is a fresh Government initiative under new leadership that will confront the growing inequities in our health services, the escalating waiting lists, the shattering of hospital staff morale and, most significantly, the increasing despair felt by thousands of sick and vulnerable people. The release of the Hawkins House One is the first step towards resolving the vital issues that are impacting so severely on our acute hospital services. I commend this motion to the House.
Ms Shortall: The motion before the House this evening is timely. The Minister, Deputy Cowen, has been in office for over a year and a half and in that time he has presided over a period of unprecedented turmoil in the public health system. The 18 months of the Minister's tenure have been marked by ward closures, industrial strife and lengthening waiting lists. It is time the Taoiseach recognised the Minister's failure to deliver quality health care to the citizens and brought this appalling state of affairs to an end.
The motion before the House this evening is not a personal attack on the Minister for Health and Children. He is a capable, intelligent and resourceful politician. In a lacklustre Cabinet I am sure he adds much needed weight to Cabinet discussions. However, in his role as Minister of Health and Children he has failed abysmally. In such a vital Department, that failure results in untold hardship and anguish for thousands of families. It is time for the Minister, Deputy Cowen to admit that, as Minister for Health and Children, he has not created a record of achievement but a legacy of failure. As a result, the public has lost confidence in him.
The Minister rarely speaks to the media about his management of the health services. In contrast he has had no hesitancy of late in gracing the national airwaves to try to shore up support for the increasingly embattled Taoiseach. However, on the rare occasions when the Minister, Deputy Cowen, does speak on policy issues he is quick to remind us of his disdain for ideology. In his world ideology and ideas are a hindrance. This attitude provides an insight into the Minister's perform ance in the Department of Health and Children, in particular the total lack of progress on the issue of child welfare and child protection that is, supposedly, a key part of his brief.
When the Government was formed it took the decision to expand the remit of the Department of Health to include children. However, since then I have never heard the Minister say one significant thing about the Government's policy on children. He seems content to abandon all responsibility for this key area to the Minister of State, Deputy Fahey. As a result children have no voice at the Cabinet table. Their needs, and the commitments contained in the Government's An Action Programme for the Millennium have slipped way down the Government's priority list. An isolated Minister of State is expected to carry the can for the Government's failings on child welfare and child protection. Instead of actually driving forward a policy on children, the Minister, Deputy Cowen, is more concerned with insulating himself from responsibility to account for the disastrous record on children's issues. After 18 months it is becoming increasingly clear that the Department's change of name to include children was a cynical exercise, designed simply to portray the impression that this issue is high on the Government's agenda when nothing could be further from the truth.
As regards child care policy, the Government's An Action Programme for the Millennium increasingly resembles a work of fiction. The first priority the Government committed itself to was “to enact comprehensive juvenile justice legislation”. Legislation of this nature was first promised in 1971. Eventually, after years of delay, the rainbow Government published the Juvenile Justice Bill, 1996. The Bill was debated in the House and passed Second Stage. The Bill was on Committee Stage when the current Government came to power. The Bill was restored to the Order Paper but since then absolutely nothing has been done. The Bill has been parked in Committee Stage and, seemingly, abandoned by the Government. Each month I raise this matter on the Order of Business with the Taoiseach. Each month I receive the same reply – the Government is compiling its own amendments and this process has not been finalised. There is no sense of urgency within Government in this long awaited important Bill. We are now informed it is likely that, after 18 months of prevarication, the Government will scrap the 1996 Bill and introduce its own legislation. The enactment of comprehensive juvenile justice legislation has been put back for many years due to this shameful inaction on the Minister's part.
It is important to bear in mind that vehement criticism of this Government's failure to implement a coherent child care strategy will not just be found on the Opposition benches. The most valuable and strident criticisms of this State's policy on children was delivered more than 12 months ago by the UN Committee on the Rights of the Child. The UN report addressed a  situation which has pertained in Ireland for many years. I am not attempting to claim that all the faults and failings highlighted in that report can be laid at the door of this Government. However, as Deputy O'Malley pointed out to this House in a different context last week, the way the politicians of the late 1990s respond to the failings of previous incumbents is of crucial importance. By this yardstick, the Minister and the Government have failed miserably to meet the moral and political challenges set out by the UN report.
In summary, the UN report criticised the absence of a comprehensive national policy on child care, the dearth of co-operation and co-ordination between agencies whose role is to protect the welfare of children and the failure to appoint an ombudsman for children. The Government's response to this trenchant and legitimate criticism has been quite pathetic and responsibility for that lies squarely at the door of the present Minister for Health and Children.
One of the first acts of the new Department of Health and Children was to abolish the previous Government's proposal to establish an ombudsman for children. At the time, we were promised that in place of the ombudsman, a new social services inspectorate, which in the first instance would concentrate on monitoring State child care services and developing child welfare policy, would be established.
In the wake of the UN report, the Government rushed to roll back its decision to scrap the proposal for an ombudsman for children. Since last January, we have been informed that the Government is reconsidering the matter. We are also reassured that proposals regarding the social services inspectorate are proceeding but in reality, nothing has happened. Confusions reigns in the Department of Health and Children. There is still no ombudsman for children and the long awaited social services inspectorate is not up and running.
In addition, there are no proposals to put either of those vital services on an independent footing as statutory services. Legislation has not been promised. Although it was in the programme for Government in the last term, it has vanished off the current programme.
The proposed social services inspectorate was meant to concentrate on monitoring services for children. However, 18 months after the Government took office, this inspectorate has not been established because a chief executive for the agency has not been recruited. It seems the monitoring and development of child care services in this State is not a priority for the Minister. The inertia over the establishment of an inspectorate is matched by Government dithering over the appointment of an ombudsman. The Government is at sixes and sevens on this important policy initiative.
It is obvious there is little co-ordination in the Government's approach. In addition to the failure to establish an inspectorate or the Ombudsman, the Government seems utterly unclear about to how to develop policy in this area. There  is no indication as to what the relationship should be between these two bodies. The lack of progress to date can be based on the fact that the Minister for Health and Children has no clear goals on child policy. He has no clear objectives, his only concern is to make sure he cannot be blamed for the dearth of direction in child policy. If this means hanging his Minister of State out to dry, then the Minister it would seem, has no hesitation in taking this course of action.
Another key priority for the Government, according to An Action Programme for the Millennium was the introduction of mandatory reporting of child abuse. To date we have seen spats between the Minister of State, Deputy Fahey, and the Tánaiste on this matter. It appears the Minister of State has grave reservations about the introduction of these measures, concerns which are not shared by the Tánaiste and the Progressive Democrats. Has the Minister raised his voice in this debate? Has he come to the defence of his junior Minister or has he indicated support for the Tánaiste's view on the contents of the programme for Government? Not a chance. On one of the most contentious issues relating to child protection, the Minister has buried his head in the sand and hoped the whole messy business will blow over. Some leadership, some Minister.
Child welfare and child protection are urgent issues that must be addressed. To date, the Government has been big on talk and short on action in this area. The failure to establish a well resourced body to monitor child care services is just one example of the lethargy that dominates Government policy in this area. Ultimately, it is the most vulnerable children who have to pay the price for this lacklustre approach to child policy.
The child protection services operated by health boards are in a state of crisis. In the Eastern Health Board, for instance, child protection services are concentrated on emergency cases. The amount of time and resources that can be dedicated to the vital preventive work that needs to be done are abysmal.
Information systems are appalling. Figures relating to the number of children in care, the reasons for them being in care and the number of families awaiting assessment by a child care worker cannot be provided.
Ms Shortall: The lack of planning and co-ordination of child care policy means huge amounts of staff time is held up in attending court cases where the needs of individual children are discussed against a backdrop of scarce facilities and inappropriate care centres. Last year it took strong condemnation from a High Court judge to shake the Government out of its complacency in the provision of adequate places for children in need of care.
Under-resourcing child care services leads to a  serious morale problem within child care services. Many talented and dedicated people have had to leave the profession, and that is as a result of lack of planning on the part of the Minister.
There is a palpable anger among the public at the condition of our public health system and the chronic state of our child care services. Nothing the Minister or his supporting chorus on the Fianna Fáil backbenches say tonight can change that fact. Despite his aversion to public comment on health and children, the Minister has managed to spend a king ransom's on public relations advice since coming into office. He should have held on to this money as it now appears that his colleague, the Minister for Finance, Deputy McCreevy has no problem in dishing out media advice for free to his colleagues in Cabinet. However, we have now reached a point in time where all the PR advice and slick media gurus—
Ms Shortall: —cannot turn back the clock. The Minister might have been better if he had a decent programme manager and implemented some of his commitments. He might have helped the Minister because he needs a great deal of help to do his job.
Ms Shortall: None of the PR stunts will turn back the clock on the damage that has been caused to the most important services in the country since the Minister took over the helm at the Department of Health and Children. It is time the Taoiseach took action to repair that serious damage. Voting no confidence in the Minister tomorrow night is an essential part of that process and I urge colleagues on both sides of the House to support the motion.
Dáil Éireann has full confidence in the Minister for Health and Children and, in noting with particular approval the Minister's achievement in securing an increase of 28 per cent in revenue funding and 43 per cent in capital funding in 1999 over the 1997 provision in place on coming to office, also welcomes the major service improvements under way across a whole range of areas as a result of the provision of this greatly enhanced level funding.
I am happy to contribute to this debate and outline once again what the Government is achieving in developing the health service. I am also happy to respond to the criticism from the Opposition and, in the process, give some facts which it may not welcome. I will point, in particular, to the  huge gap between its rhetoric and its achievements when it held the purse strings in government.
I face a dilemma. Do I react and deal with the petty political agenda being followed by those who want to use the issues within the health service as a political football or do I ignore the nonsense and concentrate on what concerns the public? I have taken the view that it is best to ignore the politics and get on with the job. I intend, therefore, to ignore the political jousting that is of no interest to the majority whom we aim to serve.
Those working in the health service have become cynical of the extent to which the services are increasingly used as a political football. They know that issues now being exploited were also issues during the Opposition's time in government. There was a persistent failure by the previous Government to address them over a number of years. The major difference between the Government's approach to the health service and that of its immediate predecessor is that it is committing resources, instead of uttering platitudes. I lay down the challenge that no matter how the Opposition pours over the respective figures it cannot fail to be embarrassed when a comparison is made between the Government's investment in the health service and what happened under its stewardship.
I do not deny there are problems in the health service that have to be addressed. The Government is determined to address them in a structured and planned fashion in partnership with all those interested in improving the health service. There are those who seek to portray a systematic and reasoned approach to reform of the health service as indicative of inertia and lethargy, to use a favourite phrase of Deputy Shatter. On the contrary, I make no apology for diagnosing problems, identifying solutions and implementing reforms in a structured way so that the progress achieved endures. Our strategy for the health service is based on three key elements: a substantial increase in the resources provided; proper planning of the use of these resources; and a partnership approach to the resolution of problems with interests of the patients the overriding consideration.
The Government has given unprecedented recognition to the need for increased investment in the health service. Reform, however, is not just about increased resources. It is about tackling underlying structural weaknesses in the system. The Government has devised a clear and coherent programme for the health service in An Action Programme for the Millennium and in many other policy documents, including the Department's strategy statement. I am open to  constructive dialogue on the implementation of these improvements. I am conscious that, for certain parties, improving services in the medium and long-term is less important than exploiting short-term opportunities. The main result of such mischief is to create unnecessary doubt and fear among patients.
I care deeply about preventing illness and providing good services for those who need them. I have a special responsibility to those for whom there are few advocates and who do not have major interest groups to plead their cause. I take the concept of equity seriously. The major initiative I have taken for public patients – an all out assault on waiting lists – is the one which was subjected to a significant reduction in expenditure by the previous Government. I have done much and I hope to do much more for the mentally handicapped, the physically disabled and older people. Public patients should enjoy the best standards of physical accommodation and be treated by fully trained doctors. On these issues, I ask Deputies opposite to reflect on what they failed to do when they had the opportunity and were fully aware of the need.
The health service is a soft target from within and without. It is subject to easy black propaganda and much hyperbole. It will never be perfect but it can always be improved, provided the improvement is designed with the needs of patients at the core of the initiative. That is my mission. I will now outline, not for the first time, what I and the Department are achieving, with the ready co-operation of all the health agencies and their staff.
Critics of the health service like to present it as unplanned, unfocused and unco-ordinated. This is not supported by the facts. The development of services is based on basic principles which are applied quietly and consistently to a health service which does not readily lend itself to the classic concepts of corporate management and control. The framework can be described simply.
There is an overall strategy which focuses on real and measurable improvement in health status and is based on the principles of equity, quality and accountability. For most sectors, there is a specific strategy supported by an assessment of need and a plan to meet that need. Each sector is reviewed regularly through special working groups and, more recently, service reviews. The priorities for development are agreed across the service and form the basis for the acquisition and allocation of development funds. Each agency is required to produce and implement a service plan within its annual determination. The Health (Amendment) (No. 3) Act, 1996, referred to as the accountability legislation, ensures the system lives within its means and supports planning accountability and orderly development.
All politics is local and we tend to focus on what is nearest to us. In doing so, we forget to make objective comparisons. The organisation, cohesion, impact and value for money of the health service is properly regarded, by those who  have examined it objectively, as providing good quality at relatively low cost to the taxpayer. Critics tend to highlight what it may lack. They rarely acknowledge the considerable strengths which come from a centrally funded, well planned service, staffed by a well trained and highly committed workforce. For example, significantly more people were treated in our hospitals in 1998 than in previous years. It is right that the gaps in the service should be addressed. That is what I am doing far more quickly than those who are criticising me. We should not talk ourselves and health service staff into artificial depression about imagined crises.
Deputy McManus stated that Tallaght Hospital is the catalyst that sparked her move. Given the extent to which the Opposition has deliberately misrepresented the difficulties at Tallaght Hospital, let me briefly give the salient facts before informing Deputies of the latest welcome developments.
The board of the hospital failed to produce a service plan within the determination for 1998. It initially indicated a shortfall of £900,000. It then claimed to be short £5.9 million and after less than three months in operation it informed the Department that it would require an additional £21 million in 1998, of which £16.4 million was attributed to non-capital. It was in these unprecedented and alarming circumstances that I commissioned the Deloitte & Touche report. The hospital, the board and senior management created the conditions which made this review essential. Any other presentation of the root cause of the current difficulties is not a reflection of what happened.
The report which was received in early December was critical of issues relating to governance and top general management at the hospital and pointed to serious deficiencies in these areas. It did not deal with clinical issues at the hospital. The determination process used by the Department in relation to the hospital for 1998 has been the focus of critical comment. I invite reflection on the following points. The report states, on pages 25 to 27, that the determination was a relatively blunt instrument in relation to the development and commissioning costs. This represents about 10 per cent of the total determination.
The alternative method regarded as preferred by the consultants – in effect a zero-based budgeting approach – was not feasible. The hospital had not geared itself to make such a submission to the Department. It was its responsibility to do so, if it wished to provide an alternative model. It did not recruit a director of finance until September 1997.
It is wrong to automatically assume such a method would have been more favourable to the hospital. In such a process every post would have to be fully justified, allowances would have to be incorporated, based in the main on appropriate case mix costings in hospitals operating to best  practice. It is the Department's view that the product of such an exercise was unlikely to have been more favourable to the hospital than the determination made.
The Department used, in the way most favourable to the hospital, the only available methodology. Three scenarios were computed and the most favourable chosen. The hospital opened with 76 fewer beds than in the base hospitals. It was provided with 35 beds to treat longer stay sub-acute patients in the Meath Hospital, funded by the Eastern Health Board. The net position of the hospital in 1998 was improved by about £4 million as a result of these factors.
The report states that the incremental method of determination was inappropriate. However, the method preferred by Deloitte & Touche, effectively zero based budgeting, would have been particularly difficult, especially in relation to staffing levels. Given that one would expect savings in a merger, it is highly likely that the outcome would be that even less funding would have been given in that scenario. It is also worth noting that the hospital is currently working on 76 beds less than the base hospitals. Even taking account of a more complex case mix in Tallaght, the incremental approach was the most favourable to the hospital. The Deloitte & Touche report shows that since the move to Tallaght, the hospital has been operating below its service plan levels and, consequently, below the 1997 outturn level.
The hospital was notified of its non-capital determination for 1999 on 23 December 1998 in the sum of £64.69 million. A further £3.916 million was approved in respect of the spending in the federated Dublin voluntary hospitals. Almost all this latter amount refers to staffing at the Tallaght Hospital. The total amount available to the hospital for 1999 is, therefore, £69 million. The House will be aware that I agreed to a two-week extension on the time limit for submission of the hospital's service plan until 12 February 1999. This extension was agreed to initially following contact with the Department by the chairman of the Tallaght Hospital group of unions. This extension allowed the three-person group I established to oversee the implementation of the Deloitte & Touche report, have an input into the service plan. I subsequently agreed to a further extension which means that the service plan is due today.
Given the hospital's case mix and state of the art facilities, I am satisfied the amount provided for this year, £69 million, is sufficient to meet pay and non-pay costs for approved services, including the full year costs of 1998 developments. The determination does not include any provision for the further development of services. It has been agreed that the detail of such development will be the subject of further discussions with my Department when it is clear that the recommendations in the Deloitte & Touche report are implemented.
Very considerable energy and expertise has been expended in helping the hospital resolve its difficulties. That commitment will remain in place  for as long as is necessary. On a number of occasions I met with the chairman and officers of the board since the Deloitte & Touche report was published. On every such occasion I have reaffirmed my commitment to putting the hospital on a firm footing. I have made available to the hospital the expertise of three eminent people to help implement the Deloitte & Touche report and they are being supported by management consultants. A team dedicated to helping the hospital remains in place in the Department. The staff at the hospital have continued to give dedicated services in a period of turbulence and uncertainty. It is, therefore, very gratifying to report the first major fruits of all this effort.
I am pleased to inform Deputies that at a meeting held earlier today, the board agreed to a service plan for 1999 which, on the basis of the information now available to me, will comply with the requirements set out in the letter of determination. The plan provides for the full delivery of the approved level of services during 1999. There will be no enforced redundancies and the shedding of excess staff will be linked primarily to the completion of their short-term contracts. There will be no bed closures, other than those which occur seasonally. The plan will provide a very good basis for resolving potential industrial relations problems and I take the opportunity to urge all staff to support its implementation. In reaching this very satisfactory outcome I have been pleased to assist the board in its difficulties by agreeing to provide £1 million in 1999 to develop top priority services at the hospital, once the three person group assisting the board is satisfied, in line with the recommendations in the Deloitte & Touche report, that sufficient progress has been made on the implementation of the consultants' report to resume the phased further development of services at the hospital.
The orderly, planned and focused approach to planning and budgeting to which I am committed and which is now in place for all agencies has stood the test in very difficult circumstances at Tallaght. We must now focus on helping the hospital to implement the plan and overcome the challenges it faces. The full and rapid implementation of the recommendations in the consultants' report is now a prerequisite for the planned further development of this magnificent facility. The governance, management and cost control problems must be addressed. The hospital needs a long period away from the distracting glare of public conflict and a very early appointment of a chief executive. I understand the board is determined to bring this about very quickly and I hope it will have every success in its efforts.
I take this opportunity to thank the board for the very positive way it has availed of the assistance provided by Mr. Kevin Bonner, Professor John Murray and Mr. Donal O'Shea since their appointment at the end of January. I am confident that a very good basis has now been laid to fully resolve the current difficulties at the hospital. I have had very cordial meetings with  representatives of the board in the past two months and we are all agreed that establishing the hospital on a firm footing is our fully shared objective.
However, this debate must be about more than one hospital or, indeed, all hospitals. There are many other vital services which must be maintained and developed. We must take a strategic approach, integrating all services in pursuit of better health outcomes. We are actively applying this approach in tackling the two main diseases – cancer and cardiovascular disease.
Since coming into office, I have provided substantial funding to implement the provisions of the national cancer strategy. I acknowledge the initiative which my predecessor, Deputy Michael Noonan, took in launching this strategy and I am very happy to build on his very good work in this area. I am happy to acknowledge the obvious benefits of the approach he adopted, developing a strategy based on inclusive consultation and implementing a realistic plan on a multi-annual basis.
I have made £19.5 million available to implement the provisions of the national cancer strategy since coming into office. This substantial funding is, inter alia, addressing regional imbalances in the availability of cancer treatment services outside Dublin. I am pleased with the progress made so far. Since implementation of the strategy commenced we have provided for 22 additional major consultant posts in the treatment and care of people with cancer, alongside a range of important support staff, who have either taken up duty or are currently being recruited.
The national cancer strategy was accompanied by an action plan. The funding I have provided effectively delivers on that plan. There is more to be done in the area of cancer and I will be looking at this in the context of the Estimates for 2000. The Government can be justifiably proud of its record in delivering on a major programme of improvements to cancer services on a national basis.
I am also committed to making the necessary resources available to implement a national breast screening programme. I hope the programme will get under way in the autumn. Another important initiative to receive funding is the national cervical screening programme. In 1995, 72 women died due to cancer of the cervix. If diagnosed late the disease has a high fatality rate, hence the importance of an effective screening programme.
It was decided to pilot a screening programme in the Mid-Western Health Board as a forerunner to the introduction of a national programme. A project office has been set up and work is currently under way on setting up a computerised population register of the target group of 67,000 women in the mid-west region. Further funding has been secured in 1999 in respect of this project. Until such time as a screening programme is available nationally I will continue to provide resources to hospitals and health boards to  improve access to screening services and to reduce waiting times for results of smear tests.
I now turn to the major problem of cardiovascular disease, an issue on which we can effect very considerable improvement for the whole population. Important initiatives have already been taken. Even more far-reaching developments will be launched during 1999.
I will first address the improvements planned and under way in existing services. I am confident the development of additional adult public cardiac surgery facilities at St. James's Hospital, Dublin, and University College Hospital, Galway, announced last year will help reduce existing waiting lists. Target activity levels are in the region of 450 procedures annually at St. James's Hospital and 300 procedures at UCHG. I am pleased to announce I have today approved the acceptance of tenders for the new cardiac unit in St James's at a total cost of £6.1 million. This development is scheduled for completion by the end of this year. This additional activity will increase existing adult public cardiac surgery capacity by more than 50 per cent. I am also developing additional children's cardiac surgery capacity at Our Lady's Hospital for Sick Children, Crumlin, in association with the national cardiac unit in the Mater Hospital to provide for up to an additional 100 cardiac procedures for children. This additional activity will increase existing paediatric cardiac surgery capacity by up to 40 per cent.
By the end of 1999, an additional £16 million will have been invested since 1997 in the improvement of cardiac services. At the end of 1998, there had been a significant reduction in the number of adults and children waiting for treatment. Between September 1997 and March 1998, the number of patients awaiting surgery reduced from 1619 to 1300, a reduction of 23 per cent. The 1998 initiative built on the success of my 1997 initiative as evidenced by the latest waiting list data which shows an overall reduction of 22 per cent in adult and children waiting.
More needs to be done and it will be done. In particular, we are formulating a strategy on how the incidence and management of the disease can be improved. I expect shortly the report of the group which I established in January 1998 to make recommendations on an overall cardiovascular strategy. This will address the preventative, medical and rehabilitation services needed to reduce the incidence of the disease and improve the services available to those who develop cardiovascular problems. I am committed to delivering and supporting whatever programmes are necessary to reduce the burden which affects so many in our community as a result of this modern killer disease, which is due in part to lifestyle and environmental factors.
The programme for Government contains a specific commitment to support the establishment of a heart and lung transplant facility in Ireland.  The existing arrangement is clearly not ideal for patients and their families. I am taking a number of steps to follow through on the Government's commitment and ensure the introduction as soon as practicable of this new and highly complex service.
The Mater Hospital has been designated as the surgical site in Ireland for heart and lung transplants. The hospital will provide this service in association with other key service providers, in particular St. Vincent's Hospital, which is the major centre in Ireland for the treatment of cystic fibrosis. The Mater Hospital, as a matter of urgency, is co-ordinating and finalising a detailed assessment of the infrastructural and service issues involved in developing the programme. I am committed to providing the necessary finance and support for the development of a quality transplant programme in this country.
On taking up office, I immediately recognised the serious needs that required to be addressed in the capital area. The health capital programme had been significantly under-resourced in the years prior to my appointment. The previous Government appeared to be content with accepting hospitals and other units which belonged more to the last century than to the last decade of the 20th century. My objective is to secure the necessary capital funding so that the people have the best possible standards in hospital care and other areas of the health services.
I negotiated a three year programme in relation to planned capital expenditure. This is the first time that any Minister for Health has been in a position to provide such assurance on the capital development front over the medium term. I set about securing significant annual increases in funding for the capital area. Exchequer capital spending for this year is £155 million and the corresponding allocations for 2000 and 2001 will be £165 million and £205 million respectively. Over the three year period 1999-2001, the total amount of investment will be £525 million compared to the 1995-97 period when the Opposition was in office and only £309 million was spent.
Major hospital developments which are in construction or planning and require capital funding in 1999 include the Mater, St. James's, Naas, St. Vincent's, Elm Park, Limerick Regional, Tullamore, Portlaoise, Clonmel, Cashel, Mayo, Portiuncula in Ballinasloe and University College Hospital, Galway. In addition, I introduced specific funding last year of £10 million for priority equipment replacement and also continued the provision of £6 million capital funding in respect of maintenance backlogs and fire precaution works. These will now go ahead because of political decisions taken by this Government in contrast to the previous Administration.
I am not only concerned with radically improving the acute hospital infrastructure, I am also determined to increase capital spending on groups like the elderly where I have committed  £14 million this year compared to £4 million when the Opposition was in office. I recently visited Thurles where I went to see privately the conditions of the Hospital of the Assumption. I wanted to see for myself the conditions which had been allowed to develop for some of the most vulnerable elderly persons in our society. I did not bring along the media on this visit.
In respect of St. Ita's, Portrane, again I visited privately to see at first hand the very outdated conditions. I was very pleased to announce a major project costing £13 million to be funded by my Department and the Eastern Health Board. This is my strategy, to go and see the facts of the situation and not to allow bad conditions to get worse. There is also, for the first time ever, the £30 million national capital programme for those with mental handicap. There was no capital programme for mental handicap services before I took office. This will include St. Ita's and it is the first time such a programme has been put in place.
Mr. Cowen: In her radio interview this morning, Deputy McManus sought to make much of our relative position in the EU league table of health spending. I remind the Deputy that the expenditure figures are based on the situation which prevailed in 1995 when the last Government was in office.
Mr. Cowen: We need to be careful of simple comparisons. The figures on which the Deputy is relying need to be interpreted, having regard to the different demographic profiles of the countries and the relative cost effectiveness of their systems. It is acknowledged by the OECD that our system results “in good provision of health care at relatively low cost to the taxpayer”. We also need to remind ourselves that we are not yet carrying the burden which falls on many other EU countries in providing services for the very high proportion of their populations which are old or very old. We need hardly look beyond the state of health agencies in the USA to see that high per capita spending does not automatically equate to a high quality, equitable and comprehensive system.
It would be interesting if we could look at the situation at the end of 1998 or 1999. If the level of increased investment by this Government is sustained, I would expect that our relative position as we move into the next millennium will be more favourable. The acid test is the adequacy of the services provided, not our relative position in interesting but not conclusive league tables.
Mr. Cowen: I wish to turn to the services on  which the Deputies have chosen to be critical of my performance, usually without a backward glance on their parts to when they were in office. Since my appointment I have consistently identified as one of my top priorities the provision of the additional residential, respite and day services outlined in the document, “Services to Persons with a Mental Handicap – An Assessment of Need 1997-2001”.
Since June 1997 I have allocated an additional £53 million, with a full year cost of £59 million in 2000, towards the cost of meeting the needs identified in the assessment of need report. In the three year period, 1995-97, the previous Government allocated a total of £36.22 million in capital and revenue funding, or on average just over £12 million per year to these services. This compares to an average of £25 million per year allocated by me to these services to date. As I stated, I have also put in place a £30 million national capital programme to run over four years in tandem with the assessment of need. The level of additional funding provided to date has given clear and concrete evidence of my commitment to meeting the service needs of persons with a mental handicap, their families and carers.
In relation to services for people with physical and sensory disabilities, the report of the review group on health and personal social services, which was published in December 1996, sets out the requirements for the development of the services. Prior to the publication of that report, the previous Government provided a total of £3.688 million in 1997. Before the end of that year, my Government invested another £10 million in this sector. Last year a further £12.4 million was provided and this year £13.4 million is being made available. This gives a total of £35.8 million since this Government took office. This is substantial funding by any standard and compares very favourably to what the previous Government did for this deserving group of people. There is no contest.
The issue of waiting lists has received much attention. No country has solved the problem and all the most comprehensive studies, both here and abroad, emphasise that there are no simple, quick fix solutions. Despite these hard facts, I have been subject to some extremely simplistic and poorly thought out criticisms from the other side of the House on this matter. I wish we could have reasoned debate on this issue, rather than the extraordinarily ill-informed approach taken by the Opposition. Despite its complaints, it loses sight entirely of the fact that I have provided two and a half times more funding this year than it did before it left office in 1997.
The review group has pointed out what needs to be done in the short, medium and long-term. The Government is providing the funds to ensure that happens. The measures I have taken were not in place in 1998. Nevertheless, the information available to me on the position at the end of last year indicates that the overall numbers have stabilised and that numbers in many special ities and, importantly, waiting times are being stabilised. We will now attack that problem on the basis of the review group's recommendations and the funding which the Minister for Finance has made available to me.
There has been understandable criticism of the difficulties which arise during peak demand periods in providing beds promptly for emergency admissions. The entire question of the adequacy of emergency beds is being considered in the context of the Estimates for next year.
The Opposition skirts over the issue of resources and accountability. I do not intend to revert to the position in the 1980s when that side was in Government and there was an ad hoc system which created critical service pressures.
Mr. Cowen: We know what happened as a result of the non-preparedness to take decisions. There have been many misleading statements about the accountability legislation. The Opposition sponsored and enacted it, but they do not want to live by it. That is the comfort of being in Opposition – having your cake and eating it.
During the course of this debate, my colleagues will take great pleasure in pointing out the real improvements that have happened during our tenure in office. We do not claim the system is perfect but we are providing far greater resources. An extra £800 million in revenue is going into the health services, compared to the previous Government's term when the increase was £400 million. During the tenure of this Administration we will bring about real improvements in the health service which deserves better than the Opposition's catch cries this evening.
Mr. Shatter: We need a new, dynamic and radical approach to the provision of health care as we enter a new millennium. It is quite clear that dynamic approach, despite all the Minister's bluster, is not forthcoming form the present Government. The increasing prosperity of this Ireland of the Celtic tiger requires a new patriotism committed to ensuring equality of access for all to essential health services and an end to the type of chaos experienced by many who had to seek hospital care over the past two months.
The tragedy is that we have, under this Government an incompetent Minister for Health and Children presiding over a dysfunctional Department with, what the Spanish would call, a manana mentality. Nothing is seen as sufficiently urgent in its impact on the lives of people to merit  immediate action. Most of the plans we have heard from the Minister this evening may come on stream at the end of 1999 or maybe in the year 2000. A number of them were announced more than a year ago. In the context of new hospital facilities, the foundation stones have not yet been laid for many of the projects the Minister referred to.
Breast and cervical screening programmes that should have commenced last September will not now get under way until next autumn. Prostrate screening programmes will not be seen until well into the new millennium. Cervical screening programmes may, if we are lucky, be seen by the year 2000. While internecine warfare publicly and embarrassingly breaks out between top officials in his Department, the Minister stands aside and observes the scene like a spectator at a football match. It is not acceptable that any Minister, who is accountable for the workings of his Department, so behaves.
Financial, not human, considerations have been the Government's central concern in all aspects of health policy. On past occasions the Minister for Health and Children has talked in this House of the “levels of productivity” in our hospitals, as if treating people is the equivalent of manufacturing cars or computer parts. Patients' needs do not feature in his vocabulary. The Fine Gael vision of ensuring equal and speedy access for all to essential medical care is alien to the thinking of the present Government. At a time when this State is experiencing unprecedented economic prosperity we have a Minister for Health and Children who, to date, has been locked in a 1980s time warp of economic recession and who sees his main political mission as limiting health expenditure rather than expanding our health services in a planned and coherent way to meet the real needs of our people. The rhetoric of tonight has not been matched by ministerial action since this Minister took office.
Limiting expenditure does not apply to his expenditure on promoting his own image. Sadly, this Minister still does not realise his policy of self-promotion entirely lacks credibility with the general public. To many he now has the image of the “tyrant from Tullamore”. While prepared to publicly criticise the board of Tallaght hospital for overspending on patient needs – and he did so, yet again, this evening – he has been strangely silent when it comes to the greed of his former Taoiseach, Mr. Charles Haughey, and to allegations that some of his former ministerial colleagues were pocketing other people's money, including Fianna Fáil's, for their own excessive requirements.
In Tallaght, the taxpayers have provided funding for a new state-of-the-art hospital, of which we should all be proud. The hospital opened successfully on 21 June 1998. New and excellent relationships were forged between the board members of the different hospitals and between all of those employed within the hospitals at all different levels. By initially grossly under funding  the hospital and failing to acknowledge and speedily act upon the findings in the Deloitte & Touche report that the mechanisms applied to determine the funding of the hospital were “inappropriate”, the Minister destroyed the good relationships between many board members, destroyed labour relations within the hospital, grossly undermined the morale of the hospital's nursing, medical and servicing staff, and damaged public confidence in a new hospital which is providing excellent medical care.
Tonight the Minister announced a resolution of some of the conflict in Tallaght and has indicated to the House that he is now making an additional £1 million available over and above the allocation originally announced for 1999. It remains to be seen whether the announcements made by the Minister in this House tonight are a true resolution of the difficulties that have arisen and whether they truly reflect the real position in Tallaght. In the past, the Minister has not fully informed the House of the reality of his discussions with those involved in negotiating on behalf of Tallaght hospital. The Minister and his Department have been loathe to release documentation concerning the contacts between departmental officials and Deloitte & Touche during the course of carrying out their consultancy. We now know there were three different draft versions of this report before it was finally published. To date, the Minister's Department has been unwilling to release documentation which would detail the nature of the contacts between his officials and Deloitte & Touche prior to the report being published.
Under the Freedom of Information Act, they are demanding hundreds of pounds in return for the release of information to me as Fine Gael's spokesperson on health. I challenge the Minister to release all the documentation in his Department relating to the contacts that took place between Deloitte & Touche and ministerial officials in the run up to the publication of that report in December, so that we will know finally whether this was truly an independent report or whether, to some degree, it was influenced by secret discussions that took place with departmental officials.
Despite what the Minister says, our health service is in crisis. The growth in our population arising from economic prosperity, increases in births, the return of thousands of former emigrants, and greater longevity resulting in a substantial increase in the elderly within our community, has placed our hospitals, doctors and nurses under unprecedented pressure. Neither the Minister for Health and Children nor his Department have yet come to terms with the needs of our growing population, nor have they put in place the radical changes required to ensure those needs are properly met, as outlined in the Fine Gael document “Patients First”, which was published last October.
The Minister referred to the report of the working group on the waiting list initiative, which  he received in July 1998. However, he refused to publish it until December 1998 and, to date, little if anything in the report has been implemented.
As I said at the Fine Gael Árd Fheis, the present Minister in his dealings with the health service has shown the insight and sensitivity of a rhinoceros in heat. He has no understanding of the havoc he leaves in his wake on each occasion he briefly dips into an important area of health policy.
As Minister for escalating waiting lists, he is not only presiding over the growth of waiting lists that existed when he came into office but can be credited with inventing entirely new ones. There are today more than 3,000 anxious women awaiting mammograms. In December 1998 there was an estimated 38,000 patients on in-patient waiting lists. In January there was a waiting list of more than 400 elderly patients in acute hospitals in need of long-term nursing home or convalescent care, or seeking a place in rehabilitation facilities, who could not be released from hospital as no places were available to meet their needs.
In the fight against drugs, we know it is essential that addicted young people have treatment programmes immediately available to them when they seek help to become drug free. Yet, at the end of December, there were 617 people on waiting lists for treatment in various drug treatment centres in the Dublin area alone. Scandalously, they are abandoned to continue their habit until a place becomes available.
We even have waiting lists for wheelchairs. At the beginning of January 581 people, spread across health boards throughout the country, were on the wheelchair waiting list. If the present Minister for Health and Children could extend the nine month period of pregnancy, we would also have an escalating maternity waiting list.
There is no logic or coherence in the policies of the current Government. As hospital waiting lists escalated, 16,000 bed days were lost during the past six weeks of 1998 due to bed closures forced by financial stringencies. Many of the hospitals who closed down surgical beds did so because they had during the first 11 months of the year completed the number of procedures for which they were funded. The Minister for Health and Children negligently failed to review the hospital financial needs to facilitate additional targeted procedures being undertaken to tackle the waiting list scandal. As the Minister in his budget statement announced a waiting list initiative for 1999, hospitals throughout the country were notifying patients of the cancellation or postponement of long awaited operations. People in pain awaiting hip or knee replacement surgery learnt it was the policy of this Government that they remain in pain. Patients awaiting critical cardiac surgery learned that, as far as this Government was concerned, their lives had no value.
In a six week period, more than 1,500 patients were informed that their long awaited surgery  was being cancelled or postponed. The policy of closing hospital beds and wards must end. It is clear from comments made by the Minister, even this evening, that he intends to continue with this foolish policy.
The closure of hospital beds and wards to balance budgets is false economy. It results in paltry savings, prolongs pain and suffering, places at greater risk patients with life-threatening conditions, demoralises hospital staff, contributes to the acceleration of waiting lists and ultimately puts additional pressures on many accident and emergency departments. The cancellation of operations originally scheduled for the end of last year and early this year was partially responsible for the accident and emergency crisis with which our hospitals were confronted in January. During the crisis, the Minister was noticeable for his invisibility. Presumably he was advised to lie low by the public relations consultancy firm recruited by him to promote his image. To date, £120,000 of taxpayers' money has been wasted on this futile promotional exercise.
We need a different Minister in the Department: one who is committed to developing our health services, who has a genuine interest in health care and who has insight into the needs of those who are consumers of health services. In short, we need a different Minister. The current Minister's confrontational style and gratuitous attitude are detrimentally impacting on the morale of doctors and nurses and undermining public confidence in the health service. It is time for him to go.
Mr. Bradford: I am sorry the Minister had to leave but I am sure it was on pressing business. At least we had the opportunity to see him, because over the past months when we have debated the crisis in the health service, the Minister, Deputy Cowen, has been the invisible man of the Government. He has been 20 months in office and has had that time to deal with the problems which existed when he took office. However, his record during that time has not been good. The Fianna Fáil backbenchers who came to the House to applaud him would have to concede that, every weekend at their clinics, they deal with people who are suffering because of the health crisis. The imprint of the Minister on the Department over the past 20 months has been one of lengthening waiting lists. We were told by the Minister that we should not use the words “waiting lists” but speak instead of “waiting times”. Whether we speak of waiting lists or waiting times, a bad picture is being painted by him.
The Minister of State with responsibility for the elderly, Deputy Moffatt, is present. I point out to  him that there are elderly people throughout the country waiting in many cases for 18 to 24 months for hospital services. I could show him letters some of my elderly constituents received in the autumn of 1998 detailing appointments for May 2000. That is the health service we have. That is the reality, not what the Minister said.
Mr. Bradford: The Minister of State is going down cul-de-sacs. We are all aware from our clinic work of the severe health crisis. Regardless of whether we speak of “waiting lists” or “waiting times”, it is a problem in need of urgent attention.
The Minister, Deputy Cowen, was seen in other Departments as a tough man who talked tough and took tough decisions. He has now become an almost invisible Minister and we are not receiving the response we should at a time of a Celtic tiger economy. No Minister for Health and Children in the history of the State has had the resources the Minister, Deputy Cowen, has to deal with problems. Yet nothing is working, and neither is he.
As I do not have time to go into detail, I will finish by stating that I support the motion that it is time for the Minister, Deputy Cowen, to examine his position because 40,000 people on waiting lists are suffering as a result of his inaction.
Mr. McCormack: I also support the motion. Irrespective of the vote on it tomorrow, when the minority Government party and some Independent Members will probably support the Government, it is clear the Minister has already lost the confidence of the people and he should realise that. One only has to ask anyone on the waiting lists or their families if they have any confidence in him to realise that. There is nothing personal in the motion. The Minister is regarded as a fine person, but he is obviously not fit to continue as Minister for Health and Children. He is good for a sound bite and one of his most celebrated was when he said of the minority party in Government, “If in doubt, leave them out”. Perhaps those remarks could now be attributed to the Minister himself.
The Minister's greatest failure is the manner in which he has stood idly by and watched waiting lists spiral out of control, yet there was no reference to waiting lists in his half hour speech. As regards University College Hospital, Galway, the hospital with which I am familiar, figures I have received from replies to parliamentary questions show that the waiting list is now at crisis level. In June 1997, when the Minister came into office, there were 2,000 people on the waiting list for procedures at the hospital. In September 1998, 15 months later and the latest date for which figures are available, there were 3,500 people on the waiting list, an increase of 1,500 people in 15  months, an average increase of 100 a month. One must assume, although no figures are available, that, five months later, that figure is now 4,000, exactly twice what it was when the Minister and the Government came to power. That alone is an indictment of the Minister. There were 2,000 people on the waiting list in June 1997 and, 15 months later, 1,300 of those have still not received a call-up for treatment. The Minister should deal with that.
The Minister referred to the fact that today he approved the tender for the cardiac unit at St. James's Hospital. That was sanctioned by the previous Minister more than two years ago, yet the tender documents are only being approved today. This has delayed the progress of the cardiac unit at University College Hospital, Galway, by another three years.
What investigation has the Minister carried out into the serious accusations made by the Minister of State, Deputy Fahey, late last year during the crisis in University College Hospital, Galway? He said the hospital was not being run as it should be, that there was bad bed and patient management, that there were fundamental management problems at the hospital and that the new management structures implemented were not working. Perhaps the Minister could reply to that.
Mr. Crawford: Thank you, a Leas-Cheann Comhairle. As I only have a few minutes left, perhaps the Galway people would settle their differences at home. The situation in Tallaght Hospital is one about which I am very anxious. The Minister said it had experienced a period of turbulence and uncertainty. Why? Could the Minister not have adopted a more conciliatory stance? The amalgamation of the Adelaide Hospital and two other hospitals was a unique move and was regarded as a step forward. What would some of the nurses – my mother being one of them – thank of the manner in which this new body was treated by the Minister? I am not proud of his treatment of it and it does not help in the movement towards peace in Ireland.
Waiting lists are an extraordinary problem, and previous speakers said they are worse now than ever, I have been in Dáil Éireann for only six years but, in that time, my clinics have never been as busy with people anxious either about relatives on waiting lists or the treatment they receive in hospital.
I hope some of the funds of which the Minister  spoke make their way to the constituency of Cavan-Monaghan; I know the Leas-Cheann Comhairle supports me in this. A strong programme has been submitted by the North-Eastern Health Board, with Monaghan General Hospital a main feature because it needs a minimum of £5 million spent on it.
The Minister must make an announcement in the next few weeks and give an indication, if this motion does not put him out of office, to the people of Monaghan that the long awaited programme of rejuvenation, including car parking and other necessary structures which will avoid crises in that area, will be provided. I beg the Minister to make that announcement at the earliest possible date so that uncertainty and the unnecessary pain and suffering caused by a lack of commitment and funds will be alleviated. At the time of the Celtic tiger, this Minister has a rare opportunity to curtail waiting lists and do what is necessary for hospitals such as Monaghan General Hospital.
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