Tuesday, 22 June 2004
Dáil Eireann Debate
Mr. Kenny: An unprecedented level of abuse has flown between Fianna Fáil and Progressive Democrats members of the Government in the past week. The sight of Fianna Fáil backbenchers on the plinth is nothing new, as they have publicly wrestled with their consciences in recent months in respect of a range of issues, such as cutbacks in community employment schemes, the smoking ban, social welfare cutbacks and stealth taxes. They have provided meek lobby fodder in the House, however, when the Government has voted its business through the Chamber. One occasionally encounters the rare sight of a PD backbencher sighing publicly about issues such as freedom of information, electronic voting or something else that is about to upset the national psyche.
The business of slagging has reached unprecedented levels in the past week, involving Ministers from the same Cabinet. The Constitution sets out clearly that members of the Government are “collectively responsible” for the Departments they administer. Such collective responsibility now appears to be in shreds. The human punchbag for the Government is in the House today to soak up and absorb all the treatment being meted out to it.
Mr. Kenny: When the Minister, Deputy Michael Smith, has been in the House on behalf of the Government in recent weeks there has been evidence to suggest that he has not wanted to answer questions, that he has not had the information to answer them, or, if the information has been available to him, that he has been economical with the truth. There is evidence today that the Minister for Communications, Marine and Natural Resources has actually communicated who he was giving out about.
Mr. Kenny: It may have been a member of the Minister’s own party. Can I ask the Minister, Deputy Michael Smith, to state on behalf of the Government if it continues to have collective responsibility? Do we have a functioning Government? Has it started to reflect on the people’s verdict of last week? Is it listening to the concerns of the people?
Will the Government implement certain aspects of its programme for Government during its term of office? I refer to the recruitment of 2,000 extra gardaí, the issuing of 200,000 extra medical cards and the opening of 3,000 extra hospital beds. Will the Government implement those promises which were made in the programme for Government?
Minister for Defence (Mr. M. Smith): Fianna Fáil and the Progressive Democrats are separate parties with distinct policies and mandates. It is natural that we have different outlooks from time to time. We do not attempt to deny that we have differences of opinion. It is important that Fianna Fáil and the Progressive Democrats have agreed an effective programme for Government. We are working effectively on the five-year programme.
Mr. M. Smith: Fianna Fáil and the Progressive Democrats have made great strides in promoting social inclusion and ensuring that economic prosperity is more equitably spread throughout our communities.
Mr. M. Smith: We have successfully introduced the highest minimum wage in Europe, over 90% of which is free of tax. Almost 420,000 people have been removed from the tax net since our first budget in 1997. Some 380,000 new jobs have been created which proves that work has become the best way out of poverty.
Mr. M. Smith: This is a week in which Deputy Kenny and every Deputy in this House can be proud of the achievements of the Government, led by the Taoiseach and the Minister for Foreign Affairs, in Brussels. As far as the proposals that have been made are concerned, the Minister for Justice, Equality and Law Reform has outlined on a number of occasions——
Mr. M. Smith: ——the commitment of the Government to ensure that programme is completed and the steps that will be taken, with the best efforts that could be made in the Garda College in Templemore, to meet that target. Already, 589 of the hospital beds promised have been provided and there is an ongoing commitment from the Minister for Health and Children on additional resources to ensure that the necessary ground will be made up in the provision of hospital beds as soon as possible.
Mr. Kenny: The Minister spoke about social inclusion and said that the Government is in favour of social inclusion. Did he consider, at that businesslike meeting this morning, that a man in Tallaght left his cubicle to go to the toilet only to find his bed gone when he came back? At that businesslike meeting this morning, did he consider that 150 patients are lying on trolleys in accident and emergency units? Did he consider at that meeting the thousands of parents who are waiting for psychological assessments for their children and that, in the case of parents to whom psychological assessments have been provided, the national educational psychological service branch of the Department of Education and Science is unable to process their applications and they do not know whether they will have full care assistance in September? So much for social inclusion in the Government’s businesslike meeting.
Mr. Kenny: When will we have a situation where Cabinet responsibility applies and where the people elected to Government stop squabbling among themselves when they know the people are out to get them? The Minister should answer the questions. Will the Minister confirm that the Government will employ the 2,000 extra gardaí in its lifetime?
Mr. M. Smith: It would put that Administration to shame in terms of what has been attempted to be done for the people with special needs. Whether one is talking about special assistance, resource teachers, remedial teachers, the provision of long-stay facilities or respite care——
Mr. M. Smith: We will continue to dedicate additional resources to these special needs areas. It is a high priority for the Government but I will not be lectured by parties which put £1 million into capital resources for special needs in their last year of Government.
Mr. M. Smith: ——we have increased the number of specialists in the emergency areas. We are trying to provide additional step-down facilities. We know the medical services have to be improved in these areas. We are understanding and sympathetic and we want to provide additional resources for these areas——
An Ceann Comhairle: For the benefit of Members on both sides who have difficulty with the clock, the Chair has requested a report on the timing system in the European Parliament where, when the time allocated under Standing Order arrives, the microphone is cut off.
An Ceann Comhairle: Yes, Deputy, and the Members lay down Standing Orders. If Members continue to abuse the Standing Order, there is no option but to find another way in which we can implement the Standing Order as laid down by the Members of the House.
Mr. Rabbitte: That is the way many Government backbenchers treat it. I want to ask the Minister about the new caring face of Fianna Fáil that is trying to break out all over the place. What exactly does it mean in terms of the implementation of the Hanly report? Will the Hanly report be implemented à la the Minister for Health and Children or will it be abridged and aborted in line with this Minister’s thinking? Which will it be? I ask the question specifically in regard to the implications of the Hanly report for accident and emergency services throughout the country and in the context of the point made by Deputy Kenny when he averted to the fact that a man in my constituency who got off a trolley to go to the toilet came back and found the trolley was gone.
In this region yesterday, 150 patients were on trolleys. There were 30 patients on trolleys in Naas hospital alone, with 40 beds closed, a shortage of nurses and nurses in that hospital on work to rule. What are the implications of this state of chaos for the new caring Fianna Fáil that is about to break out were it not for the Progressive Democrats? The Minister of State, Deputy Brian Lenihan, told the country this morning that our economy is the envy of Europe. Our health services are not the envy of Europe. What is the point of economic growth if we are to endure health services like these? Will the Minister indicate exactly what the new social democratic wing of Fianna Fáil says it should do with Hanly if it could get the Progressive Democrats off its back? What are the implications for patients lying on trolleys in the circumstances described in this morning’s newspapers, a phenomenon that existed once or twice during peak winter periods in the past but which now appears to be a regular feature throughout the year?
Mr. M. Smith: First, there is no new social democratic wing in Fianna Fáil. As for the Fianna Fáil record on helping the poor, increasing pensions and providing funds for those who are in need, we will stand our record against that of any political party in this House, and we will continue to do that.
The numbers of people on hospital trolleys and the problems in accident and emergency services are unacceptable. That is the reason the number of accident and emergency specialists has increased from 14 in 1997 to 51, including ten in Dublin, bringing the number there to 21, to try to grapple with the problems associated with accident and emergency services.
Other services, such as those provided by GPs, need to be developed to ensure that only appropriate admissions are made to accident and emergency departments. Step-down services for patients in acute beds must also be developed to free up beds. Accident and emergency departments must also be expanded and developed.
With regard to the Hanly report, the Minister for Health and Children and I have already indicated to the House the core principles of improving the structures of the health services through providing more consultants to the regions and the provision of services that have hitherto not been available. At the same time, local communities must be listened to to ensure accident and emergency services are provided in regional hospitals on a 24-hour basis and improvements in existing services.
Mr. Rabbitte: This is in total contradiction to what is actually in the Hanly report. From the Minister’s answer, I take it that the report’s recommendations are now dead. Will the Minister specifically address the problems in accident and emergency service provision? After seven years in office, it is unacceptable, even with its new social democratic and caring face, that there are approximately 100,000 fewer medical cards in the system. The reality is that while in the economically difficult days of the 1980s approximately 40% of the population had medical cards, the figure is now only 29.6%. I do not want to raise the other social welfare cuts such as rent allowance.
If that is the social democratic and caring face of Fianna Fáil, no wonder it is concentrating its fire on choreographed press statements, well-signalled in advance to the newspapers, attacking the Progressive Democrats. This focus on the Minister for Justice, Equality and Law Reform, Deputy McDowell, will only undermine his already fragile self-confidence. It will not improve the lot of those using accident and emergency wards.
Caoimhghín Ó Caoláin: It must be remembered that we are talking about people, not statistics. A man with a degenerative heart condition was recently admitted to Tallaght Hospital where he spent three full days on a trolley before getting a bed. He was then discharged 45 minutes later. In the course of waiting, while having to attend the toilet, his trolley was taken. These are traumatic experiences for ordinary people. Many of those lying in trolleys in hospital corridors, not just in the eastern region but throughout the country, are subjected to difficult experiences. Older people are robbed of their dignity while young people visiting are unnerved, even frightened, when going past these streams of trolleys with sick people.
What steps is the Government taking to address this problem? Is the Government increasing bed provision or providing additional staff? What nursing staff have to contend with at the coalface of the delivery of acute services is unacceptable. We do not want reports constantly cited to us in answer to these questions but evidence of what the Government is actually doing to address these issues. With an upturn in the economy, there are no excuses for failing to address these needs.
Mr. M. Smith: In the last seven years in the health services, the number of additional nurses has increased to 8,200 and the number of additional consultants stands at 491. The number of patients treated in-hospital and at out-patient facilities has increased by over 250,000. In 2003, 47,000 additional patients were treated in hospitals between in-patient and out-patient facilities. That marks an increase of 4.7%.
I understand the pressures on accident and emergency wards. I have already indicated the number of additional consultants that have been employed and the additional facilities provided. Step-down facilities and improvements in GP services must be developed to ensure that patients are screened to ensure accident and emergency facilities are available for the acutely ill.
In Tallaght Hospital, the nine cubicles in the accident and emergency ward have a high turnover. Many patients arrive without prior notice and many need resuscitation and other urgent assistance to save their lives. In the event of a life-threatening admission, it is normal for a patient to be moved to another bed or trolley after assessment so that space can be freed up. Due to different patient types, this is part of the work of many accident and emergency departments in major hospitals. I accept that the number of patients on trolleys is unacceptable. However, additional resources are being dedicated in a wide range of areas to combat that problem.
Caoimhghín Ó Caoláin: The Minister’s response will be but cold comfort to the 150 patients who are now on trolleys in the Eastern Regional Health Authority area. How many more are on trolleys in other regional acute hospitals? Nothing in what the Minister has said will address their need today. Make no mistake, it could be the Minister’s or my need tomorrow. This is an urgent issue that needs to be addressed.
In the Fianna Fáil 2002 general election manifesto, a promise, often overlooked while others are cited, was made that the Government intended to implement a full range of measures to improve accident and emergency services by significantly reducing waiting times and having senior doctors available at all times. The Government has failed to live up to this promise. The promises regarding an additional 200,000 medical cards and the ending of waiting lists are often cited. However, this is another promise that brought this Government into power. While the House discusses this issue, the Government is offering no redress to the situation in which many people find themselves. Will the Minister outline how he proposes to address the policy deficiencies of this Government?
Mr. M. Smith: A sum of €17.6 million has been allocated to the Eastern Regional Health Authority to facilitate the discharge of patients from the acute system to more appropriate settings. This funding has already resulted in the discharge of some 300 patients from acute hospitals in the eastern region. Funding has been provided for the recruitment of additional emergency medicine consultants and consultant anaesthetists. There are now 51 emergency medicine consultant posts in acute hospitals and the number of emergency medicine consultants in the eastern region has increased from ten to 21. A sum of €46.5 million has been allocated for the development of general practitioner out of hours co-operatives between 2000 and 2003, with an additional €24 million being provided in 2004. These additional resources are clearly making an impact. All the problems have not been resolved and the Minister for Health and Children will continue his efforts and will be supported strongly in the Government to get the additional resources which will ultimately deal with the remaining problems which need to be addressed.
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