Private Members’ Business - Health Services: Motion (Resumed).

Wednesday, 13 October 2004

Dáil Eireann Debate
Vol. 590 No. 2

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The following motion was moved by Deputy Gregory on Tuesday, 12 October 2004:


—the two-tier health service with access based on ability to pay rather than on need;

—the failure of the Government to deliver on the promise of providing an extra 200,000 medical cards and the fiasco where well over 100,000 medical cards have been taken out of the system since 1997;

—the failure of the Government to deliver on the promises of 1,000 extra hospital beds, which will become more acute as we enter the winter season once again;

—the failure of the Government to address the underlying problems which contribute to the gross overcrowding of accident and emergency departments leading to the unacceptable loading of ill people on trolleys;

—the failure to develop a coherent strategy for outpatient waiting lists with special regard to those suffering on rheumatology, neurology, urology, orthopaedic and dermatology waiting lists;

—the failure of the Government to deliver on the primary care strategy regarding which €130 million was promised per year over ten years, but only €15 million has been delivered in total after three years;

—the failure of the Government to end cancer care apartheid by providing multidisciplinary care including radiotherapy services to those who live outside Dublin and Cork such that some cancer patients will endure more radical surgery, or a painful death, due to an inability to properly access radiotherapy services;

—the failure of the Government to act on the feasibility study into an all-Ireland helicopter emergency medical service, HEMS, completed since April 2004, which is costing lives unnecessarily due to dangerous transport practices between hospitals and is causing permanent disability, we being the only country in Europe without this service;

—the disgraceful underdevelopment of our hospital oncology services;

[454]—that the number of consultant rheumatologists per 100,000 population at 0.3 is the lowest by far in the European Community, and also considerably lower than non-EU countries such as Croatia and the USSR;

—the failure of the Government to extend the mid-west pilot on cervical screening to the entire country, we being the only developed country in the EU which does not have a national cervical screening programme;

—the failure to extend the BreastCheck programme nationally in 2000, leading to needless death and suffering for our female population in the south west;

—the failure of the Government to ensure an acceptable ambulance response time of 20 minutes resulting in a lesser chance of successful treatment and survival in acute medical emergencies such as road traffic accidents and heart attacks;

—the failure of the Government to address the promised upgrade of Ennis Hospital; the failure to provide adequate nurses for the Mayo dialysis unit; capital funding for Ballinrobe community nursing unit; development of Tuam Hospital; the health care facility at Our Lady’s Hospital, Cashel;

—the failure of the Government to invest in the development of new parallel services before contemplating the withdrawal of existing medical services; and

—the failure of the Government to extend to the rest of the health services the model already existing in general practice, i.e. delivery of a same day and same place GP service, with equal access for public and private patients;

—equality of access to the health service based on need and not on ability to pay;

—whether she intends to implement the Hanly report in view of the absence of public support, and no alternative services being available;

—the financial threshold for qualification for a medical card to be increased so that the 200,000 extra medical cards promised can be delivered;

—the urgent provision of 1,000 extra hospital beds — with full supporting staff;

—the Government to urgently address the overcrowding situation in our accident and emergency departments;

[455]—strategy to address the disgraceful outpatient waiting list situation;

—the proper funding of the primary care strategy as promised;

—adequate access to radiotherapy services for those outside of the Cork and Dublin areas;

—the immediate establishment of an inter-hospital helicopter emergency medical service, HEMS, for Ireland;

—the full development of oncology services in our hospitals;

—the immediate appointment of consultants to include consultant rheumatologists and other necessary consultants to address the gross shortage existing presently;

—the extension of cervical screening nationally;

—the extension of the BreastCheck programme to the south and west of Ireland;

—a guarantee that all citizens be within a 20 mile radius of the nearest ambulance station and that adequate ambulances are available; and

—the full development of Ennis Hospital as promised; adequate nurse staffing for the Mayo dialysis unit; capital funding for the Ballinrobe community nursing unit; the opening of the completed health care facilities at Our Lady’s Hospital, Cashel; and approve the planning brief for Tuam Hospital;

Debate resumed on amendment No. 1:

Tánaiste and Minister for Health and Children (Ms Harney): Information on Mary Harney  Zoom on Mary Harney  I propose to share my time with Deputy Fiona O’Malley and Deputy Devins.

[456]Mr. J. Higgins: Information on Joe Higgins  Zoom on Joe Higgins  Will the Minister of State, Deputy Parlon, not partake in the discussion?

Ms Harney: Information on Mary Harney  Zoom on Mary Harney  Deputy Higgins should be nice to me as I was to him yesterday. I even heard the radio programme this morning on which we were both praised.

I am pleased to have this opportunity to address the House and outline the Government’s record in prioritising health services, the advances made over the last five years and to place on record my goals for the next five years. The Government’s programme has two key elements: to sustain and improve health service developments and to reform the way the health service works so that money is used efficiently and effectively for the purposes intended. The Government is engaging in this programme of investment and real reform for the entire population. The goal of our health policy is better health care and improved health status for everybody. Everyone is included, whether they use public or private health care or a mixture of both. We have an interest in all the means of delivery of health care, public or private, and at primary, secondary and tertiary care levels.

Within that, we will give priority to using scarce public resources to support those who need help to access the health care they need, whether in the GP’s surgery or in an acute hospital. We have a particular duty to ensure public resources used in the delivery of health care are managed and applied efficiently and with public accountability.

In terms of investment, we are catching up from previous decades and the missed opportunities from the mismanagement of the economy. This year the Government will spend over €10 billion on the health services, a threefold increase since 1997. According to the OECD, our rate of increase in public investment in health from 1997 to 2002, 10% per annum, has been more than twice that of the OECD and EU averages. We had the second highest increase in health spending in that period in the OECD, that is, among the richest economies in the world. Our health spending as a proportion of national income is now at the EU average, even though our population is younger than in many other countries. Our successful economy, achieved in the framework of the Government’s economic strategy, is generating these unprecedented levels of resources for health spending. We cannot achieve or sustain high levels of investment in health without a very healthy economy.

It is clear to nearly all people who take an interest in health policy that simply spending more without reforms is no solution and would not be an effective use of taxpayers’ money. I do not, however, subscribe to the theory that all the recent increased spending on health has disappeared into some black hole. The additional funding is being spent on increased levels of clinical activity, new procedures, better treatments and greater numbers of patients availing of services. Our hospital system is providing more and [457]better services than ever before. Activity levels in our acute hospitals continue to rise. The number of patients treated as either inpatients or as day cases in 2003 was over 1 million. This is the first time the number of patients has exceeded the 1 million mark and represents a 30% increase in the number of patients treated in 1997, which was approximately 780,000.

Since the Government made a commitment in the health strategy to increase bed capacity, we have provided funding for an additional 900 beds. In addition, further capacity has been sourced in the private hospital sector by the national treatment purchase fund to treat those waiting longest for surgical procedures on public waiting lists. Some 19,000 people have been treated so far and the initiative has been a success in cutting the often endless waiting times for public patients who need hospital treatments. Waiting times have been reduced and public patients are now offered definite appointments under the national treatment purchase fund. It has not solved all the problems for elective treatments. We never said it would. However, it has changed patients’ experience of health care: it is more responsive, more patient-oriented and people are treated as having equal buying power as privately insured patients. I acknowledge that we have yet to address the often long waiting times for outpatient appointments. The difficulties we have yet to solve, however, should not blind us to the progress we have made in any area.

Part of the progress of recent years is that we have also significantly increased the number of medical consultants. There are more than 1,800 consultant posts in the public sector in Ireland. This represents an increase of over 40% in the last six years. There are over 6,400 more nurses working in the system than in 1997. We have, according to the OECD, the highest proportion of nurses to the population at 15:1. We are now training more nurses than ever before. The annual number of training places has increased from less than 1,000 in 1997 to over 1,600 in 2004. In the period 2000 to 2003, the health capital budget involved spending some €1.7 billion. The capital investment framework for the health services between 2004 and 2008 will amount to €2.7 billion.

As part of the reform programme, we face significant challenges in developing an acute hospital service that meets patients’ needs quickly and effectively. We will seek, as an essential part of good health policy, to maintain and increase public confidence in hospital services in every region of the country. We want accident and emergency and casualty services in particular that people will have confidence in, region by region. Irrespective of the exact solutions put forward, there is a strong consensus that the current situation is not sustainable and that change is necessary.

The Hanly report stimulated considerable debate about how we should reorganise our acute hospital services. Some of it was well informed, [458]some of it much less so but all those contributing genuinely believe their stated positions are valid. In this atmosphere, we should not forget that there is widespread agreement about many of the key recommendations of the Hanly report. For example, the need to reduce the very long working hours of junior doctors, which are not good for either the doctors or their patients. The Hanly report proposes a series of important measures to reduce working hours in line with the European working time directive.

We intend to introduce a consultant-provided service with much greater access for patients to senior clinical decision making. Patients should see a doctor who is fully trained to deal with their condition at the earliest possible stage. Currently, patients may wait for lengthy periods before they can see a doctor who is sufficiently experienced to diagnose and treat them. The Government accepts the case for groups of acute hospitals to work together closely in networks in order to maximise the services that can be provided in each location. Instead of institutional rivalries, we need a genuinely co-ordinated service based on true co-operation between hospitals and health professionals. We need to involve health professionals more fully in major decisions affecting the management of services. This can happen through structures such as clinical directorates, in which doctors, nurses and other health professionals have a close involvement and greater responsibility for their unit.

The Hanly report sets out the path to substantial improvements in services for patients. Its emphasis is on ensuring a safe, high quality and sustainable service in every hospital. It is not about closing or downgrading hospitals. It offers an extremely important role for smaller hospitals in meeting a high proportion of the hospital needs of the local community.

The way forward lies in setting a constructive, innovative approach to implementing the agenda of hospital reform. We recognise that to improve acute hospital services, we need to develop them in close conjunction with primary and continuing care. This will mean taking full account of the concerns of local communities and working with them to maintain and build up public confidence in every region in the development of our acute hospital services. It is clear that doing nothing is simply not an option, neither is doing more of the same. The Government’s reform programme sets out a road map for change and I am committed to implementing it sensitively, flexibly and with common sense.

Tonight’s motion raises, among many other points, the issue of the public-private mix in our hospital service. Private care in public acute hospitals is seen as a long-standing feature of the Irish health care system. The VHI was set up in the late 1950s. We have never had an exclusively public system and we have, fortunately, for decades provided for public health services too.

The current consultants’ contract includes a provision which allows them to treat private [459]patients in public hospitals. I am committed to ensuring that private practice within public hospitals will not be at the expense of access for public patients. We are some distance from achieving that, but are determined to do so. Notwithstanding the complex and long-standing nature of this issue, I do not intend to leave it simply as it stands. The negotiation of a new consultants’ contract is one of my key objectives. In particular, I intend to ensure equity for public patients in a revised contract for consultants.

I wish to get these contract discussions started early and finished in a definite timeframe, dealing with all issues between the Government and consultants in a businesslike, professional and fair manner. I believe this is achievable and I hope that consultants will agree to engage on this basis. We need to get to a new, steady state in the relationship between consultants and the Government as soon as possible in the interests of all concerned.

The health reform programme will make the health system more responsive to patient needs, provide value for money and increase quality of care. The better planned and managed health system of the future will deliver measurably improved health care for all patients and consumers alike. My aim is to have the necessary legislation which sets up the health service executive on a statutory basis passed in the current Oireachtas session. This major change, the largest reform of our health services since 1970, will involve more than 70,000 people moving to work in a single health service executive, the largest change management programme ever undertaken by any Irish organisation.

I intend to include in this legislation arrangements for public representation through a number of regional fora. These will enable meaningful and sustained dialogue and consultation between the health service executive and the public representatives at local level.

I want the reform programme to improve every aspect of health care delivery to achieve the real change the public, the patient and the client want. It is not just about changing structures. This reform will change every corner of the system, every service delivery unit, every specialist agency, statutory and voluntary, the Department and, most importantly, the experience of every patient. The consolidation of service providers will help achieve one of the central objectives of the health reform programme, to provide a national framework in which health and personal social services are delivered.

The new national focus on service delivery and executive management of the system will result in a major reduction in fragmentation of health service delivery; a quality driven approach to services and information; more integrated service planning; improved administrative cost effectiveness; clear accountability throughout the system; and greater involvement of the service user [460]through structured consultative arrangements and a statutory complaints procedure.

We cannot deliver high quality services without standards that are based on evidence-supported best practice. High quality information lies at the heart of all good decision making.

The recent appointment of the chairperson of the Health Information and Quality Authority, Mr. Pat McGrath, is a major first step in the architecture of planning and developing health and personal social services in Ireland. This body will help to embed a continuous quality improvement ethos in our system and will be a vehicle through which the national health information strategy will be implemented.

Effective primary care is essential for our health services. The general practitioner is at the centre of every person’s health care experience. Primary care can lessen the current reliance on specialist services and the hospital system and provide effective, efficient and user-friendly services in the communities where people live.

Since the Government’s primary care strategy was published in 2001, initial development funding has been provided to enable the first group of ten primary care teams to be established. These have provided, and continue to provide, much useful experience which will help in the process of wider implementation, particularly in the context of the transition to a single delivery system under the Health Service Executive.

A significant element in the development of primary care teams must involve the reorientation of the substantial staff and physical resources currently within the primary care setting. The health boards are working to map the general configuration of future teams and networks and to develop team and collaborative working in the existing primary care services. The physical infrastructure to support the roll-out of the new team-based model of primary care will need to be significantly improved.

One of the Government’s key objectives is to facilitate and encourage the development, where appropriate, of modern, well equipped, user-friendly buildings from which the broad range of primary care services, including general practice, can be delivered. While the State may contribute towards such developments, because of the scale of what will be required, it is necessary to explore a range of different approaches to the financing and provision of these facilities. We will develop policy to encourage innovative approaches that have the potential to result in the provision of appropriate facilities to support the development and operation of primary care teams on a widespread basis.

I fully recognise the human trauma associated with a diagnosis of cancer for the individual patient and his or her family. It is for that reason I have placed the improvement and development of cancer services as a key priority. I intend to build on the considerable investment made by my predecessor since 1997 in the development of cancer services. The return on this investment is [461]the substantial increase in the volume of oncology services, from diagnosis to primary treatment and follow-up care. In 1998, for example, there were 58,000 cancer related hospital discharges. Currently there are over 80,000. In the same period, day case activity increased by over 70%.

Over 100 additional medical consultant posts have been created in key areas of cancer services such as medical oncology, surgery, radiation oncology and genetics. An additional 245 clinical nurse specialists have also been appointed in the cancer services area. These appointments have directly improved the quality and range of services to cancer patients in every region.

This substantial increase in manpower and activity has impacted positively on cancer. For example, the key goal of the 1996 national cancer strategy was to reduce the death rate from cancer in the under 65 age group by 15% in the ten year period to 2004. This key objective was achieved in 2001, three years ahead of target.

The Government has invested heavily in health care since 1997. We have been consistent in prioritising the health service and investing a significant funding base. We have had major achievements and now face major challenges, the challenges of reform. I believe the health system is providing a high quality service backed by a dedicated and skilled workforce. The system has begun its reform. This task will be complex and challenging and will not be achieved overnight. If it was easy, it would have been done long ago.

Before handing over to those sharing time with me, I congratulate Deputy Twomey on his appointment as health spokesperson for Fine Gael. I look forward over the coming years to working with him and with Deputy McManus, who has been Labour Party spokesperson for a considerable length of time.

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  The Technical Group’s motion before the House tonight clearly demonstrates that while Government governs for all its citizens, Independent Members care only for their narrow local base and want every service available in their constituency regardless of need, cost or practicality.

Mr. Howlin: Information on Brendan Howlin  Zoom on Brendan Howlin  What did Dessie O’Malley do when in office? Does the Deputy recall Barrington’s hospital?

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  The nakedly parochial motion cobbled together by the Technical Group is out of step with the realisation that to deliver a world class sustainable health service for all citizens, parish pump politics must not play a part in the equation. That is one of the reasons the health boards were disbanded. Local political factors continued to intervene and, frequently, prevented the correct decisions from being made.

The motion refers to Ennis hospital and services in Mayo, Tuam and Cashel.

Mr. J. Breen: Information on James Breen  Zoom on James Breen  We need them.

[462]Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  Deputy O Caoláin lamented last night that Monaghan was not included in the motion. However, the Independents do not care a damn about the people of Monaghan because none of them represents his constituents.

Mr. J. Higgins: Information on Joe Higgins  Zoom on Joe Higgins  What constituency does Deputy Connolly represent?

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  That demonstrates the parochialism of Independents.

Deputy Twomey recognised how narrowly focused it is to be an Independent and how limited are the opportunities. He hotfooted it to the Fine Gael party to become spokesperson on health, an appointment I welcome. However, I fear his appointment might not be as welcome within his party as it is by the rest of the House. The Government envisaged a system of newly expanded speciality services that will be delivered in the reconfigured local hospitals, providing long overdue and badly needed new services in rheumatology, diabetes care, cardiology and neurology.

Mr. Healy: Information on Seamus Healy  Zoom on Seamus Healy  Where are they?

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  They are the worst in Europe.

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  These will be delivered in the patient’s locality by senior doctors. We are suffering from a lack of a proper system of regionalism.

Mr. Howlin: Information on Brendan Howlin  Zoom on Brendan Howlin  How long are the Progressive Democrats in Government?

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  Only a small number of specialist services are available in local hospitals and Deputy Cowley, in particular, knows that.

The majority of patients with chronic illnesses who require lifelong management and access to specialist care must be catered for in Dublin or Cork. We must move on from this scenario and the Government is keen to cast it to history, yet local interests are rejecting these improvements in speciality care and cling to the impossible position of a seven day a week, 24 hour a day fully staffed accident and emergency departments in local hospitals. This concept is passed its sell-by date.

Mr. Healy: Information on Seamus Healy  Zoom on Seamus Healy  The Progressive Democrats will close accident and emergency departments. I thank the Deputy for telling the House.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Clonmel is secure.

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  An important challenge the new Minister faces is to ensure the range of new investment and reform commands public confidence. I will encounter constituents who will be anxious about the future of the services at Loughlinstown hospital and they will need to be reassured that services will improve, but I have every confidence they will and that only improvements will take place.

[463]Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  There are loads of hospitals in Dublin.

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  The Labour Party policy of free universal general practitioner care is a waste of limited resources. Is the party seriously suggesting it will pay my GP bill or that of any other Member? That is the reality of universal GP care. I caution Labour about the tyranny of consistency because if its members find themselves in Government, will they deliver that policy? Will Fine Gael support it and how much will it cost? Resources, as the Government knows well, need to be targeted at those who need them post. No Member needs his or her GP bills paid.

Mr. J. Breen: Information on James Breen  Zoom on James Breen  I needed mine paid this year. I was a victim of the health service for six months in a hospital in the west.

Ms Harney: Information on Mary Harney  Zoom on Mary Harney  Deputy Killeen will look after them.

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  I congratulate Deputy Twomey on his promotion to the front bench and I wonder whether he will withdraw his comment when he described the 19,000 patients who had been treated under the national treatment purchase fund as “rubbish”.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  They cannot get on the fund.

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  Deputy Twomey will not take that comment back. I thought he would like the record corrected. Unfortunately, Deputy Boyle was also disparaging about the fund. Why do these Members allow their ideology to get in the way of proper public service treatment? A woman who has waited a long time for a hip replacement does not care about what kind of hospital she is in because she is only glad she is not suffering anymore. It is well recognised the national treatment purchase fund has been an enormous success.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  If one can get on it.

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  I have not yet formally congratulated the new Minister on her appointment but it is well understood I am enthusiastic about it. Her enthusiasm for taking up the challenge of reform of our health services is a refreshing change. Near universal approval of her appointment is also to be welcomed.

Mr. Howlin: Information on Brendan Howlin  Zoom on Brendan Howlin  The Deputy is putting the Tánaiste on a high plinth.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  The Tánaiste must have written the Deputy’s script.

Ms F. O’Malley: Information on Fiona O'Malley  Zoom on Fiona O'Malley  She is perceived as a woman of actions rather than words. The political authority she brings to the position demonstrates the commitment on the part of Government to provide a health service worthy of the 21st century [464]for all people. Players should take advantage of this political clout and become partners in delivering a service which places the patient at the centre of a reformed service.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  Here is hoping.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  I congratulate the Tánaiste on her appointment as Minister for Health and Children and I also congratulate my colleague, Dr. Twomey, on his elevation to the Fine Gael front bench.

Mr. J. Higgins: Information on Joe Higgins  Zoom on Joe Higgins  Poor Deputy Ring was all at sea.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  I am delighted to have the opportunity to contribute to the debate. When I saw that Private Members’ Business was devoted to health issues, I looked forward with great anticipation to a stimulating debate. Unfortunately, I am severely disappointed at the debate thus far and, particularly, last night. This must be one of the longest worded motions to come before the House in my time as a Member.

Mr. Howlin: Information on Brendan Howlin  Zoom on Brendan Howlin  How can the Deputy say that from a prepared script?

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  It touches on almost every aspect of the health service. The provision of health services is extremely important business for the House. However, despite the wide-ranging nature of the motion, what we heard so far from the Opposition is more of the failed politics of the past. I expected and hoped to hear constructive ideas on how the problems facing the health service might be addressed. All we have had so far is more of the politics of negativity.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  Why did the Deputy not read the motion?

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  It refers to the Soviet Union.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  The motion should have been a golden opportunity to discuss in a constructive manner the future development of the provision of health services but we have had instead the sterile politics of the past.

Mr. Howlin: Information on Brendan Howlin  Zoom on Brendan Howlin  Is the Deputy reading the same script again?

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  The reason Opposition Members have become stuck in negative, non-productive debate is they have no new ideas to offer or else they agree with the actions the Government is taking to improve our health services but cannot bring themselves to say so.

I could quote facts and figures which demonstrate there is a significant increase for the health services over recent years or reiterate ad nauseam the reforms initiated by the former Minister for Health and Children, Deputy Martin, which will be developed by the new Minister but I will con[465]fine myself to one area that has the potential to radically improve our health service without costing an arm and a leg. General practice or primary care is the bedrock of the health service.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  Why did the Deputy not support it?

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  Despite all the negative stories, it is the one section of the health service that is working well. It needs more investment——

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  It has been promised but not provided.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  ——and the rapid implementation of the primary care strategy is badly needed.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  It is badly needed but not implemented. The Government said that two years ago.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  Enough reports have been published and now is the time for their implementation. A key objective of the health service reform programme will be to develop the roll-out of the entire primary care strategy and the sooner this is done, the better.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  We have heard that before.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  We hear a great deal about the problems associated with accident and emergency facilities. However, most of them are confined to hospitals in the tertiary sector.

Mr. Howlin: Information on Brendan Howlin  Zoom on Brendan Howlin  That is not true.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  A key component in ensuring the smooth running of an accident and emergency service is the presence in the immediate catchment area of the hospital concerned of a fully operational 24-hour GP service.

Mr. Healy: Information on Seamus Healy  Zoom on Seamus Healy  Deputy Fiona O’Malley said hospitals would close.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  I worked as a GP for many years and know what it is like to do a full day’s work, be on call that night, possibly get out of bed once or twice and do another day’s work the following day. The roll-out of the GP co-operative service is transforming the face of general practice and is ensuring a fully operational and staffed GP service is available for 24-hour medical emergencies in both urban and rural areas.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  That is only in cities and towns, not in rural areas.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  It would be interesting to analyse how a local GP co-operative service is running in an area and compare that with the difficulties of the local accident and emergency service in the area. More than €46 million was allocated to co-operatives last year and quick implementation of [466]such a worthwhile reform of the health service represents excellent value for money.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  There is no co-operative in my area.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  I hope all Members will work together, while respecting our political differences, to ensure the ongoing improvement of this most important health service.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  I wish to share my time with Deputies Wall and Howlin.

An Leas-Cheann Comhairle: Information on Séamus Pattison  Zoom on Séamus Pattison  Is that agreed? Agreed.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  I congratulate the new Minister and the new Fine Gael spokesman on health and wish them well. To be fair to Deputy Fiona O’Malley, she sent the message very clearly to the unfortunate people of Dún Laoghaire-Rathdown that they cannot look to her to defend the accident and emergency department at St. Colmcille’s Hospital in Loughlinstown. I find it astonishing that somebody who knows her hospital is in the front line to have its accident and emergency department closed down under the Hanly recommendations should speak with such gay abandon and ignorance about the true situation.

I was disappointed by the Minister’s speech. We all expected more from her even at this early date. She spoke about new beds in the system, of which everyone has heard before, but she failed to mention beds which have been removed from the system, replacement beds and beds which are not being used due to ongoing cutbacks. The Minister spoke about the national treatment purchase fund. While it is true that people can access treatments through the fund, 27,000 people remain on waiting lists, the figures having increased slightly at the last count. There continue to be thousands who have been waiting months and in some cases over a year to see a specialists. The Minister referred to the Hanly report but failed to state her position on the closure of accident and emergency departments which are currently operating on a 24 hours a day, seven days a week basis. This is a crucial issue in respect of which the Minister cannot use disingenuous language like that employed by her predecessor while expecting to maintain her reputation as a plain speaker.

The Minister should either tell it like it is and put us out of our misery or adopt a new policy on the Hanly recommendations and recognise the need to keep these accident and emergency units open. Anyone who contends that the departments in question are only in tertiary hospitals does not understand the matter.

Mr. Howlin: Information on Brendan Howlin  Zoom on Brendan Howlin  He or she is ignorant.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  The Minister points to consultant contracts in the context of the public-private mix as a problem without saying what is her sol[467]ution. This is a central issue to be addressed in dealing with the iniquity and apartheid which is retained and maintained in our health system. Unless one addresses the incentivisation of the system to care for private patients and the complete lack of incentives to look after public patients, one will fail to bridge the divide. We have argued for a system in which the money follows the patient. I do not care how that is done as long as the system is fair and efficient. While I have proposed universal insurance because it seems to be the most effective solution, I have an open mind with which to consider alternatives. I have not heard an alternative proposal but rather that there will be negotiations about consultant contracts. As those negotiations were discussed long before the Minister came into office, by referring to them she is not telling us anything new.

We need an integrated service which reaches patients and is blind to their resources whether they are rich or poor. Unless it is stated that the goal is to treat people on the basis of need and unless the means to achieve it are outlined, the Minister will not be able to deal with inequality in the system.

I urge Deputy Harney to look again at primary care as no one can remain Minister for Health and Children who does not understand what is happening at that level. Mulhuddart, County Dublin, has a population of 10,000 but no general practitioner, chemist or dentist. While there are doctors on the periphery of the area, according to best practice it should have six of its own. There are rural areas in my constituency and others in which doctors who are ageing or becoming sick themselves are not being replaced. There is a serious shortage in general practice. Even if the Minister establishes magnificent primary centres in Virginia and other locations, while that shortage remains unaddressed, patients who require care will not get it. I ask the Minister to develop a sense of realism about this.

I welcome the opportunity to speak on this debate. There is a crisis in our health service which deserves our attention. Today’s revelation that two children suffering from a serious cardiac condition were sent home from Our Lady’s hospital in Crumlin because of a nursing shortage is bound to shock people. We had hoped that the awful tragedy of the death of Róisín Ruddle would have led to a guarantee that cardiac operations for children would never have to be postponed due to a nursing shortage. We were given such an undertaking, but like others it has been broken.

Last Monday, one of the children in question was due to have his operation. He is five years old and his parents and grandparents were anxiously waiting for surgery to begin. An entire team of experts was waiting to assist at the operation and in his ongoing care. A theatre was available and everything was ready, but that little boy was sent home because there were not enough nurses in [468]the intensive care unit. The father of that little boy asked me in wonder today how it was that a Minister who could take a Government aircraft to fly to Leitrim to open an off-licence premises could not ensure a child’s access to vital health care — those are his words not mine.

Nobody pushed or forced the Tánaiste to take the position of Minister for Health and Children. It was her choice and it is her responsibility to ensure that patients can access care when they need it. Even though hers is a new appointment, she must bear responsibility for what has gone before. The Tánaiste, Deputy Harney, supported the launch of the health strategy despite the fact that the Minister for Finance informed the Minister for Health and Children in writing two weeks beforehand that there would be no funds to deliver it. Even as he spoke, the Minister, Deputy Martin, knew he could not deliver on his fine words. The Tánaiste, Deputy Harney, sat at the Cabinet table at Ballymascanlon when the Minister, Deputy Martin, was again told he would not get the money he was seeking.

The Tánaiste presided over and colluded in the debacle of the over 70s schemes which cost the taxpayer not the €19 million per annum estimated by the Department of Health and Children, but over €55 million. The Government introduced a new form of inequality into the medical card scheme whereby family doctors are now paid four times more to treat wealthy over 70 year olds than they are for caring for poor over 70 year olds. That is a gross inequality, a squandering of resources and gross inefficiency. These are the hallmarks of this and the previous Fianna Fáil-Progressive Democrats Government. Inequality has become worse during its time in office.

When the Minister, Deputy Martin, promised 200,000 new medical cards, the Tánaiste did not demur. When 101,000 medical cards were taken away from people, she was again silent. Fianna Fáil swore blind at the last general election that there would be no cutbacks in health but when the party returned to office, it promptly set about making them. During that time, the Tánaiste remained silent. Her record on health is the Government record on health, and it is sorry — the recently published ESRI report shows just how sorry by ranking health care in Ireland 21st out of 22 OECD countries. By all performance indicators on health, Ireland is performing dismally. We have the highest mortality from heart attacks and a frighteningly high level of female breast cancer. This is the reality in a country in which women in the south and west receive no breast cancer screening and little children are sent home from Crumlin hospital without having undergone vital cardiac procedures.

The Government’s amendment refers to increased health funding. Even on the most benign measurement, funding in the Irish health service is only average compared to other OECD countries. This is in spite of the great deal of catching up we have had to do since the major cutbacks of the 1980s and the growth of our [469]population. Approximately 4,000 beds have been lost and we continue to have a disturbingly low number of specialists in rhumatology, neurology, urology and other areas. Where new facilities have been built, they lie idle. Facilities costing €400 million, including cancer wards, operating theatres and accident and emergency units, have yet to commence operation.

Before he left the Department of Health and Children, the Minister, Deputy Martin, announced an allocation of €84 million to staff and fit out these facilities. Will the current Minister explain exactly where that money has been diverted from? Was it from the mental health area or does it explain the missing millions from the sale of St. Loman’s Hospital for which the Minister is unable to account? Was the money diverted from the primary care strategy which is already starved of funding? We have been promised 600 primary care teams. We are also facing a shortage in general practitioners.

The leaked memos published in the last month show a disagreement between the Departments of Health and Children and Finance, a matter on which I would like the Minister to comment. In the first instance, the Minister for Health and Children states there is not enough money for capital investment and in the second instance she states the Department is extremely concerned that money is being overly spent on the acute hospital sector and is not being allocated fairly to the non-acute hospital sector. We are all aware of the dilapidated hospital buildings which are a grave embarrassment — though I am not sure this Government can be embarrassed — to all who walk through their doors. We need investment in community services, mental health and primary care so those currently denied access to such services can access them.

It is disgraceful policy to shift resources and to rob Peter to pay Paul. That is the type of game being played in the Department of Health and Children at a time when the State can afford additional funding. There is a desperate need to invest the money in our coffers in the health system.

Mr. Wall: Information on Jack Wall  Zoom on Jack Wall  I congratulate the Tánaiste on her appointment as Minister for Health and Children and congratulate my constituency colleague, Deputy Power, on his appointment as Minister of State at that Department.

Each Member who speaks has his or her own concerns. Despite what Deputy O’Malley had to say, that reflects the issues raised in our constituency offices. A problem often brought to my attention is the difficulties encountered by families in accident and emergency departments. In many cases senior citizens are unable to leave hospital because of the unavailability of nursing home or secondary care facilities in geriatric hospitals. The Minister of State, Deputy Power, [470]will be aware of the problems at Naas General Hospital.

I am asking the Minister to look at the issue of enhanced nursing subventions, which are not working. Everyone knows the problem exists but no one wants to address it. The current subvention of €192 plus a person’s old age pension amounts to €400. However, obtaining an enhanced subvention is like trying to win the lottery. While the subvention differs depending on which part of the country one is from it is €200 to €300 below that which a person must pay for care in a nursing home. Also, filling in the forms for enhanced subvention is a nightmare. I ask the Minister to examine this issue. Improvements in this area would free up many beds in accident and emergency departments which are currently held by senior citizens who have no home or secondary care facility to go to.

I know of six or seven people who recently received treatment in accident and emergency departments and who are fit to move on but cannot do so because they cannot get the enhanced nursing home subvention. It is not possible to get that payment. This issue is a stumbling block to the creation of extra beds in accident and emergency departments. The allocation for enhanced nursing subventions is a joke. I hope the Minister will examine this issue in the early days of her new Ministry. Any improvements made would have immediate affects.

Another problem is the issue of ERHA payment of prescriptions. That system does not operate in any other health board. A person eligible for such a payment in the eastern, south-west or northern health board areas, through the ERHA scheme, may find himself or herself no longer eligible for it should he or she move two miles down the road to the midlands. That is a contradiction in terms of alleviating people’s concerns and may result in many people not getting their required medication.

The care of the elderly grant is at a standstill in all health boards. Grants for essential repairs have been done away with. The only hope for senior citizens is that they can get the care of the elderly grant. I ask the Minister to try to regenerate and re-invigorate that scheme which has been of great benefit to those who need it.

Mr. Howlin: Information on Brendan Howlin  Zoom on Brendan Howlin  Like other Members, I have a great deal to say on this issue. I thank my colleagues on the benches opposite for providing us with an opportunity to do so. I too welcome the appointment of the Tánaiste as Minister for Health and Children. She has the intellectual capacity and political clout to make a real difference. I genuinely hope she will do so because it is important to the nation. I also welcome the appointment of my constituency colleague, Deputy Twomey, as Fine Gael spokesperson on health, an appointment which I hope will have a [471]positive impact not only on our health services but on our constituency.

I would like to briefly mention a few issues of concern in my constituency and to refer to one national issue which I know will be on the shopping list which Members of this House will bring to the Minister’s attention. I speak with some experience of the pressures which the Minister now faces having once served as a Minister in that Department. It is a difficult, demanding task. I hope the Minister will be a woman of her word and that when she makes promises to hard working people in the health service, of which there are more than 100,000, she will deliver on them.

Wexford has been promised a day hospital for the elderly. There is no point in building such a facility if it is not opened and remains idle for more than a year. The Minister must provide the resources to bring capital projects on stream once developed. We heard in an ill-informed contribution from the Government benches earlier that the accident and emergency crisis pertains only in tertiary hospitals. That is not true. That crisis pertains in hospitals throughout the country. For the first time in its history there were up to 20 people on hospital trolleys at Wexford General Hospital because of the absence of beds which have been promised for more than ten years. I plead with the Minister to provide those beds. I have good contacts in the Department of Health and Children and know one of the difficulties is the Government’s refusal to release the capital to provide the beds until expenditure for the three years ahead has been signed off. The Minister needs to deal with such bottlenecks.

Another issue of concern is that of child and adolescent psychiatric services which are in crisis. The allocation in that area is so meagre while the need is so great. We could resolve many problems such as binge drinking, teenage suicide and depression by providing early intervention through support teams. The Minister must provide the resources necessary to do so. The guidelines are one full team of 15 specialists, one consultant psychiatrist and other support staff for every 66,000 of population. No such service exists. I have no doubt I will have another opportunity to develop the issue of child and adolescent psychiatric intervention, which would have an enormous social impact on this State.

I welcome the appointment of Deputy Power as Minister of State at the Department of Health and Children. He will have to fill the very large spats of the former Minister of State. Deputy Callely visited my constituency earlier this summer and promised to provide a lift for a geriatric facility in New Ross, the New Houghton Hospital. If that facility were a place of work within the Tánaiste’s remit it would be closed down under the health and welfare Act. I am ask[472]ing the Tánaiste to provide the lift promised by the former Minister of State.

I would like to briefly refer to another facility in the psychiatric area. The Tánaiste promised that land would be sold off to provide for upgrading psychiatric facilities but not all psychiatric patients can be brought into the community. In my time in the Department of Health, I received a very sane letter from a woman who asked me not to close down all the psychiatric hospitals because she needed a place in which to be mad. She could not do it in a community house in the middle of an estate. There is a need for some secure places, although they do not need to be places that resemble Victorian or 1950s antiquated hospitals, like St. Senan’s Hospital in Enniscorthy, where a coterie of people do heroic work and deserve better facilities.

We all have a shopping list for the new Minister and Minister of State. This Government had a unique opportunity, because it was re-elected to office, to have a ten year run at real reform. It gives me no pleasure to say it wasted the first seven years. Two and a half years remain for real change and we trust the Tánaiste can lead that. Right now she has the benefit of the doubt and carries all our hopes and expectations but she will be held to account. We pledge our support for real change for the better for the people we represent.

Mr. Ferris: Information on Martin Ferris  Zoom on Martin Ferris  There are many issues of concern surrounding health care provision in Kerry but I will address only a few of them this evening. I welcome the announcement of €14 million for the construction of a primary health care centre at Annascaul. I hope there will be continuous support for the facility and that it will go a long way to meeting critical health care needs in the region.

I cautiously await the Minister’s announcement about raising the means threshold for medical card provision. This must be acted on urgently. It has been pointed out repeatedly that the Government’s promise of 200,000 new medical cards has not only gone down the drain, but 100,000 fewer people have a medical card now than in 1997.

The BreastCheck programme must be addressed. The programme must be expanded nationally as soon as possible. In 2003, the then Minister for Health and Children, Deputy Martin, promised that BreastCheck would be extended to the Southern Health Board region by 2005. We have now been told that it will be 2007 or 2008 before that happens. We need a commitment from the Minister that this programme will be rolled out with the utmost speed. The South Infirmary in Cork has acquired a large site for this purpose and has submitted a detailed option assessment to the Department of Health and Children. This must be given prompt consideration and approval.

[473]The BreastCheck programme has saved many lives through prompt diagnosis. The incidence of breast cancer on the island has steadily increased yet deaths due to breast cancer in the Six Counties have dropped by a fifth while mortality remains constant in the South. This is due to the lack of a full breast care screening programme. In Tralee General Hospital, 68 newly diagnosed cases were treated in 2002 and the figures for this year will be higher. The staff who treat breast cancer are excellent but the breast care unit is under staffed and under resourced with limited space and privacy for patients. They are still awaiting the promised consultant surgeon with the special interest in breast surgery.

Inadequate resources affect the efficient delivery of services in other departments within the hospital such as cardiology and maternity. Tralee General Hospital is the second largest hospital in the Southern Health Board region, serving Kerry, west Limerick and north Cork, yet staff in the various units are overworked, hospital beds are closed periodically and waiting periods in outpatient clinics and radiology are appalling. If and when consultants arrive, there is a lack of resources to accompany them. Each position requires additional staff, equipment and space.

Currently, there is a freeze on hiring additional staff. As a result, sexual assault victims must travel to Cork for examination and treatment due to a lack of forensic examination coverage. This results in further trauma, with potential loss of evidence and increased demand on already limited garda resources. GPs in Tralee General Hospital are prepared to work on a rota basis to help address this issue but they need co-ordinated nursing support to do it and I ask the Minister to look at that matter.

Mr. Morgan: Information on Arthur Morgan  Zoom on Arthur Morgan  I only have five minutes to deal with the most important issue in the public domain at the moment. It was interesting that a Progressive Democrats Deputy took umbrage because Members were giving examples of the consequences of Government policy for their constituents when that is their responsibility.

My responsibility is to my constituency and the consequences of the cruel policy of downgrading hospitals across the State. Unfortunately, the first ward to go in Louth County Hospital was the children’s ward, forcing children to travel a significant distance to the Lourdes Hospital in Drogheda. Next to go was the maternity unit, closed in 2001 under the guise of there being not enough births at the hospital, at a time when there was only one gynaecologist in the hospital and any expectant mother presenting with any prospect of difficulty was automatically referred to the Drogheda Hospital where there is a full complement of gynaecological services. Tricks like that being played by the health board and [474]the Department will fool no one, certainly not the people of County Louth.

Government Deputies told us that the hospital issue only arises before an election. Deputies around the House are raising this issue more loudly than ever, just after an election. I wish Deputies on the Government benches were more honest. They cannot fail to hear the outcry that we hear in their constituencies.

Pregnant women, the most vulnerable sector of this society, are being forced to have their babies at the side of the road in the 21st century. I am not talking about this happening in Africa but here, in one of the richest economies in the European Union. How can any Government stand over that? How can any backbencher vote for Government policies when these are the consequences for the people? It is a scandal and it is time they wakened up to it. I thought they got the message in June but it is clearly not being heeded.

On several occasions there were attempts to close the accident and emergency unit at Louth General Hospital. Thankfully the people of Dundalk came out in great numbers and marched through the streets, putting the fear of God into the hearts of Government Deputies, with the result that the department was saved at the last minute. Consequently the issue is regularly raised before elections but it is also highlighted many times afterwards because there have been several attempts to close the unit.

I acknowledge the work of the staff at those hospitals. They do back-breaking work as they carry this health service that is so shambolic as a result of Government policy. The service is under staffed and over-worked. At the Lourdes hospital in Drogheda, it is a scandal that nurses have been taking industrial action for almost two years.

  8 o’clock

A family of four in my constituency, two adults and two children, the eldest of whom is a 19 year old college student, with a total income of €320 per week, has been told it is €33 over the limit for a medical card. The Government’s own family income supplement recommends an income of €405 per family. One Government agency states that a minimum of €405 per week is necessary for a family of four while the health board, another Government agency, tells the family that it is over the limit for a medical card. How can that be resolved? Which of those two bodies, acting under the Government’s instructions, is correct? Clearly the two cannot be. When the Minister answers that question, we will find out exactly where we are going. On the scandal of the so-called national treatment purchase fund, I acknowledge it has been useful in dealing with patients who have urgent need of hospital care. Unfortunately, that money would have been much better spent on the infrastructure of the public health service rather than diverting it into [475]the private hospitals where the money is lost to the public good.

I look forward to hearing what the new Minister for Health and Children can do. I sincerely wish her well because the people of this State are depending on somebody to claw back the Government policy and put in place a health care service that is accessible and amenable to all the citizens of this State.

Mr. Gormley: Information on John Gormley  Zoom on John Gormley  I welcome the opportunity to speak on this important motion. I congratulate the Independent Deputies for proposing it. Coinciding as it does with the appointment of the Tánaiste, Deputy Harney, to the health portfolio, it could not be more timely or opportune. It is, after all, the Progressive Democrats which has done more than any other party to create a two-tiered society. It is a party that regards inequality as a positive driving force and that has overseen the rundown of our public services while the private sector disproportionately prospered. Is it not a supreme irony that this same party, headed by the Tánaiste, Deputy Harney, the new Minister for Health and Children, promises to deliver a more equitable health service?

The influence of the Progressive Democrats has been profound and pernicious. Dublin, we are now told, has more BMWs per capita than Munich and so, in a strange way, we are heading towards Berlin. While some individuals may be more prosperous than the wealthy of Berlin, our health service resembles the American model so beloved of the Progressive Democrats. That model is based on one’s ability to pay. The Progressive Democrats philosophy has fostered greed and envy and superficiality. It is this superficial response to complex problems which, I have no doubt, will result in the Minister’s failure to transform our health service.

Repeated studies has shown that inequality, the bedrock of the Progressive Democrats philosophy, has been shown to be fundamentally unhealthy. I would expect a Minister for Health and Children to understand that and that the health of society is about getting the basics right, and we do not get the basics right in this country. Our water is contaminated with fluoride and other substances such as aluminium sulphate, our air is polluted by car fumes, our diet is high in fat and sugar, and people suffer high levels of stress and take less exercise because they commute to work by car. Has it dawned on the Tánaiste that the huge demand on the health services just may have something to do with the policies of this Fianna Fáil and Progressive Democrats Government?

The Tánaiste will be pleased to know that solutions exist to some of these problems which do not require large sums of money. All that is required is a little joined-up thinking in Govern[476]ment. Making it safe to walk and cycle to school would mean a less sedentary lifestyle and more exercise for children who increasingly suffer from obesity which will lead in later life to heart problems and diabetes. Proper planning would mean that schools and services would not require a car journey, thus cutting down on pollution.

Given the woeful state of the public transport system, many still opt for the car. Public transport requires greater investment. The Green Party has suggested reversing the ratio of spend on roads versus rail. The health service also requires greater investment. There is no getting away from this point. The Tánaiste can talk all she wants about restructuring and value for money but good health and equitable access actually costs. Delivering on the health care strategy will cost. Is the Government prepared to deliver on that strategy or will it renege on those promises as well? We need 300,000 medical cards to make up for those taken out of the system. We need thousands more beds and proper step-down facilities. We need a proper primary care system, as proposed by the Green Party. We need more nurses and consultants. The problem in the health service is a capacity problem. To solve the problem, more money must be expended.

The Tánaiste’s predecessor even went so far as to suggest tax increases. I do not know if that will go down well with the Tánaiste but certainly it will not go down well with the slash and burn philosophy of the Progressive Democrats. How then does the Tánaiste intend to raise the extra money required? For 27 years, from 1970 to 1996, Irish capital investment in the health service only exceeded the EU average in one year, 1980. Years of underinvestment must be made up. The ESRI has calculated that the implementation of the 2001 health strategy will cost 9.9% of gross national product, GNP, annually. This is still lower than German spending. Irish health spending was 46.8% of the German level in 1996 and still only 78.5% in 2002. I use those figures because 1996 was just before this Government came to power.

The Irish health service is a patient that needs radical spending surgery. Instead, the Tánaiste will probably simply try to make the patient look a little better by proposing plastic surgery. This was the idea behind the treatment purchase——

Ms Harney: Information on Mary Harney  Zoom on Mary Harney  Plastic surgery is even more expensive.

Mr. Gormley: Information on John Gormley  Zoom on John Gormley  Plastic surgery is part of the superficial proposal which the Tánaiste would put.

Ms Harney: Information on Mary Harney  Zoom on Mary Harney  The Deputy’s figures are out of date. What is the Deputy reading?

Mr. Gormley: Information on John Gormley  Zoom on John Gormley  This is what the treatment purchase fund was all about. It was to make things [477]look good. Public money is used to buy treatment for public patients in private hospitals in a system which ordinarily uses public money to treat private patients in public hospitals. If that sounds confusing, it is because it is confusing. The Tánaiste will have to sort out that confusion but I do not think she will. I think she will add to that confusion.

When the Tánaiste took up office, she stated that she was not an ideologue. In some ways, I wish she was because the Progressive Democrats ideology is about individual choice. I wish to refer to one issue involving individual choice, the question of water fluoridation. This is a perfect case of the nanny State. Ireland is the only country in the world that has mass fluoridation of water. Some countries have cities with fluoridation. Will the Tánaiste in her first few weeks as Minister for Health and Children examine this problem? She should look at the high rate of fluorosis in this country and examine why so many children and adults under the age of 30 suffer from fluorosis. According to dentists, the reason is that fluorosis is a manifestation of fluoride toxicity. Will the Tánaiste go back to the legislation which introduced water fluoridation and examine the section which provided for tests to be carried out on the Irish population? No tests have ever been carried out. If those tests were carried out, either by sampling of blood or urine, they would show that Irish people have too much fluoride in their systems.

Dr. Hardy Limeback made a submission to the fluoride forum in which he stated that fluoridated water should not be used to bottle-feed babies. Dr. Wayne Anderson from the Food Safety Authority of Ireland stated in his submission that fluoridated water should not be used to bottle-feed babies. That recommendation was changed in mysterious circumstances. Will the Tánaiste investigate how this recommendation was changed? They put forward the precautionary principle and said the water should not be used. The fluoride forum knew that if fluoridated water were used to feed babies, it would increase the incidence of fluorosis. If the ban were recommended, they knew that would mean the end of water fluoridation in this country and so the decision was reversed. Will the Tánaiste examine those issues? If she manages to end water fluoridation, it would equal her policy decision taken in respect of smog which I welcomed. I would heartily welcome an examination of this issue for the sake of making a major difference to people’s health.

Minister of State at the Department of Health and Children (Mr. S. Power): Information on Seán Power  Zoom on Seán Power  I thank Members for their good wishes and look forward to working with the Tánaiste and Ministers of State at the Department of Health and Children, Deputies Brian Lenihan and Tim O’Malley. I [478]hope we can prove effective during the next two and a half years and bring about the change for which all Members and everyone outside the House is crying.

I am pleased to be afforded the opportunity to contribute to this debate on the health service. It is my first opportunity to place on the record the Government’s commitment to provide quality health care for all. The range of services provided within the health system is unique by international standards. It covers everything from health promotion, disease prevention, general practitioner services and acute hospital treatment to a wide spectrum of personal, social and community services.

The Government has prioritised the health service in terms of investing taxpayers’ money. Allied to this investment we have put in place a major reform programme to ensure the funding invested will make the health system more responsive to patient needs, provide value for money and increase quality of care. The better planned and managed health system of the future will deliver measurably improved health care for all patients throughout the country. This year we are investing over €10 billion in the health system. This represents an increase of over €6.5 billion since 1997.

This extra investment in recent years has brought about significant results, including record levels of activity in acute hospitals and a whole range of additional services across the health system as follows. Last year, for the first time ever, the number of patients discharged from hospital having been treated as either an inpatient or a day case was over 1 million. This represents an increase of 46,000 discharges or almost 5% over 2002. In the area of day cases there has been a massive increase of over 190,000 cases or 76% since 1997, giving a total of over 400,000 at the end of 2003. Indications for 2004 suggest a continuation of this trend, with day case work again showing significant increases.

Total staffing figures for the public health system has increased from approximately 68,000 in 1997 to 96,000, a 40% increase. This figure excludes home helps who provide services directly to older people. According to the Brennan commission ten out of every 11 additional employees recruited since 1997 are engaged in duties of direct service to patients and the public. The national treatment purchase fund has reduced waiting times for those public patients waiting longest for surgical procedures. Up to the end of September treatment had been arranged for 19,000 people. Significantly increased capital funding has been provided to the health service. This has provided the necessary funding to build new modern facilities throughout the country. The Government recently provided €85 million to allow these facilities to open.

[479]I avail of this opportunity to respond to two issues raised during the debate last night. I should place on record the position of the Cavan-Monaghan hospital group. The previous Minister was briefed on progress relating to the reconfiguration of hospital services across the group as follows. The board proposes to recruit five additional non-consultant hospital doctors to facilitate the early restoration of 24 hour a day, seven days a week medical cover to Monaghan General Hospital.

Work is due to commence shortly on an expanded treatment room at Monaghan hospital. The Department has approved capital funding of €750,000 for this purpose. The board is to furnish the Department with details of the additional revenue funding required to commission this expanded facility. The board intends to commission ten additional day beds at Monaghan General Hospital to facilitate an increased volume of elective surgery on a day basis at the hospital. My Department has approved revenue funding of €500,000 for this purpose.

Applications for three consultant surgical posts to facilitate the development of surgical services across the Cavan-Monaghan hospital group have been submitted to Comhairle na nOspidéal for approval. The board is to submit proposals to my Department for the provision of an additional 19 beds at Cavan General Hospital as part of the reconfiguration of services across the group.

Last night a number of Deputies referred to the headline in the ESRI report regarding Ireland being ranked 21 out of 22 countries on health status. It is worth pointing out that in coming to that conclusion, the report used data on life expectancy and referred to non-medical factors such as tobacco and alcohol consumption. Many of these can be broadly described as non-medical lifestyle factors which impact significantly on health outcomes and health status. As part of the major reform process the Department is in the process of implementing a population health approach and health impact assessment, both of which are key to addressing these issues.

The Government is addressing the key health outcomes set out in the ESRI report, particularly through its investment in the cancer strategy and the cardiovascular strategy, these diseases being two of the greatest causes of premature mortality.

Mr. Hayes: Information on Tom Hayes  Zoom on Tom Hayes  I wish to share time with Deputies McHugh, Finian McGrath and Joe Higgins.

An Ceann Comhairle: Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  Is that agreed? Agreed.

Mr. Hayes: Information on Tom Hayes  Zoom on Tom Hayes  I thank the Technical Group for facilitating me to contribute to this important motion. I wish the Minister for Health and Children the best of luck in her new portfolio. While everybody knows it is an important portfolio, it is also a difficult one. The public is crying out for [480]change. There is no other Department where the public is demanding change. I also wish the three Ministers of State the best of luck.

I wish to address a couple of issues. First is the failure of the Government to deliver on the promise of providing an extra 200,000 medical cards and the fiasco where well over 100,000 medical cards have been taken out of the system since 1997. I appeal to the Tánaiste in this regard because the reality is that the income threshold is far too low in regard to medical cards. Those of us who deal with constituents on a weekly basis at our clinics see the problem at first hand. In my constituency approximately 6,000 would benefit from medical cards if that promise was delivered. The Government should look seriously at that situation and the hardship caused to many throughout the country.

The second issue I wish to address is the radiotherapy service. I cannot understand why people in the south-eastern region, who have worked hard and paid their taxes, who have developed cancer cannot have radiotherapy treatment in their own area. Neither I nor the public can understand it. The doctors and consultants do not think the same way as those who compiled the report commissioned by the Department of Health and Children. I ask the Tánaiste to look at this matter. On a human level I see and meet people from my constituency travelling to Dublin by train on a regular basis for radiotherapy treatment. In this day and age when we call ourselves a well-off country, this is deplorable and needs to be addressed.

Another issue that has been mentioned and is of grave concern to me, and one I raised with the Tánaiste yesterday, is the position of hospital services in south Tipperary. In January 1996 an agreement was reached following an ongoing dispute over 40 years between Cashel and Clonmel on services for south Tipperary. It was agreed that the surgical service would transfer from Cashel hospital to Clonmel hospital. Despite the delay over many years, it was only in the past few weeks that money was allocated for staffing of the surgical service at Clonmel hospital.

This is where the real trouble begins because the heath board does not have money for the developments which were promised for Cashel. Before I came to Dublin yesterday, I visited the staff and heard their anxieties about what the future holds despite their having signed an agreement to stay in Cashel Hospital. I ask the Tánaiste to examine the positive plan for services which was proposed for Cashel and Clonmel as soon as possible. If the plan for the south Tipperary region is to work, Cashel Hospital must get funding and its problems must be resolved.

Mr. McHugh: Information on Paddy McHugh  Zoom on Paddy McHugh  I wish the Tánaiste and Deputies Peter Power and Twomey the best of luck in their new appointments.

[481]This Private Members’ motion is extensive and broad ranging but I wish to deal with just one element, namely, the need to approve the planning brief for Tuam hospital and make funding available to allow the project to proceed. I make no apology whatsoever to Deputy Fiona
O’Malley or anyone else for doing so. It is my duty to represent in this House the issues which are of concern to my constituents and to pursue a solution to the best of my ability. The lightweight, juvenile and ill-informed comments of Deputy Fiona O’Malley add zero to the standard of debate in the House. It is not my style to be personal, but there is only so much rubbish to which one can listen.

The Taoiseach and the previous Minister for Health and Children, Deputy Martin, committed to this project as recently as the 2002 general election when he visited Tuam. This weeks’Tuam Herald states:

That statement is clear, however, it is not clear why nothing happened in regard to Tuam hospital when the Taoiseach and the Minister for Health and Children returned to Government two and a half years ago. We now need the Tánaiste to approve the planning brief for Tuam Hospital which has been with her Department since 8 October 2002 gathering dust on a shelf.

The case for a hospital in Tuam is fully backed up by the relevant agencies, plans and strategies. The Taoiseach and the former Minister for Health and Children support the project as do the Western Health Board and the national spatial strategy. The Western Health Board separately identified the need for an ambulance base and primary care services in Tuam. I know the hospital will not be provided overnight but the essential first step is to approve the planning brief and make funding available to allow the planning to begin. Finance also needs to be made available for the establishment of an ambulance base now as well as the provision of a primary care unit.

[482]Mr. F. McGrath: Information on Finian McGrath  Zoom on Finian McGrath  I thank the Ceann Comhairle for the opportunity to speak to this Independent Private Members’ motion.

It is refreshing to hear the Tánaiste and Minister for Health and Children adopt the vision and concern of the Independent Members when she stated that she wanted to have a health service which is accessible to every citizen regardless of their wealth. This is a fine statement but sadly, for many patients and people with disabilities, it is only a statement, particularly given that the Government has been in power for eight years.

I will not waste time pointing out the Government’s failures in respect of waiting lists, accident and emergency departments, the promised 1,000 extra hospital beds and 200,000 extra medical cards and the 3,000 people with intellectual disabilities on waiting lists. Rather, I want to look to the future and set out the priorities for this Minister and her Government. They are basic rights for all people in the State and are achievable within two years and I urge the Minister to listen to the constructive proposals for reform and investment in our health service, more beds in the front line at accident and emergency departments, dealing with the shortage of nurses and lack of ICU nurses and less consultant bashing and more common sense in resolving disputes. The Government should try listening to the medical staff instead of trying to paint them as the bad guys in the media. It should take up their challenge and provide more beds. This is a simple basic political decision which is in the hands of the Minister.

In regard to Beaumont Hospital in my constituency, the Tánaiste should listen to people like Dr. Christopher Thompson who stated that “the diabetes service is completely under-resourced and this has been the subject of the last four business plans that I have submitted to the Eastern Regional Health Authority and which have not been addressed”. These are the core issues in this debate and I urge the Tánaiste to listen to the people on the front line.

In regard to people with intellectual disabilities, there are five priorities, namely, to end the waiting list for residential services for people with an intellectual disability by providing, over a three year period, 1,500 new residential places; to increase the number of respite places for children and adults by 600 over a three year period; to complete the programme to transfer people with an intellectual disability inappropriately placed in psychiatric hospitals; to introduce a national standards for disability service; and I also encourage the Minister to end the means test for the carer’s allowance.

These are all sensible suggestions and it is time they were delivered to our citizens. There is no logical reason why these services are not being delivered. I urge all Deputies to support the motion tabled by the Independent Deputies. This [483]motion is about people, it is about caring and it is about quality services but, above all, it is about a chance to invest in and reform our health services.

Mr. J. Higgins: Information on Joe Higgins  Zoom on Joe Higgins  This motion hits out at a health service where access is based on ability to pay rather than on need. That is the reality in our society and is inevitable in an economic system which dominates this society which is driven primarily by the greed of a powerful minority, vindicated by the political masters of our system at present.

Given that Fianna Fáil and the Progressive Democrats champion inequality in society by championing the ethos of capitalism and globalisation, what confidence can we have that the Tánaiste, one of the ideological sergeant-majors of the Government, having taken over the health service will give us one which is just and honest as she has promised and one which is in the interests of all the people? The health service mirrors the structures of our society.

Under this Government in the past seven and a half years, the chasm between the classes has grown immeasurably. Therefore, despite the claims made by the Tánaiste and Minister for Health and Children, Deputy Harney, her ideology will dictate greater rather than less inequality. The newly-opened Galway Clinic is a monument to health inequality with the stamp of approval of the Taoiseach. Powerful big business investors are getting major tax breaks and their profits are therefore subsidised by those taxpayers on the minimum wage who will never be able to place a foot on the plush carpets of that private facility [484]unless they are brought there in a token fashion under the national treatment purchase fund.

Ms Sexton: Information on Mae Sexton  Zoom on Mae Sexton  Does the Deputy suggest we do not treat them at all?

Mr. J. Higgins: Information on Joe Higgins  Zoom on Joe Higgins  In the provision of primary care, the Minister for Health and Children again hinted tonight that we will have to depend further on those seeking profits. If one crosses Mulhuddart Bridge travelling from Blanchardstown, one will find a population rapidly approaching 10,000 with not a single hint of primary care. There are no doctors, pharmacies or health centres and they are badly needed. The Tánaiste’s colleague, Deputy Brian Lenihan, will have to get his togs on in regard to providing such essential services to the people of Mulhuddart. I find it extraordinary that the Tánaiste did not refer to the 200,000 medical cards that she promised. She did not refer to the grotesquely low eligibility levels which keep poor people from the right to a comprehensive health service.

The accident and emergency facilities in hospitals are incredibly poor. We acknowledge that Deputy Fiona O’Malley had a rush of blood to the head tonight. She probably thought she was back debating in the literary and historical society in college and was therefore unable to read her script properly. Coming out in favour of the closure of accident and emergency departments in general hospitals is an extraordinary call by any Member of this House purporting to represent ordinary people. It is crucial that we have comprehensive, good quality facilities that are available to all our people in all regions and counties.

Amendment put.

[483]The Dáil divided: Tá, 62; Níl, 51.

Information on Michael Ahern  Zoom on Michael Ahern  Ahern, Michael. Information on Noel Ahern  Zoom on Noel Ahern  Ahern, Noel.
Information on Barry Andrews  Zoom on Barry Andrews  Andrews, Barry. Information on Seán Ardagh  Zoom on Seán Ardagh  Ardagh, Seán.
Information on Niall Blaney  Zoom on Niall Blaney  Blaney, Niall. Information on Johnny Brady  Zoom on Johnny Brady  Brady, Johnny.
Information on Martin Brady  Zoom on Martin Brady  Brady, Martin. Information on John Browne  Zoom on John Browne  Browne, John.
Information on Joe Callanan  Zoom on Joe Callanan  Callanan, Joe. Information on Ivor Callely  Zoom on Ivor Callely  Callely, Ivor.
Information on Pat Carey  Zoom on Pat Carey  Carey, Pat. Information on John Carty  Zoom on John Carty  Carty, John.
Information on Michael Collins  Zoom on Michael Collins  Collins, Michael. Information on Mary Coughlan  Zoom on Mary Coughlan  Coughlan, Mary.
Information on Brian Cowen  Zoom on Brian Cowen  Cowen, Brian. Information on John Cregan  Zoom on John Cregan  Cregan, John.
Information on Martin Cullen  Zoom on Martin Cullen  Cullen, Martin. Information on John Curran  Zoom on John Curran  Curran, John.
Information on Noel Davern  Zoom on Noel Davern  Davern, Noel. Information on John Dennehy  Zoom on John Dennehy  Dennehy, John.
Information on Jimmy Devins  Zoom on Jimmy Devins  Devins, Jimmy. Information on Michael Finneran  Zoom on Michael Finneran  Finneran, Michael.
Information on Dermot Fitzpatrick  Zoom on Dermot Fitzpatrick  Fitzpatrick, Dermot. Information on Seán Fleming  Zoom on Seán Fleming  Fleming, Seán.
Information on Pat the Cope Gallagher  Zoom on Pat the Cope Gallagher  Gallagher, Pat The Cope. Information on Jim Glennon  Zoom on Jim Glennon  Glennon, Jim.
Information on Noel Grealish  Zoom on Noel Grealish  Grealish, Noel. Information on Mary Hanafin  Zoom on Mary Hanafin  Hanafin, Mary.
Information on Mary Harney  Zoom on Mary Harney  Harney, Mary. Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán.
Information on Joe Jacob  Zoom on Joe Jacob  Jacob, Joe. Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  Keaveney, Cecilia.
Information on Peter Kelly  Zoom on Peter Kelly  Kelly, Peter. Information on Tony Killeen  Zoom on Tony Killeen  Killeen, Tony.
Information on Seamus Kirk  Zoom on Seamus Kirk  Kirk, Seamus. Information on Tom Kitt  Zoom on Tom Kitt  Kitt, Tom.
Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Lenihan, Brian. Information on Michael McDowell  Zoom on Michael McDowell  McDowell, Michael.
Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas. Information on Micheál Martin  Zoom on Micheál Martin  Martin, Micheál.
Information on Donal Moynihan  Zoom on Donal Moynihan  Moynihan, Donal. Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael.
Information on M. J. Nolan  Zoom on M. J. Nolan  Nolan, M. J. Information on Éamon Ó Cuív  Zoom on Éamon Ó Cuív  Ó Cuív, Éamon.
Information on Seán Ó Fearghaíl  Zoom on Seán Ó Fearghaíl  Ó Fearghaíl, Seán. Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie.
Information on Liz O'Donnell  Zoom on Liz O'Donnell  O’Donnell, Liz. Information on Dennis O'Donovan  Zoom on Dennis O'Donovan  O’Donovan, Denis.
Information on Noel O'Flynn  Zoom on Noel O'Flynn  O’Flynn, Noel. Information on Ned O'Keeffe  Zoom on Ned O'Keeffe  O’Keeffe, Ned.
Information on Tim O'Malley  Zoom on Tim O'Malley  [485]O’Malley, Tim. Information on Tom Parlon  Zoom on Tom Parlon  Parlon, Tom.
Information on Peter Power  Zoom on Peter Power  Power, Peter. Information on Seán Power  Zoom on Seán Power  Power, Seán.
Information on Mae Sexton  Zoom on Mae Sexton  Sexton, Mae. Information on Brendan Smith  Zoom on Brendan Smith  Smith, Brendan.
Information on Michael Smith  Zoom on Michael Smith  Smith, Michael. Information on Dan Wallace  Zoom on Dan Wallace  Wallace, Dan.
Information on Mary Wallace  Zoom on Mary Wallace  Wallace, Mary. Information on Joe Walsh  Zoom on Joe Walsh  Walsh, Joe.
Information on Ollie Wilkinson  Zoom on Ollie Wilkinson  Wilkinson, Ollie. Information on Michael J. Woods  Zoom on Michael J. Woods  Woods, Michael.

Information on Bernard Allen  Zoom on Bernard Allen  Allen, Bernard. Information on Dan Boyle  Zoom on Dan Boyle  Boyle, Dan.
Information on James Breen  Zoom on James Breen  Breen, James. Information on Pat Breen  Zoom on Pat Breen  Breen, Pat.
Information on Thomas P. Broughan  Zoom on Thomas P. Broughan  Broughan, Thomas P. Information on Richard Bruton  Zoom on Richard Bruton  Bruton, Richard.
Information on Joan Burton  Zoom on Joan Burton  Burton, Joan. Information on Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul.
Information on Joe Costello  Zoom on Joe Costello  Costello, Joe. Information on Jerry Cowley  Zoom on Jerry Cowley  Cowley, Jerry.
Information on Seymour Crawford  Zoom on Seymour Crawford  Crawford, Seymour. Information on Sean Crowe  Zoom on Sean Crowe  Crowe, Seán.
Information on Ciaran Cuffe  Zoom on Ciaran Cuffe  Cuffe, Ciarán. Information on Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy.
Information on Martin Ferris  Zoom on Martin Ferris  Ferris, Martin. Information on Eamon Gilmore  Zoom on Eamon Gilmore  Gilmore, Eamon.
Information on Paul Nicholas Gogarty  Zoom on Paul Nicholas Gogarty  Gogarty, Paul. Information on John Gormley  Zoom on John Gormley  Gormley, John.
Information on Tony Gregory  Zoom on Tony Gregory  Gregory, Tony. Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom.
Information on Seamus Healy  Zoom on Seamus Healy  Healy, Seamus. Information on Joe Higgins  Zoom on Joe Higgins  Higgins, Joe.
Information on Michael D. Higgins  Zoom on Michael D. Higgins  Higgins, Michael D. Information on Philip Hogan  Zoom on Philip Hogan  Hogan, Phil.
Information on Brendan Howlin  Zoom on Brendan Howlin  Howlin, Brendan. Information on Paul Kehoe  Zoom on Paul Kehoe  Kehoe, Paul.
Information on Kathleen Lynch  Zoom on Kathleen Lynch  Lynch, Kathleen. Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian.
Information on Paddy McHugh  Zoom on Paddy McHugh  McHugh, Paddy. Information on Liz McManus  Zoom on Liz McManus  McManus, Liz.
Information on Gay Mitchell  Zoom on Gay Mitchell  Mitchell, Gay. Information on Olivia Mitchell  Zoom on Olivia Mitchell  Mitchell, Olivia.
Information on Arthur Morgan  Zoom on Arthur Morgan  Morgan, Arthur. Information on Gerard Murphy  Zoom on Gerard Murphy  Murphy, Gerard.
Information on Dan Neville  Zoom on Dan Neville  Neville, Dan. Information on Caoimhghín Ó Caoláin  Zoom on Caoimhghín Ó Caoláin  Ó Caoláin, Caoimhghín.
Information on Fergus O'Dowd  Zoom on Fergus O'Dowd  O’Dowd, Fergus. Information on Jim O'Keeffe  Zoom on Jim O'Keeffe  O’Keeffe, Jim.
Information on Brian O'Shea  Zoom on Brian O'Shea  O’Shea, Brian. Information on Jan O'Sullivan  Zoom on Jan O'Sullivan  O’Sullivan, Jan.
Information on Séamus Pattison  Zoom on Séamus Pattison  Pattison, Seamus. Information on Willie Penrose  Zoom on Willie Penrose  Penrose, Willie.
Information on Pat Rabbitte  Zoom on Pat Rabbitte  Rabbitte, Pat. Information on Seán Ryan  Zoom on Seán Ryan  Ryan, Seán.
Information on Trevor Sargent  Zoom on Trevor Sargent  Sargent, Trevor. Information on Joe Sherlock  Zoom on Joe Sherlock  Sherlock, Joe.
Information on David Stanton  Zoom on David Stanton  Stanton, David. Information on Billy Timmins  Zoom on Billy Timmins  Timmins, Billy.
Information on Liam Twomey  Zoom on Liam Twomey  Liam Twomey Information on Mary Upton  Zoom on Mary Upton  Upton, Mary.
Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.  

[485]Tellers: Tá, Deputies Kitt and Power; Níl, Deputies Gregory and McHugh.

[485]Amendment declared carried.

Motion, as amended, put and declared carried.

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