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

Wednesday, 10 November 2004

Dáil Eireann Debate
Vol. 592 No. 2

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The following motion was moved by Deputy Twomey on Tuesday, 9 November 2004:

—acknowledging the hard work of all doctors, nurses and healthcare professionals in the North Eastern Health Board (NEHB);

[424]—noting that:

—there have been a number of tragic events in the NEHB that have contributed to a crisis of confidence in the health services provided in the NEHB;

—there is a need to look at the provision of health services in the NEHB and to find solutions to restore patients’ confidence in the provision of healthcare services in the NEHB region;

—steps must be taken in the NEHB to ensure that the new Dublin/north east regional area does not encounter the same difficulties after 1 January 2005 when the new health service executive structures are in place;

—explain the circumstances in which the recommendations of the Bonner report were not implemented;

—explain why this Government has failed to review the NEHB in light of a number of recent revelations;

—explain the mechanism by which the Dublin/north east regional health office and all other regional health offices will be accountable to Dáil Éireann and to commit the Tánaiste and Minister for Health and Children to answer parliamentary questions on behalf of the regional health offices;

—consult with all stakeholders in the new Dublin/north east regional area and all regional health areas to provide both primary, acute and non-acute hospital care that is acceptable to the people and is medically safe;

—properly resource the Cavan-Monaghan group of hospitals so that acute and elective care can be provided to the people of Cavan-Monaghan;

—properly resource the Louth/Meath group of hospitals so that acute, elective and regional specialties can be safely provided at those hospitals;

—properly resource the Beaumont hospital to provide acute and elective care to the local, regional and national tertiary services that it is responsible for providing to the people of the NEHB and the rest of the country; and

—properly resource the Navan hospital to provide acute and elective care to the people of Meath.

[425]Debate resumed on amendment No. 1:

—(Minister for Health and Children).

Minister of State at the Department of Health and Children (Mr. S. Power): Information on Seán Power  Zoom on Seán Power  I wish to share my time with Deputies Sexton, Devins, Kirk and Johnny Brady.

The Fine Gael motion calls on this Government to resource properly the Louth-Meath and Cavan-Monaghan hospital groups. The Tánaiste and Minister for Health and Children, Deputy Harney, and the Minister of State, Deputy Tim O’Malley, have spoken about the comprehensive investment programme which has been put in place since 1997 in the North Eastern Health Board area under this Government. In the context of the hospital reform programme, the Tánaiste referred last night to the recommendations of the Hanly report as regards the configuration of hospital services. It should be noted that the Hanly report emphasised the need for further development of the ambulance services.

Pre-hospital emergency care is a key component in the planning and reconfiguration of hospital services. It is disappointing that some Opposition Members chose to ignore the valuable role played by ambulance personnel in the delivery of care in the north east.

It is important to outline some of the main developments that have taken place nationally and in the north east in the area of pre-hospital emergency care in recent years. These include the following: a major upgrading in training and standards; the equipping of emergency ambulances with defibrillators and the training of ambulance personnel in their use; the introduction of two person crewing; and improvements in communication equipment and control operations. Among the developments being addressed are the elimination of on-call as a means of providing emergency cover, improved fleet reliability and the roll-out of the advanced paramedic training programme

Ambulance personnel are limited in the range of medications they can administer at the scene of an illness or accident. To address this issue, the former Minister for Health and Children, Deputy Martin announced policy approval for the development of the advanced paramedic training programme. Considerable work has been done in preparing the legislative base necessary to give effect to the introduction of the programme. I am pleased to advise that the new statutory instrument amending the pre-hospital emergency care [426]council’s establishment order has recently been amended to facilitate its introduction.

Additional legislative changes are being progressed as a priority and will provide a statutory basis for the administration by ambulance personnel of treatment, such as cardiac medications, to patients. The new measures mean that patients, wherever they live, will have equitable and rapid access to a wider range of emergency services. It is intended that this expanded service will commence roll-out in 2005 following the completion of training of ambulance personnel.

Consistent with the policy agenda for pre-hospital care, a number of important developments have taken place in recent years in the north-eastern region. Staffing levels have increased from 95 in 2001 to 126 in 2004 and two new ambulance stations opened in Ardee and Dunshaughlin in 2001. A new ambulance station is expected to be operational in Virginia before the end of 2004 and sanction has been given for the development of a new ambulance station on the grounds of St. Davnet’s Hospital in Monaghan at a cost of €1.8 million. All frontline ambulances are equipped with ECG monitors-defibrillators and each unit has a telemetry facility to transmit a patient’s ECG to the receiving hospital before his or her arrival. More than €500,000 has been invested in information technology and communications at ambulance control in the past two years, providing integrated command and control and a computer-aided despatch system. The NEHB has invested €1.5 million on vehicle replacement over the last three years.

The level of investment and development which is taking place in the area of pre-hospital emergency care complements the investment programme in the acute hospital sector which has been outlined by the Tánaiste and the Minister of State. The ambulance service has an important role to play in the delivery of an integrated hospital service in the north east and in all the other regions. The Government will continue to focus on the development of the service and ensure that the issue of ready access to treatment remains at the centre of evolving health policy in this country.

Ms Sexton: Information on Mae Sexton  Zoom on Mae Sexton  I welcome the opportunity to contribute to tonight’s Private Members’ debate. Like my colleagues on all sides of the House, I record my support for and appreciation and acknowledgement of the various groups within the health sector who provide a superb, safe and outstanding service to the people in the north east. This Government policy on health has two fundamental elements which are worthy of repetition and support, namely, investment in service developments and real and lasting reform. My party colleagues, the Tánaiste, Deputy Harney, and the Minister of State, Deputy Tim O’Malley, spoke last night and addressed the issue of Government funding for the health services. They spoke, in particular, about substantial Government funding for the North Eastern Health [427]Board area and the fact that since 1997 the extra €383 million has been the largest increase in day-to-day spending in all of the health boards. It has been unprecedented and is a substantial investment.

I want to acknowledge the Tánaiste’s commitment that the Estimates for 2005 when published will again show the consistent record of the Government in prioritising the health services. However, in my few short minutes I do not intend to repeat verbatim all the current capital works in the region put on record by the Minister and the Minister of State, or the interim projects indicated. They are too numerous to mention. In conjunction with those, any reasonable person would agree that a 65% increase in consultants’ posts, almost 20% more than the national average, does not indicate a Government that has neglected the region, which I believe is suggested in the motion before the House. It is a figure I have no doubt is envied by many other health regions.

However, I do not suggest that the Minister is any less eager than the movers of the motion to ensure the provision of even greater and enhanced supports in the region. Any time I speak in the House on health-related matters, I repeat that concern for the ill, vulnerable and under-privileged in society is not just the prerogative of the Opposition. Improvement in the health service is both desirable and necessary on an ongoing basis.

I wish to address the real and lasting reforms taking place. While the Government continues to generate the necessary resources to fund the health services, real reform must also take place in each health region. Reform means making and implementing decisions, which is why I am delighted the Tánaiste, Deputy Harney, is at the helm in the Department of Health and Children. However, she will not be able to succeed without the support and co-operation of all in the health service — the people who manage and staff it, health care professionals and patients. Every region will undergo a degree of reform, change and re-organisation. All this will be driven with the patient as priority. Nobody will be left without access to the services he or she needs.

In my area of the Midland Health Board, change will happen and similarly it will take place in the north-eastern area too. I firmly believe that this will be embraced by all those at the coalface of the health service in a partnership approach with the new Minister for Health and Children. Future reform is about striking a balance between mammoth centres concentrated in one part of the country and a few acute hospital services in every county in Ireland. Future reform means a full range of regional hospital services working in a network in co-operation for all but the most specialised of services, which is what the Hanly report is based on. It is not about downgrading or closing hospitals, as has been suggested, or leaving patients without vital services but about striking the right balance.

[428]In the UK, Leicester has a population of just 1 million. It has one accident and emergency service, no queues and no waiting lists on trolleys. Dublin, with approximately the same number of people, has seven accident and emergency departments and a unique set of difficulties that must be addressed. With a total population of four million in Ireland, it is essential we properly balance our acute services throughout the country in a manner in which the best of hospital care is delivered to all patients. This is both achievable and desirable and I have no doubt that the majority of those who work in the health service are prepared for change in a partnership approach with the Minister.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  I take this opportunity to wish the Minister of State, Deputy Seán Power, the very best in his job as I have not spoken in the House in his presence since his promotion.

I am delighted to speak on this important Private Members’ motion. I do not represent any of the constituencies covered by the former North Eastern Health Board and unlike many of tonight’s speakers do not have the experience of day-to-day representations from the north east. However, people who live in the area have contacted me and like all of my Dáil colleagues, I have listened to many debates on the health board in question.

Unfortunately, the North Eastern Health Board has been in the news more regularly than its counterparts in the last few years. This has in general been for the wrong reasons. It saddens everybody to hear of a death and the tragic death of young Bronagh Livingstone was a tragic reminder of this fact. Last night, I listened with great interest to the debate. The Minister outlined clearly the support her predecessor, Deputy Martin, provided to the North Eastern Health Board over the last few years. I was particularly interested to hear about the board’s programme of reform of its hospital services. The programme is based on the realisation that it will never be possible to develop the same range of services at each of the five hospitals in the north east.

In the short time available, I intend to expand the debate to a discussion of the wider health service. As reform of service delivery in health is essential, I am especially interested to know where exactly the Opposition stands. It has been said repeatedly in the course of this debate that numerous reports have been produced. We all acknowledge that the time for reports is over and the time for action has come. The pathway for health service reform has been clearly set out in the Hanly report. While opportunistic and selective attacks on this blueprint by some Members have allowed them to build a high profile, the same Deputies have been remarkably silent in coming up with an alternative. It is very easy to adopt a destructive approach and criticise everything. While criticism is sometimes constructive, selective targeting while failing to recognise the overall thrust of reform leads ultimately to pre[429]varication. Prevarication leads to confusion and the only people who suffer are those members of the public who have to put up with hospital facilities which fail to meet their contemporary requirements.

I look forward with great interest to the presentation to be given to the Joint Committee on Health and Children by those opposed to the Hanly recommendations. I hope they will not be parochial and play on the unfounded fears of the general public. Reform is necessary and the Hanly report recommends investment in local hospitals to allow them to provide more rather than less services to patients. The application of this principle to the hospital services in general and the north east area in particular should ensure that the banner headlines of disaster and crisis become a thing of the past. Reference to such headlines has become commonplace among certain people who discuss our health services. The public must have faith in the people and service delivering health care. If we are constructive and forget headline grabbing, the necessary reforms can be implemented and the problems experienced in the former North Eastern Health Board area forgotten.

Mr. Kirk: Information on Seamus Kirk  Zoom on Seamus Kirk  I am grateful for the opportunity to contribute to this important debate. Private Members’ time allows the Opposition to table motions for debate which are clearly relevant to many people in various constituencies. It is the essence of democracy that Members can table controversial motions which are relevant to the present or near future. It is important that when an individual or party moves a motion, negative comment is avoided. While criticism is one thing, downright negativity can have serious consequences in the context of positive achievements and provisions such as those at Our Lady of Lourdes Hospital in Drogheda and Louth County Hospital in Dundalk.

A cardiac rehabilitation unit opened at Louth County Hospital in 2002 while an additional 14 beds opened under the national bed-capacity initiative. The full-year revenue cost of these beds exceeds €1.4 million. Last year, the Department sanctioned the purchase by the board of 6.85 acres of land for development purposes adjacent to Louth County Hospital at a cost of €2.6 million.

Developments at Our Lady of Lourdes Hospital in Drogheda have included the upgrading of the intensive care and coronary care units at a capital cost of €1.3 million. An additional four beds were commissioned in June at an additional revenue cost of €800,000 and an extensive re-equipping programme was implemented over three years costing in the region of €2 million. A new symptomatic breast care and palliative care service commenced in June 2004 with the commissioning of new modular accommodation while a cardiac rehabilitation service commenced in July 2004.

[430]Project teams have been formed for Drogheda and Dundalk hospitals and approval issued earlier this year to commence a feasibility study at Our Lady of Lourdes Hospital to assess the development potential of the site. The Department of Health and Children has also agreed to the selection of a design team for Louth County Hospital. In August 2004, the Department issued approval to the North Eastern Health Board to progress a series of interim capital works. Specifically, the Department approved a design team to advance the provision of two modular theatres and upgrade kitchens at an estimated capital cost of €1.4 million. A design team was appointed to progress the development of midwife-led maternity units in Drogheda and at Cavan General Hospital at a capital cost of €1.5 million. Design teams were also approved to upgrade the accident and emergency department and the kitchens at Our Lady of Lourdes Hospital at a combined capital cost of over €4 million.

There has been significant population growth in the former North Eastern Health Board area, especially in Louth and Meath. Not only must this significant population block be catered to currently, but a rapid increase is projected. Accordingly, we must plan for a full range of health services. Drogheda and Dundalk are two of Ireland’s largest provincial towns and with the projected rapid growth it is essential to provide a full range of health services going forward. Hospital plans must be phased to permit expansion on existing sites and the additional land which has been provided at Louth County Hospital is particularly welcome in that context.

Accident and emergency services are regularly denigrated due to over-crowding at certain times. We must ask how this problem can be alleviated. Some of those who attend accident and emergency departments should be treated by their general practitioner. We must ask if we need to take more drastic action to tackle the road carnage besetting the country and to adopt a more proactive approach to the provision of facilities for the active retired as well as those of younger age. We must discover what percentage of the population takes regular exercise and is conscious of dietary habits.

How many lay people have first-aid knowledge and how many sports clubs have suitably qualified first-aid personnel who can help out in emergencies? I dare say it is a relatively small percentage. Consequently, many players and participants in sport must be transferred automatically to a local accident and emergency unit on a Saturday or Sunday evening. On an isolated playing field in Galway or Louth to take a player to hospital may seem irrelevant, but there is a cumulative effect. Inevitably, pressure is put on our accident and emergency services.

Apart from the broader plan for hospitals, it is clear that accident and emergency services constitute the most controversial aspect of the health system. It is an area that can be tackled with common sense and practical management arrange[431]ments in the various hospitals. It behoves us all as public representatives to encourage and cajole people and make them aware of their individual responsibilities in the circumstances.

Mr. J. Brady: Information on Johnny Brady  Zoom on Johnny Brady  I wish the Minister of State at the Department of Health and Children, Deputy Seán Power, well in his new position. I am happy to support the Government’s amendment to the motion. Since 1997 funding for the North Eastern Health Board has increased by €383 million, more than three times the 1997 level. The Government has put significant investment into the north east. In 2004 the funding provided for the North Eastern Health Board was €549 million, an increase of almost €66 million on 2003, or over 13%. In the north eastern region the number of patients discharged from acute hospitals has increased from 53,000 in 1997 to 75,000 in 2003. The number of day cases has more than doubled from 12,000 in 1997 to 28,000 in 2003. There were 124 consultants in the north-eastern region in January, up from 75 in 1997, an increase of almost two thirds, which compares well with the national average of 46% in the same period.

I have no doubt that the Government is committed to the provision of a high quality cost effective and responsive hospital service for all people in the north-eastern region. The North Eastern Health Board has engaged in a programme of hospital reform in a challenging and changing environment. Recently, it was announced that Kells was to be the Dublin north east region centre for the new health executive which has taken over the functions of the health boards. Kells joins Galway and Cork cities as well as Tullamore in serving the western, southern, Dublin north east and Dublin midlands regions. This news has been warmly welcomed in Kells, putting an end to opposition speculation that the town was about to lose its health headquarters. There have been numerous doubters and naysayers locally who doubted that Kells would be in the frame for such an important base.

These new structures will help to improve patient service in the region. They will also serve to minimise disruption to staff working in existing locations. I welcome the fact that there will be ongoing consultation about changes in roles, responsibilities and lines of accountability with staff. I thank the former Minister for Health and Children, Deputy Martin, whom I lobbied constantly and told him of our determination to ensure Kells was in a position to expand the range of office and professional functions available. I wish to highlight how an earlier undertaking from the former Minister, Deputy Martin, that no jobs would be put at risk in the North Eastern Health Board headquarters town had been borne out.

I thank my colleagues on the Kells Town Council and the cathaoirleach and officials who travelled with me to Dublin to meet the Minister to ensure the new executive was placed in Kells. [432]Under the national development plan, health projects have included ongoing refurbishment works and equipment at Our Lady’s Hospital in Navan, a new health care unit in Trim with community health centres and GP practice centre and a mental health day centre and day resource centre for persons with disabilities. I am sure the Minister for Communications, Marine and Natural Resources, Deputy Noel Dempsey, has played a major part in achieving those services. We also benefit from 80 new ambulances. In Oldcastle a new community health centre, GP practice centre and day centre has been completed. The extension and refurbishment of the health centre in Dunboyne is complete as is refurbishment work for Meath health centre and an extension to the health centre in Slane. My colleague, Deputy Mary Wallace, played her part.

Mr. English: Information on Damien English  Zoom on Damien English  My colleague granted it.

Mr. J. Brady: Information on Johnny Brady  Zoom on Johnny Brady  A design team has been approved to upgrade the existing orthopaedic operating theatre at Our Lady’s Hospital in Navan. I thank my colleagues for allowing me to contribute. There is a great deal more I could say. I could speak for the next half hour about the achievements of the Government.

Mr. Connaughton: Information on Paul Connaughton  Zoom on Paul Connaughton  Put it on the web.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  I am glad to speak on this motion. I would not be here, nor would many of my Independent colleagues were it not for the neglect of successive Governments, including Fine Gael Governments. Given that Fianna Fáil has been in office for a much longer period it must accept the major portion of the blame.

Mr. Connaughton: Information on Paul Connaughton  Zoom on Paul Connaughton  Eighteen out of 20 years.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  We have felt the apartheid and despite what Deputies on the other side say, this is the reality we have to deal with every day. It is much less frustrating for me to be here than to be in my surgery putting up with the fact that cancer patients have to wait so long to get basic services. I mentioned a case this morning, under Standing Order 31, of a gentleman who was diagnosed with probable cancer by his GP last April and he is still waiting to get into UCHG for treatment. If that man had money he would have been looked after and neither he nor his family would be in dread wondering what are his chances. What are the chances of a man who was diagnosed with probable cancer last April and is still waiting to find out? That is not acceptable. Deputies on the other side of the House are talking through their hat.

As a result of the Hanly report we will never have a urology service and for the 1,000 plus people who have been waiting seven years for a urology appointment there will be no change.

Dr. Devins: Information on Jimmy Devins  Zoom on Jimmy Devins  That is rubbish.

[433]Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  It is not rubbish because that is the service we have at present. That is the reality. The Deputy cannot deny that reality irrespective of his guff. We need two consultant urologists in Mayo General Hospital, but as a result of the Hanly report, we will never get them. That is not unique. I spoke here not long ago about another man with cancer who waited months for a first appointment. That is not acceptable. As a result of the Hanly report, 24-hour accident and emergency services will close down. There has been backtracking since, but people are not stupid. If one applies the Hanly report literally, as has been done with the Trinity report, one will see that people will have to travel further to get the essential services for a heart attack and so on.

Mr. Connaughton: Information on Paul Connaughton  Zoom on Paul Connaughton  Exactly.

Dr. Cowley: Information on Jerry Cowley  Zoom on Jerry Cowley  That is not scaremongering, that is the reality. If one looks at the ambulance service, it is clear it is dependent on the road network, time of call-out and location of ambulance bases. In Ballina the response time is 58.8% within 20 minutes. In the Eastern Regional Health Authority area it is 97%, which is a fair difference. Given that services are being cut back people have to travel further. The standard is that each ambulance base should be within 20 miles of a population. The Western Health Board area is unique in that three ambulance bases are urgently needed to provide that standard of service. That is the reality no matter what anybody says.

We do not have the BreastCheck service in west although it has been available in the south and east since 2000. We do not have rheumatology services in the west. We now have an orthopaedic unit but under the Hanly report we would not have such a unit. We have that unit only because I started a campaign many years ago and brought it to the streets last summer. Under the Hanly report local services will be closed down, and that is not acceptable. Irrespective of what Deputies on the other side of the House say, that is the reality.

Mr. Gormley: Information on John Gormley  Zoom on John Gormley  I congratulate Fine Gael on moving this important motion. In his opening remarks Deputy Twomey told the House that the north-eastern region, which has a population of 350,000 got an extra €2 million for cancer care and an extra €400,000 for primary care. We can all agree these are paltry amounts of money and do little to help deal with the serious health problems in that region. The problem is that we have not made up for the shortfall in spending during the 1980s when beds were taken out of the system and spending fell way below the EU average. The Minister now tells us that we are spending vast sums on the health service, but it just does not make up for that shortfall. Spending of €400,000 on primary care and €2 million on cancer care will not go very far.

We know that we have a very high incidence of cancer on the east coast and in the north-eastern [434]region. It has been said that this has nothing to do with Sellafield or other environmental factors. Primary care ought to be about prevention. Once one begins to deal with the symptoms it is often too late and extremely expensive, especially in cases of heart disease, diabetes or cancer. Primary care, in which we should be investing a lot of money, would help us to address the root causes of disease. A starting point would be to examine the environment in which we are living and to conduct baseline studies. We know from the WHO that 80% of cancers are environmentally linked.

I recently became aware of a serious problem in Ringsend in my constituency, where there is a very high incidence of cancer. Every time there is a funeral in Ringsend church, it seems to be that of someone who died of cancer. Many of the women who live in a part of Ringsend known as “the new houses”, although they are now 20 years old, are very concerned. They contacted me recently and pointed out that practically every house in the area has had a cancer death. There is no question but that this is abnormal. Statistically, one in four will get cancer at some stage in his life, but the incidence is way above average in the area in question. Furthermore, there has been a considerable number of thyroid problems.

It seems that this is certainly out of the ordinary and needs to be investigated. The area is built on the old city dump. Nowadays, we would never allow houses to be built on an old dump. The area would first have to be remediated and made safe. That never happened in Ringsend. There were peculiar occurrences in which the ground suddenly swelled up and there were gas emissions. Sometimes the people did not have to heat their houses because the heat from the ground was so intense. All these stories are true. It is equally true that people are dying and therefore we need an investigation.

When talking about primary care, it is important that we examine baseline studies to determine how healthy it is to live in a particular environment. We cannot allow circumstances such as those in Ringsend to continue. People are dying mysteriously but I do not believe there is a mystery. There is a root cause and it is up to the Government and health authorities to look into it. I have raised this before but people do not want to know because they are concerned that compensation may have to be paid at some stage. The quality of the environment, particularly air quality, in the Ringsend area has been very poor over the years. Ringsend has had to deal with the city dump, numerous dirty industries, including power stations burning coal, and other industries such as scrapworks. There used to be incinerators and there is now a proposal for another. It is unacceptable for those living in the area and I want an investigation. It is what the people deserve. The amount we are investing in primary health care is laughable.

[435]Mr. Connolly: Information on Paudge Connolly  Zoom on Paudge Connolly  I welcome the opportunity to speak on this motion. We must remember that the staff in Cavan, Monaghan and the north east will probably become further demoralised and feel that they are being criticised when in fact it is the failure of the whole system that has brought about this debate. People in Monaghan are worried about their jobs and those in Cavan are worried about performing their jobs. The latter are not actively allowed to do so because of numbers.

Cavan, Monaghan and the North Eastern Health Board region always appear to come under the spotlight of the media. They almost deserve their own channel because there is so much news of the wrong kind being generated in the area. The Cavan-Monaghan area is a guinea pig for those implementing the Hanly report. The north east is effectively the prototype.

If one wants to know why the report’s proposals will not work, one should visit the north east. Consider the well-noted case of Benny McCullagh, for example. Last week he had a heart attack and was carted by ambulance for 30 miles because he was not allowed to be taken to Monaghan General Hospital, which was within sight. After the funeral of Mr. McCullagh on Friday, I decided to ring the deputy CEO in charge of acute hospital services, based in Kells. I did so on Monday morning. I stated my business related to the Benny McCullagh case and that I wanted to discuss how the recurrence of such a case could be avoided. I was told my call would be returned that evening but this did not happen. I waited until Tuesday afternoon and rang again. I got through to the deputy CEO’s department again and re-stated my business. My mobile number and other details were taken but I received no return call. On Wednesday I got a call from the office to say that the person in question would step down from his little high horse and ring me on Monday, yet I am still awaiting that call. This attitude problem must be addressed.

It strikes me that officials do not want to talk to Dáil representatives. This is not good enough, nor is it sufficiently responsible. To me, it is sending out the signal that they do not care if a case such as that of Mr. McCullagh recurs. They are so far removed from reality and common sense that it is unreal.

It is well known that minutes matter when a person has a heart attack. The sooner clot-busting medication is administered into the veins of the patient, the better in terms of the treatment outcome. This is what we should be examining. We should also be ensuring that a person having a very severe haemorrhage or broken limbs can be brought to a hospital and stabilised.

I am not talking out of one side of my mouth because my son was brought to hospital less than 12 months ago with a very badly damaged hand and was treated extremely well and professionally by a junior doctor. I was certainly not expecting an accident and emergency consultant to be present on a Saturday afternoon. The junior [436]doctor administered pain-relief medication, put my son on a drip, X-rayed him and sent him to Dublin to the centre of excellence, where he was treated by a senior registrar. Again, I would not have expected a top consultant at this point, yet my son got the very best chance available at the time. That is the type of common sense approach to medicine that we should be taking.

The Hanly recommendations have lost it in terms of this common sense approach. I was astonished to hear the Minister say in the House last night — I read her script twice — that it is not a report about taking services away from people and that it is not a question of centralising services. Are there two Hanly reports? Maybe we have the wrong one and the Minister is reading another. She also stated that people want services and want to have confidence therein, and she claimed that the Government intends to deliver in this regard. If one asks the representatives of the hospitals of Cavan, Monaghan, Ennis, Nenagh, Clones or any of the other small hospitals earmarked in the report whether they have confidence in the Hanly report, they will state that they do not. They will argue that those implementing the report’s recommendations are taking the SHOs out of Monaghan Hospital and sending them to Cavan with a consultant surgeon. From this point, they are to be sent back to Monaghan to perform surgery on a daily basis. How can any college of surgeons say this is best practice?

Consider the size of the teams that must travel from hospital to hospital. There will possibly be more than four individuals and I am quite sure that those who travel for the health board travel alone in their cars. This incurs an expense and takes up considerable man hours. This time will be subtracted from the SHOs’ session time. It takes at least an hour to travel from Cavan to Monaghan. At present there are road blocks and road works and therefore circuitous routes must be taken. Asking a surgeon to travel 30 miles on bad roads in the winter to provide a day surgeon in Monaghan Hospital does not make sense. Furthermore, a different surgeon and team are expected to travel the following day. This is absolute lunacy. They should build a 19 bed psychiatric extension for the people who dream up these proposals. It is crazy. We referred earlier to funding for the North Eastern Health Board, which is a waste of funding.

The surgeon who performs an operation should discharge the patient. He is the one who should tell a patient it is all right to go home, which is not happening. Members praise the Hanly report as if it was the best thing that happened, which is not the case. We need to re-examine the proposals because we need to provide common-sense services, which is what people want. Two days ago, there were 18 patients on trolleys in Cavan General Hospital. They were taking up space in corridors, dental rooms, day rooms and so on, which is not acceptable. This service is not acceptable to the people of north east, Monaghan or Cavan.

[437]Mr. Connaughton: Information on Paul Connaughton  Zoom on Paul Connaughton  The reason Fine Gael tabled this Private Members’ motion is because of the frustration, annoyance and downright pent up anger that almost everyone in the country, not just in the North Eastern Health Board area, feels towards the health services. This is not a witch hunt against doctors, consultants or administrative staff. All those who work in the health service work very hard but, because they are not well directed from the top, they do not appear to be able to deliver the type of service people want. It appears that no one feels secure or safe in any part of the country in so far as the delivery of the health service is concerned. We are asked to accept clapped out health strategies that seem to get rustier as the days pass.

If the debate this evening does nothing else — I am pleased the new Minister of State is present to listen to it — I hope it will prompt the Government to be honest about the Hanly report. Let us start from that basis. Over the past two years, I listened each day in this House to the previous Government and this Government consistently stand four square behind the Hanly report. The contents of the report are nauseating for the public and they proved it last June. It is one of the reasons the Government lost so many seats. People will not accept the Hanly strategy. People who have become used to services at their local accident and emergency and maternity departments will never accept a pig in a poke strategy which may provide them with a better service.

During the course of the debate, several Members said that the golden hour is sacrosanct. One does not have to be a doctor to be aware of this fact. The chances of survival following the first crucial hour after an accident diminish alarmingly. The public will not accept a health strategy which could result in their having to travel by ambulance or car for 50 miles or 60 miles in heavy traffic past their local hospital in which they have confidence. The public will not accept this type of strategy whether it be in Ennis, Monaghan, Cavan, Ballinasloe, Nenagh or Roscommon. It appears the Government still insists on ramming down the throats of people that Hanly is good for them, but it will not get away with it. The advances the Government made in primary care are pathetic. Localised professional primary care, which would prevent so many unnecessary trips to hospital, would work wonders. Resources have not been made available to allow local general practitioners and other professional staff to provide the service which they can and want to deliver.

Great concern has been expressed in my area in County Galway and in other areas about the organisation of the WestDoc proposals. This allows people to contact doctors out of hours and at weekends. The principle of the service may be all right, but recently I have received calls from the public stating that they are not satisfied with the service. People tell me that they would prefer to be in closer contact with their local doctors. There is a great opportunity to manage the [438]WestDoc service in a slightly different way which involves local doctors at times of great stress and urgency for patients. This issue will have to be examined immediately by the new Minister.

Mr. Ring: Information on Michael Ring  Zoom on Michael Ring  I wish to share my time with Deputies McCormack, Durkan and Paul McGrath.

I now know why there is such a crisis in the health service. I suppose it is why the former Minister, Deputy Martin, was removed from office and new people appointed.

Deputy Durkan: Information on Bernard Durkan  Zoom on Bernard Durkan  Unceremoniously.

Mr. Ring: Information on Michael Ring  Zoom on Michael Ring  He did not know the difference between a medical consultant and an ordinary consultant. He spent more money on ordinary consultants or spin doctors — I call them witch doctors and others call them Fianna Fáil doctors — because this has been the fastest growing industry in Ireland over the last ten years. The Department spent in the region of €60 million on reports. If the Minister wishes, I will draw up any number of reports. I will go into every library, including the Oireachtas Library, and produce all the reports the Minister wants.

It is now time to find out what is happening to the health service, which is collapsing. Is what is happening orchestrated and, if so, what is the Minister and the Government doing about it? Each day mothers, fathers, brothers and sisters contact public representatives seeking hospital beds for their loved ones. Yesterday I met a man in Mayo General Hospital who has been trying to get into hospital for the past two weeks. He is an emergency patient and he has been told by St. James’s Hospital that as soon as a bed is available, he will be given a bed. This is no way to operate the health service. We have been waiting for years in County Mayo for the appointment of a rheumatologist. One man is responsible for services in Connacht and Clare. People wait for appointments for months and years. Ill men and women of 70 years of age must leave the county each day and travel a 120 mile round journey to Galway. Funding should be provided to operate the service 20 hours a day in hospitals in our county. If funding can be made available for consultants to draw up reports, money should be provided for nurses to operate the dialysis unit, which is not a significant request.

What is happening with cancer services? While funds are being raised throughout the world, why do more people die each day in this country from cancer? Nowadays, if one reaches 50 years of age or more, one has a good chance of survival. The dangerous period now is from birth to 50 years. What has gone wrong? The foodstuff imported into this country is being pumped with chemicals and the Government, doctors and consultants do nothing about it. We let these companies come in from Europe. An asbestos industry wants to set up business in my county. Asahi, which was located in north Mayo, walked away when it was [439]finished and did not decommission the plant. As a result, there is a high rate of cancer in and around the area and no one does anything about it.

The drinks industry is supported by the Government. The previous Minister, Deputy Martin, introduced the smoking ban, and rightly so. But why are we not tackling the greatest crisis in the country, namely, the abuse of alcohol? It is not safe to walk the streets of any town or village at the weekend because of the abuse of alcohol. Why does the Minister for Health and Children not do something about this problem? Why does she not take the same steps that were taken in regard to smoking? Do drink or cigarettes do more damage to the country? Drink does more damage, and because of it we must put more gardaí on the streets. They are brought into accident and emergency units in hospitals every weekend where there are people with broken noses, injured eyes and so on. Nobody is prepared to speak out and do something about it because the Government has a vested interest — it takes massive revenue from the drinks industry. It is time we spoke out. It is time mothers, father, brothers, sisters and priests took moral control and spoke out about the abuse of alcohol. What is going on is wrong and the effect it has on the health service and on families is devastating.

An Leas-Cheann Comhairle: Information on Séamus Pattison  Zoom on Séamus Pattison  The Deputy should conclude.

Mr. McCormack: Information on Pádraic McCormack  Zoom on Pádraic McCormack  Deputy Ring was given no drinking up time. He was going well when he was cut off. That is the result of time constraints in this House. I am glad to have the opportunity to speak on this motion and that the first sentence of the motion acknowledges the hard work of all doctors, nurses, and health care professionals in the North Eastern Health Board area and every other health board area. That is acknowledged by Fine Gael in putting down this motion.

The motion deals with the crisis of confidence in our health services. This crisis of confidence has led to recent protest marches on the Dáil by patient groups who highlighted it. Good has been done by another group, Patient Focus, which has highlighted problems in our hospitals for a number of years. These groups were born of the frustration of families seeing their loved ones, parents or other older relatives, left on trolleys in accident and emergency units, sometimes for up to 30 hours. Elderly people have been forced to lie on uncomfortable trolleys in embarrassing and degrading circumstances because there are no beds available in hospitals.

Other examples of hardship involve cases where patients have their appointments cancelled at the last minute. I have dealt with one person whose appointments have been cancelled on eight occasions. The North Eastern Health Board area is no different from any other health board area. I dealt recently with a man from the Aran [440]Islands who had an appointment at University College Hospital at 11 a.m. He was told there was no bed available and was asked to call back in the afternoon. He spent part of the day walking around town and came back in the afternoon, but there was still no bed available. He had to stay overnight and go back to the island without his appointment. That is causing frustration for families and people who have been awaiting an operation. People have made the necessary arrangements for somebody to look after their homes, their stock or their businesses, and have been fasting since the previous night only to be told their appointment has been cancelled. That is not a health service. It is no wonder there are groups marching in protest about it.

In the North Eastern Health Board area primary care has been suspended in Monaghan General Hospital. Cavan General Hospital is working at capacity and is under enormous strain. Despite that, there are large numbers of beds in all hospitals, and wards are closed on one pretence or another — one ward was being painted this year and another last year. One ward is closed and another opened. I have seen padlocks on wards in University College Hospital Galway where there are 50 beds idle because there is not enough staff to man the wards.

I recently tabled a question to the Minister for Health and Children asking whether she intended to lift the Government embargo on the recruitment of permanent staff so that the wards could be opened. I was informed by the Minister that there was no Government embargo on the recruitment of nurses. In the same paragraph the Minister stated that recruitment was subject to the overall employment levels remaining within the authorised ceiling and if the levels of employment are at the authorised ceiling the health board cannot take on a nurse or anybody else to work on the wards. Somebody must leave before the health board can take on another person. The beds, therefore, remain closed and people remain on trolleys in the corridors and accident and emergency units because of the Government embargo. There is an embargo on the employment of staff in hospitals if they cannot take on any more staff because levels are at the authorised ceiling.

I ask the Minister of State, in the absence of the Minister, to address the problem whereby hospitals cannot take on the staff to open and run beds that have been closed. That might go some way towards alleviating the serious problem in accident and emergency units where old people are degraded and forced to lie on trolleys sometimes for more than 30 hours.

Mr. Durkan: Information on Bernard Durkan  Zoom on Bernard Durkan  A superficial examination of the delivery of health services in the north-eastern area will show that the situation there is symptomatic of what is happening all over the country. The Government lost sight of its duty to the public, its duty to provide services when and as required. The Minister commissioned a consult[441]ant’s report followed by another and another, with the aim of advising the Minister what could be done and seeing who could be found to blame for what had happened. However, the blame rests fairly and squarely with the Government.

  8 o’clock

What has happened over the past five years? The Government treated the health service as an employment agency. A total of 30,000 extra people were employed, but not in essential areas involving the delivery of services. The Government engaged in an employment creation exercise in which more people were employed in administration. They could have meetings in the mornings and were unable to answer other essential telephone calls. They had regular management meetings, morning, afternoon and evening. They went on courses to figure out where they had gone wrong and they lost sight of their primary responsibility to deliver services.

We have seen a number of very traumatic cases in the north-eastern region over the past few years which should have indicated to the Government that something was drastically wrong. It is for the Minister to identify problems and to give leadership, not to blame somebody else and not to seek a consultant’s report and walk away from the problem. When the people involved in the delivery of services saw what was going on, there was no reason for them to do anything other than wait to see what the Government would do. However, the Government did nothing.

The sad part of all this is the Government’s conclusion that abolishing health boards was the answer to the problems. This was done for one purpose only, to show the public in the run-up to the local elections that the Government was doing something when it was doing nothing and was guilty of gross negligence in the delivery of health services.

What will happen now? The Hanly report and a number of others are lying on the shelves. I have no doubt the Government has no intention of implementing the Hanly report. If it did, half the services we have would be closed down. That has happened already. It is ironic that over the past couple of years there was at one stage a threat to treat patients in a hospital car park because beds had been closed owing to a lack of specialist staff. There is no sense in employing administrators if specialist staff are wanted. There is no point in the hospital closing theatres and wards if it is intent on providing a service.

It is common now to put a question to the Minister for Health and Children only to be told in a reply, three months or more after the question was put, that the subject of the question is a matter for the regional health authority or the health board. It is another clear example of the lack of determination on the part of the Government to get to grips with the situation and ensure there is accountability. There has been no accountability, in particular, on the part the Government.

[442]It is sad we have a service that is costing so much, that has so many flaws and where we have to send patients abroad for treatment under the treatment purchase scheme.

There is a crisis situation on a daily basis, with wards closed and clear evidence of a lack of medical, nursing and surgical staff in various wards and hospitals throughout the country. The Government has nothing to do and nothing to say about this matter. Last summer, a Minister had to go overboard, to the embarrassment of the Government, to prevent the closure of his local hospital.

Mr. F. McGrath: Information on Finian McGrath  Zoom on Finian McGrath  I wish to concentrate on sections 1 and 11 of the motion, and to address the issue of Beaumont Hospital, which is in my constituency. I challenge the Government and those others who say the health issue has only come to the top of the political agenda recently with the appointment of the new Minister for Health and Children. On what planet have they been living for the last three years? Several Deputies were elected to this House in 2002 on a strong health and disability platform. People asked us to raise health issues and we have done so many times with questions, motions and Adjournment debates, but the Government and the Cabinet refuse to respond.

It is not good enough that people are waiting on trolleys and chairs in our accident and emergency departments when this Government has been in power for seven years. It can blame nobody but itself. Some €30 million has been spent on reports while citizens remain on trolleys and waiting lists. The Government was told of the situation many times in this House and it is time its members took their heads out of the sand.

I support Patients Together, a non-political group, in its efforts to end this crisis and I urge people to support its march on Saturday. The Government parties should not jump on the bandwagon now, because they have had their chance to deal with this issue. When dealing with the health service, one simply needs to remember two words, “reform” and “investment”. There is no other way and I challenge the Tánaiste and Minister for Health and Children, Deputy Harney, on these core principles. It is not possible to run a quality health service on the cheap. The patients and staff of Beaumont Hospital contact me with real facts about real people and I urge the Minister to listen to them. Reform and investment are needed.

In reference to section 1 of the motion, I pay tribute to the consultants, doctors, nurses and other health care professionals at Beaumont Hospital and at the orthopaedic hospital in Clontarf. This is a group of people dedicated to our health service, many of them working against the odds. They need our support and we must ensure that they get the resources necessary to deliver a good quality health service. Beaumont Hospital must be properly resourced to provide acute and elective care to those patients for whose care it is responsible in the North Eastern Health Board area. There have been [443]enough reports. It is time now to bite the bullet and invest in the health service.

With regard to the budget and services to people with intellectual disabilities, we have seen that the follow-on allocation for 2004 fell far short of the €35 million called for. Failure to provide significant extra resources in the coming budget will add to the length of existing waiting lists. The 2003 report of the national intellectual disability database, published in June 2004, states that the number requiring full-time residential services has increased for the first time since 2000 and is the highest recorded figure since formal reporting through the national intellectual disability database was established. This report indicates that 1,776 people will require a full-time residential service between 2004 and 2008, and some 1,441 of them require this service in 2004. A further 1,637 people, the majority of whom live at home, require residential support services, that is, respite care, of which 1,526 require this service immediately. Some 546 people are in need of a day service and 356 have no service whatsoever. There are 494 people with intellectual disabilities resident in our psychiatric services. Of this group, 330 have been identified as requiring a specific intellectual disability service.

These figures are an indictment of the manner in which services for people with an intellectual disability, and their families, are prioritised. While it is true that extra resources have been allocated in the area of intellectual disability during the period 2000 to 2002, these funds were allocated at a time when the then Minister for Health and Children, Deputy Cowen, recognised the historical level of under-funding in this area. The abrupt halt to extra funding in 2003, until public outcry led to a U-turn in July 2003, combined with the reduced allocation in 2004, have lead to a crisis reminiscent of the worst days in the early 1990s. This situation must not be exacerbated by the next budget.

This motion is about the health service and the patients who use that service. Above all, it is concerned with real people and I urge all Deputies to support it.

Minister of State at the Department of Health and Children (Mr. B. Lenihan): Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  The Tánaiste and Minister for Health and Children, Deputy Harney, is well aware of the problems of the disability sector, as outlined by Deputy Finian McGrath. I am sure she will have specific proposals to bring forward in this regard. The motion before the House deals with the circumstances of the North Eastern Health Board. I remind Fine Gael Deputies who tabled this motion of some basic facts. Deputy Durkan claims the Government has done little. However, more than €10 billion will be invested in the health service this year, some €926 million more than in 2003. The level of funding provided for the North Eastern Health Board out of this year’s allocation is €549 million, an increase of €66 million over 2003.

[444]Mr. Connolly: Information on Paudge Connolly  Zoom on Paudge Connolly  It is the most under-funded health board in the country.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  The overall increase in funding for the North Eastern Health Board between 1997 and 2004 is €383 million, or 231%. To address the point made by Deputy Connolly, this represents the largest increase in day-to-day funding of all the health boards.

Mr. English: Information on Damien English  Zoom on Damien English  The Minister of State knows the health board is under-funded. He should cop himself on.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  It is the health board which has seen the greatest level of increase in funding.

Mr. English: Information on Damien English  Zoom on Damien English  The area has seen a significant increase in population.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  I reassure Deputy English that I will deal presently with the matter of County Meath.

Mr. English: Information on Damien English  Zoom on Damien English  I hope the Minister of State does so.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  The number of patients treated by the North Eastern Health Board has increased significantly since 1997, with 22,000 additional inpatients and 16,000 more day cases over the six years to 2003. Total staffing has risen from 4,400 in 1997 to more than 7,000 in 2004, and the number of permanent consultant posts has increased by 65% since 1997. Deputy McCormack raised the issue of the embargo. Any discussion or judgment of this matter must take account of those basic, raw figures in one health board functional area. I am sure they are mirrored in every other health board functional area. There have been substantial increases in staffing. Staff must also be managed and that is the function of health management.

The North Eastern Health Board has been working to develop a high-quality, safe, responsive hospital service, across all five hospital sites in the region, to a population of approximately 350,000.

Mr. Connolly: Information on Paudge Connolly  Zoom on Paudge Connolly  Why are there always reports in the newspapers of the board’s difficulties?

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  The strategy of the board to plan services across two hospital groups is appropriate and consistent with national health policy. That strategy is being pursued, not because of a lack of resources, but because it is the right strategy. The motion tabled by the Fine Gael Deputies, with regard to this strategy of the two hospital groups, is interesting. It is akin to a Fine Gael version of the Hanly report. After noting the circumstances which give rise to the motion and raising certain questions about the health board, the motion then seeks to suggest that we should properly resource the Cavan-Monaghan group of hospitals so that acute and elective care [445]can be provided to the people of Cavan-Monaghan. I notice this region is defined as one entity and each county is not taken on its own. This is an indication of good “Hanly thinking” and the Deputies must be given 100 out of 100 for that.

Mr. English: Information on Damien English  Zoom on Damien English  This has been the practice for a number of years. The Minister of State has the intelligence to recognise that.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  The motion then mentions the Louth-Meath group of hospitals, another indication of “Hanly thinking”. The call to “resource the Beaumont Hospital to provide acute and elective care to the local, regional and national tertiary services” represents a type of “super-Hanly thinking”.

Mr. Connolly: Information on Paudge Connolly  Zoom on Paudge Connolly  There must be a lot of Hanly reports out there.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  The next request is to “properly resource the Navan hospital to provide acute and elective care to the people of Meath”. One does not need to be a genius to know that the next time people will be consulted in a parliamentary election will be in County Meath, not in counties Cavan or Monaghan. It is County Meath which is given particular emphasis in the motion.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  That is a paranoid observation.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  This is the type of thinking that has the health service in its current state, particularly the hospital service outside Dublin.

Mr. English: Information on Damien English  Zoom on Damien English  The Minister of State should note the state of Navan hospital. Has he visited it? In 2004, its accident and emergency unit is in a portakabin. It is little more than a cardboard box.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  I do not blame the Deputy for trying. This is the Fine Gael version of the Hanly report, carefully tailored for immediate electoral prospects. The board has reorganised services in areas such as trauma, orthopaedics, obstetrics and breast services, and is working with the various professional bodies.

Mr. Connolly: Information on Paudge Connolly  Zoom on Paudge Connolly  Will the Minister of State recommend that to all the health boards?

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Last night Ministers outlined an impressive investment programme across the hospital and emergency services in the north east. The programme includes two modular theatres and upgrading of the kitchens at Dundalk, at a cost of more than €4 million; the development of the midwife led units at Drogheda and Cavan, at a cost of €1.5 million; the upgrading of the accident and emergency department and the kitchens at Our Lady of Lourdes Hospital, Drogheda, at a combined capital cost of more than €4 million; and the upgrading of the orthopaedic operating [446]theatre unit at Our Lady’s Hospital, Navan, which is under way.

Mr. English: Information on Damien English  Zoom on Damien English  A design team is examining it, the work is not under way.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  The programme also includes the development of an expanded treatment room at Monaghan General Hospital, at a cost of €750,000, and the upgrading of the male medical ward at the hospital, at a capital cost of €2 million. Within the Cavan-Monaghan hospital group, the following developments are progressing: five additional non-consultant hospital doctors to facilitate an early restoration of 24 hour seven day medical cover to Monaghan General Hospital and ten additional day beds are being provided at Monaghan General Hospital.

Mr. Crawford: Information on Seymour Crawford  Zoom on Seymour Crawford  Five will be removed on 1 January next.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  I will deal with that matter on the Adjournment. The Deputy should not chase that rabbit until he has a chance to do so at 8.40 p.m., of which I have no doubt he will avail.

Mr. Crawford: Information on Seymour Crawford  Zoom on Seymour Crawford  I will chase it.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Further developments include financial clearance to the recruitment of three replacement surgical posts to facilitate the development of surgical services across the Cavan-Monaghan hospital group and proposals are being progressed for the commissioning of an additional 19 beds at Cavan General Hospital. In the area of cancer services, additional cumulative investment of approximately €28 million has been provided for since 1997. Cardiovascular services have received additional funding of €5 million, facilitating a 32% increase in admission since 1997.

In Beaumont Hospital there has been substantial investment in equipment, at a cost of €40 million; an additional 35 beds have been provided; there is provision for a second MRI scanner; approval has been granted for a purpose-built 44-station dialysis unit; there is provision for a 15-bed rehabilitation unit at St. Joseph’s for patients over the age of 65 requiring rehabilitation; and ten additional consultants will provide additional services at Beaumont and St. Joseph’s Hospitals.

The ambulance service has a key role to play. The Minister of State, Deputy Seán Power, outlined a number of important developments being progressed across the ambulance service, including the rolling out of the advanced paramedic training programme. This programme will ensure that ambulance personnel can deliver a wider range of services to patients at the scene of an illness or an accident. The programme represents the most significant policy development in pre-hospital care for many years. I am sure any of the Deputies who have examined the Bonner report and other matters will recognise the importance of that message.

[447]Mr. Sherlock: Information on Joe Sherlock  Zoom on Joe Sherlock  Is the Minister of State in favour of implementing the Hanly report?

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  I am in favour of giving the people of Ireland the best possible hospital service.

Mr. Sherlock: Information on Joe Sherlock  Zoom on Joe Sherlock  Is the Minister of State in favour of implementing it?

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  I am guided in that by people who know what they are talking about and not by people who just sit in this House to protect vested interests in particular localities.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  That is an outrageous statement.

Mr. English: Information on Damien English  Zoom on Damien English  It is their job to do that.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  On the question of accountability to Dáil Éireann——

An Leas-Cheann Comhairle: Information on Séamus Pattison  Zoom on Séamus Pattison  Order, please, the Minister of State to continue without interruption.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  Someone who represents his or her constituency does not have a vested interest. That was an outrageous remark by the Minister of State.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Unfortunately, we have to consider the national interest. There is a national interest to ensure that people have the best possible hospital service.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  The Minister of State should have some respect for the dozens of Deputies in this House.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  I have every respect for the Deputies in this House. We have to listen to the people who work in the hospital service.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  Where are they putting the patients?

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  We must be talking to different people because we are talking to people in the service.

An Leas-Cheann Comhairle: Information on Séamus Pattison  Zoom on Séamus Pattison  Order, please.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  We have to examine what is the best outcome for the patient.

Mr. English: Information on Damien English  Zoom on Damien English  The Minister of State should ask the patients.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  We have been advised in the Hanly report——

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  The Minister of State is unquestioning.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  ——where we can get the best outcomes for patients. We have been advised how [448]we can develop not one hospital or another but every local hospital——

Mr. Sherlock: Information on Joe Sherlock  Zoom on Joe Sherlock  As a general hospital.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  ——and how we can develop centres of excellence.

Mr. Sherlock: Information on Joe Sherlock  Zoom on Joe Sherlock  Will they be general hospitals?

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  When the Deputy uses an expression such as “general hospital” I advise him to read the Hanly report. He should read its analysis of patient outcome and he will note what it recommends.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  The Government is not even implementing the Hanly report.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  The Hanly report cannot be implemented until many other elements are in place. Therefore, it is extraordinary we are having this highly theoretical argument. We will not go down that road.

In the limited time available, I wish to address the point Deputy Durkan raised about the accountability to Dáil Éireann of the new structures to be established under the reform programme, the legislation to establish the Health Service Executive on a statutory basis. The local and regional offices will be accountable to the Health Service Executive. That is an important point to be made because the motion refers to the mechanism by which the Dublin north east regional health office and other regional health offices will be accountable to Dáil Éireann. The regional health offices are completely assimilated legally to the Health Service Executive. They have no independent existence. In no sense are they a reincarnation of the old health boards, nor is it intended that they should be. The legislation will make provision for the appearance of the chief executive officer before the relevant committees of the Houses of the Oireachtas in regard to the activities and operations of the Health Service Executive. The executive will report and be accountable to the Minister for Health and Children. The immediate goal will be for the executive to respond efficiently and effectively——

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  Although not democratically.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  ——to inquiries from Members of the House regarding matters within its statutory remit. The executive will also be tasked with building on the existing strength of consumer panels and co-ordinating committees within the health system.

Ms McManus: Information on Liz McManus  Zoom on Liz McManus  With no democracy.

Mr. English: Information on Damien English  Zoom on Damien English  I could talk for the next three hours about why the latter part of the motion relating to Navan hospital and the provision of a service to the people of Meath is included. Navan hospital serves Meath and the north-east region. [449]The Minister of State is aware it is famous for its orthopaedic service. Therefore, he should not question why it has been included in the motion. Some 38% of the population of the North Eastern Health Board area live in Meath. That is why the hospital is included, not because of any by-election, in the hope that the new Minister for Health and Children, who is not a member of the party of which the Minster of State is a member, might do something to improve it. That hospital has every right to be included in the motion.

The Minister of State spoke of an extra €66 million increase in 2003 funding. The region per head of population was €60 million to €70 million short in 2003. That figure only brings the funding up to what it should be and the funding for the region is still far short for this year.

Others have spoken about the issues in other hospitals, but I will concentrate on Navan hospital and point out some home truths about it. I notice every speaker in this debate over the past two days avoided mentioning Navan hospital. They ducked and dived and were afraid to comment on it.

Before I deal with the problems in the hospital, I will make three points. In regard to medical cards, the number of people in the north-eastern region who hold a medical card is down approximately 24,000, to 30,000, in the past few years. In Meath alone there was a drop in the numbers who had medical cards by 7,000. That is with a population increase of nearly 30,000. The Minister can work out the figures — there is something wrong with that.

Last week, three people came to see me who had given up their jobs to hold on to their medical cards. Two of them worked in the home help service while the other was a school assistant. They left their jobs because they were €10, €12 and €17 over the eligibility limit for a medical card. It is time we copped on to ourselves. That is not a health service. That will result in a further burden on the State.

I know of another man who has to leave hospital. He had his foot amputated yet he is being sent home. He needs a wheelchair because he cannot walk. Because of the procedures and red tape of the health service, he cannot be assessed until he gets home. When he is finally assessed at home, it will take at least two to three weeks to process his application. That is the health service we are providing. That man cannot function for two or three weeks. He cannot even move around his own house because of procedures and red tape. That is not a health service. That was not the position seven or eight years ago, or even 20 years ago. We have gone backwards in that regard. I could talk about that forever.

The Government amendment commends the Government on the unprecedented increase in the level of investment in the health service and refers to threefold increases since 1997. The population has increased by 30%. The cost of the health service — the payment of doctors or any [450]type of equipment — has increased by 20% or 30% in the past few years. Everyone knows that. It is time to stop referring back to 1997 as a comparison. It is not a proper base figure. It was a different century. The Government should cop on and stop going back to 1997 and 1998. That is not real. Nobody in business does that. Why is the Governing doing it? It is trying to be political. It is burying its head in the sand and not facing the facts.

Since the Government took up office in 1997, Navan hospital has had no capital investment. Last night, the Tánaiste complimented herself and said that significant progress has been made in advancing the development of each of the five acute hospital sites under the capital programme. That is wrong, and it is a disgrace, because Navan hospital did not get any capital investment. A design team is examining it. The phrase “design team” was mentioned three times last night and the Minister of State almost mentioned it again tonight — he said the development is on the way. Reference to a design team is spin. It is not evidence of buildings. There is mention in the amendment of capital improvements for Navan hospital. It refers to refurbishment of the accident and emergency department. Has the Minister of State been in that department? I wonder has the Tánaiste been in it. It is a portakabin which was added on to the hospital building 20 or 30 years ago. The portakabin has 12 seats inside. The refurbishment consisted of painting. No extra beds, equipment, trolleys or waiting rooms were provided. Ambulances must reverse in a tight spot when bringing patients in. This is not refurbishment. Navan hospital needs a proper purpose-built accident and emergency unit. It will not cost a fortune but Government commitment is needed.

This is not news. The provision and refurbishment of all X-ray equipment was referred to. We had a mammography unit until a few years ago but it has now gone. The Government decided it was not worth staffing it. X-ray services have deteriorated. The Government claims to have refurbished the female medical ward. That was done under the previous Government, which was the last time a Government made capital investment in Navan hospital. How dare the Government claim to look after the north east and Navan hospital?

Deputy Sexton said she did not want to go the trouble of mentioning the many developments and capital projects. I do not blame her. There are none to mention. This is a disgrace. Deputy Johnny Brady congratulated the Government and is delighted with it. The people of Meath will not be delighted with that, and I am surprised to hear him say it.

The Minister of State at the Department of Health and Children, Deputy Power, referred to the comprehensive development and capital projects. This is an absolute disgrace. This was lies because there has been no capital investment in Navan hospital.

[451]Leas-Cheann Comhairle: Information on Séamus Pattison  Zoom on Séamus Pattison  The Deputy should not use the word “lies”.

Mr. English: Information on Damien English  Zoom on Damien English  It is true.

Leas-Cheann Comhairle: Information on Séamus Pattison  Zoom on Séamus Pattison  The Deputy is out of order.

Mr. English: Information on Damien English  Zoom on Damien English  Tell the people it is out of order, a Leas-Cheann Comhairle. Investment in car parking is included in the Government’s list. Navan hospital always had a car park. It has simply been painted and barriers erected. Visitors and patients are now charged €2 per car for parking. That is what is called capital investment in Navan hospital. We also acquired a sign saying, “For paediatric services and orthopaedic trauma go to Drogheda” and a roundabout to facilitate patients in leaving the hospital when it cannot take them.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  This is a U-turn.

Mr. English: Information on Damien English  Zoom on Damien English  It is a U-turn on the Government’s previous policies. The Government has insulted the people of Navan, Meath and the north east in claiming it is looking after their hospitals. Capital investment in hospitals in the area since 1998 will not reach €15 million. Monaghan and Cavan hospitals have each received capital investment of €4 million. Land bought last year for Our Lady of Lourdes Hospital, Drogheda, was valued at €6 million. Capital investment will not reach €15 million and it is wrong to claim it will.

A Leas-Cheann Comhairle, I am sorry I used the wrong word but this is how strongly I feel about this matter.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I am surprised the Government’s €60 million worth of spin doctors could not provide the Minister of State with better facts than this. The Minister of State mentioned a figure of €66 million. He should have been more clear as to where that money was spent. He referred to a 160% increase in staff in the north east, yet we know from reports that there has been an increase of only 22% in the number of nurses working in our hospitals. I like the way the Government’s spin doctors use percentages or figures depending on what suits them. The Minister of State says permanent consultants increased by 65% since 1997. Why did he not say seven extra consultants have been appointed for a population of 350,000 every year for the past seven years? That would give people a better idea of how miserable these increases are. The figures of 65% looks better than the total number of seven extra consultants per year.

Most of the capital funding spoken about by the Minister of State is projected, in the design stage or will come when the next Government arrives in the House. I hope that will be from this side of the House because, since 1997, the Government has spent less than €20 million. The Minister of State referred to spending €10 million [452]on this and €5 million on that. He spoke of ten beds here and 20 beds there. However, the Government has done none of this. The Minister of State was simply talking about doing it.

We are told that cancer care is very close to the Government’s heart. The Minister of State says cumulative investment in the north east is €28 million. That figure breaks down to €4 per year. This is not a fantastic amount of money when one is talking about cancer treatment drugs, doctors and services. The Minister should be realistic and not accuse the Opposition of “pseudo-Hanlyism” or of playing political games on the Navan hospital issue.

I am fully aware of how health services should be organised and that quality of care and patient services are the most important issue. The Government has misled people as to what they are going to get, and it has grossly under-resourced the health services. The Hanly report is not worth talking about because it is unimplementable.

Mr. English: Information on Damien English  Zoom on Damien English  It is not patient friendly.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  What is Deputy Sexton thinking about when she compares Leicester with Dublin. She says Leicester has one accident and emergency department. Nowhere in the Hanly report did I read that six of the seven accident and emergency departments in Dublin should be closed. Is Deputy Sexton saying there will be only one accident and emergency unit in Dublin when the Progressive Democrats Minister is up and running?

This type of balderdash continually comes from the Government. Facts and figures are thrown out to suit what is thought to be an unreceptive audience. The Government thinks no one is listening and that if one treats people like mushrooms, they will eventually believe what they are told. We now know this is rubbish. The elective services broke down years ago. In some parts of the country people must wait four years for an orthopaedic appointment and three years for a rheumatology appointment. They have grown to accept that the elective services have broken down.

We now see the acute services breaking down. Maternity units in Dublin and Limerick cannot cope. The accident and emergency crisis has grown from a winter crisis to an all-year crisis. Meanwhile, the Government rattles out the same old figures about what it has done for health spending. Why does the Government not show what it has really done to health spending? It has made a mess of the health services. The only truthful thing the Tánaiste said is that health spending does not equate with health services. The Government should point out where it is making these mistakes.

How can Deputy Devins say he supports the Hanly report unconditionally, coming from his part of the country and knowing that Hanly proposes the closure of accident and emergency [453]departments and expects patients to travel to an unsuitable service in the nearest regional trauma centre?

There is no one-size-fits-all health care system. Every region is different and has different deficiencies. The Minister of State may have forgotten what reality is like outside Leinster House and Dublin. I know the Mater Hospital is in crisis but Ministers would not bother to go up to see it. This crisis exists outside of Dublin as well and the same solution will not sort out every region.

Last night we were told Monaghan hospital will keep its acute medical services. When I asked the Tánaiste if that also included acute surgical services, she did not reply. The reason is obvious. The contracts of junior doctors in surgery in Monaghan will not be renewed in January. The former Minister for Health and Children gave letters to the people of Monaghan stating that they will have selective elective surgical services. Selective elective surgery is five-day surgery, not day surgery. Five-day surgery cannot be done without junior doctors. Is the Minister for State considering going to Monaghan to assist the consultants when they are operating? It is not possible to do what is proposed without junior doctors.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  Why, then, are we recruiting five anaesthetists?

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I would love to know.

Mr. English: Information on Damien English  Zoom on Damien English  To waste more money, probably.

Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  The service promised to the people of Monaghan cannot be provided.

Mr. G. Mitchell: Information on Gay Mitchell  Zoom on Gay Mitchell  The Government will need to sedate its backbenchers.

[454]Dr. Twomey: Information on Liam Twomey  Zoom on Liam Twomey  I do not know how the Minister will get around this one. Anyone with the minimum of medical knowledge knows this will not work. The idea of bussing consultants to Monaghan every day to do the five-day surgery is the most airy fairy thing I have ever heard.

The Minister of State should take the trouble to visit Cavan hospital. Mr. Finbar Lennon, the medical adviser to the North Eastern Health Board, seems to have a different opinion of what should happen in Cavan from that of the Royal College of Surgeons in Ireland. The Government is responsible for the provision of services in hospitals. It is not the responsibility of the North Eastern Health Board, the hospital administrators, the Royal College of Surgeons in Ireland or Mr. Finbar Lennon. If there is a contradiction in the services proposed for one of our hospitals the Government should make it its business to find that out. The Minister of State should not come to the House with a simplistic argument about whether one is pro-Hanly or anti-Hanly.

We will definitely change the Hanly report because we know it cannot work in the form in which was published and in the way the Minister of State believes it can.

I was shocked that no Government Deputy referred to what improvements could be made. Nobody discussed the medical admissions unit or how day case procedures can make things better. Nobody discussed what is being done in the North Western Health Board area where patients are being assessed before they even come to hospital, and pre-discharge wards were not discussed either.

An Ceann Comhairle: Information on Rory O'Hanlon  Zoom on Rory O'Hanlon  As it is now 8.30 p.m. I am obliged to put the question.

Amendment put.

[453]The Dáil divided: Tá, 67; Níl, 50.

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 Seamus Brennan  Zoom on Seamus Brennan  Brennan, Seamus.
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 Donie Cassidy  Zoom on Donie Cassidy  Cassidy, Donie.
Information on Michael Collins  Zoom on Michael Collins  Collins, Michael. Information on Mary Coughlan  Zoom on Mary Coughlan  Coughlan, Mary.
Information on Martin Cullen  Zoom on Martin Cullen  Cullen, Martin. Information on John Curran  Zoom on John Curran  Curran, John.
Information on Síle de Valera  Zoom on Síle de Valera  de Valera, Síle. Information on Tony Dempsey  Zoom on Tony Dempsey  Dempsey, Tony.
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 Mary Hanafin  Zoom on Mary Hanafin  Hanafin, Mary.
Information on Seán Haughey  Zoom on Seán Haughey  Haughey, Seán. Information on Máire Hoctor  Zoom on Máire Hoctor  Hoctor, Máire.
Information on Joe Jacob  Zoom on Joe Jacob  Jacob, Joe. Information on Cecilia Keaveney  Zoom on Cecilia Keaveney  Keaveney, Cecilia.
Information on Billy Kelleher  Zoom on Billy Kelleher  Kelleher, Billy. 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 Conor Lenihan  Zoom on Conor Lenihan  Lenihan, Conor. Information on Michael McDowell  Zoom on Michael McDowell  McDowell, Michael.
Information on Tom McEllistrim  Zoom on Tom McEllistrim  McEllistrim, Thomas. Information on John McGuinness  Zoom on John McGuinness  McGuinness, John.
Information on John Moloney  Zoom on John Moloney  Moloney, John. Information on Michael Moynihan  Zoom on Michael Moynihan  Moynihan, Michael.
Information on Michael Mulcahy  Zoom on Michael Mulcahy  Mulcahy, 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 Fearghail, Seán.
Information on Charlie O'Connor  Zoom on Charlie O'Connor  O’Connor, Charlie. Information on Willie O'Dea  Zoom on Willie O'Dea  O’Dea, Willie.
Information on Liz O'Donnell  Zoom on Liz O'Donnell  [455]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 Batt O'Keeffe  Zoom on Batt O'Keeffe  O’Keeffe, Batt.
Information on Ned O'Keeffe  Zoom on Ned O'Keeffe  O’Keeffe, Ned. Information on Fiona O'Malley  Zoom on Fiona O'Malley  O’Malley, Fiona.
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.  


[455]Níl
Information on Dan Boyle  Zoom on Dan Boyle  Boyle, Dan. 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 Paul Connaughton  Zoom on Paul Connaughton  Connaughton, Paul. Information on Paudge Connolly  Zoom on Paudge Connolly  Connolly, Paudge.
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 Jimmy Deenihan  Zoom on Jimmy Deenihan  Deenihan, Jimmy. Information on Bernard Durkan  Zoom on Bernard Durkan  Durkan, Bernard J.
Information on Damien English  Zoom on Damien English  English, Damien. Information on Olwyn Enright  Zoom on Olwyn Enright  Enright, Olwyn.
Information on Eamon Gilmore  Zoom on Eamon Gilmore  Gilmore, Eamon. Information on John Gormley  Zoom on John Gormley  Gormley, John.
Information on Tom Hayes  Zoom on Tom Hayes  Hayes, Tom. 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 Pádraic McCormack  Zoom on Pádraic McCormack  McCormack, Padraic.
Information on Dinny McGinley  Zoom on Dinny McGinley  McGinley, Dinny. Information on Finian McGrath  Zoom on Finian McGrath  McGrath, Finian.
Information on Paul McGrath  Zoom on Paul McGrath  McGrath, Paul. 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 Breeda Moynihan-Cronin  Zoom on Breeda Moynihan-Cronin  Moynihan-Cronin, Breeda. Information on Gerard Murphy  Zoom on Gerard Murphy  Murphy, Gerard.
Information on Denis Naughten  Zoom on Denis Naughten  Naughten, Denis. Information on Aengus O Snodaigh  Zoom on Aengus O Snodaigh  Ó Snodaigh, Aengus.
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 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 John Perry  Zoom on John Perry  Perry, John.
Information on Eamon Ryan  Zoom on Eamon Ryan  Ryan, Eamon. 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 Róisín Shortall  Zoom on Róisín Shortall  Shortall, Róisín. Information on Emmet Stagg  Zoom on Emmet Stagg  Stagg, Emmet.
Information on David Stanton  Zoom on David Stanton  Stanton, David. Information on Liam Twomey  Zoom on Liam Twomey  Twomey, Liam.
Information on Mary Upton  Zoom on Mary Upton  Upton, Mary. Information on Jack Wall  Zoom on Jack Wall  Wall, Jack.

[455]Tellers: Tá, Deputies Kitt and Kelleher; Níl, Deputies Kehoe and Stagg.

[455]Amendment declared carried.

Motion, as amended, put and declared carried.


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