Wednesday, 30 June 2004
Seanad Eireann Debate
—noting that, by the admission of the Minister for Health and Children, over €400 million worth of new hospital facilities are lying idle because of Government failure to provide funding for equipment and staffing and
No Member can debate the health service without mentioning the crisis in accident and emergency services. This motion addresses the extraordinary situation where, in the words of the Minister for Health and Children, approximately €500 million worth of capital investment in hospitals and health facilities is lying idle because the Government cannot organise the funding to run those very facilities. I am grateful to the authors of the Government amendment to this motion. Among their glowing praise for the Government’s achievements, the substantial capital investment of €1.7 billion in health infrastructure spent between 2000 and 2003 is included. The equivalent of 25% of the capital expenditure is now lying idle.
I am not sure whether this debate should focus on the health services or incompetence. The incompetence spins off into the most appalling consequences for those who are sick and need hospital services. It is difficult to know how many cities and towns this spin-off affects. In Dublin city, a €100 million hospital wing is empty. In Cork city, a much touted and sung and danced about accident and emergency service is unused. In Clonmel, which I visited on my recent electoral adventures, a €30 million hospital wing is also unused. It is the same in Mayo, Letterkenny and many other places. Each of these cases impacts on individuals’ health, security and sense of well-being. Each damages people’s belief that they are safe if they fall ill. However, it is worse in terms of what it says about the Government’s incompetence. It suggests that it cannot plan or organise, leaving gaps in the hope that in the future something will turn up. A health service based on such a premise will only turn up pain, suffering and disaster for people.
The Government has decided that it will not make the necessary money available to bring the health service up to a proper standard. Recently, my secretary, on my behalf, sent out an e-mail query on hospital waiting lists to EU member state embassies in Dublin. The German Embassy’s reply was prompt and Germanic, stating that there are no hospital waiting lists in Germany. The Austrian reply stated that there are only waiting lists for orthopaedic and ophthalmology services. Yet, it is part of this Government’s mythology that waiting lists are inevitable. The Government has actually redefined the abolition of waiting lists as having no one waiting for more than three months. Ireland has defined the lower end of its expectations at the upper end of public patients in the rest of the EU.
The Government believes that only going some of the way is sufficient. It boasts of spending €1.7 billion on capital investment, yet a quarter of that investment remains unused. Some of it is even used for offices or to keep private security firms in business as they prevent the facilities from being vandalised. In south Tipperary, a person from Clonmel at the most critical part of an illness that requires surgical care has to be moved to Cashel, a distance of 15 miles. In a good hospital at such a time, moving the person from one ward to another would require proper medical supervision.
This occurs because someone in Government decided the money will not be spent. There are two possible reasons for this decision. The first is incompetence, which I would almost prefer to believe because incompetent people can be shamed into a modicum of competence. Underlying this is an indifference to the human suffering it causes. The second reason is the reactionary position of the Department of Finance. Today, the Minister for Finance, Deputy McCreevy, re-articulated it, in classically flamboyant fashion, when he claimed every view except his on how to run the economy is wrong. He continued that if he was not Minister, the financial world would take fright and refuse to invest in Ireland. When a Minister for Finance begins to talk in those terms, it is time to get rid of him. Once anyone in a position of power believes that he or she is indispensable, it is time to remove him or her. The fundamental problem with the Minister, his Department and the Government, which is dominated by the Minister and the ideology he shares with the minority party in Government is that it is dangerously hurtful to ordinary people. It is also wrong, because wrong figures have been used.
The Government took comfort from an analysis in the Irish Banking Review by an economist who because he did not understand health spending figures, gave a completely wrong perspective on Ireland’s comparative performance on health expenditure. He suggested that we were near the top of the league and that the problem was therefore one of incompetent management, an argument the Department of Finance loves, which is why it will not pay out the extra expenditure to open these facilities. It prefers to believe that the problem is inefficient use of sufficient resources. That is the view of the Minister for Finance and his Department and it has prevailed over the views of every other Department and over the Taoiseach. The result is that in terms of capital costs, a quarter of the facilities provided by the Government over the years 2002 to 2003 lie idle.
The trouble with the view taken by the Department of Finance is that it is factually wrong. The OECD health data of 2004, including tables and charts from a news release issued on 3 June 2004, less than four weeks ago, show that Irish health expenditure as a percentage of gross domestic product stands at 7.3%. The countries spending less are Turkey, Mexico, Poland, Korea, Slovakia and Luxembourg. All of the other OECD countries spend a greater proportion of their GDP on health than we do. A civilised country like Germany, where there are no hospital waiting lists, spends 10.9% of its GDP on health care. The figure for the United States is 14.6%. If ever there was an argument against the use of the private market as a way of organising health care, the United States experience of having the highest percentage of GDP expenditure and the highest growth rate in expansion of costs over the past few years provides it.
We are seventh from the bottom of the OECD league in health care expenditure. The fundamental problem is that we will not spend sufficient money. One can have all the ideological twaddle one wants from the Department of Finance, the Progressive Democrats and that party’s Minister for Finance, but while there are many problems with the Irish health service, the fundamental one is that it is underfunded to a scandalous degree.
The amendment lists all the alleged glorious achievements of the Government. As a percentage of GDP, in the five years of the previous Government, from 1997 to 2002, our expenditure on health increased by less than 1%, perhaps the lowest rise in the OECD. What has happened in the case of the €450 million of capital expenditure is that ideology has clashed with reality. When that happens, when one has the rigid ideology that has driven this Government, and has driven Fianna Fáil into its worst electoral disaster in 80 years, facts get lost, reality is denied and one ends up with the crazy situation of hospitals worth close to €500 million lying idle because trivial sums will not be spent on them.
Ms O’Meara: I second the motion. Once again we return to the thorny subject of Irish health services. It will not be the last time, considering the state of the health services and the widespread disquiet and dissatisfaction with how the Government is mismanaging them. In that regard, the scandal of unopened facilities, hospitals built yet lying idle, unopened, is one of the greatest examples of the level of mismanagement of the public finances and of the health services in this country.
Some years ago, to great noise and acclaim — attempted, at least — the Government announced spending on the national development plan and €2 billion was set aside for health capital spending. Arising from that, a number of capital projects, all of them overdue and greatly needed, were embarked on. The spending and the building began. That was welcome. The same Government, which allocated the money for capital spending for building wards, extensions and so on then said that the money was not available to staff them. Hence we have an extraordinary situation where all over the country there are facilities lying idle, facilities on which millions of euro of public money have been spent.
There are related problems involving mismanagement of the health services, particularly with regard to the shortage of nurses. That is another issue, which I hope I will have time to consider. The examples of what is lying idle, along with the reasons for the situation, constitute a scandal. No sooner had the Government returned to the corridors of power after the last general election, having promised the sun, moon and stars, than the Minister for Finance announced the famous cutbacks, which he had said would never happen. This was followed by the wonderful concept of the existing level of service, which according to an extensive article in The Sunday Tribune on 2 May, based on a Cabinet memo, is the fundamental reason why the tap was turned off for health spending, in particular with regard to the staffing and equipping of these facilities, for which a massive amount of money had been provided. The result of the introduction of the notion of existing level of service is a new spending policy to discipline Departments, making no sense at all, and a classic example of how not to manage the public finances and in particular how not to manage health spending.
Let us look at a few examples of what is not working or not open as a result of the unbelievable mismanagement by the Government. The examples from the Government’s own list include a new hospital at Naas, with 56 beds; the transfer of services to the new €90 million wing at James Connolly Memorial Hospital in Blanchardstown; a new 22-bed facility at University College Hospital Galway; a new maternity suite in Letterkenny; a new 12-bed assessment unit in Mullingar; a new trauma elective orthopaedic service in Mayo and a new accident and emergency and medical assessment unit at Roscommon. Also due was the commissioning of a new hospital at St. James’s Hospital in Dublin with 62 beds, extra theatres at Our Lady’s Hospital in Dublin and the completion later this year of the long-awaited radiotherapy unit in Galway. The Minister for Health and Children, Deputy Martin, put these initiatives a few months ago to the Government in order to release the stranglehold of the Department of Finance and have these facilities opened by means of a small amount of money.
The list goes on. Other examples include the development of a 90-bed community nursing unit at Birr, County Offaly, elderly care units in Cork and Wexford and the funding of almost €10 million to improve services for the homeless in Dublin, Cork, Kerry, Galway and Limerick. In the same memo the Minister stressed the urgent need within the health services to open these long-awaited new facilities but his argument clearly fell on deaf ears because nothing has happened since. I wonder when anything will happen. A housekeeper knows how to manage finances but the way the Government is managing finances in this context is horrendous. I have no doubt it will be the subject of major commentary at some stage by the Comptroller and Auditor General.
My colleague, Senator Ryan, referred to the crisis in accident and emergency services. We are very aware from media reports of the crisis in Dublin accident and emergency services. There is clearly a crisis throughout the country arising from an acute shortage of beds. Against this background, the Government wants to downgrade several hospitals throughout the country and cause an even greater shortage of beds. The same Government says it will replace these beds in new facilities in the so-called super hospitals. However, if the current service is anything to go by, that promise is not to be relied upon.
I would like to relay for the Minister of State a true story, which I heard during the recent election campaign when I was canvassing in Newport, which is near Limerick. I met a woman whose son seriously injured his hand over the bank holiday weekend. She thanked God for Nenagh Hospital because she was able to bring him there. I said that was interesting and that I thought she would be closer to Limerick Regional Hospital. The mother replied that I must be joking, that she would not go there in a million years because they would be waiting for three days to be treated and that at Nenagh one is treated more or less straight away. Arising out of that, a number of people from Birdhill to Castleconnell said no way would they go to Limerick; they always go to Nenagh to be treated in an efficient and caring manner. The accident and emergency unit in Limerick Regional Hospital simply cannot cope with the demand for its services. People on the ground know that the notion of downgrading accident and emergency services in places like Ennis and Nenagh is a daft and dangerous idea.
This is the Government we are relying on to expand services. This is the Government that keeps telling us how much money it has spent on health services. It has done us a favour in its amendment to our motion because it has set out clearly some of the resources that were put into health. It is not surprising, therefore, that the public is asking if all this money has been spent, why are there increasingly long waiting lists and increasingly long waiting times in accident and emergency units? Why is it virtually impossible to get a bed and why is the health service so mismanaged? It is a fundamental point and it was one of the major issues during the recent election campaign. People are aware that massive amounts of their money have been spent on a health service, which is simply not delivering. It is not delivering the service people want where and when they need it. People know the reason is that the investment has been mismanaged. The particular example contained in the motion is the most blatant and obvious instance of how the Government has completely mismanaged the health service.
It is amusing to hear Members on the other side of the House chastise Fianna Fáil and the Progressive Democrats for what they have not done in regard to the health services. This is very funny when one looks back at the period 1994 to 1997 when they were last in Government.
Mr. Glynn: I will not be put off by the carping of Members on the other side. Fianna Fáil’s goal is to ensure a world class health service for every patient. We define “world class” in terms of internationally determined best standards of care to be delivered within the specific times available on an equitable basis.
Mr. Glynn: Since coming into office, the largest ever expansion in health funding has been accompanied by unprecedented work on planning comprehensively for the future. Each day tens of thousands of people use the health service and receive the highest quality care. A survey carried out in 2002 by the Irish Society for Quality and Safety in Health Care tested the attitudes of 1,800 patients who had been through the acute system. The results indicated that 92.9% were satisfied or very satisfied with the quality of care they received.
We are all aware of the pressure on accident and emergency departments, including the unreasonable waiting lists and lack of essential support services. However, the people do not want a knee-jerk reaction; a quick fix is no good.
Mr. Glynn: We know what Members opposite did when they had the opportunity. The health system has had enough people pretending there is a magic remedy which will cure all our ills. People voted for Fianna Fáil because they promised and will deliver sustained action on these services.
Fianna Fáil is committed to a programme of investment and reform involving all elements of the system. The health strategy is the core of that programme. Since its publication, it has set the agenda for health. This is a strategy for fundamental reform, which is unprecedented in its depth and vision, based upon partnership with patients and professionals who are most familiar with the needs of the health services. The only way to deliver an effective strategy for the entire health service is to ensure that it is based on a progressive programme of research and negotiation, which was utterly absent before the Fianna Fáil-Progressive Democrats Government took office in 1997.
Since coming into office, we have implemented the largest sustained increase in the history of the health service. In four years, between 1997 and 2001, the per capita spend on health has risen from fifth from the bottom of the EU scale to just above the EU average. The Opposition refuses to acknowledge any progress in any area. The argument is based on hyperbole, not fact. It constantly ignores and misrepresents what has happened and what is under way. Opposition Members will not acknowledge that the Government has delivered the largest sustained programme of increases in the history of our health services. They will not acknowledge that approximately 200,000 more people are being treated in our hospitals. They will not acknowledge that in the past year there was a 42% reduction in the number of adults waiting more than 12 months for in-patient treatment and a 39% reduction in the number of children waiting more than six months. They will not acknowledge that work is well under way in more than 80% of the health strategy’s actions. They will not acknowledge that a percentage of gross national product in Exchequer funding for health is the highest figure for almost 20 years, even though we have been through a period of massive growth.
Fianna Fáil is the only party interested in developing our health services rather than just using it as a populist football. The sole objective of our policy is to develop a service where employees are enabled to work to the best of their ability and every patient has equal access to high quality care. We have increased health spending by over 188% since 1997 and will continue with this unprecedented investment. In addition, we are carrying out the most radical programme of change for the health sector since the establishment of the health board structures in the 1970s.
We are not interested in the empty soundbites perpetuated by some on the other side of the House. Of course, in recent times there has been much talk from Fine Gael and the Labour Party about a democratic alternative. The reality is that the record of the parties of the self-styled coalition of the caring, from the last time they held office, does not compare favourably to the progress of recent times.
Mr. Glynn: In the 1990s, the Labour Party and Fine Gael, the members of the dynamic duo now offering themselves as the saviours of the health services, held the portfolios of finance and health. The Opposition parties were in prime position to drive the agenda of investment and reform in our health services. However, they failed abjectly on both counts. I remind Senators on the opposite side of the House that waiting lists stood at 23,000 in December 1994 when the Labour Party and Fine Gael, with Deputy Noonan as Minister for Health, assumed control of the health services. In their programme for Government, they spelled out clearly that they would continue the progress of the previous two years in reducing waiting lists. What happened? Despite their pledge, waiting lists rose by 27% under that Government from approximately 23,000 in December 1994 to approximately 30,000 in June 1997.
Mr. Glynn: That is the record of the caring alternative. What was the reaction of the rainbow Government to this state of affairs? In January 1997, in the face of a 27% rise in waiting lists, they cut funding by 20%. I would not call that a coalition of the caring but of the uncaring. I know that Senators will argue they did not have the benefit of the boom generated by the policies of the Government. I reject that argument.
Mr. Glynn: While a shortage of funding can excuse early failings in the health system, by 1995 sufficient funding was available to advance the agenda of reform. However, it was not done. Starting from the low base left by the coalition, we have increased the health spend by over €10 billion, an increase of 188%.
I admit that while much has been done, much more needs to be done. Negotiations are ongoing between the Department of Health and Children and the Department of Finance. I am always amused when I hear the Labour Party advising us on how we should care for our health system and health professionals. A Labour Party Deputy held the position of Minister for Finance yet when parity was sought by the retired nurses who had built the health services, he would not give it to them. Not alone that, the Labour Party’s then leader attempted over the airwaves to chastise the Taoiseach, Deputy Bertie Ahern, and the Tánaiste, Deputy Harney, for having granted parity, for which I strongly commend them. Moreover, to his eternal credit, the Minister, Deputy Martin, provided funding for a number of health boards, including the Midland Health Board, to effect the out-of-hours general practitioners’ service which has ensured that a quality of life never before enjoyed by general practitioners or the general community is now available. The facts speak for themselves.
Mr. Feighan: I support the motion that Seanad Éireann, alarmed at the growing crisis in accident and emergency services throughout the State, has noted that, by the admission of the Minister for Health and Children, over €400 million worth of new hospital facilities are lying idle. It is a good place to start. Senator Glynn has done hospital patients and carers an enormous disservice by highlighting situations from over seven years ago.
Mr. Feighan: He rightly stated that the Government has increased funding by 188% since 1997. However, the service has become progressively worse. That is not my comment but that of those in the hospitals. If the health services were a private business or company, the chief executive officer would be sacked and questions asked.
Mr. Feighan: The health services are a mess and getting worse. Mr. Paul Byrne from Tallaght, after a visit to hospital during which his trolley was taken for another patient while he went to the toilet, stated: “The next time I go to A& E, I would rather not be breathing."
Mr. Feighan: It is a serious indictment of the health services. On 22 June last, 150 patients were on trolleys in ERHA hospitals. On 26 April, 160 were on trolleys in Dublin hospitals while on 26 February, the figure was 150. On 5 February, St. James’s Hospital Dublin had to invoke a major incident plan due to overcrowding in accident and emergency. On 3 February, 207 patients were waiting on trolleys in Dublin accident and emergency units and the figure for 7 January was 179. The facts speak for themselves and belie the notion of an efficient health service. It is a mess.
It is ironic that this situation pertained while Ireland held the Presidency of the EU. Perhaps those on the Government side are confused by the fact that the Taoiseach held the Presidency and they have been using EU figures. I am talking about the Irish figures because the Irish Presidency finished today.
Mr. Feighan: I apologise. More worrying for those waiting on trolleys is that while June is supposed to be a quiet time for accident and emergency, the numbers are not much better than during the winter months. This indicates that the situation is at crisis point.
Despite bumper spending of €10.8 billion on the health budget, funding is not getting through on the ground. Similar problems have been expressed throughout the year at University Hospital, Galway, Mayo General Hospital in Castlebar, the Midlands Regional Hospital in Tullamore, the Mid-West Regional Hospital in Limerick and Naas General Hospital. In April of this year, nurses at Wexford General Hospital worked under protest in the accident and emergency unit because of the intolerable working conditions they had to endure due to a lack of beds and inadequate staffing. The excessive overcrowding in accident and emergency units is resulting in staff being left in unacceptable and unsafe environments.
Mr. Feighan: The Minister promised 709 beds but they have not been allocated. Those beds were supposed to be the first phase of an additional 3,000 acute hospital beds, which were promised on the health strategy by 2011. However, given the pace and failure to deliver on the first phase, questions arise as to whether the Government will be able to deliver urgently on any of the additional 3,000 beds. It is a serious issue that the beds promised for 2003 are not in place.
In tandem with the accident and emergency crisis, community services are being cut. People regularly come to my office seeking carers and various allowances. Many acute admissions could be prevented and, in other cases, early discharge could be facilitated if the community supports were in place. Despite this, valuable community employment supports are being cut. Some 200,000 extra medical cards were promised at the last general election but, instead, over 46,500 medical cards were withdrawn. Approximately 20,000 people are now on hospital waiting lists despite a pre-election promise by the Minister to eliminate them within two years. In addition, community services for the elderly are being cut back. This is having a major effect on accident and emergency services.
Approximately €460 million worth of hospital facilities are lying idle because the Government has failed to provide the necessary money to open them. Process meetings have been held all over the country. We saw what happened during the local elections. There are facilities to be opened in Dublin, Mayo, Clonmel and Letterkenny. The opening of a €10.5 million orthopaedic unit at Mayo General Hospital has been cancelled due to lack of funding. The unit was due to be fully operational from 1 July but following developments in recent weeks, people are beginning to wonder whether Mayo will ever see orthopaedic services again. Two weeks ago it was announced that out-patients would be treated in Mayo General Hospital from 1 July. A date in September has yet to be confirmed for the commencement of services for in-patients.
In Dublin, most of a €96 million wing of James Connolly Memorial Hospital in Blanchardstown has never been used. In Ballymun, a brand new health centre, worth approximately €48 million, has been lying vacant since it was finished more than 18 months ago. During this time the Northern Area Health Board has paid an estimated €5.2 million in rent for the facility. I state again that if the health service were a private company, the CEO would have to resign. It is a mess. I am surprised to see an amendment to the Labour Party motion.
This Government has invested unprecedented levels of capital and revenue funding in our health services. It is important to appreciate that from a very low base, we have built up and will continue to enhance the infrastructure of our health system to provide modern and accessible health facilities. I will deal with some of the points that have been made in the contributions of Senators.
It is important to put the provision of acute hospital services in context. Over the last two or three decades there have been numerous important advances in surgical technology and anaesthesia. These advances have greatly improved the range, safety and effectiveness of the procedures that can be offered by modern health systems. Modern medicine has allowed us to live longer and have a better quality of life. As a consequence, however, there have been dramatic increases in the demand for treatment. When people say the health service is chaotic, a mess or not working, they are wrong. By any yardstick, over the last 20 years modern health care systems have worked. They have been far more successful in the quality of their interventions and their outcomes. This is true across the OECD and also in Ireland.
We have different pressures and demands now than we had ten or 20 years ago. I recently heard Tom McGurk interviewing a man who had suffered from leukaemia. He said that if this had happened to him 15 years ago his chances of overcoming the disease would have been much less. We are making successful interventions. I will detail our progress in terms of the development of our health care system. That is not to say there is no pressure or that there are no difficulties associated with modern demands arising from an ageing population.
To help Senators understand the complexity and scale of our acute hospital system, I offer some statistics to provide a context. The number of patients discharged from hospital having been treated as either in-patients or day cases in 2003 was more than 1 million. This represents an increase of more than 25% in the number of patients treated compared to 1997, when around 780,000 were treated, and is the first time the number has exceeded 1 million. Day activity is now a significant component of hospital-based care in Ireland. Evidence shows that much of this growth is the result of technological and medical innovations such as less invasive surgery and advances in anaesthetics.
There has been a staggering increase of nearly 80% in day case procedures between 1997 and 2003, from 245,000 to 440,000. That statistic alone proves we cannot go around saying the system is a mess or in chaos. That growth is a benchmark for a modern approach to health care. All our teaching hospitals are at that level in terms of day case procedures and volumes. This reflects the increasing ability of the hospital system to treat more patients on a day basis, where patients are admitted and discharged on the same day. Productivity has increased. Despite all the talk of a black hole that absorbs money, productivity has increased year on year. Hospitals are dealing with more people even within existing envelopes.
In 2003, there were 1.2 million attendances at emergency medicine departments and 2.2 million attendances at acute hospital out-patient departments. This shows that as a population we are quite active in accessing services. The increasing capacity of the public hospital system to treat more patients is a product of the significant investment by the Government in health services. This year the Government has provided a gross allocation of €10 billion for the health service, which is nearly double the level of funding in 1997. One example of how this investment has yielded results is the increase in medical consultant numbers. According to the Comhairle na nOspidéal report on consultant staffing, on 1 January 2004 there were 1,824 consultant posts in the public sector. This represents an increase of 41% over the last six years. This means that more people are being treated.
Senator Feighan said the health service was a mess. However, let us consider the cardiovascular health strategy. There is no comparison between the quality of interventions in this area currently and that of five or six years ago. Since the launch of the cardiovascular health strategy in July 1999, €54 million has been invested in its implementation. Almost 800 new staff were appointed in the first years of implementation, from 139 health promotion officers to 113 primary care and pre-hospital care personnel. Pre-hospital care is vital, supporting prevention, diagnosis and rapid response among people in the community. This is a key issue in terms of cardiovascular health.
A total 328 hospital-based professionals have been employed and funding for the appointment of 17 additional consultant cardiologists has been provided. This represents the largest increase in cardiologist numbers in the history of the State. The majority of these will be coming into the system this year. The number of cardiology procedures has more than doubled over a short period. An additional 109 cardiac rehabilitation staff are now in place and every acute hospital treating people with heart disease has developed structured cardiac rehabilitation services. I have spoken to people who have benefited from these services and they are enthusiastic about the difference it has made to their recovery and their return to normal life after serious heart trouble. In terms of information systems, audit and research, we have provided additional staff to improve quality and agree on guidelines and protocols for patient care.
The bottom line is that when we talk about health care in Ireland we must remember the objective of public health policy is to reduce the incidence of mortality and morbidity from heart disease and cancer. These are the major causes of death and illness in society, along with injury and accidents. People ask where all the money has gone. We have strategically allocated major resources to the treatment of heart disease and cancer in order to change the story of modern Ireland in terms of what we die from and what makes us ill and therefore reduces our quality of life. Accident and emergency services are extremely important, but they are not the only piece of the jigsaw. We must consider the big picture. We want people to, live longer, with improved quality of life. Through an aggressive, focused and strategic approach to heart disease and cancer we are achieving this.
Since 1997 there has been a cumulative investment of €550 million in cancer services. Once again I made this a priority in 2004, despite the existing envelope of financial provision. Although we had to live with 2003 levels of funding we managed to provide additional funding for cancer services. That has enabled the approval of an additional 92 consultant posts over the last number of years in key areas of cancer services, including medical oncology, histopathology and oncology surgery. The benefit of this can be seen in the substantial increase in activity levels in the three modalities of cancer treatment. For example, since 1996 the annual number of discharges of patients receiving chemotherapy has more than doubled, from 22,000 in 1996 to more than 50,000 in 2002. Similarly, for radiotherapy the increase in discharges reported at Cork University Hospital increased from less than 7,000 cases in 1996 to nearly 15,000 in 2002. There has been a 36% increase nationally in surgical procedures for breast cancer, with an additional 500 procedures performed in 2002 compared to 1997.
The complexity of the care today is different. I recently opened the radiotherapy unit in the Cork University Hospital. It has a state-of-the-art brachytherapy facility and 13 professionals will be involved in the treatment of one patient. That is an indication of the complexity of a radiotherapy and brachytherapy centre, which is not often appreciated or understood by people who ask where the money is going. If we want world class quality care, that is the type of facility in which we must invest, and it must be done across the country.
In terms of the national development plan, anybody who is honest about the scale of development will acknowledge that progress is being made in addressing the historical deficits in health infrastructure. A range of major projects have been completed, are in planning or under construction across all health care programmes. Capital funding provided under the NDP for health services has also allowed for the commencement of important new initiatives in other health areas such as putting in place new infrastructure to support and develop the area of information and communications technology.
Long-term progress means long-term investment in facilities. In the past three years alone the health capital budget involved spending some €1.7 billion. The capital investment framework for health between 2004 and 2008 amounts to some €2.7 billion.
In terms of a historical deficit, I have travelled the country and I have seen some of our hospitals and some our older community nursing units. Many of them date back to the last century and the previous one. We had a significant long-term deficit because there was little incremental capital investment in health until the NDP came on stream and an envelope for health for three or four years was given to begin modernising the plant, along with ongoing minor capital. The system lived hand-to-mouth because of economic and financial circumstances for 20 or 30 years. The concrete result of the capital investment in the health service is evident all around the country by way of new, expanded or refurbished health care facilities. For example, a major construction project has been completed at University College Hospital Galway. I invite anyone to go to UCHG. More than €120 to €200 million will have been spent by the time it is complete. What that is doing for the west is making all specialties available to public patients who heretofore had to travel to Dublin for heart surgery or radiotherapy and other specialist treatment. That is being put in place for the west in a modern infrastructure which did not exist before. Many new units in that area have been commenced. More development is needed, but much has already happened at that site. A new acute psychiatric unit has been provided at St. Luke’s Hospital in Kilkenny. These are examples. There are others around the country. A new extension has been built at Portlaoise General Hospital. I visited that recently. There was no comparison between paediatric services in Portlaoise today and the services that were previously available. Anyone in the health service in the area will say the same.
Senator Feighan’s suggestion that matters have got worse with all the money is rubbish. Portlaoise hospital is one example that proves that is not true. One only needs to compare the acute psychiatric unit there and the quality of the building to what was there before. One need only look at the paediatric unit. One cannot say with any credibility that the system has got worse. It has got infinitely better in terms of the quality of care in many instances.
Mr. Martin: That needs to be said. I accept the criticisms as well. There are many drawbacks and deficiencies in the system that we must correct. In accepting the deficiencies, we must acknowledge that major improvements have been made and get the balance sheet right. It does no one any good to use such general labels about the system.
Mr. Martin: It feeds into the notion that there is no point in spending money on health because it all goes into a black hole. It is a dangerous philosophy to keep peddling the line that the money is going into a black hole. That is the greatest disservice to the health service.
Mr. Martin: New radiotherapy facilities have been built in Cork and in Galway. In Galway they are coming on stream. Major construction is under way at St. Vincent’s Hospital in Dublin, at Tullamore General Hospital, at Cork University Hospital and at many other hospitals.
With regard to the fiscal position, the Government has maintained a strong economic policy. It has meant that national priorities had to take precedence over sectoral requirements. From the perspective of health funding this has resulted in a funding policy of maintaining existing levels of service.
Mr. Martin: The ELS concept has had the result of delaying the full opening of some new units which are now built and ready to open. As the economic position improves it will allow Government an opportunity to examine existing policies and consider their relative priority. We are equipping the units. They could not all be opened tomorrow.
Mr. Martin: They must be equipped and staffed. That involves negotiations. Industrial relations issues are holding up the opening of some of these new units. People are saying they need this and that in order to move from a very dilapidated old system to a modern facility. It beggars belief that people are making that type of demand when I would have thought there would be an enthusiasm to move to a new facility. Neither is it a question of signing a blank cheque for service providers to staff a new unit. There must be realism in terms of additionality and staffing and there must be negotiation. The idea that we will cave in and sign off on whatever is demanded is not realistic. That will not happen. That is an important point.
The economy was affected by international events in the period 2002-03. We have learned our lessons from what happened in the 1980s. We had to take particular decisions to correct the economy and lay the foundations for ongoing funding of social areas such as health and education. We will be ultimately vindicated in taking that approach. As a member of Government I supported it.
Discussions are taking place between my Department and the Department of Finance regarding the revenue costs of the proposal to open the new units and the impact of the proposal on staffing levels. By any yardstick — the European context was mentioned — the rate of public spending in Ireland is over and above what it is in other European countries. So are the rates of increases.
Mr. Martin: There are issues of an ageing population and in terms of financial sustainability right across the globe. We are hearing the same refrain from Health Ministers all over the world. We have just been through the EU Health Presidency. I am on first-name terms with all my colleagues at this stage. There are similarities in terms of the issues. There are no big surprises. The big issues at global level in any major international debate on health are financial sustainability, the ageing population and the health care costs of meeting the demands of an ageing population, which I accept we have not addressed properly as a society. It is a societal response that will determine that, and it is a key issue.
Mr. Martin: Some of these units are already partially in use as they are replacing old and outdated facilities. My Department will continue to work with the Department of Finance to identify a timescale for the full commissioning of new facilities.
In terms of primary care, the strategy, Primary Care: A New Direction, recognises that the Irish health system places considerable reliance on hospital care and that an appropriately developed primary care system can meet 90-95% of all health and personal social service needs. This strategy sets out a new direction for primary care as the central focus for the delivery of health and personal social services. It promotes a team-based approach to service provision which will help to provide a fully integrated primary care service. A properly integrated primary care service can lead to better outcomes, better health status and better cost effectiveness. Appropriately developed, primary care services can help prevent or reduce the impact of conditions that might later require hospitalisation and can also facilitate earlier hospital discharge. Overall, a strengthened primary care system can have a significant impact in alleviating demands on specialist services and the hospital system, particularly accident and emergency and outpatient services.
The motion refers to difficulties in accident and emergency. I am concerned about the current situation and the difficulties being experienced by patients. Patients should be treated with dignity and respect. The problems in accident and emergency cannot be dealt with in isolation as many of the difficulties and delays being experienced by patients reflect system-wide issues, which demand a multi-dimensional approach. In order to deal with the current pressures on acute services both in the shorter and longer term I would like to briefly outline some of the key actions I have taken.
It has been widely documented that there are a number of patients in acute hospital beds who have completed their acute phase of treatment and are ready for discharge to a more appropriate setting. The availability of suitable sub-acute beds is a particular problem in the eastern and southern areas. In this regard I have provided additional funding of €17.6 million to the Eastern Regional Health Authority and to the Southern Health Board to facilitate the discharge of patients from acute hospitals to a more appropriate setting, thus freeing up acute beds. This funding allows for the funding through the subvention system of additional beds in the private nursing home sector and ongoing support in the community. I have been informed by the Eastern Regional Health Authority that nearly 300 patients have been discharged so far from acute hospitals as a direct result of this funding. The Southern Health Board has reported that some 350 patients from the southern region have benefited from the initiative. It is a different initiative as up until now, we have been pumping money into nursing homes to make up the slack. In Dublin, there is an historical lack of district hospitals, many of which were closed in the 1980s and early 1990s along with the community nursing units.
Mr. Martin: Last year we asked the system to come up with a more innovative approach on how to deal with the discharge policy. The Southern Health Board came up with a very good initiative which the Department funded and asked to be replicated in the eastern region. It has worked more effectively in the south through the effective management of the discharge which leads to a better turnover. We have met with the hospital management and we will continue to emphasise that. Unfortunately, when 300 people are discharged, another 300 take their place. The long-term care issue is the key to accident and emergency in Dublin. The discharge of patients to appropriate long-term care settings is a critical factor. Some hospitals have come up with different approaches.
The system of subventions for nursing homes was introduced in the early 1990s. In 1993, it started off with €5 million. In 1997 it increased to €35 million and by 2003 it had reached €110 million. This year it will reach €120 million or higher. That gives the range and speed of the leap forward made. It also reflects the ageing issue. In Dublin there has been less investment in community care than there has been around the country. That is a historical development. The strength in community and connections to community are not as strong now in urban areas as they would have been 20 or 30 years ago. All that has impinged on the hospital accident and emergency department.
There are now 51 emergency medicine consultant posts in acute hospitals as opposed to 14 in 1997. That is the largest increase in any specialty aside from the cancer and heart specialities. We have also invested in additional nursing staff and security arrangements in accident and emergency departments. We are being told by the hospitals that this has resulted in better clinical decision making in the hospitals in the accident and emergency departments, as well as enhanced management diagnosis and treatment of patients. There are huge pressures on accident and emergency departments but the actual quality of the management of the patient is better. Unfortunately, overcrowding repeatedly occurs because of the wider issues across the system.
The other issue is bed capacity. The acute hospital bed capacity national review called for 3,000 beds by 2011. We said we could provide 709. The base funding is in place for that and 589 of those beds have already been commissioned. We have exceeded the target of 450 private beds through the national treatment purchase fund, which has now treated up to 15,000 patients on the waiting lists. Many hospitals are down to six months, while some are down to three months waiting times for surgical procedures. The dedicated funding stream is eating into the waiting list. The validation by the hospitals of the lists would open one’s eyes on how big the waiting list really is. We have been given a figure of 20,000 to 21,000 for the waiting list. This validation occurs when people out there are asked whether they are available for the operation. In many instances people did not need the operation, had had the operation and so on. It will be interesting to follow the evolution of the management of the waiting lists by the NTPF.
Emergency medicine departments sometimes have to deal with injuries and conditions, which are more appropriate to a primary care setting. General practitioner out-of-hours co-operatives have been established and are operating in at least part of all health board areas, with one health board, the North Eastern Health Board, having a region-wide project. Between 2000 and 2003, €46.5 million was allocated to the health boards for the purpose of out-of-hours co-operatives and this figure does not include the fees paid to participating GPs. An amount of €24 million has been allocated for 2004. The satisfaction rate with the GP co-operative service is very high from both patient and provider perspectives. In fact a recent survey by the Western Health Board’s service, WestDoc, indicated that of the persons surveyed, 30% said that they would have gone to the emergency medicine department if the service had not been available.
However, there is one difficulty. This is happening all over the country but not in Dublin. Dublin is the one problem area for out-of-hours GP cover. Despite our allocation and offer of funding, there has not been a take-up. There is not the same enthusiasm in Dublin for the establishment of out-of-hours GP co-operatives. Around the country, doctors are approaching us in delegations, asking when will they be provided with extra money to complete the coverage in a health board area. That has never happened in the Dublin area. The ERHA has informed me that it is working with various interests to see if it can come up with a solution for Dublin. That has a bearing on the anecdotal evidence that an accident and emergency unit at night effectively serves as a GP, where people attend the accident and emergency department as a first response. We allocated funding out in Dublin for GP co-operatives, but the ERHA was not in a position to get agreement to provide out-of-hours cover.
In order to address the needs of patients presenting at the emergency department some hospitals have established minor injury or illness units. These units provide rapid assessment and appropriate treatment of minor injuries by nurse practitioners or junior doctors. The main advantages of having a separate minor injuries area within the emergency department include the better streamlining of patients and decreased waiting times. St. John’s Hospital in Limerick is a very good example of that.
The processing of patients through the emergency services of a hospital has been greatly assisted by the use of medical assessment units. One such hospital is St. Luke’s in Kilkenny where innovative solutions and a hospital wide response have improved the delivery of emergency services to patients. The consultants in St. Luke’s Hospital approached us through public representatives and asked for funding for their ideas. We gave them €2 million and they took the beds off the corridors. They put in a medical assessment unit, a pre-discharge unit and made huge progress. The benefit of having a medical assessment unit on site has facilitated the rapid assessment and treatment of medical patients. Another recent development is the acute medical assessment unit at St. James’s Hospital. I invite anyone to have a look at how they are doing the business there. This unit has contributed to a noticeable improvement in the delivery of emergency services at the hospital. The problems in St. James’s Hospital are now exclusively of a long-term care variety. In other words, they are not in a position to discharge as quickly as they would like. They have put in a very sophisticated chest pain programme, where anyone presenting with chest pain will go directly into the chest pain facility rather than the accident and emergency department. Within 12 hours, they will have a full diagnostic process carried out and will know whether they have to stay or can be discharged. Prior to the development of that unit, a patient presenting would spend three days in that hospital. I tell hospitals around the country that, if they have innovative ideas, I will be open to supporting them. A key finding in the Comhairle na nOspidéal report on accident and emergency services was that a hospital-wide response was needed to meet the requirements of the emergency service. Improved processing of patients through the emergency department, via minor injuries units or medical assessment units, is but one aspect of the hospital-wide response needed. Delivery of the emergency service at hospital level is interdependent on the in-patient elective service, day patient and out-patient care. The effective delivery of emergency services, therefore, cannot be dealt with in isolation from the delivery of all hospital-based services.
One of the outcomes of the Comhairle na nOspidéal report on accident and emergency services, in which clinicians were involved, was that, historically, hospitals did not take possession of such services in a hospital-wide approach. In other words, it was seen as something out there on its own. Doctors and nurses were allocated, but not everyone took possession of the ball and said that they had an obligation and responsibility. That mindset is changing, and this is critical since it is the key to prioritisation within the overall hospital ethos of a successful accident and emergency department.
I acknowledge there are ongoing pressures, the critical one being the long-term care issue rather than the acute hospital beds themselves. That is important in the context of an overall hospitals capacity to deal with elective and medical admissions. However, the nature of health is changing. The complexity and acuity of patients now arriving has by and large increased. Age is a significant factor in the presentation to accident and emergency. There is a lack of community support in some areas, particularly in the Dublin region. I know Members from all over the country are present, and I am not claiming there are no problems elsewhere. However, the problems in the east are particularly acute because of the way in which the system has evolved over time compared with other regions where there is more of a health board-wide response. In Dublin one does not necessarily have that, since many of the hospitals grew up individually rather than as part of a health board system. As a result there are many gaps in community links with hospitals, and the same is true with community care. Over the last few years we have changed that, and we must do more with that to get the right response. It will require more resources to provide the long-term care beds to alleviate the current difficulties. We are working with the hospitals to do just that. In doing so, I am careful to say that I will not simply throw money at the problem. We wish to ensure a return. The type of scheme that, we had last year got such a return, and we need more of that.
Dr. Henry: I thank the Minister for his speech and welcome him to the House. No one denies that a great deal of money has been spent on the health services. No one says that he has been doing nothing over the last few years. However, in spite of all the money being spent and the effort made, we seem to have terrible problems in some situations. I agree with some of my colleagues who have said that patients’ lives are certainly in danger in some places owing to what I describe as a lack of co-ordination, and the effect on staff has been terrible. Other Senators have pointed out the grave shortage of nurses, with most of them leaving within two years of qualification. That is what the Irish Nurses’ Organisation tells me.
Mr. Martin: That is what they say, but we have no facts. I have received no documents and seen no presentation or study. We must question those figures rather than simply repeat them. I apologise for interrupting, but it is critically important for the debate that we analyse this a little more.
Dr. Henry: I assure the Minister that I would not want to mislead the House on anything. However, irrespective of what the Irish Nurses’ Organisation says, I frequently see two nurses trying to do the work of eight. I am told that it is because they cannot get other staff. I must accept what my nursing colleagues tell me, just as I must accept the fact that morale is very low — a large number of people in the health service have spoken about this before — because of such matters as the building of expensive units which are not opened. The Leader of the House might be interested to know that, during the last Leader’s reign, I used to ask him every six months — as if it were a tennis match — when the new wing of Mullingar Hospital would open. Can the Minister imagine what it does to staff to see such a unit there without any access to those facilities?
We constantly hear about the appalling situation in accident and emergency departments, and that is true. I recently went to visit a colleague who was on a trolley for days. That should not be the case. This constant problem has gone on for years. At the same time, we have a splendid unit in the James Connolly Memorial Hospital in Blanchardstown. Can the Minister imagine what that does to the morale of those in that hospital, not to mind the morale of those in the other accident and emergency units? Think what they could take off our shoulders if that unit were open.
I will describe the situation in Ballymun. Last winter, the old Ballymun health centre was virtually unusable for quite some time. They had trouble with heating and facilities for patients, and they closed down for some time. I know the general practitioners who work in that health centre. One could not meet a more devoted group. I know it is not the personal fault of the Minister that the funding is not there to open the new Ballymun centre, but it is his responsibility because he is in charge of the health services. It is very serious, not just from the point of view of the patients but from that of the people who work in those centres.
Senator Ryan mentioned Clonmel. It is very serious if ill patients are brought by ambulance from Clonmel to Cashel for surgical procedures. I was almost a child when the trouble started between Cashel and Clonmel. I am sure the Minister had not been born then. The fact is that these things go on interminably. I presume the people who have been employed in Castlebar will have to be paid. The logic defies me. There were advertisements for staff. I know the Minister sometimes has problems with people refusing to move, but more often than not they go, and there is certainly no way that anyone who in any way obstructs a move to new facilities would have support from me; it is outrageous. There must be some sense of addressing situations that have continued for years; if it were a matter of months, it would not be quite so bad. Great efforts have been made in the psychiatric system in particular. However, it took about 20 years to achieve that, and people working in the health service look at that now and wonder if it will take the same time again.
The Minister points out the good things that are happening, such as the medical assessment units, which began in Limerick while the one in Kilkenny seems to be going well. The Minister is ever so slightly optimistic about St. James’s. There is no harm in this as one is entitled to seek a rosy future. However, do we really have new radiotherapy units in Cork and Galway? The last I heard, people were telling me about antique radiotherapy equipment in Cork.
Dr. Henry: Sorry. I meant when the Leader speaks. Sometimes one can get absolutely no answers on any of these issues. How long is it since the radiotherapy plan for the country was issued? I understand why Waterford and Limerick have not got going. They want to get Cork and Galway going first. However, what about the two in Dublin? Apparently no decision has been made about the two radiotherapy facilities for Dublin. Some preference must be given as to which two hospitals, north and south of the city respectively, should provide this service. People must be told and those working in the health service cannot string this out forever. Decisions must be made. I cannot recall when Professor Donal Hollywood’s report was delivered but it is a long time ago.
Dr. Henry: I attended that session of the committee and it was months ago. A decision must be made. I was a member of Comhairle na nOspidéal, which was frequently blamed for the delay in the appointment of consultants, but I often found that the delay was longer in the Department of Health and Children because the financing is not available for posts long before they are needed. One consultant told me that he returned from the United States to take up a position here only to find that no beds had been allocated. It is pointless to appoint people to hospitals where no provision has been made for them to perform their function. I was afraid this consultant would return to the United States even though his services were urgently needed here.
It is a depressing situation. Having worked in the health service for so long, I clearly recognise the improvements that have taken place in procedures. I am also very aware, however, of the huge demand from patients and the attendant difficulties in provision, our ageing population, the very slow progress we are making in many areas and the dreadful effect the building of capital projects in which nobody is allowed to work is having on the morale of health service workers.
Ms Feeney: I formally second the amendment to the motion. I understood from Professor Hollywood’s address to the Joint Committee on Health and Children that he was quite satisfied with the ongoing progress. As the Minister observed in his speech, the radiotherapy service is working well. The unit in Galway will open in January 2005, €80 million has been invested in a facility for Cork and extra consultants are being provided for both of those facilities. As a former member of An Bord Altranais, I should point out that there are 8,000 extra nurses in the system since 1998 and we have created more spaces in the nursing schools in the last five years. It does not make sense therefore that, for example, two nurses should be looking after a large number of patients, as Senator Henry observed.
The Minister has acknowledged in his presentation that there are problems in the accident and emergency service but it is wrong for the Opposition to say that it is a problem throughout the State because it is not. I spoke to the two accident and emergency consultants in Sligo General Hospital this morning. That hospital had no accident and emergency consultants six years ago but has since benefited from the 41% increase in consultants throughout the country. Those consultants are quite happy with the service they provide and I doubt that they are the only consultants in the country who feel that way. I am glad to hear the Minister is concerned about the east coast area, as we all are. The Minister has rightly acknowledged that there are problems there, which require a multidisciplinary type of approach, and he has outlined his strategy in this regard.
I was interested to hear from the two consultants in Sligo that it is at the weekends that overcrowding occurs. We have frequently discussed in this House the phenomenon of weekend drink and drug abuse particularly among young people. These are the people who are taking up precious spaces in accident and emergency departments. Of course they must be treated and they could be any of our sons and daughters. A change in the culture regarding young people’s drinking patterns is required. Tax evasion was accepted in this country ten years ago as was drink driving. Today the latter is considered the worst crime of all and is completely frowned upon. This is not entirely a matter for the Minister but some element of it is within his remit. The Joint Committee on Health and Children has just delivered a report, with which Senator Henry was involved, on the problems regarding under age drinking.
I am glad I can make my next point in this House before the Minister. For the last few months I have been holding my breath every time I heard it said that the Hanly report would presage the closure of accident and emergency departments all over the country. As a member of the Medical Council I can say that is rubbish. The Hanly report will ensure that accident and emergency departments remain open. It is part of my duty as a member of the council to inspect hospitals around the country and I have visited accident and emergency departments in counties Clare, Cork, Tipperary, Kildare, Monaghan and Wexford, among others. I was part of a five person group within the council which ruled that those departments should be closed. In the case of one hospital in the Mid-Western Health Board area, we gave it an alternative to closure of the accident and emergency department within six to nine months whereby the CEO of the health board came together with personnel from the Medical Council and medical staff from the hospital to make representations to the Department of Health and Children. That hospital has now been assigned an accident and emergency consultant who is ready to take up that position. The Hanly report is the way to go. Medical people agree that it is the blueprint for the future of medicine in this country and the methodology is second to none.
There are two major hospitals in the North-Western Health Board, Letterkenny General and Sligo General. Letterkenny is ready to appoint a second consultant, for which I thank the Minister. Sligo already has its second consultant and its accident and emergency numbers are under 30,000 and we are happy with that. I was surprised by something Senator Feighan said as he lives only 20 miles from me in Sligo, although it is a different health board area. He spoke about a big black hole and maintained that services had not improved. As I pointed out a few months ago, Sligo General Hospital has a new oncology unit with 14 beds. Our cancer patients no longer have to leave the county or the region and they are absolutely delighted. The Minister is correct that the benefits are beyond belief in some areas of the country. Yes I am speaking for my own area and I am better qualified than anybody else to make this case——
Ms Feeney: I am talking about my own area. The motion refers to a problem with the accident and emergency service throughout the State and that is inaccurate. The State is bigger than the east coast. The Senator may forget that people also live in the north-west.
Ms Feeney: Senator Cummins is wasting my time. I refer to Senator O’Meara’s list of projects that have not yet opened, of which Birr Hospital is one. As an Offaly woman I can go into Leinster for a while.
Unions have a big role in this. The Labour Party may well grin. Nurses are looking for €4,000 to move from one side of the road to another. It is about time unions were told they had a role to play. I heard only this morning of a consultant who had been told in a midland hospital by the Irish Medical Organisation not to see more than 20 patients per day, this at a time when there are enormous waiting lists. I take my hat off to the Minister on the Kilkenny project, which is excellent. There are a few more good ideas, but I will take these up personally with the Minister.
Mr. Bradford: This is an important debate, but given the contributions from the Government side what depresses me is that the problem is not recognised. I listened with interest to what the Minister said and indeed read his script. I also listened today to what the Minister for Finance said. At lunchtime I felt a certain sympathy for the Minister, Deputy Martin, who sends out media signals indicating he is looking for further funding. Then we hear his presentation tonight and what his colleagues have said. It would appear that the message has not got through to Members on the Government side that there is a problem of enormous proportions. It appears that all of them were active on the local and European election hustings but did not get the vibe from the public.
The public believes there is a profound problem in the health service. I wonder if that message is being taken on board. If we removed the year 1997 from the records, it appears the Government would have nothing to say. We hear all the statistics about what has happened since then. Could some on the Government side reflect back to the general election of 1987 when former Taoiseach, Mr. Haughey, led the Fianna Fáil Party? He proclaimed to the people in 1987 that health cuts hurt the old, the sick and the poor while his party proclaimed that there was “a better way”. On that fabricated argument Fianna Fáil was elected to power and within weeks there was a slashing of resources in the health services and hospital beds across the country. Those bed numbers have not been returned to the service in the intervening years. It is frightening to think we have had the Celtic tiger economy since 1987, with record resources, but we have not restored the Irish health service to the position it held in terms of beds and availability of services before that year. The Senator may shake her head, but that is the position.
Mr. Bradford: It is frightening that she does not recognise that. The Minister spoke about the improvements. Of course there have been major improvements and technology has improved worldwide, so why should it not in Ireland? Medical procedure has improved worldwide and therefore in Ireland. I do not think anyone challenged Senator Ryan’s assertion that there are no hospital waiting lists in a number of European countries, yet we are willing to accept there should be in Ireland. It is frightening that this appears to be our starting point.
The Minister continually makes the case for the defence when he refers to the enormous increase in expenditure. We recognise that sizeable money is being spent on the health service but on the other side of the equation is the desperation of people looking for hospital beds. There is also the desperation of those looking for medical cards and nursing home subventions. I do not believe, from listening to the Minister’s contribution, that he recognises the scale of the problem. That worries me.
Mr. Cummins: I acknowledge that extra resources have been pumped into the health service. There is no question about that. However, the results cannot be seen on the ground. What we see are layers of extra administration and bureaucracy as a result of the spending. One cannot see the results. Those patients who access the A& E services in the Dublin hospitals cannot see them. Often they must spend days, nights and, in some instances, weeks on trolleys. What about the situation where somebody goes to the toilet and when he returns there is another patient on his trolley? This is the type of health service you are presiding over. These are the facts.
Mr. Cummins: There is no question that there is excessive overcrowding in A& E departments. It results in patients, and indeed staff, being left in totally unacceptable and unsafe environments. A major cause of the crisis is the lack of beds and closed wards, as mentioned by several other speakers.
We have had nothing but promises from the Government. The Minister presides over reports and strategies but he is poor on delivery in terms of implementing recommendations. Some 200,000 extra medical cards were promised, yet there has been a decrease of 45,000 in the last two years. This is the type of promise and politics about which the people said they had had enough during the local elections campaign.
Some 15,000 people walked the streets of Waterford looking for their right to equity of access for radiotherapy service. They were seeking the same treatment as other areas of the country. There has been nothing but contempt from the Minister for the people of Waterford and the south east.
Mr. Cummins: The Government side got its answer in Waterford city in the local elections where one Fianna Fáil member was elected out of 15 and the Progressive Democrats were wiped out. Fianna Fáil lost three seats in Waterford county. They also lost seats in south Kilkenny and Wexford, yet the Minister is not prepared to listen to the people. He spoke about representatives making cases for people and he dished out a couple of million euro to solve problems, but he is not prepared to listen to the people of the south east. One in every four families has to travel from Waterford to Dublin five times a week for five minutes of treatment. People are dying while the Government dithers on issues.
Mr. Cummins: It is true and I can name people who have died. The Minister showed the same contempt to the House yesterday when he did not attend it to address an Adjournment matter. Nor did any of his Department’s Ministers of State. A Minister of State attended who knew nothing about it. That illustrates the contempt the Minister for Health and Children and the Government have shown to the people of Waterford.
Mr. Morrissey: Less than a week ago I raised on the Order of Business the subject I am addressing in this debate. I am pleased to see it has been so quickly put on the agenda by the Labour Party, perhaps as a result of my having raised it.
Mr. Morrissey: The day I raised it I asked that the Minister should come to this House to tell us what the Government was doing. I welcome the Minister to the House. He has outlined clearly in his speech what the Government has been doing in this and the previous term of office. There has been greater processing of patients through our hospitals as a result of investment. The Minister has acknowledged that issues remain to be resolved. Many new hospitals have been built and many more have been refurbished. I am often angered by the comments of other public representatives from Dublin West in the context of James Connolly Memorial Hospital. I was the only councillor among eight who voted for the rezoning of lands at that hospital when it was being promoted in the 1990s as a hospital for future investment on a pound for pound basis with Government. The councillors who voted against the proposal now cry crocodile tears. However, they did not make the hard decisions necessary at the time.
Mr. Morrissey: Every councillor in Dublin 15 at the time voted against that proposal. I accept problems exist in accident and emergency departments and that we must do something in terms of how people are treated once they present there. I suggest that one area that might be examined is the junior doctor service provided at accident and emergency departments. I was told today that contracts for junior hospital doctors commence on 1 January and 1 July each year. The provision of consultants at that point might yield greater results, an issue, which is dealt with in the Hanly report. It is a positive aspect of that report, one which I hope will be implemented.
In raising this issue last week, I hoped the Minister would deal with an issue not yet raised here this evening although mentioned in previous debates. It is often the case that sick and injured people must wait for treatment until those who have taken too much alcohol or drugs are cared for. We must examine that issue in the context of how people present themselves at accident and emergency departments.
The Minister acknowledged the great strides made in the area of cardiac surgery, cancer treatment and health promotion offices throughout the country. He also referred to the enormous investment in our hospitals. Hopefully the one or two issues remaining will be resolved during the Government’s remaining years in office.
Mr. McCarthy: I welcome the opportunity to participate in the debate on this motion. Much of what has been said hurts people on a particular side of the House. However, that happens when one speaks of statistics and facts. It is no secret that our health service is at the point of collapse not because of a lack of funding but because of sheer bad management. The management shown by Government in this sector is nothing short of appalling.
Senator Bradford rightly pointed out a worrying trend in the contributions from the Government side, namely the belief on its part that nothing is wrong. That is frightening. An accident and emergency unit at Cork University Hospital built at a cost of €16 million has not yet been opened because the Minister has not allocated funding for the appointment of staff. There is no defence in that regard. It is a little simplistic for the Minister to waltz in here and blame trade unions for it. If there is a recognition of a failing in the system surely it cannot be linked to a trade union. This Minister has presided over a sham of a health service for the past four years. When presented with proof that his lack of managerial ability fails in his own backyard and fails abysmally the people in Cork city and county, he blames the trade unions. That is simplistic and disgraceful.
A consultant hired by the health board stated that 35 staff would be sufficient to operate the unit. I understand funding for the equipment needed is on stream. However, there is no timeframe as to when funding for the provision of staff will be made available. Until such time as it is made available this unit, like others, will remain idle. This problems does not exist in Cork city alone; it is a nationwide problem. Some €460 million worth of facilities nationally are lying idle. They include a €96 million wing at James Connolly Memorial Hospital; a €24 million surgical unit at Clonmel General Hospital; a €10 million orthopaedic unit at Mayo General Hospital; a €48 million health centre in Ballymun and a €16 million unit at Cork University Hospital. That is frightening.
Senator Cummins highlighted the case, which was dismissed by Government Members, of a man occupying a trolley at Tallaght Hospital, going to the toilet and returning to find another person on the trolley. If this matter were not so serious, it would be funny. Are we now to have a waiting list for trolleys? The manner in which the Government has attempted to dress up and disguise a serious trend once confined to weekends and seasons, but now permanent is despicable and disgraceful. I am not an expert on any particular element of the health service. The Government is showing contempt to organisations such as the Irish Nurses Organisation, which has experience of the extent of the crisis. It is time for the Minister and Government to sit up and listen when it states that the situation is worse than it has ever witnessed or than people have ever experienced.
Why are 750 nursing positions vacant? I am glad Senator Leyden has returned to the House but he missed Senator Feeney’s eloquent defence of the Hanly report. Perhaps the Minister will tell the House when it is proposed to close the accident and emergency units at the hospitals in Bantry, Nenagh, Ennis and, in Senator Leyden’s bailiwick, Roscommon?
Mr. McCarthy: Under the Hanly report, accident and emergency services are to be curtailed. I admire the political will of people to defend services at their local hospitals. The Hanly report was defended by a Government Senator this evening. It is clear that accident and emergency units are under serious threat. I would like the Minister to tell us when those closures will commence.
Ms Tuffy: I, too, would like to speak about the new wing at James Connolly Memorial Hospital, which is lying idle. I am told by a local Labour representative that one of the local newspapers this week contained a photograph of the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, and a consultant for that hospital regarding the announcement of a new system which they intend to introduce before the winter.
Ms Tuffy: The system relates to elderly patients with chest illnesses. The idea is that these patients would be seen as out-patients, thereby freeing up beds. The article also refers to the appointment of three new consultants. That is great news, a good story and a good photo opportunity for the Minister of State. However, as Members are aware, the new wing built at a cost of €96 million, one part of which is being used following an emergency, remains idle apparently due to unforeseen running costs. The local Labour councillor has sought a comprehensive explanation for the failure to occupy the wing, but she has been unable to get one. I cannot derive much information from the replies given by the Minister for Health and Children in the Dáil because they do not say very much. It is costing money to maintain the wing that is lying idle. The hospital’s staff are working in the old accident and emergency department, in bad conditions, beside the state-of-the-art wing. One of the reasons I am raising the issue is because it is the nearest hospital for people in my local area. It has great potential as a regional hospital for the area, but that potential is not being realised.
If the Government learnt anything from the results of the local elections, it must have been that one can fool people with announcements and photo opportunities some of the time, but people eventually see the way things are in reality and respond suitably when they vote in elections. In a reply to Deputy Rabbitte this week, the Minister for Health and Children said the matter has to be dealt with by the Eastern Regional Health Authority. The buck stops with the Minister, however, and he should do whatever is required to sort the issue out. If the Minister of State, Deputy Tim O’Malley, responds to this debate, I ask him to outline what the Minister, Deputy Martin, is doing to ensure the wing becomes active as soon as possible.
Mr. Leyden: It is strange how circumstances change — what comes around, goes around. I was sitting where the Minister of State, Deputy Tim O’Malley, is sitting now, when there was a debate in the House on health services in 1987. Roscommon General Hospital was mentioned during the discussion.
Mr. Leyden: ——has appointed a second consultant. There will be four sessions a week. It was approved by the Department of Health and Children two weeks ago and it has gone to Comhairle na nOspidéal for approval.
Mr. Leyden: It will be approved. Radiologists are on call. It had 13,000 accident and emergency visits in the last year. It is a busy hospital that is working well. When I spoke to the Minister outside the House, I argued the case for the extra staff that are needed to make it absolutely perfect.
Mr. Kitt: I appreciate that things have improved. If the Minister of State, Deputy Tim O’Malley, can get more money for the Western Health Board, I will be glad if he invests it as soon as possible. I have been a member of the board for two of the last five years. There have been significant developments in the health board area during the last five years, especially increases in day activity cases and improvements in the accident and emergency units. In 2003, we exceeded 200,000 out-patient attendances for the first time. We have succeeded in reducing waiting lists by means of a combination of waiting list initiatives and the national treatment purchase fund. I am sorry there is a waiting list, but we have to have waiting lists in certain areas. Children are not waiting longer than six months for in-patient procedures and the orthodontic waiting list has been reduced.
I congratulate the Government on phases one and two of the development of University College Hospital, Galway. I was particularly delighted when the board purchased Portiuncula Hospital in Ballinasloe from the Franciscan Missionaries of the Divine Motherhood in 2001. The hospital has a 206-bed acute unit and an eight-bed IPU complex. Consultant staffing has increased threefold and two further posts have been approved. I hope the posts will be processed soon and I am waiting for a letter from the Minister in that regard.
Senator Leyden spoke about matters relating to counties Roscommon and Mayo. I welcome the developments in those areas. Perhaps it is time for the Minister to come to the Western Health Board area to open some of the facilities that have been approved by his Department.
Mr. Kitt: He owes it to the board members, who have worked with two CEOs over 34 years, to provide services in the western region. He owes it to the board members and the staff to open those units. I welcome the developments in the GP out-of-hours service in the western region, which is known as WestDoc. It has been very successful.
Mr. Kitt: We have established the health board’s first primary care team in the Erris area of County Mayo. It is significant that the first team was established in that location. I hope the GP service, in which 104 GPs are participating, will grow. I hope more GPs will get involved in continuing the service, which has proved to be so successful in counties Galway, Mayo and Roscommon.
Mr. Ryan: It is the custom when summing up debates such as this to refer to the speeches of other Senators. In the case of Senator Glynn, I will leave it to the people of County Westmeath, who have made their choice between Fianna Fáil and Deputy Penrose.
Mr. Ryan: ——with a considerably greater degree of success than Senator Glynn has had in any election in which he was not depending on party votes. We do not need to start worrying about that one.
The really disappointing thing is that the Minister for Health and Children came to the House to talk about everything except the nub of the motion, which is why hospital facilities worth €500 million are lying idle. What sort of incompetence means that those responsible for the management of our health services, when they are building something, cannot plan to bring it on stream when it has been finished? If the National Roads Authority left roads and motorways lying unused because it could not afford to put road markings on them, we would sack the NRA. If third level educational institutions left buildings empty, we would sack the Department of Education and Science. Apparently, a quarter of that capital expenditure has been used on hospital buildings that are lying idle. That scale of incompetence deserves nothing less than sacking, phase one of which, namely protective notice, was issued to this Government on 11 June. The final notice will issue whenever it plucks up the courage or is forced by the Constitution to face the people in a general election. The major difference now from four weeks ago is that the people have shown that they have copped on. They will no longer tolerate Fianna Fáil’s nonsense. The people have said “No” to Fianna Fáil’s choice of the rich against the poor and the powerful against the powerless and the real question for Fianna Fáil at this stage is what part of “No” it does not understand. Today, the Minister for Finance, the favourite Minister of the Progressive Democrats — a member of the PDs could not be better in terms of political ideology — asserted yet again that he would do it his way. The Minister for Health and Children came in here and pretended he is fighting with this Minister and accepted Deputy McCreevy’s definition that the national interest is the national interest.
There is a section in the Minister’s script, which describes precisely what I am talking about. It is on page 4 and is headed Fiscal Reality. That is a Charlie McCreevy phrase if ever I heard one. As far as I am concerned, I am entitled to deal with what the Minister quoted as fiscal reality, which is in fact fictional reality defined by an ideologically blind Minister who cannot see beyond his nose in terms of what is needed in this country. I have said that consistently.
Mr. Ryan: Six years ago I said he was the worst Minister for Finance this country has ever had and I have been proven right. He is a disaster for this country. He has destroyed the heart of Fianna Fáil and turned it into an extension of the Progressive Democrats.
|Bohan, Eddie.||Brady, Cyprian.|
|Brennan, Michael.||Callanan, Peter.|
|Cox, Margaret.||Daly, Brendan.|
|Dardis, John.||Dooley, Timmy.|
|Feeney, Geraldine.||Fitzgerald, Liam.|
|Glynn, Camillus.||Hanafin, John.|
|Kenneally, Brendan.||Kett, Tony.|
|Kitt, Michael P.||Leyden, Terry.|
|Lydon, Donal J.||Minihan, John.|
|Mooney, Paschal C.||Morrissey, Tom.|
|Moylan, Pat.||O’Brien, Francis.|
|Ó Murchú, Labhrás.||O’Rourke, Mary.|
|Ormonde, Ann.||Phelan, Kieran.|
|Scanlon, Eamon.||Walsh, Jim.|
|White, Mary M.||Wilson, Diarmuid.|
|Bannon, James.||Bradford, Paul.|
|Browne, Fergal.||Burke, Paddy.|
|Burke, Ulick.||Coghlan, Paul.|
|Coonan, Noel.||Cummins, Maurice.|
|Feighan, Frank.||Finucane, Michael.|
|Hayes, Brian.||Henry, Mary.|
|McCarthy, Michael.||McDowell, Derek.|
|McHugh, Joe.||O’Meara, Kathleen.|
|O’Toole, Joe.||Phelan, John.|
|Ryan, Brendan.||Terry, Sheila.|
|Last Updated: 09/09/2010 10:46:49||Page of 14|