Joan Collins (Dublin South Central, People Before Profit Alliance)

On 15 February this year the Minister gave an interview in which he said that health service managers who do not achieve targets for reducing waiting lists and trolley numbers would be fired under the Fine Gael Government. On 15 February, the figure from the INMO trolley watch was 461. The figure for today is 429. I presume no-one has been fired. I have not heard of any firing from the media. The Minister also stated that anybody who did not meet the target given to them would be shown the door, but that has not happened. These were strong words from the Minister, but should they not apply to him now? The special delivery unit has been set up, but what targets have been set for it? Have those targets been achieved? Has anybody been fired and will anybody be fired if those targets are not achieved.

Yesterday I met a campaign group from Skibereen which was highlighting the fact that an ambulance was about to be withdrawn from its area and the people there would be left depending on two ambulances based in Clonakilty and Castletownbere. It takes a minimum of 30 minutes to drive from those areas to Skibbereen. If the other two ambulances are involved in an accident while bringing someone to a hospital or are called out elsewhere, there is no ambulance immediately available for this area. If anyone needs an ambulance in the area due to a stroke, heart attack or pregnancy, these people's lives will be put at risk. One of the campaign members said that Skibbereen had one of the highest recorded burials for a town of its size during the Famine and he felt that Skibbereen could have the distinction of having the highest number of deaths due to cutbacks in the 21st century. The Fine Gael manifesto stated: "Fine Gael will review the fire brigade and ambulance service with a view to achieving greater efficiency and economy". That example shows that it will achieve greater efficiency and economies that have nothing to do with the human needs of the community.

I see extraordinary complacency in the Government amendment to the motion. This is a Government amendment carrying the full backing of the Labour Party. In September of this year, there was a very interesting article in the health supplement of The Irish Times by Dr. Jacky Jones. She pointed out that it is estimated that health services determine 10% of wealth status and the other 90% is due to factors such as education, social status, employment and income. Mortality rates for Irish adults almost halved between 1979 and 2005. This means that Ireland went from having the highest mortality rate among 19 western countries to ranking seventh and achieved this while, despite the comments of our Fine Gael colleagues, spending the least on our health services. This follows not because of a big improvement in health services but because of a reduction in the percentage of people without a second level education. Between 1979 and 2005, this fell from 64% to 15%, while unemployment fell from 14% in 1983 to 4% in 2005. The situation has reversed dramatically with 500,000 people on the dole and tens of thousands of people under huge stress because of the mortgage crisis, cuts in wages, the universal social charge and unnecessarily long waiting times for medical cards. These are things people need to survive in the economy at the moment. Dr. Jacky Jones pointed out that health services treat the ill-health caused by inequality and poverty.

If we accept this premise, which I do, our health service will now come under enormous strain and increased demands because of the economic collapse and the austerity programme following the IMF-ECB-EU bailout. The evidence for this includes the annual health index report for 2010, which found that visits to GPs have fallen from 75% to 71% since 2008. The survey found that the decline in use of medical services was most pronounced among the lower income groups. Those with the least access to health care, those without private health insurance and medical cards, cannot afford the fee of between €45 and €60 for a GP visit. Some 87% of GPs said that in the past two years visits from patients had decreased due to financial problems. These people will be most affected by the economic crisis and austerity and they will also be the most affected by health cuts. Our shambolic two-tier health service cannot take the cuts being imposed on it. By international standards, we have a low-level of acute beds, with 2.7 beds per 1,000 population where the OECD average is 3.8. A study by PA Consulting Group estimated that, based on our high current utilisation levels, some 8,000 more beds will be needed by 2020. The only alternative is a major increase in resources for community care, including free access to GP services and the provision of well-staffed public health centres. This will also mean confronting vested interests in the medical profession, and private health care and insurance companies.

Some Deputies say that one can throw as much money at the health service as one wants without solving the problem. The problem is the inequality in society. The Minister has been in office for eight months and has caused more problems for the health service in bowing to the EU-IMF-ECB bailout and implementing further austerity measures over the next three years. These will be crippling for our economy, our people and our services.

See this speech in context