Liz McManus (Wicklow, Labour)

I am concerned that the Minister for Health and Children has not bothered to come to the House. He has no difficulty appearing on television and spinning yarns to the public, but he is not willing to come to the House to debate the issues which are within his remit and on which he has failed so abysmally.

This motion is tabled by the Labour Party with the sole purpose of ensuring that the thousands of patients who have been left on hospital waiting lists can finally get the treatment to which they are entitled and the justice they deserve. They have been subjected to the most cruel deception by the Taoiseach and the Minister for Health and Children who promised an end to the long wait and who promptly reneged on their word.

The latest published figures show that 27,308 adults and children are waiting to access the health care they need and 20% of adult patients are waiting for more than a year. Many thousands more are on the hidden waiting list, waiting for an appointment to see a specialist so that they can then join those already on the hospital waiting lists. All these people know that if they could afford health insurance, they would not be forced to wait, but because they are public patients, they are stuck and the Government deliberately denies them the access to health care they need.

In a panic response to this motion the Minister for Health and Children has released a statement to try to cover up the extent of his failure. The figures published at the end of September 2003 showed 27,212 people waiting. Those published today for the end of December 2003 show an increase to 27,318.

In an attempt to disguise the extent of its failure the Government has handed responsibility for the issue to the national treatment purchase fund. It, in turn, has invented a new validation system which as far as one can gather — it is all very murky and unclear — is a comparison of the actual waiting list numbers and those presenting for national purchase treatment fund treatment. The shortfall of 4,500 is not explained in any coherent fashion. We do not know if patients who are described as not available for treatment are unavailable because they are too sick to avail of care, how many have died while waiting in vain for treatment or how many have gone into debt to pay for private care. However, we know that those described as postponing treatment at their own request still, undoubtedly, need treatment and it is dishonest for anyone, including the Minister, to try to claim otherwise.

The Minister for Health and Children again makes fraudulent claims when he says health strategy targets are being met. The target set in the health strategy was that, by the end of 2002, no adult would be waiting more than 12 months. We know from today's figures that 20% of patients, approximately 6,000, are still waiting more than 12 months and that others are waiting even longer. No massaging of the figures by the Minister can disguise that fact. Many of these people are elderly and infirm. They need and deserve the best health care the country can afford.

Before the last general election, the Taoiseach promised that, come this week, no patient would be left on any hospital waiting list anywhere. The Fianna Fáil manifesto declared: "Fianna Fáil will permanently end waiting lists in our hospitals within two years through a combination of bed capacity, primary care, secondary care and targeted reform initiatives." This was a solemn undertaking made to the people. The Taoiseach said health would be the number one spending priority even if, in his own words, the economy falters. The public now knows the truth. It knows it was swindled by Fianna Fáil and that the Taoiseach made an empty, dishonest, fraudulent promise. The Fianna Fáil Minister for Health, Deputy Martin, promised 200,000 new medical cards and 3,000 new beds. These commitments were also bogus. The Fianna Fáil Minister for Finance, Deputy McCreevy, promised there would be no cutbacks. He said: "No cutbacks whatsoever are being planned, secretly or otherwise." That promise turned out to be spurious also. Immediately after the election a Government memo outlining €900 million in cutbacks was issued to the Cabinet.

Fianna Fáil has people to collude with it on its project of misleading the public. The Progressive Democrats Party has supported, every step of the way, what has been proposed at Cabinet. The Government turned its back on the illness and suffering of thousands of people waiting for health care and jettisoned its commitment. It raised medical charges, instituted a staff embargo and made savage cutbacks that targeted the most vulnerable. For 12 months before the general election of 2002, the money tap was turned on and public expenditure increased by 27%. Once the election was won, the tap was turned off and the splurge ended along with the hopes of thousands of hospital patients. So steeped in cynicism is the Government that it is now preparing for a second time to manipulate the health needs of sick people to win votes in the run-up to the local and European elections. It is again planning to turn on the money tap for electoral advantage.

The Labour Party is having this debate so that, this time, patients will not be made to suffer. We will not tolerate the brand of Fianna Fáil trickery that had Ray Burke transporting trees into a newly built housing estate for the duration of a by-election in Dublin West. Once the votes were counted, the trees vanished. The Labour Party is determined to ensure that Fianna Fáil and the Progressive Democrats do not pull the same stunt twice. This is why we have tabled this Private Members' motion: to hold the Government to account and to ensure that those in need of health care can access the care they need through the locked doors of medical units that have been callously kept closed by the Government, and through the introduction of effective measures to deal with the crisis.

This week, a confidential Government aide-mémoire was leaked to The Sunday Tribune. It sets out the stark reality that health has never been a priority for the Government. In fact, the needs of patients have been cruelly and deliberately set aside. Despite the urgent need to expand capacity within the health service, the Government decided to spend the money elsewhere. It chose other priorities. According to the aide-mémoire:

Some €400 million capital funding has been invested in a number of new health facilities that are ready for equipping, commissioning and opening. Many have been completed and have been waiting to open across a range of health care programmes. With the introduction of the existing level of service bases for conducting the Estimates process, funding was not provided for the opening of new units in either 2003 or 2004. If these units are not opened in 2004 the investment that has already been made in the units will not be properly utilised. It should be noted that there is an ongoing cost to the Exchequer in maintaining completed and vacant facilities by way of security, depreciation and other non-pay costs, for example, heating.

In other words, it is deliberate Government policy that is keeping these new health facilities closed. Not only are patients paying the price for this policy, the taxpayers are also paying the cost of unnecessary security and maintenance in unopened facilities.

Being in Government is about making choices. Instead of choosing to spend money to alleviate the suffering, pain and illness of those on hospital waiting lists, as it promised it would, the Government chose to spend the money elsewhere. They squandered an equivalent amount on an electronic voting system that was so unreliable it had to be abandoned. A ministerial ego trip became the priority instead of health. Here was a voting system that nobody wanted, nobody requested and ultimately nobody could stand over. This resulted in €50 million being flushed down the drain by an irresponsible, arrogant Cabinet headed up by a man who promised to abolish hospital waiting lists within two years.

We now know because officials from the Department of Health and Children have spelled it out in black and white that this €50 million would have opened up a whole range of new medical facilities and that had this been done, a great amount of suffering and sickness would have been alleviated. For example, the Government could have opened new and expanded accident and emergency departments at Cork University Hospital, Naas General Hospital, James Connolly Memorial Hospital and Roscommon County Hospital. Instead these units continue to lie idle.

In the meantime the crisis in the emergency services has deepened in the past two years. Hundreds and hundreds of patients have been laid on trolleys or sat on chairs in accident and emergency departments across the country. Patients have been treated on occasion in the car park of Beaumont Hospital. On 5 February 2004, in an unprecedented move, St. James's Hospital was forced to invoke its major incident plan because clinicians were simply overwhelmed by the demand. In Wexford Hospital, the situation was described as chaotic.

The Irish Nurses' Organisation itemised the overcrowding in accident and emergency departments, stating the number of patients waiting on trolleys and chairs on one day as follows: Tallaght Hospital, 42 patients; Naas Hospital, 37 patients; the Mater Hospital, 30 patients; Beaumont Hospital, 28 patients; St. James's Hospital, 28 patients; James Connolly Memorial Hospital, 23 patients; St. Vincent's Hospital, 13 patients; St. Colmcille's Hospital, six patients — a total of 207 patients on trolleys and chairs. On the same day in Limerick Hospital, 33 patients were waiting on trolleys and chairs. In Cork University Hospital there were 18 people waiting and in the Mercy Hospital, Cork another 11 patients were waiting in this way. That is the true human cost of the failure of the Minister for Health and Children, Deputy Martin.

In December 2001, in the run up to the Taoiseach's solemn promise to the people, 26,126 were waiting for hospital treatment and in the most recent figure, it has risen to more than 27,000. Hospital units have been constructed and completed that would have eased this pressure but are being deliberately kept closed. According to a Government aide-mémoire, 220 new beds could have been added to the current bed numbers, as well as increased theatre capacity for example at Our Lady's Hospital for Sick Children, Crumlin, Limerick Regional Hospital, South Tipperary Hospital, Clonmel. There could have been increased capacity in intensive care, coronary care and high dependency units for example in Portiuncula, University College Hospital Galway, James Connolly Memorial Hospital and at Naas Hospital. We could have developed cancer services in Cork and Galway and opened new hospital buildings at St. James's Hospital, James Connolly Memorial Hospital and Naas Hospital and we could have fully commissioned a new trauma and elective orthopaedic service at Mayo General Hospital. I have not mentioned Mullingar Hospital, because my colleague, Deputy Penrose will deal with it tomorrow, but it is probably the longest standing scandal.

It is clear the Government had within its powers the capability to address the needs of critically ill patients and patients waiting for elective procedures. It could have done what it promised, introduced improved bed capacity, primary and secondary care and targeted reform initiatives. What did it do? The Cabinet spent €50 million on e-voting machinery and €15 million on an equestrian centre. It looked after the horses and machines, but forgot about people. The Government refused to spend the money on opening health care facilities as they came on stream. Let us be clear, all the Cabinet, including the Taoiseach, the Minister for Finance and the Minister for Health and Children bear responsibility for what has happened and what has not been done.

The Labour Party raised the crisis in our health service on many occasions in the House. Our view is expressed in the motion before the House and is vindicated by the contents of the leaked departmental memo which states:

The challenges currently facing the acute hospital system include shortage of beds, unacceptably long waiting times, long delays in A & E departments, frequent cancellations of elective admissions, inappropriate occupancy of acute hospital beds, unacceptably high bed occupancy levels.

One issue that we would have added to the list is the unequal treatment between public and private patients. It skews the treatment that people can access when they need it. Treatment is not delivered on the basis of need, but on the basis of income.

Belatedly I welcome the Minister for Health and Children. I know Deputy Martin has had a busy schedule, spinning yarns to the public, but people will not be fooled by the gloss he is able to put on the bad figures.

The aide-mémoire prepared by Government officials is substantially the same as the Labour Party has articulated and repeated in the motion before the House tonight as being the outline of the underlying problems in the acute hospital services, in particular. This is in direct contrast to the smug assurances given many times in this House by both the Minister for Health and Children the Taoiseach and the Tánaiste on the state of the health service. Not only does the memo spell out the real and parlous state of the health service, it reveals the mendacity of a Government that deliberately prevented people gaining access to the new facilities that have been constructed under the National Development Plan but have been kept closed under the Fianna Fáil and Progressive Democrats Government. The memo states that €400 million worth of facilities are lying idle across the country and if they were opened they "would have an immediate impact on relieving pressure on services such as acute hospitals, services for older people, mental health services, services for persons with intellectual disability or autism and adult homelessness".

We are calling on the Government to open these units immediately, not because there is an election in the offing but because patients needs access to health care and they have been denied this access for too long. We are also seeking in the motion that all hospital beds currently closed or under threat of closure be re-opened. Earlier this year, the Eastern Regional Health Authority promised to open 196 acute and non-acute beds. Will the Minister for Health and Children tell us how many have been opened and the current number of closed beds across the country? In recent days I have received a complaint that approximately 30 to 40 beds will be closed in Tralee Hospital for a number of months for "budgetary reasons". How can the Minister stand over such closures?

It is bizarre and perverse that on the one hand, Government policy is supposed to be committed to providing new beds, while at the same time hospital beds are closed to save on running costs. In the latest figures, it is estimated that 50,000 bed-days were lost in the first six months of 2003. When money was allocated to re-open beds to deal with this problem particularly in the Eastern Regional Health Authority area, another aspect of bed closures, the lack of nursing staff, suddenly became the issue. According to the national survey on nursing resources, published by the health services employers agency in February 2004, there are still 675 nursing vacancies. In one case alone, there are 59 vacant posts in Beaumont Hospital, one of the largest and busiest hospitals in the country where the total number of nurses fell in 2003. In all acute hospitals that have waiting lists, a full nursing complement must be guaranteed and it is up to the Government to introduce the necessary measures to meet that target. The dedication and the hard work of the existing nursing staff cannot be relied upon indefinitely to prop up a failing system. There will be no nursing graduates next year due to the introduction of a new nursing degree programme. Surely that prospect is sufficient to focus the Government on the gravity of the situation.

There is a need to tackle the blocking of acute beds by patients who could and should be in rehabilitation beds. Again, the Government promised much but did not deliver. The PPP nursing units never materialised. There are hundreds of private nursing home beds vacant, yet waiting lists for rehabilitation places and budgetary pressures determine an inappropriate use of acute beds in our hospitals.

The motion seeks that a real emphasis be put on community and primary care. Regrettably, the record shows that, far from supporting a policy shift towards primary care, all we have got from the Minister, Deputy Martin, and the Minister for Finance, Deputy McCreevy, is greater inequality and unfairness at that level of care. Today only 27.7% of people have medical cards on income grounds. This is the lowest level since the GMS card was introduced in 1972. This country has become wealthy in the meantime, yet we cannot ensure that people on modest and low incomes are protected in the way they were in 1972. In 1977, almost 39% of the population was covered by the GMS scheme. The income limits rise with the consumer price index but not with wages or social welfare rates. Fewer and fewer low paid workers have medical cards, yet medical costs are increasing much faster than the CPI. GPs' charges have increased and most of the increases are the direct responsibility of the Minister for Health and Children. He increased costs in the drugs refund scheme, accident and emergency charges and in-patient hospital care.

One family doctor said at the recent IMO conference that they have all seen people putting their own lives and the lives of their family and children at risk because they cannot afford to see a doctor. What kind of legacy is that? What Minister for Health and Children can stand over a situation where people cannot access their family doctor because of the cost of doing so? No other European country would tolerate this situation, yet the Minister can blithely continue on as if a promise to provide medical cards is something which simply exists to be broken. The Minister for Health and Children promised 200,000 new medical cards prior to the last general election. Since then the number of medical cards has decreased. There are 100,000 fewer medical cards in the system than previously. It is a scandal that low income families, living in one of the wealthiest countries in Europe, cannot afford to bring their children to the doctor.

Another IMO member said, in reference to the debacle regarding the over 70's deal which the Minister bungled following the budget announcement by the Minister for Finance, that people with less need were prioritised over people with more need for purely cynical political reasons.

I have no doubt that when the Minister for Health and Children responds he will go through his usual rigmarole, explaining how more money is being put into the system and everything is hunky-dory. No doubt he will refer to his primary care strategy, but he will not tell us the fully story. He will not admit that seven of the ten primary care projects are bogged down, funding has dried to a trickle and the entire process appears to be going nowhere.

We have had, and continue to have, a Minister for Health and Children who has not dealt with the real issues in the health service, real issues that impact on patients. The record is clear. Thousands are still waiting for hospital care. There are fewer medical cards and greater injustice at primary care level. New hospital wards and operating theatres are locked and existing beds are closed. When a need has gained his attention, the Minister's response has been to commission yet another report. Approximately 147 reports, commissions and task forces have come out of his Department since 1997. I heard today that the Government is producing €1 million worth of reports each week. It would be interesting to know if that is true because I have it on good authority.

I suspect that the Minister is blinded by the flow of expert advice he had unleashed. He no longer sees the needs of patients. Today he is confronted by an increasing number of patients on hospital waiting lists and his response has been to manipulate the figures and make false claims. It is as if nothing has changed. The only difference is that in the meantime the plans have become more grandiose, more ambitious and more out of touch with what people who are trying to access health care need. This is evident in his whole approach to local hospitals and his policy of closing accident and emergency departments.

Concerns are now being raised about the Minister's approach by health professionals, people working in the health service who have knowledge that none of us here have. They are increasingly worried about his neglect of the nuts and bolts which are now slipping off the programme, particularly proposed legislation. The Government can no longer give a timeframe for such vital and basic legislation as the medical practitioners Bill or the nurses Bill. All this has been put aside while the Minister concentrates on his major health reform project.

He has no answer to the serious concerns being raised by health professionals about the working time directive to be implemented on 1 August. The Minister has made it clear that he will not seek a derogation of the working time directive, and the deadline will be met. He has made it clear that he will not appoint new junior hospital doctors. He has also made it clear that no extra consultants will be in place on this date. The question that has been asked by people working within the service, including doctors, nurses and managers, is how will this be done. The obvious way the directive requirements will be met is by reducing out-patient clinics and operating theatre hours, which means reducing patient care.

Too often patients have to pay the price for failure of Government policy. It appears that we are again facing patient suffering and patient pain being prolonged unnecessarily because the Minister for Health and Children is unable to meet the basic needs to put in place the patient-friendly and efficient measures sought in the motion before us tonight. The motion seeks to ensure that the crises in accident and emergency departments are tackled, that bed blocking is reduced significantly, new beds are put in place, existing beds are maintained and that people, including children, who get sick know they can see their family doctor and no longer put theirs or their children's lives at risk because the Government has failed to deliver on a promise made to the Irish people.

The Minister for Health and Children is continuing to spin as best he can, even though he is running out of credibility.

See this speech in context