Olivia Mitchell (Dublin South, Fine Gael)

Irrespective of who draws up the lists, how they are manipulated and what spin is put on them, the fact remains that even using a new accounting method discovered just in time for today's debate, a staggering 22,500 people still await treatment. The Minister's boast is that the figure has been reduced to 22,500 after two years, despite the large amount of money at his disposal. What happened to the 4,500 people in question between this morning and lunchtime? According to the Minister's statement, they were either not available for treatment, not medically suitable for treatment, no longer in need of treatment or requested postponing treatment. How do we explain this? The answer is that they either emigrated in despair, were too sick to be treated, died, or moved into the private system. The reality is that nobody recovered miraculously or if someone did, the Minister should start selling relics.

This motion is not only about political point scoring and another broken promise but the price people pay for the Minister's broken promises. Sick and disabled people, the elderly and those in pain pay the price in pain, suffering, lost mobility, lost jobs and lost lives. Chronic waiting lists are not just another problem in the health service but the manifestation of the accumulation of many problems in the health service which have remained unresolved. They are the bottleneck into which indecision, shortages, inadequacies and inefficiencies have fed. Consequently, as the motion states, ending waiting lists is not solely a matter of bed capacity but of staffing and equipping beds and a range of other measures.

Let us examine the Government's record on bed capacity. It has known for years from numerous reports that there are not enough beds in the system and the Minister has accepted that. Not since the time of the MacSharry cutbacks of the 1980s and even before that has the problem been so acute. Even the Hanly report accepted the need for an additional 3,000 beds as recommended in the health strategy. Despite giving a commitment to provide this number of beds over ten years, as with so many other promises, the Government's undertaking appears to have run into the ground.

What is most disturbing is the absence of preparation to deal with the problem, not only in terms of developing physical infrastructure but as regards staffing — consultants, nurses or the many specialist health care professionals required. Where will the professionals be found to provide the beds the Government continues to promise on foot of the Hanly report? The problem is not only one of money but that the staff required have not been recruited not to mention trained.

We cannot even retain those whom we train. Endless warnings have been made about the need to match the number of those in training with service needs. Like so many other well signalled disasters, however, these warnings have been ignored. It was precisely this lack of foresight in health and other sectors that killed the Celtic tiger. In other words, demand outstripped the supply of skilled manpower, which fed into higher labour costs and prices and, ultimately, resulted in a loss of competitiveness. The Government has learned nothing from that, yet it expects us to slavishly believe the promise in the Hanly report that we will have hordes of consultants touring networks of hospitals to treat people at will. Increasingly, such fanciful promises sound like the ravings of someone less and less in touch with reality. Perhaps the Minister is very much in touch with reality and the Hanly report and all the other reforms are nothing more than an effort to distract attention from the crisis now pervading virtually every sector and layer of the health service.

Growing hospital lists and trolley clogged accident and emergency departments are all part of the same problem. They are two sides of the same coin which are widely reported, visible, quantifiable and shocking. Other waiting lists, however, are not reported in the media and while they may not be as visible or quantifiable, they are just as shocking. We do not hear of the children who will never be able to communicate because they were unable to get speech therapy at the crucial time of their lives, or of those who become permanently disabled or lose mobility because of a lack of physiotherapy.

The real scandal, the real hidden waiting list, is the one that causes the greatest distress and suffering and results in the highest morbidity and mortality. It is the list of those waiting to see a consultant in the first instance, a group of people without even a diagnosis, much less a treatment, who sit on referral lists for endless months and about whom we never hear.

If we had a sufficient number of consultants, this would not happen. If we did not have the ludicrous position in which virtually the only way to become a consultant is through Government appointment, perhaps it would not happen. If, instead of rationing access to care for patients, consultants were competing for business, perhaps it would not happen. If that idea is too revolutionary, we should at least have some transparency about waiting lists. Why are the public and general practitioners unable to find out which consultants have long and which have short waiting lists? This would enable them to at least make choices. Surely, in this age of consumer information, this is not too much to ask.

If we had more consultants, there is no doubt that demand for expensive, acute beds would be reduced, people would see their consultants before their conditions deteriorated and consultants would have more time to organise tests outside acute hospitals without feeling the need to admit patients and cluster them as a time saving exercise.

We were also promised improved and enhanced primary care as a means of reducing waiting lists. A strategy outlined a brave new world of primary care in which demand for hospital admission would be reduced through targeted intervention, early detection and ongoing illness management but virtually nothing happened. Even this year, primary care is the only area in which Government expenditure is falling as fewer and fewer families can afford to attend their general practitioners. More families must now make a choice as regards which members can attend a GP. They must prioritise between the breadwinner and the sickest, oldest and youngest family members and decide which of them will get part of the family's limited budget to pay for a visit to their general practitioner.

These are the kind of devastating choices families have to make as a result of this Government's broken promises. There are families who are on waiting lists to see a consultant for a worrying and maybe painful condition, families who have loved ones awaiting admission for elective surgery, and families whose elderly parents lie for several days on trolleys. All these families place their trust in the Minister and the Government. No matter how the Minister spins it, and he is good at doing that, they know he has failed them. He will pay the price for this.

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