Dan Neville (Limerick West, Fine Gael)

I welcome this debate and compliment the Independent Deputies on their initiative in proposing it. I am pleased to have an opportunity to contribute on behalf of Fine Gael.

The Ministers of State, Deputies Tim O'Malley and Brian Lenihan, must be extremely concerned at the confirmation today of the Opposition contention over a number of years that the health services fare badly when considered in a global context. Our service compares poorly to 22 national health systems according to a survey published by the Economic and Social Research Institute today. In fact, the Irish health system came last and second last in two of the three categories examined. The Republic rated joint last with Japan in terms of non-medical factors, including tobacco and alcohol consumption, road traffic injuries and immunisation rates, of which the Government has made great play since entering office. Ireland ranked just above the United States of America in second last position in terms of outcome in rates of heart attack, cancer and suicide. The Republic's performance on life expectancy at birth for men and women was in the bottom third of countries. These are key criteria by which the success or otherwise of a health system is examined.

Ireland is the lowest spender alongside Finland in terms of financial resources devoted to health across the 22 countries examined. We devote just 7.3% of our GDP to health spending compared with an average of 9% across the 22 states. We hear constantly that we are spending more and more and both Ministers of State present this evening said as much again. We have been shown internationally to be the lowest spender of 22 states examined by the ESRI.

The drop in medical card numbers is one of the key issues which has been raised recently. Members of the Opposition have been recalling that while 200,000 medical cards were promised almost two and a half years ago, 101,000 fewer people are covered by the medical card scheme than when the Fianna Fáil-Progressive Democrats coalition was elected. Approximately 37% of the population had medical cards in 1997, a proportion which has been reduced to 28%.

The people most affected are those on incomes marginally above the level at which they would be entitled to a medical card. They cannot afford doctors fees and access to basic medical care. General practitioner care is becoming unaffordable for a significant minority of people on the margins of eligibility and they are suffering great hardship. People on the margins are now presenting late in illness and neglect chronic problems because they cannot afford the cost of accessing early a medical doctor. The absence of a medical card is particularly problematic for people with chronic illnesses such as heart disease and diabetes. Failure to treat such problems could result in serious difficulties later, such as heart disease, kidney failure and stroke. The Government is penny-pinching and will pay later when these diseases, which could have been prevented with early intervention, arise.

The medical card scheme was introduced to provide care for those on low incomes. The vast majority of medical card holders today are those on social welfare, those aged 70 years and over, those suffering chronic illnesses and those who qualify under exceptional circumstances. It is my experience that fewer people are now eligible under the chronic illness criteria. It is as though a message has gone out to the health boards to clamp down in this area.

The Minister of State referred to the issue of over-crowding in accident and emergency departments. There is an urgent need to deal with this issue as we enter a period of climate change with many elderly people and others likely to present with symptoms of influenza. We should not have to seek to deal, under Standing Order 38 or by way of Adjournment debate, with matters such as people being treated in the back of ambulances or hospital yards, or awaiting treatment for days in emergency departments. Something by which the new Minister for Health and Children will be judged this winter will be the number of issues, such as people awaiting treatment in emergencies, raised by way of Adjournment debates or under Standing Order 38.

The Minister of State spoke at length about the reduction in waiting lists. However, he did not refer to those awaiting placement on waiting lists. Many people are awaiting consultations which will enable them to get on to waiting lists. I was approached by a person two weeks ago who has been waiting for four years for an ENT consultation following which he will be placed on a waiting list. The Minister of State may boast that he will receive surgery within 12 months. That may be true, but he will have had to wait four and a half or five years for that intervention. The Minister should, in an effort to be open and transparent on this issue, speak of those awaiting placement on waiting lists.

While I welcome the motion, it does not refer to mental health, an issue which I raised with the Independent Deputies. I am disappointed the Minister of State did not speak of mental health as an issue in terms of the general health service. I am also disappointed the Minister did not address that issue. However, I am hopeful that, as a member of the Progressive Democrats holds the senior Ministry in this area, the Government will respond favourably in terms of the availability of resources for the mental health system.

Some 11% of the total health budget was devoted to mental health when the Fianna Fáil-Progressive Democrats Government took office. That figure now stands at 6.7%. It is not unfair to ask the Government, on behalf of the 25% of the population who at some stage will suffer a mental illness, those who suffer in hospitals or from trying to access them and those who suffer because members of their families have taken their lives as a result of the lack of proper treatment in the mental health area, to restore the mental health budget to that which obtained when the Fianna Fáil-Progressive Democrats Government took office in 1997. It is only then that the Minister will have a base from which to work in improving the situation. I could be emotive and critical on this issue but I implore the Minister to seriously examine the mental health area.

I hope the new Minister for Health and Children will respond positively to the Minister of State, Deputy O'Malley, as a member of her party, in addressing that issue. I again welcome the debate and congratulate the Independent Deputies on tabling this motion.

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