Michael Woods (Dublin North East, Fianna Fail)

The chief executive and chairman of each health board used to attend. One board would not move unless the other moved owing to the way the system worked, which was that any unspent money at the end of the year was lost. One board would not make savings unless the other boards made similar savings. By bringing them together they agreed what had to be done. We were able to bring our budgets back on target even during the MacSharry era, which was a fairly tough time in terms of money. It took considerable hard work to maintain the services and get them back on line.

All these bodies have now been dissolved and their members must feel as we do on the day the Dáil is dissolved. As Deputies, we must go to the people to look for our jobs back. The former board members must find where they will go. While they have been given guarantees that their jobs will still exist, this is a traumatic period for them. We should publicly acknowledge the work they have done and their achievements on our behalf. Huge improvements have been made in the services in the past ten years.

The Tánaiste mentioned a budget of approximately €10 billion with almost 100,000 employees, which reflects a massive increase in the past six years and has resulted in better services. In the Estimates the Minister for Finance mentioned a figure of €11 billion at a time when our population is increasing. The Tánaiste has said the CEO will be the Accounting Officer for the Vote, not the Secretary General of the Department of Health and Children. This issue should be teased out on Committee Stage, as I would like to understand how that will work in practice. The CEOs often need to call on the Department of Health and Children, which needs to call on the Minister for Finance for the money to keep services going or deal with urgencies and emergencies which arise. It will be interesting to see how that will progress. I note the Tánaiste adverted to some potential technical amendments in this section on Committee Stage.

Yesterday in his speech on the Estimates, the Minister for Finance pointed to significant improvements since 1997. He said:

The cumulative increase in gross expenditure on health over the period 1997 to 2005 will amount to 205%, representing an extra €7.4 billion. Staffing levels have increased by almost 50% from a base of 66,000 in 1997 to almost 98,000 this year.

The Tánaiste might be somewhat closer to the mark with her figure of 100,000. If home helps and others were included the figure would be in excess of 100,000. The Minister for Finance continued:

This has included a significant increase in front line service staff. There is an additional 6,500 nurses, representing 21% of the increase in staff numbers, with further additional staffing increases in the provisions of therapists, dentistry and orthodontic services, medical professionals and social care professionals.

I fully appreciate the difficulties with orthodontic services because it is very difficult to get people to serve the public sector in that area. The Minister for Finance also pointed out:

There has been a concomitant improvement in service delivery with an increase of 30% since 1997 in the number of patients treated in hospitals as inpatient and day care patients. There has also been a reduction in waiting lists with 80% of patients now waiting less than one year . . . and an increase in the elective surgery rate in public hospitals of 85% between 1995 and 2002.

These are all huge achievements in recent years.

I live in the Eastern Regional Health Authority area, which covers a vast area. That authority has been operational for just over three years. Its first chief executive officer was Donal O'Shea, who came from Donegal and I congratulate him on what he achieved in that time. I knew him in the early 1980s when I was Minister for Health. He made tremendous advances in the north-western region, particularly for older people. He put enormous time and work into what he did, as did Alderman Joe Doyle, the authority's chairman. People underestimate the contributions of people like Alderman Joe Doyle of Fine Gael, who is an excellent person, to the development of the health service we have today. Michael Lyons is the regional chief executive officer now.

While the Tánaiste talked about an historic development, the dramatic improvement in the Eastern Regional Health Authority area in three years has been an historic development for us. The voluntary hospitals and agencies have been co-ordinated into one administrative body. It would have been impossible to talk about such a development four or five years ago because the voluntary hospitals were all independent, voluntary and very conscious their entitlements and rights. Budgets and financial matters are all handled in the one body now. Further decisions can now be taken based on what has been achieved in the area and it has opened up huge possibilities.

Of the €11 billion almost €4 billion will be spent in the Eastern Regional Health Authority area, which gives an idea of the number of hospitals and amount of treatment in the area. Every section of its report, the Eastern Regional Health Authority shows dramatic increases in day care patients and inpatients. For the first time we will have an integrated service for the community, a huge increase in support staff and a far better service. While we will always be able to find problems and issues, I deal with a cross-section of people whose appreciation of what is achieved on behalf of individuals in, for example, Beaumont Hospital, the Mater and other hospitals is great. We only hear about cases, however, where something goes wrong and someone was not treated as well as he should have been.

Growth has been phenomenal and rapid in recent years. Just as we need roads and rail services, we need more hospital beds. In my constituency alone, 15,000 houses are being built between the race course in Baldoyle and Belcamp, all in the catchment area of Beaumont Hospital. It is estimated that 40,000 more people will move into the area, resulting in even more pressure on the hospital. Mr. Charles Haughey was involved in the vision for Beaumont Hospital. He used the Cork Wilton model so he would not be delayed and built it on that basis. The hospital was completed in 1982 and it now has to deal with the huge extra demands. It is bursting at the seams and needs capital investment or it will be unable to cope. Similar pressures exist in Tallaght, the Mater Hospital and St. James's Hospital. Someone mentioned to me yesterday that St. James's Hospital is like a shopping arcade there are so many people there. I was in Beaumont a week ago and the volume of people coming and going was incredible.

These hospitals are not big enough to cater for these numbers. It is important to look at and meet capital needs. People worry that if we build more hospitals, we will need more staff. That is an issue but staff numbers are not always a problem. Often we are just talking about extensions or rooms for recuperation. We need major investment in beds for older people to free other beds in the hospitals.

We are storing capital to pay for pensions in 20 or 30 years. I disagreed with the figures for pensions that indicated that demand would be far greater than it will be. A report has now been published indicating that it will not be as bad as we thought in the first instance. Why is that? Because the country is growing and the population is increasing. There is more activity and there are more people. Those estimates were made on the basis of a small, static population largely based on the birth rate. Now, however, people are coming from all over the world to live and work in Ireland. There is plenty of scope for work and development in Ireland. We are now waking up to the fact that we are important internationally and have a valuable contribution to make. We are making that contribution, not just in Ireland but throughout the world in every respect. The argument on overseas development aid has made people realise how much we are spending in that area.

We should invest the capital we have, not try to hide it. The Minister for Finance cannot let the economy overheat and must keep the international investors happy that things are under control but capital can be prudently invested in the provision of facilities. Our health facilities are seriously under-provided on the capital side and we should not let that continue. We should not say that we will do more when we have more money. The Minister will do more in the budget, but he should be brave about it. I got away with five secondary schools when I was Minister for Education and Science under public private partnership that cost €85 million in one year. The spend that year, 2002, was the highest ever without including that figure. It was my job to find ways to do things for the children who did not have proper school facilities and we must do the same type of thing in health.

I wish the Tánaiste every success with this legislation. The sole caveat is that this must be done with the people in mind. If the people are supportive, it does not matter how much money the Department has. Perhaps I should not say that or the Minister for Finance will jump on it, but it is amazing what can be done with the support of the people. We want the services and we want value for money but we must look after the people.

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