Liz McManus (Wicklow, Labour)

I move:

That Dáil Éireann:

—notes that over a year has passed since the Tánaiste became Minister for Health and Children and that since her appointment the problems in the health service, in particular for emergency patients, has actually deteriorated;

—records with regret the unnecessary death of Mr. Pat Joe Walsh at Monaghan General Hospital;

—deplores the abject failure of the Tánaiste and Minister for Health and Children to ensure delivery of her ten point plan to resolve the accident and emergency crisis;

—recalls that the Tánaiste and Minister for Health and Children said on 25 January 2005 that the accident and emergency crisis was a litmus test for her and for the Government;

—expresses its concern at the continuing serious overcrowding in accident and emergency units, which reached unprecedented levels during the summer months and notes that according to the Irish Nurses Organisation (INO) as recently as 11 October there were more than 300 patients on trolleys;

—recognises that, despite the Tánaiste and Minister for Health and Children's promise that there would be significant improvement by this autumn, 378 patients in the main Dublin hospitals are still inappropriately occupying acute beds and waiting times for accident and emergency patients have increased; and

—acknowledges the deep public anger at the massive waste by this Government in the health service amounting to hundreds of millions of euro on botched projects like PPARs and FISP;

calls on the Taoiseach and the Tánaiste and Minister for Health and Children to:

—accept political responsibility for the delivery of health services;

—deliver on their promises in regard to the accident and emergency crisis;

—open immediately all outstanding hospital wards and facilities;

—develop as an urgent priority, community nursing units to relieve pressure on the acute hospital sector;

—re-balance the incentive system that is creating a dearth of GPs in areas of disadvantage and adding pressure to accident and emergency departments;

—ensure supports are put in at community level so that patients can be cared for in, or close to, their homes; and

—tackle the worrying rise in MRSA infections effectively.

I propose this motion on behalf of the Labour Party. It is a record of the failure of the Minister for Health and Children who has been in office for over a year. It is also a template for action which the Government should adopt but which it will, as so often before, choose to ignore. The Tánaiste's appointment as Minister for Health and Children was warmly welcomed. She was seen as a straight talker, one who would get the job done after the lamentable record of her predecessor whose main achievement was to commission 143 reports and working groups. When action was needed the previous Minister, Deputy Martin, gave us promises. Later we learned he did not even meet the basic duty of a Minister which is to keep himself or herself informed and to read a brief. His failure cost the taxpayer millions of euro and yet with the support of the Taoiseach and the Tánaiste he has successfully evaded any responsibility for that debacle. A year on the public is coming to understand that far from making the position better the Minister for Health and Children, Deputy Harney, has presided over a deterioration in the health service. Her promises have acquired the same hollow ring as those of the previous Minister, Deputy Martin.

It is worth reminding ourselves that the Minister, Deputy Harney, said at the beginning of the year:

People will judge our health services by accident and emergency services. The Government will also judge our health reform programme by whether it makes measurable improvements in patients' health care experience, including their experience of accident and emergency services. I have stated that long waiting times at accident and emergency departments are not acceptable to me or the Government.

These were brave words but they have turned out to be absolutely worthless. Despite the promises by the Minister, Deputy Harney, the accident and emergency crisis has got worse. We know from figures released by the Health Service Executive that the average number of people waiting for admission to the Mater Hospital in Dublin for more than six hours has risen by an extraordinary 70% between September 2004 and June 2005. The long waiting times in accident and emergency units have, in reality, got significantly worse since the Minister, Deputy Harney, took over.

The waiting times are longer and the number of people waiting is greater. On 18 November 2004 on the day when the Minister, Deputy Harney, announced her ten point plan to address the crisis in accident and emergency units there were 163 patients waiting in trolleys in accident and emergency units. Almost a year later, on 11 October 2005, the numbers reached a staggering 321. The CEOs of the main Dublin teaching hospitals recently described the position in their accident and emergency departments as chaotic. Dr. Aidan Gleeson, accident and emergency consultant at Beaumont hospital, has said that having 40 patients on trolleys is not unusual and that the position is worse now than last year.

Last year the Minister, Deputy Harney, said she expected real and measurable improvements to take place in the coming months in the delivery of accident and emergency services. The months have come and gone and the only change in accident and emergency services is a worsening of a situation that was already almost unbearable for too many patients.

In the case of one emergency patient his wait ended horrifically. At Monaghan General Hospital while staff looked on helplessly, Mr. Pat Joe Walsh bled to death because our health service was unable to provide him with the straightforward emergency surgery that he needed. People are deeply shocked by what has happened to this man. One letter printed in the Irish Independent encapsulates the feelings of revulsion and dismay that his death has engendered in all of us. It reads:

What use is all our money, all our technology, all our positive economic and government spending statistics and this nebulous and indefinable 'feel-good factor' when Patrick Walsh, may the Lord be good to him, is now nearly a week dead from a thoroughly preventable and treatable problem?

What good is it that a family has lost a loved brother, uncle and friend and these people can get no answer to this needless death, no explanation as to what went wrong, no explanation as to why our health care system in the North East failed so spectacularly, and for them so tragically?. . .

Why do the Walsh family, the people of Monaghan, and indeed the taxpayers and citizens of Ireland see only blank faces when they ask the pertinent questions as to the overall political thrust driving the management of the health system in this country?

Why do they hear only hollow expressions of sympathy . . . and calls for the issue not to become a political football? Surely the governance, performance, financing and management of one of our biggest areas of public spending — health — is a very political matter that deserves vigorous and probing debate.

In response to this tragedy the Taoiseach said in the House, "It is sad when anyone dies but it is wrong to intervene politically." In reply to Deputy Connolly's questions, the Tánaiste reverted to her timeworn and threadbare defence that it was a matter for the Health Service Executive.

Such abdication of responsibility is the hallmark of a degenerate Government that has only one goal and that is to cling to power at any cost. Health care, as the letter writer has said, is an intensely political issue and the needs of the health service demand good political leadership. Instead we have a Taoiseach who does not have the vaguest understanding of those needs and a Tánaiste who is now setting about to use the health service as a testing ground for her ideological views. Her solution is to hand over large chunks of the health service to the private sector for-profit companies who cannot believe their luck at the money to be made at the taxpayers' expense.

When she took office the Minister for Health and Children set the measure by which she would be judged. She said, "Accident and emergency services is a litmus test for me, for the Government and for the people of our country". Those were her words, not mine. She invited us to judge her by accident and emergency services so she cannot complain now when the public judge that she has failed abysmally. Her ten point plan promised minor injury units, chest pain clinics, respiratory clinics, acute medical units and direct access for general practitioners to diagnostic services, none of which has materialised. By this September three of the Dublin hospitals worst hit by overcrowding at accident and emergency units were still waiting for the go-ahead for these new units, nine months after their announcement. In another example, general practitioners are waiting seven months to have a mammography and ultrasounds done at Sligo General Hospital. A consultant radiologist at the hospital expressed herself as embarrassed about the situation. In marked contrast the Minister for Health and Children appears incapable of being embarrassed by anything that fails, and so spectacularly fails, within her remit.

Foolishly, the Minister rammed through the start-up date of 1 January 2005 for the establishment of the Health Service Executive. Her lack of preparation for change has led to an unholy mess of administration across the country which was epitomised by one assistant chief executive officer who complained wistfully that since this change of regime he has had six different job titles. As serious and more corrosive to good government is the fact the Minister, Deputy Harney, has stripped out every bit of accountability from the health service. With the demise of the health boards there is no local accountability or public scrutiny. Answers to parliamentary questions are delayed and go unrecorded. Such a climate is bad not just for democracy but for a health service struggling to meet the challenges set it.

This incoherence within health care management extends to the top of the new structures. The Minister and the Department of Health and Children were to be responsible for policy while the CEO and the Health Service Executive were to be responsible for management only. Yet following the revelations of gross wastage of public money in failed computer systems the Minister, Deputy Harney, has announced her intention to be involved in micro-management to the point where she will approve every outside consultant contract, while the CEO of the Health Service Executive, Professor Drumm, is regularly making major policy announcements which often run directly counter to Government policy. The Minister, Deputy Harney, promised her accident and emergency plan would deliver significant results this autumn.

Professor Drumm has said it will take at least two years to resolve the crisis. Government policy is to provide 3,000 new acute hospital beds. Professor Drumm is on record as opposing this. The Government imposed an embargo on recruitment while Professor Drumm has rubbished the embargo. The Minister announced her plan to hand over 1,000 acute beds to the private sector and Professor Drumm cast doubt on its real cost. Despite all the Government's claims to the contrary the number of acute hospital beds per head of population, far from increasing during the lifetime of the Government, has decreased over the past five years.

The Tánaiste and Minister for Health and Children promised to move hundreds of patients to rehabilitation beds to free up beds for patients stuck on trolleys in accident and emergency departments. Despite millions being spent and repeated claims by the Tánaiste of action, the results are disappointing. Most information about the health service reaching us is coming from Martin Wall and other journalists and not from the Tánaiste or the HSE. According to a leaked memo, in the Dublin area alone 378 patients still inappropriately occupy acute hospital beds. That figure more than any other is an indictment of the failure of the Tánaiste's plan to release beds where they are most needed. This comes from a report from the National Hospitals Office which claims a 22% reduction in the number of people on trolleys between April and September. However, these are meaningless statistics because a reduction always takes place during the summer months.

Some facilities that have been built are still idle because the Government could not find the money to staff and equip them. A figure of €4 million worth of facilities has been cited in the media as still unused. The public wonder why the Government could not find money to open these facilities and then discover that hundreds of millions of euro have been flushed away in a series of failed computer projects. The most grotesque example of delays in delivery of facilities is the extension to Longford-Westmeath General Hospital which includes an operating theatre, general medical ward, rehabilitation unit, child and adolescent psychiatric unit, OT department, education facilities, general surgical wards and an acute psychiatric unit. For more than eight years this facility has been left on hold and the health service in this instance alone is losing 100 new beds. Even within the existing system questions have been raised about the availability of beds. Consistently the Irish Nurses Organisation which represents nurses working at the coalface of the acute services has demanded the opening of up to 480 beds that they maintain remain closed within the system.

It is worth underlining the allocation of €70 million to the Tánaiste's failed ten-point plan. This is only a fraction of the money lost in the PPARS and FISP scandal. I am still receiving calls from people working within the health service itemising other abandoned computer systems. One was attempted in the HIV/AIDS treatment area and was abandoned because it was inoperable. Apparently it only cost approximately €4 million, which the Government seems to regard as acceptable.

On Sunday night the Taoiseach was interviewed on RTE's "Week in Politics" programme and spoke about the PPARS fiasco. He said, "In most Departments, officials were trying to improve the service. Okay, maybe there should have been a check every year, but nobody went out to waste money." The Taoiseach did not tell the true story. A formal body was established, the health service performance verification group, which commissioned progress reports from CEOs of 20 health agencies. These were essentially applications for pay rises under the benchmarking scheme. The CEOs of eight of the nine agencies where PPARS was deployed highlighted the system as a driver of value for money and a justification for pay increases. These reports were verified by the PVG and the increases were paid. Not only were systems in place, presumably designed carefully to verify value for money, they also became part of the problem rather than part of the solution. This is the system, PPARS, which has been abandoned by the HSE as a gross waste of public money.

In the same interview the Taoiseach explained his perspective on his Government's record in the following way:

We've put so much resources into health, so much staff into health, so much capital into health and we still seemingly don't get to where we get now.

It is unlikely that members of the public disturbed by what is happening to their elderly, vulnerable, sick relatives in overcrowded accident and emergency departments will find solace in any opinion expressed by the Taoiseach on the issue of health care. His comments show how out of touch the Government is and how it is floundering rather than tackling the serious problems that face us as we enter the winter period which is a time of pressure on our emergency services. It is important that we do not allow such flimflam to detract from the task that a new Government will face. Political leadership can alter the most intractable difficulties. We know that from our recent experience as a society.

When any Government is focused for example, as Governments have been, on resolving the deeply challenging conflict in Northern Ireland we have seen the strength and power of good political leadership. If the same effort, intelligence, resources and determination that have gone into providing a democratic resolution to a terrible conflict could be diverted now into tackling the deep-seated, endemic problems in our health service we would have the world-class health service that we can well afford. Instead the Taoiseach offers us gobbledegook and the Tánaiste hides behind the Health Service Executive.

The CEOs in the main Dublin teaching hospitals have presented a carefully prepared document for the Tánaiste and Minister for Health and Children in the last few weeks. In it they state:

At the present time we estimate there are in excess of 250 patients who will not be facilitated within the current arrangements being promoted [in the ten point plan]. It is clear to us that if these beds were created as a once-off initiative the beds in the acute hospitals could be used to create medical assessment units.

This clearly shows the plan set out by the Tánaiste is flawed and it shows her and her predecessor's lack of forward planning in not providing the community nursing units that are so desperately needed. Since 2001, according to the CEOs, fewer than 1,000 beds have been created in the system. The effect of this limited bed capacity is compounded by two significant factors, namely an increased level and intensity of activity and the requirements of elderly patients admitted to acute hospitals. The assessment by these experts underlines the case made by Professor Drumm for the need to resource community-based beds and primary care services, an argument the Labour Party has made on many occasions. Two principles need to apply in the health service, namely, an integrated service to give equality of access and a major shift out of the acute hospital sector and into primary care. Regrettably so far the Government has failed to act on either count.

The Government is good at producing strategies. However, even its own primary care strategy has withered on the vine. It has been starved of funding and the Tánaiste is advising GPs to go to the private sector to seek funding. She wants to see general practice privatised in a new form in a way that I believe will lead to dominance by companies which are driving an agenda to increase the use of pharmaceuticals and medication, which while relatively low is highly lucrative. If we go down that road we will be in great difficulty in a part of the health service, general practice, which works. It will not work unless something is done to address the growing shortage of general practitioners. General practitioners as a group are ageing. In many cases they are not being replaced and even where they are being replaced they are generally replaced by young women who will not work the extensive hours that is the norm for GPs and family doctors. The Tánaiste knows this. She has been told many times that we must make a start on this and should have long before now. This should have been dealt with in the medical schools in this academic year. More than half our medical undergraduates are non-EU citizens who are accepted here because they bring money with them which provides funding for the medical schools. If we do not train our own doctors, we will not have the necessary network and supply of GPs. It takes ten years to grow a family doctor, so to speak. The Tánaiste has said that something will happen in this regard, hopefully in the Estimates or the budget, but she has not been specific.

We should remind the Tánaiste, who seems to suffer from amnesia, that when it comes to issues and decisions made by the Cabinet while she has been Tánaiste and making decisions about the health service, she carries the collective responsibility.

The previous Government, comprised of the same parties, made a total mess of the over 70s medical card scheme. It introduced a form of inequity into the GMS system that never before existed. It created two systems of awards and incentives for family doctors. If a family doctor looks after a wealthy patient aged over 70, a retired judge, a businessman or newspaper magnate, for example, he or she is paid four times more than the standard medical card payment for caring for that person. If the doctor cares for an average worker who has qualified for a medical card, he or she gets one quarter of the over 70s payment. What is happening as a result? The obvious is happening. Doctors are no different from anybody else and operate on the basis of incentives. There is now a dearth of doctors in areas of disadvantage in cities and rural areas.

A Government that is seriously committed to increased access at primary level and to reducing the flow of patients into accident and emergency departments would have introduced incentives to rebalance the system. Such incentives would ensure that GPs were attracted into poorer areas and areas of disadvantage and would set up there to provide services at primary level. That is not happening. The wealthier and older urban areas are attracting the GPs while those areas of our cities that have large populations who need health care, where often there is a concentration of socioeconomic groups who have particularly acute health needs, are the areas having most difficulties. It is these disadvantaged people who largely end up in accident and emergency departments, putting pressure on the system even though they would prefer to be cared for in their communities.

The north side of Dublin is the most extreme example of this problem. There have been long-standing problems there with pressure on hospitals such as the Mater and Beaumont, a shortage of GPs, and difficulties with out-of-hours services which still have not been addressed. Despite the fact that this was part of the ten-point plan, we have still not seen any action..

Another of the Tánaiste's grand plans that has foundered is the Clean Hands campaign designed to combat the spread of MRSA in hospitals. Recently released figures show that in 2002 there were 445 cases of MRSA, in 2003 the figure rose to 480, in 2004 it increased to 550 cases and for the first six months of this year, the number of cases is 314. This steep curve upwards looks set to continue.

Of greatest concern is the fact the Tánaiste doesn't even know how many people have died of MRSA. She admitted this in the House last week when asked how many people had died from this condition. It is an infectious condition that is prevalent not just in hospitals but also in nursing homes and the wider community and the Tánaiste does not know how many people have died as a result of contracting MRSA. What we do know is that five babies in the National Maternity Hospital have been infected with MRSA. Dr. Susan Knowles, consultant microbiologist in Holles Street Hospital has stated:

It is a major problem that we have a total lack of isolation facilities in the neo-natal intensive care ward. There is just one room in the unit. The cots are too close together and like many hospitals, we fall behind the isolation guidelines of the new MRSA guidelines in how far apart to space the cots.

Elderly patients suffer on chairs and trolleys in the corridors of accident and emergency departments. Small babies are at risk from preventable infections picked up hospitals that are supposed to provide the best possible chance of a healthy start in life. We should not and will not blame those who work to provide health services in such difficult and stressful conditions. However, we in the Labour Party challenge those in Government who have been in power for so long and who bear responsibility for this crisis, no matter how much they try to wash their hands and deflect responsibility for it elsewhere.

See this speech in context