Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)

Ordinary citizens have a right to ask what these Estimates actually represent and what they will mean in practice. Once again the Government is attempting to blind the people with apparently massive spending figures. The money is being spent, but are the services being delivered? For many thousands of our people, the answer quite simply is "No".

This evening, people in Cavan and Monaghan in my constituency learned of another blow to the health services in those counties. The proposals from the Royal College of Surgeons in Ireland and the national hospitals office are an attempt to set in stone the scandalous situation that led directly to the death of Patrick Walsh because he could not be operated on in Monaghan General Hospital. They completely ignored the demand from the Cavan and Monaghan consultant surgeons in September for resources to be provided by the Government to allow Monaghan General Hospital to return to fully on-call status. Those resources are available. What is lacking is the political will. It is indicative of the Government's flawed approach across the public services.

The Estimates for health show another rise after successive years of rises, each failing to keep pace with current health care inflation. Consider the disaster area that is our health service today. Despite the dedication of health care workers at all levels, the system cannot cope. The open letter to the Tánaiste and Minister for Health and Children from Dr. Seamus O'Reilly, consultant medical oncologist, has again exposed the reality of a fundamentally flawed health service. Promised beds have not been delivered, the promised elimination of hospital waiting lists has not happened, the roll-out of BreastCheck and other cancer services has not yet taken place. Dr. O'Reilly serves a population of 500,000 people and states the computer systems available to him are inadequate. As a result, 10% of cancer patients under his care in the region are not recorded on the computer generated list. However, €195 million of taxpayers' money was squandered on the failed PPARS and FISP IT systems.

There is another much more fundamental reason our health system is in such a state and public expenditure is not used to best effect. We have a two-tier public private health system in which an underfunded public system subsidises a private system, and the Tánaiste wants to subsidise the private system even more. The expenditures and tax breaks for private hospitals are to be continued and lands on public hospital sites are to be gifted for the construction of private profit-driven health facilities. The Minister claims it would be too costly for the State to provide hundreds of additional public hospital beds as promised. However, the Government does not know the cost of its tax breaks for private hospitals, which will form the basis of this new plan.

With this scheme, the Tánaiste has also shredded what is left of the Fianna Fáil 2002 general election manifesto health commitments. That manifesto claimed it wanted "the end of the two-tier health system", yet the Tánaiste denies we have a two-tier system. At the heart of Government, in the biggest spending Department and the most important of our public services, is a fundamental disagreement about the basis on which services are being provided.

This Estimates process is essentially a charade, as I described it this afternoon. From the figures we can discern some of the Government's intentions. The increase for child benefit is inadequate and unless it is revised upwards between now and budget day, the budget will be a severe disappointment for low-income families with children. Yesterday the Taoiseach attempted to dampen expectations on child care in the forthcoming budget. Child care will be the litmus test of the budget and the Government has so far failed on that score. It was the biggest omission from last December's budget. It must not fail again.

Let it be clear that we do not want a repeat of the pre-election national health strategy of 2001, a bundle of promises which remain largely unfulfilled. We must await the budget to see whether the Government will deliver the comprehensive child care package it has promised. This would include measures to increase the supply of quality child care, which is accessible to all who need it and support for those using existing child care services. I hope both Ministers will heed these important points and use their influence during the remaining weeks to budget day.

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