James Reilly (Dublin North, Fine Gael)

The Minister should inform his constituents about the threshold of €184. In addition, he should indicate how this approach is patient oriented or patient centred. The Minister took a major pay rise and the Taoiseach gave himself a rise of €38,000. At the same time, someone earning little more than half the minimum wage is not entitled to a medical card. This is a disgrace and a scandal. It will be one of the greatest indictments of the Government, particularly as it occurred during a period in which the country has enjoyed its greatest ever prosperity.

What is the position with regard to the drug refund scheme? We are going to cater for the elderly, the vulnerable and the chronically ill and we will do so by charging them more for medicines. In that context, the threshold relating to the drug refund scheme has been increased from €85 to €90.

There has been a 10% increase in hospital bed and accident and emergency department charges. Someone sent me a text last night saying that I should give the Government hell because, to add insult to injury, it wants to charge people more to wait for hours on trolleys or plastic chairs in accident and emergency departments. People are furious with regard to what is happening.

I wish to refer to the ambulance service in the capital, particularly the part of it provided by Dublin Fire Brigade comprising 13 ambulances. At any given time during the day, the telephone queue for the ambulance service can stand at 300. I met members of the Dublin Fire Brigade who provided me with these figures. There has been a population explosion in Dublin but there has been no increase in the number of ambulances provided in the past 20 years. When I tabled a parliamentary question to the Minister asking why additional trolleys are not been made available in accident and emergency departments in order that ambulance crews might wheel patients straight in and then leave with replacement trolleys, I was informed that it was not safe to move people off trolleys. What a facetious response.

No additional hospital beds have been provided. In 2002, the Government promised to provide 3,000 extra beds but to date it has delivered only 1,000 of these. Where are the other 2,000 beds? This question is particularly pertinent when one considers the increase in population. The Government waxes lyrical about the increased spend in respect of health and the fact that we have reached the OECD average. Following 20 years of neglect, we have finally achieved this. How can we possibly hope to catch up? Everybody knows that one must spend more to catch up when one has been way behind. The most recent figures from the OECD show that we have 2.8 beds per 1,000 of population. This compares with an average across the OECD of 3.9 per 1,000. Is it any wonder that we are in a mess?

The beds that are in place are not used properly. A total of 22,000 bed days were lost in Beaumont last year and even more were lost at the Mater. The combined figure stood at 57,000, which is the equivalent of five 30-bed wards being closed for the entire year. People are not able to leave hospital early because community facilities are not being made available to them when the acute phase of their treatment has been completed.

A sum of €35 million has been provided in respect of cancer care. However, when one digs deeper, one realises that this has been allocated for current spending and that capital spending aimed at providing linear accelerators, new mammography machines and other necessary equipment has not been provided. Compare this amount with the previously announced figure of €400 million which the Government indicated would be the cost of its new super-plan for cancer services under a public private partnership arrangement.

The previous Minister for Health and Children, Deputy Martin, established 117 task forces and committees. He became known as the Minister for committees by the time he left the Department. His successor, Deputy Harney, commissioned a review by Ann O'Doherty — which has not been published — and another by Brendan Drumm in respect of Portlaoise. In addition, other reviews are being carried out in Cork and Galway. What is the best the Minister can do in respect of medical cards? She stated that the data relating to them will be reviewed. The ink on the budget is not even dry and the Government has already reneged on its previous promise to index link the threshold. Nothing will be done until next autumn. If he does not mind doing so, perhaps the Minister for Foreign Affairs will indicate whether he thinks the income thresholds relating to medical cards are fair.

None of the recommendations of the task force on obesity has been implemented. I have called for the carrying out of body tests on a nationwide basis. Due to the fact that prevention is better than cure, everyone should receive an age-appropriate health check and we could thereby catch disease early. For every €1 spent on prevention, €20 is saved on treatment. The Government waxed lyrical about physical health checks but action has not been forthcoming.

A total of €2.1 billion was promised in respect of primary health care and it was stated that 23 teams would be put in place. What do these 23 teams mean to patients? The answer is nothing. No additional service is being created and very few additional personnel are being provided. Everything is virtual. The HSE and Brendan Drumm stated that they want to build up community services. They also indicated that this is where the money should go and that additional hospital beds should not be provided. Community services must be in place before the number of beds can be reduced. Additional beds are required and the Government also needs to deliver in respect of primary health care.

We should have a primary health care system based on the one-stop-shop model, whereby people can see doctors, be referred for blood tests, have X-rays taken and receive their results. Instead of 25 or 37 people being obliged to travel from Swords or Balbriggan to Beaumont or the Mater, somebody could come to their area once a month to see them. That would be real change and it would represent progress. However, the Government will not make that change or provide funding in respect of it.

The number of patients seen by the National Treatment Purchase Fund has decreased to 80 per month. The figure previously stood at 1,400 to 1,700 per month. Cutbacks have obviously taken place in this regard. The allotment of an extra €10 million will not even cover half of these per month. In a memo to the Department last year, HSE officials stated that it was short €350 million for that year. This additional money will not even be able to keep pace. The Government talks the talk, but when it comes to walking the walk, it is actually engaging in health care rationing.

The Government will not give people medical cards, so they cannot afford to see their doctor and they cannot get their medicines. The Government will not support the ambulance service by putting in additional trolleys and more ambulances, so patients cannot get into accident and emergency departments. It will not use hospital beds properly nor will it build more hospital beds, so people cannot get treatment. Basically, it is about protecting the system from the patients.

The Minister of Health and Children is not here today and I know she may have other things to do. At least she had the civility to allow me to attend her press conference, unlike her ministerial colleague, the Minister for Education and Science, Deputy Mary Hanafin, who refused to enter the room and had Deputy Brian Hayes removed forcibly. That is an absolute disgrace. The Government must engage in the commitment that the Minister for Health and Children made to the people of this country. I said before that I will support her efforts if they are real, but I will not support half-hearted, poorly thought out and ill-planned policies that are not properly resourced and doomed to failure from the outset.

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