James Reilly (Dublin North, Fine Gael)

I move:

"That Dáil Éireann, noting with concern:

— that there are more than 46,000 adults and children on hospital waiting lists across the country, which is 5,400 patients more than last year;

— that over 272,000 bed days were lost in 2009 due to the delayed discharge of patients;

— that 50,000 operations have been cancelled since 2007, leaving many patients waiting in pain;

— the anguish that continues in hospital accident and emergency departments, with an average of 300 patients on trolleys each day; and

— that no further loss of capacity can be sustained;

calls on the Government to:

— ensure that there are no further reductions to front line staff or services;

— suspend the loss of front line health services and capacity at hospitals, for example, at Clonmel, Merlin Park, Nenagh, Roscommon, Navan, Sligo, Letterkenny, Portiuncula, Wexford, Monaghan, Ennis and Louth county; and

— immediately open the €16 million community hospital facility in Dingle, County Kerry."

I wish to share time with Deputies Catherine Byrne, Ulick Burke, John Perry, Paul Kehoe, Tom Sheahan, Pádraic McCormack, John O'Mahony and Damien English.

The motion is self-explanatory as it seeks to ensure there are no further reductions to front line staff or services and to consider other methods to meet the budgetary constraints faced by the HSE. I refer to the Government's amendment. Mention is made of increased life expectancy but an eminent epidemiologist has stated that less than 10% of longevity over the past 20 years can be attributed to health care, if vaccinations are excluded. The amendment notes the decrease in hospital infection rates, yet they remain unacceptably high, while it welcomes the EU's endorsement for being ranked second in quality palliative care, although many parts of the country are without a hospice. The Minister should tell that to the terminally ill who cannot obtain a medical card.

The amendment also notes progress in cancer screening, particularly cervical cancer screening, but there has been a significant drop off in women attending for screening since the methodology was changed to a letter of invitation, thus putting a barrier between them and the service. Where is the bowel cancer programme? Why has it taken so long to get cancer screening up and running? The Government parties welcome the fact that data indicate that a significant majority of patients attending accident and emergency departments are treated and discharged or admitted within the maximum waiting target of six hours. That is a clever statement. What percentage of those needing admission are admitted within six hours? It is laughable for the Minister to suggest that a substantial number of operations are cancelled by the patients themselves. I challenge her to produce the figures in this regard. I warrant is it less than 5% and probably less than 1%.

This motion is about protecting patients from cutbacks necessitated by mismanagement and waste in the HSE, presided over by this Minister. It intends to demonstrate clearly that there is a third way by changing the bizarre working practices and bloated bureaucracy at the root of the waste in our service. The Government, through a series of policy failures, continues to undermine the provision of fair and equitable health services to our citizens. Current health policy, particularly as outlined in the amendment to the motion, sends a clear statement that the Government does not view health as a priority. It has consistently ignored the concerns of local people, medical professionals and service users when stripping hospitals of their services. Nobody in the House opposes excellence in clinical care or denies the need for change in the provision of hospital services but when the Government's immediate reaction is to close theatres and wards or to withdraw front line services to save money, we do have a problem, as this is a lazy way to attack our difficult situation.

Let us examine the reality. More than 46,000 adults and children are on hospital waiting lists across the country, which is 5,400 patients more than last year. More than 272,000 bed days were lost in 2009 at very significant cost to the system, due to the delayed discharge of patients. A total of 50,000 operations have been cancelled since 2007, leaving many patients waiting in pain and distress while an average of 300 patients are on trolleys each day with 420 patients on trolleys today alone. A total of 332 service users of St. Michael's House are on a priority list waiting for care.

The Government parties have spent vast sums over the past ten years but billions of euro have been wasted on a health service that has not reformed. As a result, our health system is ranked 13th in Europe for quality and 25th for value for money. We are facing a massive economic crisis with €34 billion going into a dead bank that will never lend again, yet the Minister is planning to cut health spending next year by another €600 million without introducing any meaningful reform. Last week, we learned that the HSE has to significantly cut back health services right across the HSE west area to meet its budget deficit. These cuts mean that patients will wait longer on trolleys in accident and emergency departments for treatment and care. HSE west has informed us €5 million was lost last year through absenteeism and payments from insurers on behalf of patients in this area totalling €10 million are outstanding for more than 12 months.

People are feeling pain but HSE administrators have taken the soft option of cutting front line staff and services. Navan hospital is a case in point. The Minister alluded to it being shut because of economic considerations, given all hospitals must stay within budget, but Navan hospital is operating within budget. This is more nonsense from the Minister. The HSE had six grade 8 senior managers earning between €80,000 and €90,000 a year in 2000 but there are now 700, a 10,000% increase. Professor Drumm, the former chief executive officer of the HSE stated that he had "no doubt" that he could reduce backroom staff by "at least 30%". In 2005, some €1 million was spent on consultants to advise on how to deconstruct the executive while more than €100 million has been spent on reports over the past ten years, most of which lie unpublished, unimplemented and gathering dust.

The HSE has spent more than €121 million on taxis since 2006. Legislation on the introduction of drugs reference pricing has been deferred until late next year but it could save a few hundred million euro. Meanwhile, the Minister introduced a prescription charge, which is a measure that will cost more in terms of human misery and hospitalisations as a result of people not taking their medication. The moratorium on recruitment is forcing hospitals to hire expensive premium rate agency staff who are believed to cost 36% more than health service staff. Other inefficiencies include banking and payroll practices which are costing the HSE €20 million a year in potential savings. The executive has paid more than €11 million to people on sick leave for more than 12 months, with more than €100 million spent on agency staff every year. More than €2.3 million of taxpayers' money ended up in a bank account with no knowledge of where it was spent while RTE reported a catalogue of waste within the HSE this evening. Equipment such as crutches and Zimmer frames are not reused even though there is no reason that they cannot be sterilised and reused as is the case in other countries. We cannot reuse them and they are thrown out. The Minister alluded to the significant increase in the bills for hospital cleaning with a 54% increase on the 2005 figure.

All this waste and expenditure must stop but instead the HSE under her guidance chooses to close 32 beds in the Mater Hospital. Some 62 beds are closed in Beaumont and 24 beds are closed in Blanchardstown while Professor Drumm said earlier this year that there were plans to close another 1,100 beds. Home help hours have been frozen. Deputy Catherine Byrne instanced the case of a 97 year old woman who went into hospital for a week and returned home to find her home help had been discontinued. She want back to a cold, empty house. This is a false economy and the Government has its priorities upside down.

I want the Minister to tackle waste, take hard decisions, change work practices and stop talking about it. She has had six years to do so. Fine Gael intends to do this under its FairCare proposals. The National Treatment Purchase Fund, NTPF, spent almost €100 million last year to treat 28,000 patients and €300 million over past three years. The Northern Ireland authorities adopted a waiting list initiative that reduced a waiting list of 57,000 patients at a cost of £36 million over 18 months. That is what we need to do. We also need to examine systems in other countries where the money follows the patient model was used to make a saving of between 10% and 19%. This would allow at least €500 million more to be invested in our health services. The countries to which I refer are Canada, Holland and Taiwan. I congratulate Taiwan on its national day today. I hope to travel to speak there shortly. Taiwan introduced universal health insurance in 1995. It works extremely well and spending on health is only 6.4% of GDP. We need to deliver universal health insurance so that all our people are treated equally and so that we lose this focus on private, co-located hospitals.

The National Treatment Purchase Fund is the prime example of the Band-Aid to cover the cracks rather than any meaningful reform. We need a Minister who will put the patient first, take on all comers who stand in the way of that goal and do more than pay lip-service to it by implementing policies to ensure the patient is put first, as in the policy of the money follows the patient. Simply put, if there is no patient there will be no payment.

I commend the motion to the House.

See this speech in context