Micheál Martin (Cork South Central, Fianna Fail)

I thank Senators for the opportunity to discuss the health service. I am glad the amendment to the motion has been moved on behalf of the Government.

This Government has invested unprecedented levels of capital and revenue funding in our health services. It is important to appreciate that from a very low base, we have built up and will continue to enhance the infrastructure of our health system to provide modern and accessible health facilities. I will deal with some of the points that have been made in the contributions of Senators.

It is important to put the provision of acute hospital services in context. Over the last two or three decades there have been numerous important advances in surgical technology and anaesthesia. These advances have greatly improved the range, safety and effectiveness of the procedures that can be offered by modern health systems. Modern medicine has allowed us to live longer and have a better quality of life. As a consequence, however, there have been dramatic increases in the demand for treatment. When people say the health service is chaotic, a mess or not working, they are wrong. By any yardstick, over the last 20 years modern health care systems have worked. They have been far more successful in the quality of their interventions and their outcomes. This is true across the OECD and also in Ireland.

We have different pressures and demands now than we had ten or 20 years ago. I recently heard Tom McGurk interviewing a man who had suffered from leukaemia. He said that if this had happened to him 15 years ago his chances of overcoming the disease would have been much less. We are making successful interventions. I will detail our progress in terms of the development of our health care system. That is not to say there is no pressure or that there are no difficulties associated with modern demands arising from an ageing population.

To help Senators understand the complexity and scale of our acute hospital system, I offer some statistics to provide a context. The number of patients discharged from hospital having been treated as either in-patients or day cases in 2003 was more than 1 million. This represents an increase of more than 25% in the number of patients treated compared to 1997, when around 780,000 were treated, and is the first time the number has exceeded 1 million. Day activity is now a significant component of hospital-based care in Ireland. Evidence shows that much of this growth is the result of technological and medical innovations such as less invasive surgery and advances in anaesthetics.

There has been a staggering increase of nearly 80% in day case procedures between 1997 and 2003, from 245,000 to 440,000. That statistic alone proves we cannot go around saying the system is a mess or in chaos. That growth is a benchmark for a modern approach to health care. All our teaching hospitals are at that level in terms of day case procedures and volumes. This reflects the increasing ability of the hospital system to treat more patients on a day basis, where patients are admitted and discharged on the same day. Productivity has increased. Despite all the talk of a black hole that absorbs money, productivity has increased year on year. Hospitals are dealing with more people even within existing envelopes.

In 2003, there were 1.2 million attendances at emergency medicine departments and 2.2 million attendances at acute hospital out-patient departments. This shows that as a population we are quite active in accessing services. The increasing capacity of the public hospital system to treat more patients is a product of the significant investment by the Government in health services. This year the Government has provided a gross allocation of €10 billion for the health service, which is nearly double the level of funding in 1997. One example of how this investment has yielded results is the increase in medical consultant numbers. According to the Comhairle na nOspidéal report on consultant staffing, on 1 January 2004 there were 1,824 consultant posts in the public sector. This represents an increase of 41% over the last six years. This means that more people are being treated.

Senator Feighan said the health service was a mess. However, let us consider the cardiovascular health strategy. There is no comparison between the quality of interventions in this area currently and that of five or six years ago. Since the launch of the cardiovascular health strategy in July 1999, €54 million has been invested in its implementation. Almost 800 new staff were appointed in the first years of implementation, from 139 health promotion officers to 113 primary care and pre-hospital care personnel. Pre-hospital care is vital, supporting prevention, diagnosis and rapid response among people in the community. This is a key issue in terms of cardiovascular health.

A total 328 hospital-based professionals have been employed and funding for the appointment of 17 additional consultant cardiologists has been provided. This represents the largest increase in cardiologist numbers in the history of the State. The majority of these will be coming into the system this year. The number of cardiology procedures has more than doubled over a short period. An additional 109 cardiac rehabilitation staff are now in place and every acute hospital treating people with heart disease has developed structured cardiac rehabilitation services. I have spoken to people who have benefited from these services and they are enthusiastic about the difference it has made to their recovery and their return to normal life after serious heart trouble. In terms of information systems, audit and research, we have provided additional staff to improve quality and agree on guidelines and protocols for patient care.

The bottom line is that when we talk about health care in Ireland we must remember the objective of public health policy is to reduce the incidence of mortality and morbidity from heart disease and cancer. These are the major causes of death and illness in society, along with injury and accidents. People ask where all the money has gone. We have strategically allocated major resources to the treatment of heart disease and cancer in order to change the story of modern Ireland in terms of what we die from and what makes us ill and therefore reduces our quality of life. Accident and emergency services are extremely important, but they are not the only piece of the jigsaw. We must consider the big picture. We want people to, live longer, with improved quality of life. Through an aggressive, focused and strategic approach to heart disease and cancer we are achieving this.

Since 1997 there has been a cumulative investment of €550 million in cancer services. Once again I made this a priority in 2004, despite the existing envelope of financial provision. Although we had to live with 2003 levels of funding we managed to provide additional funding for cancer services. That has enabled the approval of an additional 92 consultant posts over the last number of years in key areas of cancer services, including medical oncology, histopathology and oncology surgery. The benefit of this can be seen in the substantial increase in activity levels in the three modalities of cancer treatment. For example, since 1996 the annual number of discharges of patients receiving chemotherapy has more than doubled, from 22,000 in 1996 to more than 50,000 in 2002. Similarly, for radiotherapy the increase in discharges reported at Cork University Hospital increased from less than 7,000 cases in 1996 to nearly 15,000 in 2002. There has been a 36% increase nationally in surgical procedures for breast cancer, with an additional 500 procedures performed in 2002 compared to 1997.

The complexity of the care today is different. I recently opened the radiotherapy unit in the Cork University Hospital. It has a state-of-the-art brachytherapy facility and 13 professionals will be involved in the treatment of one patient. That is an indication of the complexity of a radiotherapy and brachytherapy centre, which is not often appreciated or understood by people who ask where the money is going. If we want world class quality care, that is the type of facility in which we must invest, and it must be done across the country.

In terms of the national development plan, anybody who is honest about the scale of development will acknowledge that progress is being made in addressing the historical deficits in health infrastructure. A range of major projects have been completed, are in planning or under construction across all health care programmes. Capital funding provided under the NDP for health services has also allowed for the commencement of important new initiatives in other health areas such as putting in place new infrastructure to support and develop the area of information and communications technology.

Long-term progress means long-term investment in facilities. In the past three years alone the health capital budget involved spending some €1.7 billion. The capital investment framework for health between 2004 and 2008 amounts to some €2.7 billion.

In terms of a historical deficit, I have travelled the country and I have seen some of our hospitals and some our older community nursing units. Many of them date back to the last century and the previous one. We had a significant long-term deficit because there was little incremental capital investment in health until the NDP came on stream and an envelope for health for three or four years was given to begin modernising the plant, along with ongoing minor capital. The system lived hand-to-mouth because of economic and financial circumstances for 20 or 30 years. The concrete result of the capital investment in the health service is evident all around the country by way of new, expanded or refurbished health care facilities. For example, a major construction project has been completed at University College Hospital Galway. I invite anyone to go to UCHG. More than €120 to €200 million will have been spent by the time it is complete. What that is doing for the west is making all specialties available to public patients who heretofore had to travel to Dublin for heart surgery or radiotherapy and other specialist treatment. That is being put in place for the west in a modern infrastructure which did not exist before. Many new units in that area have been commenced. More development is needed, but much has already happened at that site. A new acute psychiatric unit has been provided at St. Luke's Hospital in Kilkenny. These are examples. There are others around the country. A new extension has been built at Portlaoise General Hospital. I visited that recently. There was no comparison between paediatric services in Portlaoise today and the services that were previously available. Anyone in the health service in the area will say the same.

Senator Feighan's suggestion that matters have got worse with all the money is rubbish. Portlaoise hospital is one example that proves that is not true. One only needs to compare the acute psychiatric unit there and the quality of the building to what was there before. One need only look at the paediatric unit. One cannot say with any credibility that the system has got worse. It has got infinitely better in terms of the quality of care in many instances.