Brendan Ryan (Labour)

I can make thumping speeches as well as the next person. I intend to be a little more restrained on this occasion, although I do not intend to be any less critical.

In my final year in college I was taught there are four functions of management — planning, organising, staffing and controlling. My understanding always was that staffing, organising or controlling could never be achieved adequately without planning. If we were dealing with this crisis because of a sudden outbreak of an unusual disease or an epidemic of some kind, that would be understandable. However, this is not an issue that arose today or yesterday issue but dates to the cutbacks in health in 1987. The fundamental problem is that the Government recognised, in various strategy statements and in advice given to it, that the health service requires at least 3,000 extra acute beds. The Government has announced the provision of these extra beds on numerous occasions but it has only delivered 700. That is the fundamental problem. All of the other issues regarding expenditure and order go back to the fact that there are not enough beds in the system.

If one examines the OECD statistics, one can see that Ireland has one of the lowest levels of acute hospital beds in the OECD area. Speaking of statistics, I was disappointed the Tánaiste was disingenuous with the figures she quoted. It is possible to play with statistics, but our health expenditure, as a percentage of GNP, rather than GDP, is in the bottom half of the EU. According to OECD figures, the increase in expenditure of GNP in this country between 1997 and 2002 was no higher than in many European countries. We were attempting to patch up an almost failing health service from 1997 onwards. It was as if we were trying first to fill the potholes and then build new roads because the country needed more. However, now the potholes are filled we are surprised to find that the traffic is overloaded on the limited road service. Much of the expenditure simply prevented it from falling apart.

This Government did not do anything to address the under-capacity. One does not need to be an economist to realise that if one does not provide the basic capital infrastructure and starts to employ more and more people, squeezing them into the same inadequate number of buildings, one gets less and less return on the extra staff. That is rudimentary first-year economics.

Returning to the first requirement of management, there was a failure to plan in terms of the following: looking at the real problems and what was likely to happen with regard to population growth, aging and the young population; the consequence of a reduction in the number of the population with medical cards; and the declining number of GPs in many urban areas. None of these developments happened overnight. There was a blank denial of the country's fundamental needs. An objective evaluation would have demonstrated what was required, and has done since.

The Government made a peculiar decision to spend an enormous amount of extra money on the heath services from 1997 onwards. Having spent a lot of money, it then put a strategy in place which identified that more needed to be spent. The then Minister for Finance promptly said there would be no more money, as have his predecessors since. We are spending between 0.5% to 1% of GNP less on health care than most of the equivalent rich countries in Europe. We have a great deal of catching up to do and should, in the short term, be spending more than those countries to generate capital provision to build the hospitals, provide the beds and allow for an adequate number of nurses.

We should spend a bit more than other European countries, which spend between €1 billion and €1.5 billion or more per year. We must spend that amount on health care if we are to provide the beds and staff. No amount of management, window dressing or short-term thinking will get away from that fact. The crisis in accident and emergency services is a symptom of under-provision and will continue to be so. We need 2,300 extra acute beds. Once we get them, the pressure will begin to decrease. At the same time, we must put together a decent primary care service with adequate access for the less well-off. These two measures, taken together, would take the heat off accident and emergency departments.

We have spent eight years looking at this problem, the crisis has blown up every year and a new solution is suggested every year. However, the crisis blows up again the following winter because we will not deal with the fact that the service is under-resourced, under-funded and, in many cases, badly managed.