SENATE SPEECHES
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Hospital Waiting Lists: Motion


1st March, 2000

 

Mrs. Jackman: I move:

 

That Seanad Éireann condemns the current Government health policy which has resulted in the loss of 122,400 hospital bed days in 1999 to the detriment of all those awaiting essential medical care and hospital treatment; and calls on the Government to take immediate initiatives to ensure the full and proper utilisation of our hospital resources this year so as to significantly reduce the estimated 38,000 people now awaiting in-hospital treatment.

 

Although I welcome the Minister of State, Deputy Moffatt, is it the case that the Minister, Deputy Martin, will be present?

 

Dr. Moffatt: He hopes to be here.

 

Mrs. Jackman: I hope he will be present. It is the first few weeks of his ministry and it would be inappropriate if he did not attend and give the House his impression and the results of his research and investigation into the increased figures.

 

An Cathaoirleach: I understand the Minister will be present.

 

Mr. O'Dowd: Would it be in order to wait for him to arrive?

 

An Cathaoirleach: No. A Minister of State is present and the debate can proceed.

 

Mr. O'Dowd: That is fine.

Mrs. Jackman: I wish to be accurate about the figures from the Department of Health and Children which show that, in December 1999, 36,855 people were on waiting lists. This shows a reduction of 28 in the figure for the previous December of 36,883. The point which has caught our attention and that of the media is the flabbergasting and appalling rise of 3,000 in the number on waiting lists over the past three months, which is an increase of 9% in the last quarter. This is despite the massive injection of £90 million into the health services. What is happening to the huge amount of money being put into health services because, ultimately, we are no better off than we were 12 months ago?

The problem is not only related to waiting lists. The former Minister, Deputy Cowen, addressed many Private Members' motions since I took over the health and children portfolio for my party in the Seanad, but it is necessary to continually raise the same issues. We are aware of the difference between waiting lists and waiting times, but they have also increased. The figure for the ear, nose and throat procedures, which is the worst sector, is 7,486 while the number waiting for hip replacements, which is an orthopaedic procedure, has increased from the September figure of 5,838 to 7,344 in December.

I need the detail behind these figures because, from experience in my clinics, it appears many people have switched from public to private health care because they can no longer endure the stress and intense pain associated with their conditions. Many people come to my clinics to ask if there is anything I can do to reduce the cost of a stay in hospital. They will pay the surgeon but they have a big problem finding the money for expensive accommodation fees. That is because their doctors would not allow them wait any longer than a couple of weeks, given the extremely traumatic times in relation to orthopaedic treatment.

I welcome the Minister, Deputy Martin.

 

Mr. Martin: I was watching the debate on the television.

 

Mrs. Jackman: It is not in his character to avoid dealing with the contentious issue under discussion - the exacerbated hospital waiting lists. I refer to orthopaedics, about which I am concerned, and ask him to comment on the number of people who have gone from the public to the private list, merely because they could not wait any longer for treatment. The Mater Hospital National Cardiac Centre has a waiting list of 3,855. For operations other than heart surgery, St. James's Hospital waiting list has increased from 1,592 to 1,996. These were the figures prior to the flu epidemic in January.

Mr. Finbar Fitzpatrick, Secretary General of the IHCA, says the problem is related to beds and shortages of doctors. I have already mentioned ear, nose and throat procedures, but the waiting list for eye procedures, cataract operations, is 4,309. The cataract operation - and I said this to the Minister's predecessor - is relatively simple. It is mainly for people who are elderly and expect to have one pleasure at least afforded to them, reading. Mr. Finbar Fitzpatrick referred to people going blind while awaiting cataract operations. I hear about those at my clinics.

Let us look at the specific public in-patient waiting lists in the Mid-Western Health Board area. In March 1997 the Regional Hospital, Dooradoyle, Limerick, had a waiting list of 1,142; in December 1999 the list was 1,441, an increase of 20%. St. John's Hospital has reduced its waiting list from 257 to 111. I am pleased there is also a reduction in Croom, despite the closure of 20 beds. I am extremely exasperated with those lists given that orthopaedic operations do not require great skill. The number on the waiting list for the Mid-Western Health Board was 1,841 at the end of December. The monthly average number of bed days lost was 1,056 which, if multiplied by 12, amounts to 12,672. Those are the facts. It is disingenuous of the Minister to blame much of the increase on the nurses' strike-----

 

Mr. Martin: I did not.

 

Mrs. Jackman: Did the Minster not say that?

 

Mr. Martin: No.

 

Mrs. Jackman: The Minister was reported-----

 

Mr. Martin: Wrongly.

 

Mrs. Jackman: I am glad the Minister will be able to correct that because I could see absolutely no reason why the nurses' strike would be blamed for the increase in that it included a holiday weekend. The money lost was gained in what was not paid out to nurses; they would have earned over and above their normal salaries if working that weekend. It was an X = Y situation, so that it was not a financial loss. One could argue that services were brought down but I do not think that short period was the reason for the increase at the end of the year.

I wish to make a few positive suggestions as to how the Minister might approach the whole issue of waiting time and the problems that need structural reform. It is not a question of throwing good money after bad, but of getting into the nitty gritty to see where there are conflicts in how people do their business, the different ways of doing things when one compares one hospital with another, including how they deal with nursing shortages. We have to accept that on a breakdown of costs in a typical hospital 70% are pay related, of which 50% is for nursing. About 35% of total hospital costs relate to nursing pay. They are facts and we cannot change them.

I mentioned waiting time and the operation turnover time. If one required heart surgery and was placed on a list, the length of the list would be irrelevant if one was an emergency case. The emergency patient would get priority. Also lists can be shuffled around and do not reflect the number of people who have opted to go private, essentially to prevent pain or, in many cases, death. The crux of the problem is the throughput of patients. To give an example, I looked at figures for Our Lady's Hospital in Crumlin. It has a public child heart surgery list of 96 compared to a private list of 24. The operations are carried out in the same hospital under the same conditions. The crux in this case has to be management priority reform. The Mater heart unit which has five surgeons has 1,000 patients per annum requiring operations. The unit, with considerable resources, could reach only just over 800.

The disparity in management styles between hospitals is incredible. For instance, the Mater's rules on nurses' overtime differ considerably from St. James's where much more overtime is worked. This is compounded by the fact that the Mater's bill for agency nurses is £2 million. Has the Minister control over how hospitals actually work where one can have overtime and the other does not but brings in agency nurses, an area where there are problems? An idea which was good in principle was the nurses' job sharing scheme, designed to bring more nurses back into the workplace. There is evidence that there is no proper management of this scheme. While it was a good idea in principle it failed to make a serious impact in practice. I accept more money is required but that alone will not speed up the actual number of operations. Before taxpayers' money is wasted, how does the Minister propose to tackle such problems? The biggest contributory factors are bed and staff shortages and I stress the need for structural solutions to structural problems.

I regret I do not have more time as I have mentioned only a tenth of what I wanted to say. I appeal to the Minister to take a root and branch approach as to how moneys are being spent in hospitals and how health boards are managing. It would be a shame if the £1 billion to be provided in the national development plan was to go to waste and if we were still dealing with similar waiting lists and waiting times over the next quarter when the figures will be released.

 

Mr. O'Dowd: I second the motion. I welcome the Minister to the House and wish him well in his new ministry. The health service here is a two-tier system where those who can afford to pay for it get the service and those who cannot must wait. This index of waiting lists is also an index of pain and suffering. There are over 34,000 people on waiting lists. This figure is totally unacceptable. As Senator Jackman said this problem, which the Government has failed to deal with, must be tackled in a planned and structured way.

One of the problems which we in Fine Gael have identified is the need for a new grade of consultant in our hospitals - that is, a full time public consultant who would be dedicated to looking after the people on the public waiting lists and would have no private practice. Such a person would be paid the same very high sum which a top surgeon deserves and gets in the private sector. We must take a structured approach to this question and put the structure in place immediately.

Throwing money at the health services is not the answer to its problems. It is important that we invest wisely and well. One of our major problems is the shortage, not of consultants but of nurses. We cannot recruit sufficient theatre nurses. Trained nurses have several career choices and many are leaving the country. We must recruit many more nurses with the specialist skills which are in short supply. The health boards or the Department must recruit nurses in whatever country they can be found and pay them sufficiently well to attract them to work in our hospitals. It is not acceptable, when theatres and surgeons are available, that operations are delayed because of a shortage of nurses.

Some weeks ago hundreds of trainee nurses demonstrated outside Leinster House against the charging of fees for part of their education. That situation is disgraceful. We must make it financially attractive for young people to enter the career of nursing. Student nurses should be paid while they are training and we must take a radical look at the way we fund that training. A society is judged by the way it looks after those who are in pain, have low incomes and cannot afford to buy essential services. We must make every possible effort to recruit more nurses, train them well and pay them while they are being trained.

Hospital accident and emergency departments are unnecessarily clogged up. I welcome the publicity campaign to persuade people to go first to their local doctor. However, the GP service in many of our towns and cities is not adequate. At weekends it is extremely difficult to find a GP. A patient may have to accept the service of a locum, which is not acceptable to many people. General practitioner units must be established in our acute hospital system so that, in major acute hospitals, appropriate patients can be channelled into a GP unit, leaving the accident and emergency services for those who actually need them.

Step-down facilities are not adequate for elderly people when they are discharged from acute hospitals. In many cases, stroke victims are sent home to be looked after by an elderly spouse for whom tasks such as lifting the patient or taking him or her to the toilet are impossible. Adequate step-down facilities must be made available for elderly people. The lack of these facilities causes untold upset, concern and anger. Home helps are badly paid and in very short supply. In County Louth, for example, they are almost impossible to find. A new type of professional carer is needed. Such people would be paid a full-time salary to go from home to home and look after patients. Our present system is totally inadequate and is collapsing around us.

I am particularly concerned about services for stroke victims. When elderly stroke victims are discharged from hospital, they do not have access to the physiotherapy which they badly need. The Minister should examine the question of the availability of help for stroke victims when they have been discharged from hospital. Many of these people, when they go home and receive no physiotherapy, feel they have been placed on the scrap heap and that society no longer cares about them. We must devise a strategy for dealing with victims of stroke, particularly when they are elderly.

It is upsetting to meet a person of sixty or seventy who is waiting in pain for a hip replacement operation on a list that seems to be never ending. Frequently during the summer months, orthopaedic theatre units are closed down and operating theatres deal with emergencies only. Elective surgery lists are suspended for three or four months every year in many of our orthopaedic hospitals. Elderly people must wait all summer in pain and suffering while nothing is done for them. A new strategy is needed for dealing with elective surgery lists.

Those of us who live in Border counties realise the necessity for co-ordinating our services with those in other countries and particularly in Northern Ireland. We must devise a more organised way of dealing with people in either jurisdiction whose needs are more easily met on the other side of the Border.

Many patients are on two or three waiting lists. We must compile a national database of people who are on waiting lists so that if a place becomes available in Cork, for example, it can be taken up by a patient in another part of the country. We should not be confined by the rigid structure of the health boards. Patients should be brought to any hospital where theatre space is available.

A radical overhaul of the health system is needed. It is not good enough. The Government cannot continue to defend the disgraceful system which leaves more than 34,000 people in pain and suffering, awaiting operations which they cannot afford to pay for and which the Government cannot provide.

 

Dr. Fitzpatrick: I move amendment No. 1:

 

To delete all words after "Seanad Éireann" and substitute the following:

 

"welcomes the increasing number of patients that are benefiting from acute hospital treatment, commends the increasing Government resources and the series of strategic initiatives that are being taken to facilitate a growing volume and an improving quality of service; and endorses the Government's strategy for reducing public hospital waiting lists and waiting times in a structured, co-ordinated and multi-disciplinary manner."

 

Nobody could object to a discussion on the health services, even on the lines of this evening's discussion. However, the Opposition speakers have spoken almost exclusively in terms of surgery. They referred to eye operations, hip operations, cardiac operations and so on. Unfortunately, mortality is an integral aspect of surgery. Many lay people have an unnatural faith in surgery as a cure for all ills. Many regard their bodies as they do their motor cars, in which the gear box or the engine can be replaced. The human body is not like that.

A problem for any Minister for Health arises from the length of time it takes to train doctors and nurses. To train a surgeon, for example, takes 10 or 15 years and the stress of a surgeon's workload is very great, whether in public or private medicine.

When I started my medical career people went to hospital because they were sick. Now they go to find out if they are sick or if they are going to be sick.

 

Mr. O'Dowd: Not at all.

 

Mrs. Jackman: Nobody wants to go to hospital.

 

Mr. Norris: They go for an oil change.

 

Dr. Fitzpatrick: Exactly. People are being brainwashed about screening procedures, even the best of which have a failure rate of 10% to 15%. A patient may ask a doctor to check his cholestoral level or blood pressure, the doctor tells him he is healthy and he thinks his engine has been guaranteed for another 20,000 miles. However, he could be dead in the morning. Those practising in medicine realise that but it is not to say we should not strive to improve our medical services. We are dealing with a quality of life service on the one hand and a life saving one on the other. People who require hip replacements, corneal grafts and cataract operations are deserving of them. We should try to ensure that if the operations cannot be given on demand there should be at least a structured waiting list. They should know within a month or so when their operation will be done.

We should look outside the public hospital system. There is no reason medical card patients should not be treated in private clinics such as Blackrock or the Bon Secours because the requirement is there. A patient's place on a waiting list is decided by a consultant, not by a politician or even a general practitioner. When a patient is referred to a Dublin hospital, a letter will be sent by a GP to a consultant who will decide when the patient will be seen. In some specialist areas the waiting period for private patients can be longer because consultants have a greater range of staff dealing with public patients. They have trainee surgeons and doctors and the taxpayers are paying for this. By and large, the taxpayer gets value for money.

The point was made earlier that more GPs and a better GP service are required. We also need GPs to work in the hospital system. I consider that 80% of people presenting at accident and emergency units could be seen in the first instance by their GP. General practitioners excel at about the age of 50 when they have about 20 years experience under their belt. If such GPs worked even for a few hours per day in accident and emergency departments, waiting lists would be cleared very quickly. Accident and emergency units are staffed almost exclusively by trainee doctors who, understandably, do not have the experience of knowing what to test for and what to look for. Ranges of tests and X-rays are ordered which clog up pathology and X-ray departments.

The Minister might consider having an accident and emergency hospital - I suggested this idea some years ago and I was laughed out of court. There is one such hospital in Birmingham which deals totally with accident and emergency cases. It frees up the other hospitals in the general area to deal with what we call cold medicine or cold surgery - hips, eyes, hearts, etc. For example, if 20 years ago a patient went to an accident and emergency department with a badly mangled hand more than likely amputation would have been involved. That is not the case now. That patient's hand could be saved. The minimum down time in a theatre is 12 hours - I had a patient recently who was that length of time in the operating theatre. One can imagine how the backlog builds up and this leads to the cancellation of operations.

I will not quote facts and figures as the Minister has them at his fingertips. We need more personnel in the health service. A fundamental change in attitude is needed. We must stop looking at patients as mendicant supplicants. We must treat them as valued customers and give them the service for which, as taxpayers, they are paying. A person pays once for service in a hotel. When paying for hospital services one pays through one's taxes, probably through one's VHI and there will be other charges as well. With three charges on a patient the service could be improved greatly but it will take an attitudinal change.

Minister for Health and Children (Mr. Martin): I thank Senators for raising the issue. I apologise for being a few minutes late but when I turned on the television in my office I saw the Statute of Limitations (Amendment) Bill debate was ongoing. I was in the middle of a meeting but I came here immediately. I thank Senators Jackman and Fitzpatrick for their contributions. I found Senator Fitzpatrick's contribution fascinating in terms of the practicalities of the health service. This is an important and welcome debate.

Government health policy impinges in a significant way on the overall quality of life enjoyed by us as a society. It is little wonder that the subject generates much interest and debate, particularly in relation to the quality and availability of acute hospital services which are called on in critical circumstances on a 24 hour basis, 365 days a year. Against this background, I am glad of the opportunity to publicly acknowledge the high quality service overall that is provided in our acute hospitals. I also want to place on record the Government's strategy for its further development and continued improvement to the benefit of patients and potential patients everywhere.

The Fine Gael motion put to the House this evening attempts to portray a hospital service that is under-performing and that is failing to make full use of the resources available to it, to the neglect of thousands of people. This suggestion does a great disservice to the many thousands of skilled doctors, nurses and other health care professionals and the management of the hospitals and needs to be addressed head on at the outset.

In the first instance, it needs to be recognised that the acute hospital system delivers a service that is ever growing in terms of its volume and complexity. A rapid pace of medical and technological change and ever increasing expectations of quality challenge the system itself and all those working in it on an ongoing basis. Within this highly dynamic and complex environment, the hospital system is producing constantly improving patient outcomes which are facilitated by the ongoing introduction of new services, the development of existing ones, the introduction of new technologies and treatments and an unparalleled commitment to continual professional development by staff at all levels of the service.

Aside from the many qualitative improvements that are being made, in pure volume terms more people are benefiting from services in our acute hospitals now than at any time in the past. The numbers being treated continue to grow, year on year, each year. The latest figures available show that for the first ten months of 1999 almost 2.5% or 16,000 more people were discharged overall and almost 10% more people were treated on a day case basis in our hospitals than in the same period in 1998.

The overall volume of activity delivered is the most basic measure of performance of the system. Over the course of this year, more than 1.2 million people are likely to avail of accident and emergency services, almost 2 million people will be seen in out-patient departments and more than 800,000 people will be treated on an in-patient or day case basis.

It is in this context that temporary closures of beds should be viewed. The number of bed days lost in the system through temporary closures represented just 2.73% of the overall bed days available in 1999. The bottom line is that the 97% plus of the total available bed days that were used, enabled a volume of service that was approximately 2.5% up on that provided in 1998 to be delivered.

Temporary closures do occur for good reason and have been a feature of the bed management function in acute hospitals for many years. Hospital and health board managers have a primary responsibility to ensure that the agreed volumes of service set out in the annual service plan are delivered upon. There is an important onus on them to achieve this within the resources available, be they of a physical, human or financial nature.

Periods of annual leave for consultant and other staff have traditionally led to temporary closures on a seasonal basis. The vastly increased funding that has been made available through the capital programme under this Government over the past two years has meant that major projects and minor refurbishment works are underway in hospitals all around the country. This year £231 million is available under the capital programme as against £100 million in the year that the previous Government left office. These works, which are aimed at the improvement of facilities for patients, obviously involve unavoidable periods of disruption and temporary closure of facilities while underway.

There are also, as Members will be aware, specific problems relating to the recruitment of staff, especially nurses, that have necessitated temporary closures in the eastern region in particular. Specific measures are being taken to address that problem which is a function of wider social and economic issues that are not confined to the health sector alone. The key point is that more than ever before the acute hospital system is delivering more service and a higher quality service. Shortening average lengths of stay and an increasing delivery of services at a day case level reflect ongoing advances in medicine that benefit the patient hugely and mean that the resources available can be used to better effect in a manner that suits the clinical and social needs of patients.

While it is very important to make these points, I am very aware that the issue of access to services for those who are not deemed to be an emergency or in immediate need of care remains a focus of considerable dissatisfaction. Yesterday I announced the waiting list figures for the end of the December 1999 period which showed that the numbers waiting had risen in the final quarter of last year and are now back close to the level they were at this time last year.

I have already publicly expressed my dissatisfaction with the figures. I realise that the 36,855 people on public hospital waiting lists represent less than one-twentieth of the total numbers admitted annually for treatment in the hospital system. Yet, it is a matter of genuine concern that many patients, whatever proportion they represent, have to endure lengthy waits for access to elective procedures.

I am aware that waiting lists are an international phenomenon and fully appreciate the complexity of achieving a solution to the problem. Substantial resources have been made available. This year £23.5 million is available under the waiting list initiative. Some £90 million in total was provided under the initiative between 1993 and 1999, yet, the problem of unsatisfactory access remains.

In coming at the problem there is a need to look at options more creatively and flexibly throughout the system to achieve real progress. These options include more flexible working patterns through longer opening hours for day wards and operating theatres; the use of hostel or other accommodation for patients required to travel for minor procedures; greater utilisation of facilities during periods of low seasonal demand - we will be looking at this issue in the shorter term to increase utilisation even more; more use of cross-contracting arrangements to maximise overall capacity in the system; improved collaborative arrangements between different parts of the system to facilitate a smooth passage for patients, thereby freeing up acute hospital facilities for new patients more quickly; better flows of information between general practitioners and acute hospitals; possible direct access arrangements for GPs for certain services and ready access to step down and long stay beds for acute hospital bed managers.

While there is no one simple solution to this problem, the key task is to manage the different parts of the system in a more closely integrated manner. We need to move away from narrow perspectives where each part of the system seeks to address its own problems in isolation and towards management and organisational structures that support a shared objective across programmes of achieving improved access at all stages of care. I am confident that the new era of health services management under way from today in the eastern area with the launch of the Eastern Regional Health Authority will be a major catalyst for progress in that region. The integrated organisational framework now in place in the eastern region needs to be capitalised on and the arrangements should be developed upon elsewhere.

This integrated approach to the problem underpinned the recommendations of the expert review group on waiting lists which reported in 1998. That report set out a series of short, medium and longer term measures that are directed at addressing the underlying causes of the problem. The Government strategy in place on foot of those recommendations has real potential for success. The good progress made in achieving reductions in the first three quarters of last year provided encouraging evidence of this. I intend to drive the implementation of these recommendations with an even greater urgency, with the emphasis on achieving reductions in average waiting times rather than the less meaningful measure of overall numbers waiting. Progress made to date is being reviewed and, where necessary, I will be seeking to accelerate the introduction of the required measures through direct communication and action with the chief executive officers of health boards.

The integrated approach required will also be mirrored in the organisational arrangements in place within the Department for tackling the issue. I have already established an inter-divisional group under the chairmanship of the Secretary General for this purpose. We will be looking at short-term as well as medium and longer term responses.

In planning ahead there is a need to examine the factors that have led to variations in the relative performances of hospitals in achieving waiting list reductions. Certain initiatives have clearly yielded success in some settings and we need to look at the scope for replicating those elsewhere. By the same token, the constraints that have impinged on the performances of other hospitals need to be identified and addressed.

I propose to take a number of practical steps that can facilitate progress in improving waiting times for access to services. While I am aware that there are no easy solutions, there is a coherent strategy in place which, if actively and comprehensively implemented, provides the promise of real improvement in the way we manage our services, leading to significant reductions in waiting times for access.

In tandem with the shorter-term measures now being taken there is a need to gear up the system with longer-term demand issues associated with demographic changes and to put in place the infrastructural framework required to address some of the underlying causes of the problems now being faced in the acute system. Towards this end the Government is committed to the investment of £2 billion capital funding under the national development plan over the next seven years. Significantly £1 billion of this will be directed towards the non-acute sector. This represents an unprecedented level of investment in the infrastructure necessary to ensure patients are given access to services in the setting they require. This development of non-acute and community based services should also absorb some of the load being carried by the acute hospital system. The hospital system will also see investment of an additional £1 billion over this period. Investment on this scale should show real results in addressing some of the bottlenecks and under-capacity in the system.

In tandem I am initiating an immediate review of overall bed capacity in the acute hospital sector. This review is committed to in the Programme for Prosperity and Fairness and will be undertaken by the Department in conjunction with the Department of Finance and in consultation with the social partners. It will specifically address the issue of bed capacity and projected future demand. The review will examine and assess the adequacy of day care facilities as well as the organisation and utilisation of other existing facilities. It will also look at issues arising in the areas of manpower planning and technology assessment to support future decisions on the provision of diagnostic and treatment equipment.

These measures form only part of the Government's overall strategy for the development of acute hospital services. As part of a planned, coherent approach major progress is being made on a number of fronts in improving the responsiveness of the service to meeting identified need and in ensuring a patient focused, quality based approach underpins the delivery of service at every level. This is being achieved through the implementation of the recently launched national cardiovascular strategy now under way at an anticipated full cost of £150 million; the ongoing major progress being made in implementing the national cancer strategy - £34 million has been invested to date under the Government; the development of renal services through a planned investment of £20 million over the next three years which will dramatically improve and change the environment for renal services and a wide range of initiatives aimed at improving quality, from addressing medical manpower issues through to developing hospital and laboratory accreditation, acute hospital governance, management development, clinicians in management and health technology assessment.

These strategic developments are being facilitated by the unprecendented levels of additional resources the Government is committing to the improvement of our health services. Development funding for the acute sector alone this year stands at well over four times what was provided in the previous Government's final year in office.

While there are issues remaining to be addressed, it should be borne in mind that there is no service sector, public or private, that deals with people in such large numbers day in, day out and has comparable demands placed on it in terms of complexity, quality and the need for sensitive treatment of individual patients and their families as the acute hospital sector. In terms of access, quality, effectiveness in the use of resources and the commitment and skill of staff, our acute hospital system compares extremely well internationally. The Government is committing the resources and we have the strategies in place to ensure the service can continue to respond to the demands it faces and continuously improve as we move forward in the new millennium.

 

Mr. Norris: I welcome the Minister. This is the first opportunity I have had to welcome him to this Chamber in his new role as Minister for Health and Children. I wish him well. We know him to be a good, careful, considerate and caring Minister. We had that experience of him as Minister for Education and Science, a role in which he did remarkably well. I have no doubt that he will follow the same track as Minister for Health and Children. To some politicians this is a poisoned chalice because it is not an easy position to fill as there is always greater demand than capacity, particularly as medical techniques improve and people assume that they are entitled to perfect health at the expense of the State but unfortunately we are perishable goods. We do not last forever and there are certain circumstances in which there is little that the medical profession can do. We seem to trust that everything can be set right either surgically, as Senator Fitzpatrick said, or with drugs.

There is always, it seems, a shortage of money also. I am heartened by what the Minister said, that £2 billion is being allocated, of which £1 billion is for non-acute services. This is certainly good news. I am glad that these resources are placed at his disposal because the Minister has the capacity to be a great health Minister. We have had one or two great Ministers, and the one I think of in particular is my old friend, the late Noel Browne. Recently I watched a film called "Dr. Browne Also Spoke" in which Noel Browne was standing in an empty hospital in Galway which was about to be closed. He spoke so passionately about this beautiful place and the tragedy that the beds and the wonderful facilities were being left unused. In the 1940s, with the assistance of his Department, he literally raided the funds of the Irish Hospital Sweepstakes and used all the capital to build hospitals. At that time, in the late 1940s and early 1950s, Ireland, together with Sweden, had the best health service and hospitals in Europe. I hope we can regain that position because I am not sure we have it at present.

When one reads in the newspapers of people prominent in public and political life going abroad to the Mayo Clinic or the Sloane Kettering Institute for treatment of various kinds, of course on a human level one cannot blame them. When they are there receiving the most sophisticated treatment at the top of a queue, I wonder if their increased awareness of their own vulnerability as mortal beings ever fires them up to think that they must use every effort to provide the very best services in Ireland. I suppose it is a cliché but nevertheless it is true that one of the classic indicators by which one judges the moral welfare of society is the way in which it treats its vulnerable, and particularly its sick.

I am not making a partisan point because I am an Independent and all Governments confront the same problems. There is no point in one party scoring points off the others - they have all confronted this situation. There have been shortfalls in the level of facilities made available to people by every Government and one would hope that the State's capacity to deliver good services would increase, but under successive Governments it is the disadvantaged who have suffered. I am a member of the highest possible VHI scheme, which I think is scheme E, and apparently can get everything I want. I can even go to the top of the queue. However, that does not matter. To my mind the test is the service provided for people who do not have the money to join such schemes, the people who for one reason or another, particularly financial disadvantage, are left out of the schemes.

I am worried about a few matters also, such as this business about so many people being discharged early. This is the caring Minister, and that is why I ask him to look at those figures because there is a kind of ideal of bureaucratic efficiency at work in some of the health services. The idea is to get as many people through the system as possible and sometimes that militates against the patients.

Recently I spent time in hospital. I was perfectly healthy until I got in and they got at me. The next time I will go either to a vet or a plumber.

 

Mr. Martin: That was Senator Fitzpatrick's point.

 

Mr. Norris: It was a prostate procedure. They were inserting a camera into the urethra to have a look, etc., and I assumed they were using fibre optics but, from what I felt when I woke up on the slab, it must have been the outside broadcast unit of RTE television. A couple of hours after I woke up I was discharged in a taxi. Some 24 hours later I was very ill indeed. I had to get a fire brigade ambulance and I ended up in hospital for nearly a fortnight. That is really not an economy. Sometimes if one discharges people too quickly after these procedures one is not doing any favour either to the patient, the efficiency of the service or the economy because it costs more money.

In that little procedure not everybody suffers bleeding, as I did. There were no antibiotics used. Why not? In Europe and America this is common practice. I know that the kind of strong adverse reaction which I had is unusual, but it probably occurs to a fair number of people. To my mind, it is not a saving not to use antibiotics because if they had been used as a precautionary measure, it would have saved them this further treatment. This is my personal experience but that is my contact with the service. However, I am very grateful for the wonderful care and concern which I received from the doctors and the nursing staff.

I noticed two things about the conditions of young doctors and nurses. I saw the way some of them are humiliated. I saw a consultant come in and go straight over to a fellow who was very ill. I noticed, incidentally, the difference between the patients who are very ill and those who are not very ill. The very ill patients are compliant, caring and co-operative and the ones with very little wrong with them are the most awful collection of whingers one could ever come across. The patient to whom I refer had his hand lifted up like a lump of meat without hearing so much as, "Good morning, may I introduce myself? Do I have your permission to use you as an exhibit?" The consultant started talking about the rash. A young female doctor or nurse had saved that man's life during the night, but there was some test which was not back from the laboratory and the consultant just turned and said, "Are you stupid? Have you any intelligence? Do you know anything about medicine?", in front of the patient, the other students and me. I just struggled to my feet, got to the end of the bed, waited until he looked around for applause and approval, and stuck out my tongue and gestured my disapproval. Then I pulled the curtain around the bed and the nurse came in and asked, "Are you in pain? Do you need a pain killer?" I said, "No, I do not. I want ear plugs because I will not listen to that ignorant lout humiliating people whom he is supposed to be teaching." I taught for nearly 30 years in Trinity College and one does not teach people by humiliation. One must have respect for nurses. That includes not just matters of pay but also respect for the care they give and for their dignity as human beings. One should not humiliate and trash them.

It is not just about wages. It is matters like the fact that, at a time when there is supposed to be free third level education, nurses are the only group expected to pay for their university education out of their small incomes. That is wrong. I am glad to see the Minister indicate that this is not true.

 

Mr. Martin: It is a bit more complex.

 

Mr. Norris: It is something which should be looked at because it is perceived as such by the nurses. This is probably why the nurses reacted so terribly badly to the question of the use of the word 'vocation'. That shattered me. I could not believe it. I heard decent reasonable people from the other side of the House use the word. The nurses asked, "How dare they call it a vocation?" That is because they feel they are being exploited, but of course it is a vocation. Politics is a vocation, as far as I am concerned. I was a teacher and that is a vocation also. It should not mean that one gets humiliated and does not get paid properly, but it should be a vocation. It should be a calling to help, serve and minister to other people, as is the vocation of politics.

Recently I heard on the radio of the huge bureaucracy involved in the appointment of a medical oncologist in Cork. That appointment must go before about 18 committees, which is madness. Is it not possible to cut through that bureaucracy and appoint such people? There are sick people who need these services.

 

Miss Quill: Absolutely.

 

Mr. Norris: It is not tolerable that there should be reference to all these different committees.

I am sorry that this has become a matter of contention because in the area of health we should urge the Minister rather than put things to a vote. I will not be voting because I will not be here as I must chair a meeting about James Joyce - we have a visitor from Zurich. If I were here, I would not vote anyway because I would prefer that the House urge the Minister, support the Minister and give him the teeth he needs in dealing with bureaucracies of all kinds and not make a political football of the issue. There is no side of this House which has solved the problem of the demand for medical services by every citizen, including me.

The Minister is doing a good job and I wish him well in helping people who are sick or vulnerable, particularly the people who, unlike all of us, cannot afford to pay for it themselves.

 

Miss Quill: Senator Norris has challenged all of us to be constructive in the course of this debate and that must be applauded. I will attempt to be as constructive as I can. I am not minded to come into the House and criticise the Government and pin the blame for the length of the waiting lists on it. I am mindful of the fact that this year alone £23.5 million has been invested in specific initiatives to shorten the waiting lists. If there is one lesson more than any other which can be learned from that it is that throwing money at our problems does not solve them. Our problems are infinitely more complex than that and they demand much more complex responses.

Acting Chairman (Mr. Chambers): The Minister has to go to a function arranged for the Eastern Health Board.

 

Miss Quill: I am very jealous of the Eastern Health Board.

 

Mr. Martin: Apologies.

 

Miss Quill: I would very much like the Minister to be here, but I fully understand. I wish him well in his new brief. I would like to say, while he is still within earshot, I hope that during his term of office the emphasis in the Department of Health and Children will be on health rather than on sickness and that we could switch our attitude. I will develop that point later.

I suspect that part of the reason for the swelling of the waiting lists this year was the 'flu and the way it hit people, particularly older people, in the last three months of last year. There is great scope for the development of the GP service. We are too quick to refer people to hospitals. A good deal of treatment, healing and cures could be brought about by an extension of the GP service. The extension of the GP service should be an objective during the Minister's term in office with a view to keeping as many people as possible out of hospital.

Having said that, I am acutely aware of the human misery inflicted on people who are on waiting lists for certain operations. I am thinking, in particular, of hip replacement surgery. If one has VHI or private health cover, one can have one's hip replacement in six weeks or in two months at the most. If, on the other hand, one happens to be a public health patient, one may have to wait for one and a half to two years. That is an obscenity.

It is pathetic to see the level of ongoing grinding misery inflicted on people who suffer from acute arthritis or acute failure of the joints. If we are to make inroads into that area of elective surgery we need to employ a group of surgeons dedicated specifically to public patients. We should employ and pay such surgeons and require of them, for a specified number of years, whether two to four years, to deal only with public patients and not to carry on with this lethal mix which exists at the moment where consultants can, at their own discretion, opt in and out and see their private patients on a Monday and their public patients on a Monday nine weeks hence. It is unsatisfactory and is an obscenity in any country, particularly in one as small as ours with the type of homogeneous population we have, and in a Christian country that there has to be this disparity of treatment between patients in the private and public sectors. It wounds me greatly and hurts me more than anything else.

I was very impressed at the way the Minister for Health and Children tried to address disadvantage when he was Minister for Education and Science. He tried to close that appalling and unacceptable gap between those who achieve within our system and benefit greatly from it and those who get little out of it. If that principle and philosophy were applied to health and were put into practice on a day to day basis, they would make a radical change and difference.

As a young and active Minister, I would like to see him place more emphasis on good health and good health practices. I would like us to develop a system which gives better recognition to what is now called alternative medicine. There are people who believe that those who go for herbal medicines, acupuncture and these types of treatments are hypochondriacs. In my experience, for the most part, these people are conscious of good health and are prepared to go that extra mile to maintain good health.

I would like a registration system for practitioners in that field, including acupuncturists and people who carry out deep massage and procedures of that nature. I suspect they are not all good and we have no way of knowing, which is a pity. However, we will have no way of knowing until there is a system of registration. I suspect those who are good are very good, and I have experience of this.

There is much waste in the health service and I will give a simple example. Senator Norris gave a personal example, so I feel entitled to give mine. I had hip replacement surgery about two years ago and was in hospital for nine days. I was covered by the top VHI plan and when I rang my insurers to ask about the aftercare to which I was entitled, they told me I could have two weeks in a convalescent home, the cost of which was £700 per week. They were prepared to foot a bill of £1,400 if that was what I wanted. I said I did not want that because I had been in hospital for nine days, which was long enough for me, and I wanted to go home.

I felt I was at least mentally agile enough to be able to manage at home if I got a little help because I live in a house with another professional woman who is at work during the day. I asked if I could have access to home help for maybe three weeks. Home helps are paid £3 per hour by the health board in Cork. However, that was not permissible under the private insurers scheme. That is such a bad use of money. In the event, it was not a lot of money anyway but it is the principle rather than the cost I am highlighting. I got my home help and, although I do not know what it cost per hour, it was very little and was for only a few weeks after which I was fit and fine. It goes to show how badly we think through value for money and service to customers. I would like to bring that to the Minister's notice.

On herbal medicine, there was much public debate about St. John's wort, in particular. I hoped that debate would not be let die and that, as a result of it, there would be greater focus on this type of medicine in the promotion of good health and the prevention of sickness, that there would be more public discourse about it and that there would be a system to register health shops so that clients would know, scientifically, what was good and what was being flogged commercially in shops. There is great scope to do that.

I note £150 million extra has been allocated to the cardiovascular area, which is very welcome. We need to place much greater emphasis on preventing the development of cardiovascular diseases. I come from a family where, by the standards of the previous generations, I should be dead and gone nearly ten years. None of my aunts and uncles nor my father survived beyond their fifties. I had a brother who died at 37 years so I know something of the loss to families because of heart disease and heart attacks.

We need to promote good health practices. We have more information at our fingertips than ever before as to what promotes health and prevents cardiovascular disease. The Department of Health and Children should promote, at national and local levels, good health practices, more exercise, good diet and a good attitude to life.

Sadly, one of our colleagues suffered a heart attack today. I do not know of anybody who would not put that down to the pressure of work and lifestyle. I know that person has all our good wishes and prayers. He is a young man and we hope he will make a total recovery. That should stop us in our tracks and remind us of the kind of lifestyle we all lead. We are supposed to give leadership in society. In terms of lifestyle and its impact on good health, we do not give good example. We are not great models and that is a pity. Something should be done about that.

While £34 million has been allocated for cancer treatment services, I argue that sufficient emphasis is not placed on prevention and early diagnosis. Cancer is a major killer among women. The House will have statements tomorrow on national women's day and we will love, treasure and value our women, but we ought to do more to ensure the early diagnosis and prevention of cancer. Few things are more harrowing than the death of mothers of young children and we should be conscious of that.

Henceforth, I hope less money will be spent on the administration of the health services. I endorse what Senator Norris said about the cumbersome procedure of appointing consultants. It is not the hallmark of a developed modern country. It would not happen in Chechnya. I welcome this debate.

Dr. Henry: One of the poor consultants has to stand up.

 

Dr. Fitzpatrick: There is no such thing.

 

Dr. Henry: I am delighted a general practitioner is in the ministerial chair and that my colleague, Senator Fitzpatrick, is present. I welcome the Minister's speech. I also welcome that he has set up a study into the shortage of acute beds in the hospital services. I compliment Senator Jackman on tabling this motion. Given all the money we have spent in the past ten years in the health services, it is profoundly depressing that the waiting list has increased to the level it was at when the first waiting list initiative was introduced by the then Minister, Deputy Howlin, in 1993. There were 40,000 on the waiting list at that time, but the number has increased to that level again. That is profoundly depressing not only for patients but for those who work in the services.

There is less elective surgery and fewer elective admissions. In 1994 64% of hospital admissions were emergencies, by 1997 that figure had increased to 68% and the estimated figure for last year was 70%. In five years there has been a 10% increase in the number of emergency admissions. That is also profoundly depressing because more and more people are being put down the waiting list as people are brought in as emergency cases. Whether they become emergency cases because they are waiting for treatment is another matter we must consider. One of the most important aspects of the continual lengthening of waiting lists is that we have more emergency cases. While people may become emergency cases because they have to wait for treatment, we must take into account that we have an ageing population and more of our people are likely to be admitted to hospital as emergency cases.

There are several reasons waiting lists have developed. In the late 1980s, about 3,000 acute beds in the hospital system were lost, about 1,000 of which were lost in Dublin. We have not recovered from that loss. I am delighted the Minister has at last commissioned a study to ascertain whether we need more acute beds. I think we do. He is the first Minister to consider this matter in recent years. I hope the study is completed rapidly.

I was working more actively in the hospital system when Dr. Steeven's hospital was closed down. It was only when it closed that many of us in the other Dublin hospitals realised the amount of work that went through that hospital. It was incredible. It took a great deal of casualty cases, which allowed other hospitals, such as St. Vincent's and the Mater, two of the hospitals particularly badly hit at present, to take on more of the elective cases.

Another problem is that, apparently, every night 450 acute beds are occupied by people who should be in step down hospitals. We have a grave problem due to the shortage of acute beds. An acute hospital bed costs £2,000 a week. I will leave it the better mathematicians in the Seanad to tell me how much those 450 acute beds cost every night, but it is a considerable amount of money. This happens on a nightly basis across the country. We cannot afford to allow this practice to continue.

Step down hospitals are not inferior, they are extremely good. One generally gets a very high standard of nursing there and one is away from the hustle and bustle of the activity in an acute hospital. It is preferable to be in a step down hospital when one is recovering from an acute illness. I am pleased Dr. Fitzpatrick is nodding in agreement. The faster one can get out of an acute hospital, the better. If one is not fit to go home, one would be better off in a step down hospital. I was once in an intensive care ward and it was worse than being at a crossroads. It was a nightmare. I do not know how people survive to get out of those hospitals as there is so much activity in them day and night. The rest and tranquility that is required for people to be restored to health is not to be found in those hospital. We must act to deal with the provision of step down beds.

A serious problem in surgery is that some theatres are closed because we do not have the theatre staff to run them. We have a grave shortage of theatre nurses. This is an international problem. It has been the practice in America for many years that theatre technicians are part of the career structure. It mainly came about because of the involvement of male nurses in war zones with the American army. Perhaps we should examine that possibility. Theatre technicians' training is not as long as that of nurses and it is more technical. If we examined the possibility of recruiting theatre technicians, we could augment the number of theatre staff.

There are four theatres closed in St. Vincent's hospital and its waiting list is the worst at present. How can that position be improved if the hospital cannot open those four theatres? Several theatres in Tallaght hospital have never opened. Beaumont hospital has theatres closed at present due to the lack of an anaesthetist. We put in place the bricks and mortar of hospitals, but we do not make sure we have the necessary staff to ensure the work can be done.

There is a patchwork approach to this problem in some hospitals. For example, to get its cardiac surgery unit open, St. James's hospital acquired nurses from different parts of the hospital, but that meant other theatres were left short staffed. That results in people having to cut their lists. Some hospitals now have a rota to ensure that everyone's list is not always cut. For example, if my list was cut on Monday, another person's would be cut on Tuesday and another person's would be cut on Wednesday. Without a rota, it was found that the same people were having their lists cut all the time. This practice augmented the build up of waiting lists for specialty treatments, such as ear, nose and throat, where it was easier to cut elective operations because the cases were not quite as grave as the emergencies in other cases. That led to very serious problems.

There is a shortage of 1,200 nurses in Dublin at present. Nurses' pay is an important aspect of this problem. It is very expensive to live in Dublin. The low morale within the nursing profession is also an important element. Clinical care gets very little kudos nowadays which is most unfortunate. If people do not have a hi-tech diploma, they do not feel they are worthwhile, although it is not that those with whom they work do not think they are worthwhile. Patients will not allow anybody apart from nurses to poke at them to see how they are getting on. Nurses cannot be replaced with the same ease as staff in other parts of a hospital. Nurses must be used in the places where it is absolutely essential that they be employed and where there clinical skills are most needed. More could be done to promote retraining courses for women in their 30s and 40s who might consider returning to nursing because of the seriousness of the situation. Recently I saw an advertisement for the Mater Hospital which offered shifts of two, four, six, eight or 12 hours.

I wish to address the consultant situation briefly. I am a member of Comhairle na nOspideál which carries out consultant surveys every now and then. I wonder why we do so, however, because I can say who will be retiring in 2020. I presume that half the rest of the country could do the same, yet no job ever seems to be advertised until six months after the person should have retired. This occurs even though the administrations both of the health board and the hospital know perfectly well that this greying figure who is walking the corridors is obviously going to retire soon. Why on earth is this ridiculous process going on?

I would caution Fine Gael on this matter of having people full-time in the public service. A large number of people are and if one added the private waiting lists to the public ones it would be much worse. Therefore, it is not that great a solution. The really important solution is to increase the number of consultants. Apart from parts of the United Kingdom, Ireland has the lowest level of consultants per capita, in all specialities, among the OECD group of countries. This is patently ridiculous. The country currently needs 35 neurologists and has only 11. In 1991 when we had ten we requested 25, yet in nearly ten years we got only one. Consultant staffing levels must be increased. I keep hearing promises but we must not be fooled into thinking that extra people in the public service will deal with the waiting lists. Public waiting lists in orthopaedics, ENT and dermatology are just as bad as in the private service. One would be as well to get one's name down on both lists in the hope of getting to the top of one of them.

 

Mr. Glynn: I strongly support the amendment. I was slightly amused when I saw the motion, given the previous Administration's record in this area. My colleague, Senator Fitzpatrick, mentioned the increase in people's approach to the elective method of having various procedures carried out. Twenty years ago if people had to go to hospital, half the parish rallied round and encouraged them to go, and there was wailing and gnashing of teeth. That is not the case now, however. It is quite the opposite. This is due to people knowing that little bit better. When they go to their GP for a 50 or 60 year check-up, the GP will refer them for a number of tests, as all good GPs do. Following that they can be on any of four or five waiting lists. That is one aspect of the current situation in the health service.

Other aspects include the fact that people are living longer, emigration is almost nil and Irish people are returning from other countries. While we may be criticised by some people on the other side of the House for doing so, we are also taking in political refugees. They deserve to be taken in and their health needs have to be serviced. Taking all those things into consideration, it must impact on the health service.

I find the motion amusing because, talking about waiting lists, from 1996 to 1997 the previous Administration reduced health funding for that particular service from £12 million to £8 million. When Deputy Cowen took office in 1997 as Minister for Health and Children he increased that figure to £12 million. It is now almost 300% greater at approximately £23.5 million. What is the current position? Waiting lists are still increasing and nobody can say why. I certainly do not know. As a member of the Association of Health Boards I am in constant contact with members of the medical and nursing professions and they do not seem to know why waiting lists are increasing either. The point has been well made that throwing money at the problem will not resolve it.

As Senator Fitzpatrick said, medical staff in A&E departments are not experienced people. We need to separate the wheat from the chaff. If some people have a pain in their big toe or a toothache they go to the casualty department of a hospital rather than their GP or dentist. That is why others have to wait in the A&E department of Longford-Westmeath general hospital, in some cases for up to ten or 12 hours.

In his address, the Minister made a very positive suggestion when he said:

 

Shortening average lengths of stay and an increasing delivery of services at a day case level reflect ongoing advances in medicine that benefit the patient hugely and mean that the resources available can be used to better effect in a manner that suits the clinical and social needs of patients.

 

As regards post-operative recovery periods, who is to say that when a person has a certain surgical procedure they must spend the entire recovery period in an acute bed? That is nonsense. In that respect I welcome the Minister's statement that the "development of non-acute and community based services should also absorb some of the load being carried by the acute hospital system".

Last year a motion in the name of Senator Norris and other Independent Senators dealt with the psychiatric services. A survey of acute psychiatric services by the Eastern Health Board revealed a 45% rate of inappropriate bed occupancy. While I am not saying that is the case in general hospitals, there is some evidence of it. I hope that will be eliminated in the psychiatric services and I will certainly pursue the matter. It should be reflected also in the acute general hospital services, including casualty units. We have such a unit in the Midland Health Board which is serviced by local GPs. These can reduce bed occupancy in acute hospitals.

 

Acting Chairman (Mr. R. Kiely): I am operating a 65 second minute.

 

Mr. Glynn: I am sure the Chair will not need to show me a yellow card.

 

Acting Chairman: It is the same for both sides of the House.

 

Mr. Glynn: Health is not just a matter of surgical and psychiatric beds. It is a very broad-based service. It is worth noting the Minister's investment of huge resources in areas such as mental handicap services, psychiatry and disability services in general. That should be noted.

I will not draw the Chair's ire any further, but a root and branch examination of the waiting lists is needed. It has always been and will always be a feature of beds in acute hospitals that some are closed at certain times, such as the summer and Christmas periods. They were closed under the previous Administration, the one before that and so on.

 

Mr. Ross: I was struck by one of Senator Norris's comment that he judged a society on how it treated its sickest and most vulnerable people. That is a fair way to judge a Government, society or people. At a time when Ireland's prosperity has reached a level we never thought was possible - we are richer than any economist ever predicted - I do not believe the motion goes far enough. The Government amendment is mealy-mouthed, absurd and cosmetic. There is no excuse in Ireland today for waiting lists of any sort. We can well afford over-capacity, not under-capacity, in our hospitals - we can well afford to have empty beds waiting. We can afford that flexibility to meet the demands of the growing population.

What Senator Norris said was right, but I would go further. I am a committed free marketeer who believes in the profit motive and in keeping public spending down, but health care should be non-negotiable. To a large extent, voluntary health insurance is immoral and I am immoral myself as I subscribe to it because I am selfish and can afford it. I do it for all my family and am on the top rate; it is not a matter of great pride to me but is a matter of necessity. I do it because health is the most important asset any person can carry with them. However, it is patently unfair and unjust that some people should be able to buy better treatment while others are on these long waiting lists. Do not ask me to be an angel and justify what I am doing. Everyone knows why they are on VHI and others are not. It is because they want to stay alive.

At the heart of this motion is an Opposition condemning the waiting lists but making no radical suggestions and a Government saying it congratulates itself on reducing the waiting times in a structured, co-ordinated and multidisciplinary manner. That is rhubarb - it means nothing. What we should be saying is that there is no longer an excuse in modern Ireland for people to die, which is what happens by virtue of not having enough money. The Minister knows, as do I, that some people on waiting lists with heart and brain conditions die because they do not get to hospital in time. That is what happens. We cannot justify that and we are not even taking steps to resolve it. The number one target should be to ensure nobody dies because they are on a waiting list, but the only way to do that is not to have a waiting list.

The way to achieve that is to do the exact opposite to what the last speaker said - it is to throw money at it. That is the way to do it - to build more hospitals, to train more doctors and to do what we have not done for years, to pay nurses more. If the Government said we do not have enough hospital beds, doctors or nurses, so it is introducing a programme to ensure within a certain number of years this will end and if we have over-capacity and too many doctors and nurses, I would respect them for it. What we are getting is a mealy-mouthed token attempt to convince us we are doing something.

The Government is, of course, the only shareholder in the VHI. The existence of that organisation and BUPA must be questioned, as they are the vehicles whereby better off people stay alive and poorer people die. This is a clear case for the State taking a responsibility for all its citizens equally.

Nowhere is it more apparent that the State does not take its responsibility seriously than in its attitude to nurses. I have never had it explained to me why nurses are paid so much less than most other groups in the public service. I have asked that question for ten years while I have been bellyaching for their pay and conditions to be improved, but nobody can ever explain it to me. It is not because they do not work as hard because they work a damn sight harder. It is not because they do unnecessary work because they do the most necessary work. The reason they are paid so little is that Irish society does not value the health of its lesser citizens. If it did, this Government and the previous one would have rerated the nurses and put a value on them above other areas of the public service. However, it has not because it is able to get away with it. The nurses should be paid more and given better conditions than nearly every other group in the public service. That would indicate that the State and the Government believe that health care is more important than anything else. I include teachers, gardai, prison officers and the Army. These are the people who stand for protecting the nation's health and should be rewarded accordingly. In the market economy in which we now exist nurses, because of their scarcity, will probably command greater salaries, but that is because they will have to wring it out of a Government that does not want to give it to them. It is not because the Government will say voluntarily that it feels what nurses do is so important that they should get more; it is a contest.

The Government's attitude to the VHI is very strange. It allowed the VHI to increase and decrease premiums and waste money. This was ignored for a long time. It had an extraordinary number of cars for its executives. This seems inexcusable.

 

Acting Chairman: I am not sure what that has to do with hospital beds.

 

Mr. Ross: It has a great deal to do with it. The Government's response to the crisis in the VHI is not just to sell it off but to give it £50 million, and for what purpose? This is a purely commercial response which will allow the VHI to exploit people to the full. This is the wrong response. The Government should look at ways of ridding the nation of private health insurance, which in itself is of such dubious value. This is encouraging the rich to be healthy and the poor to be unhealthy. The result is that there are people on waiting lists which is referred to in the motion. There is no radical approach to health care; there is a piecemeal and reactive approach to it. There are waiting lists to which all Governments react when in office. However, they never attack the fundamental problem which is the right of every citizen to equal health care.

 

Mr. Chambers: Last night I saw the British Prime Minister being asked questions on a live television show about the general health service in Britain. It was interesting that some of the difficulties we are experiencing seem to be similar to the problems in Britain in relation to the health care system in which the British Government in the past, particularly the Labour Party who introduced it, had such great pride. In Britain people do not seem to be able to get proper medical treatment such as surgery and hip replacements. Certainly there are long waiting lists and there is a need for change and investment. It seems that 9% of gross national product goes into the health care service and it is intended to provide the public with a proper complementary service in the next five to seven years.

The amendment to the motion and the Minister of State, Deputy Moffatt's, contribution indicates that he is carrying out an in-depth analysis of the health service. He is looking at areas where there is need for change. I agree with the previous speakers, including Senator Norris, that a yardstick of the strength of the economy is the level of health care people receive. Many people, who may not be financial wizards, believe that despite the substantial investment by this Government in the last two and a half years under the national development plan, and by Governments in the past, there are very few results by way of a reduction in the numbers on waiting lists. At the end of the day, this is the fundamental measurement.

There must be a radical approach and proper evaluation of the administration of the health service. There must be major changes in dealing with consultants and there must be a better return for the money invested by Government in the long term. There will have to be changes by technicians in operating theatres. There must be more versatility so that there is a better return for money. By having a co-ordinated approach nationally throughout the service, from administration level down, including consultants, GPs and throughout the voluntary health system, I believe we can achieve a greater return for our money and a better service for the public. I am aware we will come up against very strict structures which have been in place for many years, particularly in relation to consultants. There is need for a fundamental change in this area and for a new approach by young consultants who, if properly remunerated, will carry out the work and break down old structures. This should be encouraged because it will give a better return for money within the health service.

There should be greater opportunities for more young qualified consultants and surgeons to take on this work. This would go a long way towards reducing waiting lists nationally. The Minister of State mentioned substantial investment in overall health care from general practice upwards. This would allow for a more caring health service, it would take the pressure off hospitals and allow for greater development of acute hospital services.

There is a genuine question in relation to the voluntary health service. It should either be expanded in a national context to give a better service or it should be analysed in the context of the overall investment in the health services. It could be argued that the voluntary health service creates a two tier system, to which we are all party. However, it has served some people well but it does not serve a huge section of society. The issue of health insurance should be addressed in the overall review of the health services if they are to be brought up to the level expected of this productive modern Irish economy which has gained a lot of international prestige. A lot of effort should be put into dealing with this area. I am satisfied that the Minister, Deputy Martin, the Minister of State, Deputy Moffatt, the Department and the Government will make substantial changes in this regard and that the Irish people and those on waiting lists will be the beneficiaries in the long term.

 

Mrs. Jackman: I wish to emphasise the thrust of the motion which is that the Government should take immediate initiatives to ensure the full and proper utilisation of our hospital resources this year so as to significantly reduce the numbers now awaiting in-hospital treatment. The Minister states that the Fine Gael motion attempts to portray a hospital service that is under performing and that is failing to make full use of the resources available to it, to the neglect of thousands of people, and that our suggestion does a great disservice to the many thousands of skilled doctors, nurses and other health care professionals and the management of the hospitals and needs to be addressed head on at the outset. We called on the Government to provide a structure. There was no criticism of the skilled nurses, doctors and health care professionals. I am concerned about this because calling us the baddies is a cop-out. We are discussing facts and figures. I detected in Senator Frank Chamber's comments that he seemed to agree totally with me on the need for a strategy and integrated services, all the things I have mentioned. Many Senators have stated that an improvement and an integrated structure are needed.

The Minister stated that hospital and health board managers have a primary responsibility to ensure that the agreed volumes of service set out in the annual service plan are delivered upon. He is making the point for which he is criticised Fine Gael. He said there is an onus on them to achieve this within the resources available.

He also said that the Government has put in place major projects and that minor refurbishment works are under way in hospitals all around the country. Infrastructure was put into the Regional General Hospital in Limerick, for example, during Deputy Michael Noonan's time as Minister for Health, but the resources are not there today. The consultants and the team that a consultant needs to bring with him or her are not there. Some wards are not open and new rooms are not occupied because the consultants have not been appointed.

The Minister said there is no one simple solution to this problem and the key task is to manage the different parts of the system in a more closely integrated manner. This is what we were calling for in our motion. We agree with what he says and still an amendment was put down which contradicts the points he is making and those made by us. He mentioned the need for an integrated approach, which affirms what we are looking for.

He mentioned the expert review group on waiting lists which reported in 1998. That report sets out a series of short, medium and longer-term measures. Money is spent on short-term strategies which we would be happier to see spent implementing long-term strategies and that is why the waiting lists are long. The money does not appear to be utilised correctly to reduce the waiting lists.

The Minister referred to positive things he intends to do but he took just two or three and I would like to give him more suggestions to consider. These suggestions include the use of communication technology as referred to by Senator Fergus O'Dowd who seconded my motion. The national guidelines must detail a specific timeframe within which patients should receive care. There is a reference to the UK regarding those guidelines, which we should implement. Consultants should be appointed without delay. We said that before it was raised today and it was debated very stringently today on the "Today with Pat Kenny" radio programme. I did not hear the Minister say that the recommendations from the Commission of Nursing should be implemented.

A national assessment of unused capacity within each hospital should be carried out. Those with unused capacity should have the option of buying in work from outside their area, thereby reducing waiting lists. This would ensure current resources are fully utilised. I am helping the Minister by giving him Fine Gael proposals on how we would deal with this. He referred to those patients who do not need to stay overnight in hospital but do so for practical reasons such as living a long distance from the hospital, for whom guesthouses and hostel accommodation should be provided. We have said all this. It has been said by Deputy Alan Shatter many times but Ministers have chosen to ignore it. I did pick up that proposal and I am delighted to see that he is picking up on Fine Gael positive elements.

All hospital beds should be kept open all year round - the Minister differs from me on that - as closing them in the summer is false economy and it only further exacerbates the problem. In the mid-Western Health Board region, 39 beds are closed on average every month. That should not be the case. Day surgery units, which the Minister did not mention, should be established, to greatly increase the opportunity to reduce elective surgery waiting lists. More investment is needed to provide ongoing out-patient services to allow acute out-patients priority. This is necessary for particular services. We must consider the future. Tele-medicine is especially useful for patients in remote areas or those with mobility problems.

We have been extremely constructive in proposing this motion and I cannot understand why the Minister and the Fianna Fáil Senators could not have accepted the essence of our motion, which is to ensure the full and proper utilisation of our hospital resources this year to significantly reduce the estimated list of 37,000 people now awaiting in-hospital treatment. I am shocked that this amendment has been put down, taking up our points on dealing in a structured, co-ordinated and multi-disciplinary manner as a strategy to reduce public hospital waiting lists. This is the point of our motion and what we have been arguing. The amendment was put down for cosmetic reasons and we cannot accept it.

Amendment put.

 

The Seanad divided: Tá, 23; Níl, 14.

 

 

Bohan, Eddie.

Bonner, Enda.

Callanan, Peter.

Chambers, Frank.

Cox, Margaret.

Cregan, John

Dardis, John.

Farrell, Willie.

Finneran, Michael.

Fitzgerald, Tom.

Fitzpatrick, Dermot.

Gibbons, Jim.

Glynn, Camillus.

Keogh, Helen.

Kiely, Rory.

Lanigan, Mick.

Lydon, Don.

Mooney, Paschal.

Moylan, Pat.

O'Brien, Francis.

Ó Murchú, Labhrás.

Quill, Máirín.

Walsh, Jim.

 

Níl

 

Caffrey, Ernie.

Coghlan, Paul.

Connor, John.

Cosgrave, Liam T.

Costello, Joe.

Cregan, Denis (Dino).

Hayes, Tom.

Henry, Mary.

Jackman, Mary.

McDonagh, Jarlath.

O'Dowd, Fergus.

O'Meara, Kathleen.

Ross, Shane.

Taylor-Quinn, Madeleine.

 

Tellers: Tá, Senators T. Fitzgerald and Keogh; Níl, Senators Jackman and O'Dowd.

 

Amendment declared carried.

 

Motion, as amended, put and declared carried.

 

An Cathaoirleach: When is it proposed to sit again?

 

Mr. Dardis: Tomorrow at 10.30 a.m.


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