| 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.
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