The voted Estimates for the health services as recently passed will not produce a health service which is fair or accessible by all, regardless of income. The money contained in the 2001 Estimate does nothing to restore the health service spending to 1980 levels, despite the fact that the Exchequer has run budget surpluses of £6.4 billion. That is very regrettable. It is more than regrettable for the many thousands of people who are waiting for hospital beds. It is more than regrettable also for the doctors, nurses, therapists, paramedics and others who work within the health services and those people who rely on their expertise and care. It is deeply disappointing, as I have said to the Minister before, for all those people who believed the Minister's press releases and who expected a reforming and revitalising response. Instead of the stimulating injection expected, this year's Estimates will act as a sedative to the ailing health service, at best maintaining the current unacceptable status quo, at worst allowing a rapid deterioration of its critical condition.
It is estimated in a report published this evening that to meet the needs of the Republic on the same basis as the needs of those in Northern Ireland are met would require an additional 7,730 beds. There are only 3.12 beds in the Republic for every 5.12 in Northern Ireland. That is the kernel of the problem. Let us look at the facts contained in these figures and examine a few key areas which give the lie to any assertion of improvement. The total net increase in this year's Estimates over last year's is £850 million, an increase of 17%. So far, so good. When the detail is examined we discover that of the £850 million, 49.5% – almost half – £421 million, goes to pay salaries. The payment of salaries is an essential part of any Estimate and I fully concur with the need to pay good salaries. I take issue with what this Government has allowed for health spending after making provision for salaries. The increase is now reduced to just £429 million. The reality is that this year's Estimate simply aims to continue existing programmes and to pay staff. There is no sign in this year's Estimate of the financial outlay which would allow for the realisation of the reforming and revitalising zeal often articulated by the Minister. When asked to put his money where his mouth is, he fails miserably. This Government may have increased spending but it has not made any contribution to improving health care or reforming the health services. The Minister has increased spending but has not increased or improved health care. It is strategic planning which is lacking and there is no allowance in this year's Estimate for even the sign of that planning.
This is no more than we have come to expect from the Minister. In the Official Report of 8 May 2001, vol. 535, cols. 1236-37, the Minister said:
It is time for a strategic look at health services . . . Seven years after the previous strategy is an opportune time to look forward in terms of a new strategy.
In its fifth year in government, despite all the demographic changes and the rapidly changing health environment, this Administration has only now started to look forward. What a way to administer the health services. People's health needs are immediate and urgent but the Government has sat around noting reports, ignoring the evidence for the past four years and is only now starting to look forward. This laissez-faire attitude is totally unacceptable. The deluge of evidence of the need for rapid reform has swept on unnoticed by the Government as if it were a passing shower. There are well over 60 different reviews, examinations and standing committees working for the Minister. There has been no action. Everything that arises is under review.
Resources are part of the problem, but nothing short of major structural changes will bring about the health services required. Such structural changes should include a covenant of rights and responsibilities for patients; a dedicated health ombudsman to oversee such a covenant; an entirely new structure of health governance with hospital boards which are citizen-based and management which should have contracts of employment that are renewable on application every six or seven years. Results to be measured based on six criteria, health gain, fair and equal access, effective delivery of appropriate health care, efficiency, satisfaction levels achieved for patients and carers, and health outcomes.
Resources nearer the EU average spend on health – 8% of GDP compared to current 5.1% of GDP or 6.05% of GNP rate of spend – with value-for-money audits. I have made specific recommendations as to how the money can be used effectively – a universal health system with access based on need, not on wealth, and reform of primary care with Government investment.
Fine Gael will give back to our citizens trust in our health services. Trust in the health services has been eroded by the fact that our citizens cannot be confident of being treated in an appropriate way when ill, major health care services and providers have not justified the trust placed in them by our citizens, the poor, the elderly and many patients suffer second class treatment or, worse, receive no help when needed from the health care services, and a glaring lack of leadership and direction by the Government, now in its fifth year in office, in solving the critical problems in our health care system.
I am aware of an elderly, mentally handicapped patient who fractured her shoulder, was taken to a hospital and was left sitting all day long without anything to eat or drink. She was only eventually seen by a doctor very late at night. This was a patient with obvious special needs. What has gone wrong with our health system and what has the Minister for Health and Children been doing to correct that wrong?
The proposals put forward in the Fine Gael health plan are designed to restore trust in the health services. For this reason as well as for other reasons, Fine Gael will create a citizen-centred health service that will be trustworthy, effective, efficient and accountable to the citizens it is designed to serve. As the health plan proposed by Fine Gael is implemented, it will shape our new health care system with the following features. The new health care service will be funded to meet the health care needs of our population and will be fundamentally reoriented from curative to preventative services. This is long overdue.
Only £2.50 out of every £1 million in this year's Estimates is allocated to health promotion, despite the fact that the Minister has acknowledged the importance of health promotion. This is a priority area, yet it gets £2.50 out of every £1 million. So much for prevention and so much for priority. The new health care service will be needs-led, designed and based around evidence-based needs. It will be outcome-driven and services will be measured by health outcomes.
In 1980 when we were a much poorer nation, Ireland spent 8.7% of wealth on a GDP basis on health. By 2000, Ireland's spend had dropped to 5.1% of GDP. It has to be acknowledged that Irish GDP increased rapidly in recent years. Nonetheless, despite the rapid growth in the economy, Ireland is about 22nd in a list of 29 OECD countries in terms of health spending. From a low base in the early 1990s health spending has more than doubled, but it remains far behind the European average of more than 8% of GDP.
More than 60,000 nurses register annually in Ireland, only half of whom are in the health services. Nursing shortages leave some Dublin operating theatres closed for one week in four. Lest anybody thinks this is just a Dublin concern, 20% of all treatments in Dublin are for people living outside Dublin. Therefore, the acute nursing shortage in Dublin is a national issue. It is time for a Dublin weighting to be paid to nurses, together with an accommodation allowance to attract registered Irish nurses back into the system in Dublin where two-thirds of all nursing shortages exist,
If the Minister spent his energies trying to bring about practical solutions such as this, instead of massaging hospital waiting list statistics, real progress could be made in our hospitals. Cancer patients would not have to go to the courts to obtain treatment. What has happened to this country, the demarcation, the courts, the Executive, the Legislature? Ministers no longer make decisions. Judges make the decisions Ministers are paid to make. It was an insult in a week when such a court case was taken, that the Minister should seek to give the impression that all is rosy with hospital waiting lists. This seems to be a case of lies, damn lies and hospital waiting list statistics.
In the meantime, during the Government's term of office, what has happened to the health services? There were more than 1,800 bed closures cumulatively during 2000, more than 800 of which were due to nurse shortages. There are almost 30,000 people on hospital waiting lists nationally, more than 52% of whom are waiting for a bed in the Eastern Regional Health Authority area where the numbers on waiting lists are 19% higher than when this Government took office. Cancer patients have had their essential chemotherapy treatment delayed because of lack of beds. Four floors of a new hospital wing in the Longford Westmeath hospital, finished during the Rainbow Government's term, have lain empty for the past four years depriving the health service of 98 much needed additional beds because the Government cannot make up its mind what to do. The accident and emergency units of all hospitals are over-crowded. Medical and nursing staff are being forced to work in appalling conditions. Seriously ill patients are made to wait on trolleys for unacceptably long periods. People on modest incomes whose wage increases are almost wiped out by inflation are deprived of essential free health care by the Government. The current income limits for medical cards are so low that a husband and wife lose their eligibility if their income exceeds £144.50, or thereabouts, per week. A family with two children are excluded if their gross income exceeds £180.50 per week, and a single person cannot qualify if he or she earns more than £101 per week. As a result, only three out of four people, who qualify under the agreement which the Government has entered into with the IMO, receive medical cards because income limits are kept artificially low at a time of huge budget surpluses. It is the poor who wait on hospital waiting lists and who die younger. Fine Gael will double the medical card income limits to correct this injustice. There is under-investment in general practitioner care, and changes to the drugs payment scheme, instituted to save money – while we run budget surpluses of £6 billion per annum – mean that people with chronic conditions, such as asthma, have to pay more for their essential medication.
Fine Gael's comprehensive policy proposals, published in November 2000, are fully thought through and costed. Recognising the need for essential and far-reaching reform, we propose to double the income limit for medical card qualification; to extend free general practitioner services to children up to age 18 and over that age when in full time education; to extend it to all senior citizens over 65 years and to those with chronic disabilities; free medication for people with asthma; development incentives for GP's surgeries and pharmacies to encourage greater use of primary care and ease pressure on hospitals; to provide a non means-tested allowance to support persons cared for at home; to expand the number of public health nurses, home helps, speech therapists and other essential supports to carers in the community; to provide free health insurance for all with committed budgets to meet hospital needs; to increase the number of beds in the different care settings and appoint a health ombudsman who will oversee a covenant of patient's rights.
Fine Gael proposes a thorough reform of the hospital and health administration services to give citizens a real say and to provide for accountability as there is no accountability; a greater role for voluntary organisations and specific funding commitments to meet these objectives.
While accepting that there are no "quick-fix" solutions, it is clear the Government has no solutions at all. The four wasted years have put the development and reform of the health services back by ten years. That is indefensible. The approach of a general election is only now acting like a dose of salts to this sluggish Government.
It is a bitter irony that the Taoiseach could find the money and the time to fast-track his pet project, Stadium Ireland, to the tendering stage in a little over a year. Yet he leads an Administration which in its fifth year of office is still in the review stage for the health services. The facts speak for themselves. It is clear that while the Government has the resources at its disposal, provided by this House, it does not have the courage or the ability to make the fundamental changes which would deliver better health care for all. We should be ashamed that a cancer patient had to go to court to secure treatment. That is unacceptable. It is said that knowledge is power. If that is so, patients must be empowered through information so that they can understand and deal with their own health and care needs in a true spirit of partnership with the health care providers in primary, secondary and tertiary care. In the 21st century, many health professionals agree that patients can no longer be viewed as passive receivers of whatever the health care system deems to be in their best interests. Patients must be active participants in the process from start to finish. In most countries a major part of any empowerment in the information process is a so-called patient's charter or patient's bill of rights.
The original patients' charter for Ireland is minimalist and deals only with hospital in-patients and out-patients. It did not seek to enshrine rights for patients in a more formal way. It was and is often honoured more in the breach than in the observance. It is ironic that the Department of Health and Children is no longer able to supply printed copies of the patients' charter. The document is only sometimes found posted up on the notice board of hospitals around Ireland. It can be safely assumed that most patients are unaware of its existence.
The problem of vindicating patients' rights is difficult but by no means intractable. Equally, many patients are unaware that they have rights. Add to the equation that in the health system patients can be reduced simply to being a case to be dealt with. Individual patients may be too ill, insecure or uninformed to stand up for their rights. In recognising patients' rights, the partnership of doctor and patient can improve the quality and outcome of medical care. We should give statutory backing to a new covenant of rights and responsibilities for patients in a new health Act. A health ombudsman should be appointed to oversee that. Two or three years ago, I would have questioned the need to appoint another ombudsman. However, in view of the proliferation of tribunals, inquiries and commissions and the amount of money being spent by the Minister on up to 60 different reviews, it seems to me that such an appointment would be money well spent. A health ombudsman would also reduce the need for litigation, the fear of accusation of medical negligence and the difficulty which that creates for some doctors in terms of nervousness in carrying out some procedures.
Patients are, first and foremost, citizens. Fine Gael believes it is no longer enough simply to inject more money and resources into the existing system. We propose a complete, detailed and comprehensive reform of the health services. We have not waited until year five of this Government's term of office to make those proposals. Since 1987, Fianna Fáil has been in Government all of the time, with the exception of two and a half years and the Minister seeks to blame the Rainbow Coalition which was in office for two and a half years. He seeks to blame his predecessor, Deputy Cowan. He seeks to blame somebody, anybody other than himself; it was nothing to do with him, somebody else took the decision. I put it to him that he is the Minister for Health and Children. We know what a fright his party got in Tipperary South. There is a very much bigger fright waiting out there for the Government with its self-congratulatory approach and its efforts to be all things to all people. The Government should address the issues that really matter – traffic, housing and health. This Government is a dismal failure at a time when there is an abundance of resources available to deal with the problems. We have the resources. Where is the leadership and the strategy? They are lacking because this Government has not got a feel for the issues or the experience, the skill, the will or the sense of injustice to provide a decent system of which we could all be proud. I commend this motion.