asked the Minister for Health if he accepts that public health patients with certain conditions may have to wait years for treatment while private patients can have practically immediate access to the same public health consultant in a private hospital, or in a private bed in a public hospital; and the steps, if any, he is taking to improve the situation.

41.

asked the Minister for Health if he will outline the steps, if any, he is taking to ensure equality of access to health services irrespective of means.

I propose to take Questions Nos. 10 and 41 together.

A number of general principles govern the manner in which people have access to hospital services. A universal principal is that access to the services is determined by the needs of the patient. In the Irish hospital system there is a long-standing tradition of incorporating the public and private practices of hospital consultants within the public hospital system. I believe that this tradition has served the people of this country well in making the services of the most eminent and highly-skilled medical personnel available to all categories of patient.

Under the terms of the common contract consultants have the right to private practice within and without the hospital in which they are employed. However, in public hospitals the common contract stipulates that medical need should be the overall criterion for access to hospital and that admissions should be arranged accordingly. Admission policies and practices in private hospitals are a matter for those institutions.

However, I cannot accept that public patients who are in urgent need of treatment do not have access to hospital facilities. In the circumstances it is unavoidable that patients will exercise their right to seek treatment on a private basis. This can help relieve pressure on public facilities and facilitate speedier. access by those who are unable to avail of private facilities.

Will the Minister agree that the gap between public and private medicine is widening and, as implied in the question, that consultants are not generally available to public patients but are instantly available to private patients? Will the Minister agree that there has been evidence of this for some time, particularly with regard to hip and heart operations and a number of other procedures? Does the Minister accept that that trend exists? What steps does he propose to take to deal with it or is he satisfied to allow this trend continue?

I do not accept that the gap is widening or that the position is any different from what it was when I took office. I take the Deputy's point about long waiting lists for non-urgent procedures, particularly for such procedures as hip replacements. The Deputy will be aware that there are two waiting lists for public patients for hip replacements, a priority waiting list and an ordinary waiting list. Those in severe pain have priority and I am concerned at the length of time people have to wait for such operations. I am addressing that matter to see if it will be possible to improve the position. The problem is not new.

Will the Minister not agree that it is a scandal that there is not a national policy to seek equality of access to services in our health service system? Will the Minister agree that the community look to him, the person in control of public policy, to redress the ever widening gap which is causing such distress to the people who have to wait so long for operations? The delay is not confined to hip operations. When would a heart operation be considered urgent?

I do not accept that the gap is widening to the extent that the Deputy has alleged.

The Minister is out of touch.

He should get out of the bunker.

The Minister should be allowed to reply to Deputy Molloy's questions.

It is my responsibility to ensure that an adequate and proper service is available for public patients. I should like to point out to the Deputy that since I took office I have initiated a review of the common contract. I am anxious to ensure that consultants are readily available to patients in public hospitals.

The Minister is out of touch. Is he aware that in the Cork area young children wait three years on the public list for such basic attention as eye, ear, nose and throat operations? Is the Minister aware, too, that the parents of those children are being told that if they get the money from a credit union, or a money lender, they can have the operation carried out in three or four days? Will the Minister stand over that?

I have told the House of my concern about certain procedures such as hip operations, ear, nose and throat procedures and eye surgery. There has always been a long waiting list for such procedures and the Deputy has admitted that in some cases it has been as long as three years. I have not been in office for 12 months but the Deputy's party were in Government for the previous four years when such lists existed.

I am talking about a three year waiting period from this week.

I would like any Member to tell be of a developed country that does not have a waiting list for such procedures.

Will the Minister agree that the closure of 2,500 medical and surgical public beds in 1987 and to the end of 1988 will inevitably mean the development of more and more private work? Will the Minister agree that the addition of 600 new private beds will mean that elective medical and surgical work will go to the private sector and that consultants, who are paid £36,000 per year for 34 hours public work, are no longer doing that? Will the Minister agree that many of those consultants are spending half their time on private patients with the result that orthopaedic, ear, nose and throat and basic cardiac work for public patients, is being totally neglected? Is the Minister aware that that is happening? Will he accept that it is his responsibility to change the system?

I do not accept the Deputy's allegations. In fact in some hospitals where beds were closed as a temporary measure last year the throughput of patients was greater than it had been the previous year. I should like to add that with the advent of five-day surgery and day surgery a lot of the procedures now carried out do not demand a long stay in hospital.

The Minister has denied responsibility for waiting lists in certain areas but in the area of hip replacement he must accept that as a result of the budget allocation to Cappagh Hospital last year, which followed a period when the management of the hospital achieved substantial economies, the waiting list for hip replacements has doubled? Such patients have to wait a longer time for such procedures. Will the Minister accept that for an elderly person that delay can be critical and will mean a deterioration in the quality of their life? It may mean that those people will be housebound for a number of years and that they may not benefit to any great extent from the operation.

The Deputy should be brief.

Will the Minister qualify the signs of hope he sees in the review?

I do not have the exact number of procedures carried out at Cappagh Hospital but I accept that there has been a small reduction in the number of hip replacements carried out there in 1987. However, the reduction was not sufficient to double the waiting list. Worldwide there are waiting lists for hip replacements and countries who have tried to eliminate such waiting lists were unable to do so. It is one of the areas I am concerned about.

Is the Minister aware that in my constituency a 12-year-old primary school boy, the son of a medical card holder, is in great need of orthodontic treatment and, although his condition is deteriorating, he has been told that he cannot have the treatment? That treatment is available in Northern Ireland but the boy is not being allowed to go there for it.

I am aware of the serious situation in relation to orthodontics. I am sure Deputy Fitzpatrick is aware that the health boards advertised for five orthodontists about three years ago but only one post was filled as a result of the competition. Orthodontists were not available to fill the other four posts.

Why not.

This has certainly aggravated the situation.

Is the Minister not aware that if this boy could pay for the treatment he could get it? The orthodontists are there and could be paid on a case basis.

It is a scandal and the Minister should not stand over it.

As I have said, the health boards advertised for orthodontists during the term of office of my predecessor, who is in the House. As he knows, only one of the five posts was filled. I give him credit for advertising.

The Minister will not pay. If this boy could pay he could be treated. He will never be able to eat properly.