Hospital consultants have warned that waiting lists, and the time people spend waiting for medical treatment, will worsen next year if the Government sticks to its target of increasing health spending by only 4 per cent.
The proposal will actually result in less cash to treat patients in 1999, according to Mr Finbarr Fitzpatrick, secretary-general of the Irish Hospital Consultants' Association.
"We will end up with less cash next year than we had this year, with waiting lists increasing all the time and no noticeable decrease in the amount of time people have to wait for treatment."
Mr Fitzpatrick said the State's inflation rate was set to rise by up to 3.5 per cent next year, leaving just a small fraction to spend on the health services. Medical inflation runs at about 7 per cent alone.
The problems would be exacerbated by the lack of budgetary provision for the cost of the Freedom of Information Act, preparing computers in hospitals and health boards for the millennium "bug", and the increasing number of administrative workers.
"Hospitals, or should I say patients awaiting admission to hospitals, need a greater slice of the national cake. Any proposal to increase health spending by 4 per cent in 1999 will, in reality, result in a reduction in hospital services," said Mr Fitzpatrick.
The State had decided to give free hospitalisation to everyone who wanted it but was not delivering it, he said. "At the end of the day it is the medical card-holders who are finding hospital services inaccessible. Thirty-four thousand people - 1 per cent of the population - are on waiting lists at this stage."
According to the latest OECD figures, Mr Fitzpatrick said, Ireland ranked second-lowest, with 3.2 acute hospital beds per 1,000 people, length of stay at 6.3 days ranked the lowest, and the number of admissions was second-lowest on the league table.
Bed closures during the summer, he said, were a false economy and merely deferred the problem and the expense. "All that is happening is that the problems are being put off and the waiting lists are getting longer."
More than £70 million has been spent on waiting-list initiatives since 1993, and there were still 34,000 people waiting for treatment. According to Department of Health figures, more than 60 per cent of people waiting for cardiac surgery were waiting longer than 12 months, and 88 per cent of children waiting more than six months for orthopaedic surgery.
"These figures do not take into account the amount of time people spend waiting to get an out-patient appointment to see a consultant before they are even put on a waiting list. Of course, if they need a new hip or cardiac surgery they may be out of work, need to attend the GP fairly regularly, and are claiming social welfare. The cost of treating them may be being deferred, but where is the saving?"
Mr Fizpatrick said capital investment of about £500 million should be made in the State's hospitals. He suggested a combination of private and public investment, such as happened with the multi-storey car-park at Tallaght Hospital.
"The lead time from the planning stage of a hospital development to the actual opening for patient admission is far too long.
"A hospital extension or refurbishment that is described in 1998 as being `state of the art' will be anything but that in 10 or 15 years' time when it is actually open to patients."
He said consultants were tired of lectures on efficiency and value for money. "The general public are receiving value for money. They are concerned at the creation of an ever-increasing number of administrative posts - for every consultant there are seven administrators."