The Minister for Health has strongly defended the increase in hospital bed charges, which will make private health insurance more expensive. "I announced yesterday an increase in charges for private rooms in public hospitals. Let me make it absolutely clear again that I have no apologies to make for this increase," said Mr Cowen.

"This increase still leaves a gap between the cost of providing services to private patients in public hospitals. Am I as Minister for Health expected to allow these charges to be frozen and thereby continue with subsidies for private practice, or should those charges not reflect the realistic costs of providing services?"

Mr Cowen said there were already considerable subsidies in place for the private sector, including tax breaks, and he was not going to allow a situation to continue whereby the taxpayer must pick up an ever-increasing proportion of hospital costs, while the private sector did not meet its fair share.

He said the total amount earned by the State from private patients last year for private accommodation in public hospitals was estimated at about £68 million. It was also estimated that the cost to the Exchequer in 1997/98 was £64.5 million for income tax relief on private health insurance premiums and about £20 million for unreimbursed medical expenses.

Mr Cowen was opening a debate on the health services, during which he came under sustained attack from Opposition deputies. He insisted there was "massive investment" in public hospitals by the Exchequer, including building, equipment and staff training.

"Public hospitals also provide the accident and emergency services in this country. Health insurance companies avail of these facilities and they must make a contribution towards those services.

"There are many reasons for cost increases for insurance premiums, including the charges made by private hospitals and medical consultants, and it is estimated that the last increase of 9 per cent in January, 1998, in private accommodation charges, contributed only 2 per cent of the 9 per cent increase in private health insurance premiums introduced by the VHI in September, 1998."

On waiting lists, the Minister said he had allocated £12 million, which represented an increase of 50 per cent over the funding made available by the Rainbow government last year. The additional funding would result in an extra 15,000 procedures being carried out this year.

He added that when the Rainbow government had taken up office in December, 1994, the waiting lists stood at 24,000. When that government left office in June last year, waiting lists had increased to over 30,000. They had risen to 32,000 by the following December, due in part to the allocation by the government of just £8 million for waiting list work last year.

"This represents an increase of 33.3 per cent during the lifetime of the previous government. With the reduced funding provided by the Rainbow government, waiting lists rose by one-third."

Mr Cowen warned against adopting a "simplistic approach" to dealing with unduly long waiting lists and waiting times. Ireland was not unique in having them.

"A quick-fix solution, therefore, by simply throwing money at the problem, is not the answer. What is required is a structured, co-ordinated and multi-disciplinary approach to dealing with waiting lists and times. Fundamental to this is the establishment of the underlying causes of unduly long waiting lists and waiting times."

Having considered the report of a review group, the Minister said he was currently making the organisational arrangements necessary to ensure that a structured and planned programme was implemented in each acute hospital as a matter of urgency. This would involve shared responsibility between management and consultants.

The Government was accused by the Fine Gael spokesman on health of presiding over "one of the most dramatic increases in the hospital waiting lists" in modern times.

Mr Alan Shatter said that by the end of last June, there were 34,331 patients on the public hospital waiting list. It was conservatively estimated that the figure had grown to 36,500 by September, and it was reasonable to assume that by the end of the year it would have reached 38,500.

"In effect, during the 18-month lifetime of this Government, and this Minister for Health's term of office, the numbers on the waiting lists will have increased by 10,000. This has occurred not at a time of economic difficulty but at a time of unprecedented economic prosperity never previously experienced in the State."

Mr Shatter said that through the second half of this year, hospitals all over the State had been closing down beds and wards because of a fear that they would exceed their allocated budget. Those bed closures had resulted in patients' appointments for elective surgery being cancelled and had contributed to the dramatic increase in hospital waiting lists.

"Last week, I conservatively estimated that 800 beds would close in December. We now know the number to be 912, with an additional 16,000 bed days lost in the last six weeks of this year. "The loss of so many bed days will further add to the waiting lists and prolong the waiting time for essential surgery for thousands of people who require hospital admission. In December 1998, there will be throughout the length and breadth of this country a substantially scaled down hospital service. In the Ireland of 1998, you become ill at your peril in the month of December."

The Labour spokeswoman on health, Ms Roisin Shortall, claimed there was palpable anger among the public that hospital wards and operating theatres were being closed at a time of unprecedented economic growth.

Nobody was suggesting that the Minister should have solved all the problems in the health services after almost a year-and-a-half in office, but clear attempts should be made to tackle underlying problems. The Democratic Left spokeswoman on health, Ms Liz McManus, said that the question of hospital waiting lists was essentially one of inequality of access and care.

"We all know that there is a world of difference between the service offered to a private patient and that provided to a public patient."