There were four adjournments and a walk-out, with one TD being suspended, during heated exchanges between the Government and Opposition parties over the health services.

The Fine Gael leader, Mr John Bruton, supported by the other Opposition parties, said there should be a special debate on why £32 million of unspent funding in the Department of Health was not used to prevent ward closures and reduce waiting lists.

Mr Bruton warned: "People are going to die without life-saving operations because of mismanagement."

When the Taoiseach, Mr Ahern, said any health estimates due would be fully debated, Mr Bruton remarked: "In all seriousness, does he not realise the problem there is in the health services at the present time?"

The Ceann Comhairle, Mr Seamus Pattison, said the health services could not be debated on the Order of Business. Mr Bernard Allen (FG, Cork North Central) said: "People on the waiting lists would like to know what is happening."

The Labour leader, Mr Ruairi Quinn, said that while he accepted a debate on the health estimates on the Order of Business was out of order, it was in order for Opposition parties to ask the Taoiseach if there could be a debate on a supplementary health estimate before the end of the Dail session.

Mr Ahern said if there was a supplementary estimate in the Department of Health, arrangements could be made for a debate.

Amid continuing uproar, the Ceann Comhairle adjourned the House for five minutes.

When the House resumed, Mr Bruton said he simply wanted to ask if the Taoiseach would allow a token supplementary estimate be introduced so there could be a debate on the Minister having £32 million in unspent health levies.

The Ceann Comhairle said Mr Ahern had promised a general debate on the Book of Estimates. Mr Quinn said: "Those are the estimates for next year. We want to debate the estimates for this year."

The leader of Democratic Left, Mr Proinsias De Rossa, said it was a disgrace there were ward closures and lengthening waiting lists while money was being returned from Health to Finance.

The Taoiseach said he had no reason to bring forward a token estimate. The health boards, voluntary hospitals and health agencies were made aware at the beginning of the year that there would not be supplementary estimates and they would have to manage within the resources, Mr Ahern added. He said the health estimate had increased by 35 per cent in six years. Mr Bruton said: "The waiting lists are going up even faster."

As the uproar continued, the Ceann Comhairle again adjourned the House for five minutes.

"We are leaving the chamber," said Mr Quinn, as he led Labour deputies in a walk-out. They were joined by Democratic Left and Green Party deputies.

When the House resumed, the Ceann Comhairle said there could be brief statements from the Taoiseach and the party leaders.

Mr Padraic McCormack (FG, Galway West) said: "Are we going to let patients die in the hospital? . . . Is there any consideration for the patients in Galway?"

The Ceann Comhairle said Mr McCormack was not entitled to speak because there was not a debate on the health services. When Mr McCormack persisted, Mr Pattison suspended him from the Dail. He then adjourned the House for 10 minutes.

On the resumption, the Taoiseach said the House would have the opportunity to discuss the 11 per cent increase in the 1999 Book of Estimates, which amounted to more than £307 million.

When the Ceann Comhairle called the next business - the report stage of the Western Development Commission Bill - Mr Bruton said his party would not agree to it being taken without an adequate explanation about the £32 million. The Opposition called a division, which the Government won by 69 votes to 56. Three Independents - Mr Jackie Healy-Rae (Kerry South) Ms Mildred Fox (Wicklow) and Mr Tom Gildea (Donegal South West) - supported the Government.

After the vote, Mr Bruton said the Minister for Finance, Mr McCreevy, had been in the House for the division. "He could have been here earlier to provide answers."

The noisy exchanges continued, as Opposition deputies insisted on raising the health services, and Mr Pattison called the next business. He adjourned the House for a half-hour. When it resumed, the Fine Gael deputy leader, Mrs Nora Owen, said her party would return to the issue.

Following the House exchanges, the Department of Health issued the following statement: "The allocation to health agencies is determined by the gross estimate provision to Health. The gross health estimate is made up of the net sum provided by the Exchequer plus other income, the largest component of which is health contributions.

"Appropriations in aid are showing £65 million in buoyancy over the original projection for 1998. The expenditure underlying yesterday's figure is up by £32 million on the original. This means that the net provision is currently showing a reduction of some £32 million.

"The eventual gross provision to Health in 1998 will show a significant increase over the original provision which was agreed at the start of this year. The misinterpretation of the figures published in yesterday's Book of Estimates arises from the reduction on the net estimate. This is entirely driven by the buoyancy in appropriations in aid, in particular health contributions. However, this reduction has no implications for the expenditure of agencies.

"The reduction on the net estimate reflects the position at a point in time and as stated in the Book of Estimates is subject to revision.

"In particular, the figures do not include the full impact of a supplementary estimate for 1998 which is currently under discussion between the Department of Health and Children and the Department of Finance.

"Following agreement on the Department of Children's supplementary for 1998, and approval by the Dail, the apparent £32 million reduction will be absorbed within the final net expenditure estimate for the health services."