I move:
That a supplementary sum not exceeding £33,161,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1980, for the salaries and expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain services administered by that Office, including grants to Health Boards, miscellaneous grants, and certain grants-in-aid.
The original Vote for Health for 1980 was £541,860,000, including a capital provision of £27,500,000. The first supplementary estimate which was agreed to last June totalled £93,190,000. The Supplementary Estimate covered the amounts required to meet the cost of approved special pay claims which is £88,390,000 and the cost of increases in cash allowances which had been provided for in the 1980 budget, £4,800,000. This brought the total approved Vote for Health for 1980 to £635,050,000.
The net total additional grant now estimated to be required is £33,161,000. The gross amount required is £43,311,000 but deductions totalling £10,150,000 fall to be made because of an estimated increase of £10 million in the amount to be realised by way of appropriations-in-aid and an anticipated saving of £150,000 on Subhead G7 the Grant to the Voluntary Health Insurance Board.
As I mentioned, the gross supplementary requirement amounts to £43,311,000. This is made up of: £36,311,000 for non-capital services, and, £7 million for capital services.
The additional grant required for non-capital services arises under the following broad headings:
£m. |
|
Additional amount required to maintain essential health services in 1980 |
16 |
Pay costs arising from the second national understanding |
10.7 |
Pay awards for certain grades of health personnel |
7.261 |
Increases in social insurance contributions (employers' share) |
1.85 |
Double payment for one week in weekly payment of cash allowances |
0.5 |
Total |
36.311 |
Despite the very commendable efforts made by health boards and other health agencies to effect all possible ecomomies in the running of the services in 1980 a number of adverse factors reduced to an extent the effectiveness of their programmes for securing economies, such as particularly heavy increases in certain commodities like heating oil, drugs and medicines, and medical and surgical appliances and equipment. It was found necessary in all the circumstances to provide additional assistance in the sum of £16 million to ensure that essential services could be maintained. Of the total amount of supplementary estimate sought, £2.35 million relates to the General Medical Services Scheme as financed through the General Medical Services (Payments) Board. The amount which relates to the drugs refund scheme and the long-term illness drugs scheme is £3 million. The balance of the increase is related largely to increases in costs associated with hospital services.
Of the gross amount required for non-capital services — that is £36,311,000 — pay accounts for £19.811 million made up as follows:
£m. |
|
Second national understanding |
10.7 |
Special pay claims |
7.261 |
Increase in social insurance contributions (employers' share) |
1.85 |
Total |
19.811 |
Non-pay expenditure accounts for £16.5 million.
£m. |
|
Drugs Refund Scheme and Longterm Illnesses Drugs Scheme |
3.0 |
Double payment in one week to recipients of cash allowances |
0.5 |
Other non-pay costs |
13.0 |
Total |
16.5 |
Pay accounts for about 54.6 per cent of the gross supplementary requirement for non-capital services and non-pay expenditure for about 45.4 per cent.
The provision for approved special pay claims covers cases which have already been approved, save in one instance where negotiations are still in progress. The cost involved in cases where approval has been given comes to about £7.131 million out of a total of £7.261 million included in the Supplementary Estimate. The major items are:
£m. |
|
Further adjustment of pay of general nurses arising from clarification by the arbitrator of his arbitration finding |
1.06 |
Award of £7.60 a week for nonnursing staff in voluntary hospitals and homes for the mentally handicapped, together with an equal pay settlement for the same staff |
2.2 |
Pay award for radiographers |
1.1 |
Regrading for catering officers |
0.5 |
Increased premium payments for non-nursing staff |
0.36 |
Pay award for public dental surgeons and psychologists |
0.33 |
Pay award for child care workers |
0.25 |
If the outstanding claim has not been settled before the end of the month then the provision included in the Supplementary Estimate — £130,000 — which is referable to the claim will not be drawn.
Arising from the question of surrendering unexpended funds which are authorised by the Dáil for specific purposes, I should perhaps refer to statements made recently in regard to the surrender in 1979 of amounts approximating to £27 million. A sum of £25,918,000 was included in the Supplementary Estimate of £72,480,000 for Health in 1979 to cover the cost of pay claims where negotiations had reached an advanced stage or where offers in settlement had been made. If agreement was not reached before the end of the year in respect of any of the claims not so far finally settled then the provision made in the Supplementary Estimate which was referable to any such claims would not be drawn.
In the event the total amount falling to be surrendered on the voted subheads was £22,942,269 made up as follows:
(i) £22,804,000 in respect of offers on special pay claims which were not finally settled before the end of 1979, the main constituent of which was £21.25 million in respect of offers made to nurses;
(ii) surpluses on miscellaneous subheads offset by some minor excesses — £138,269.
The surplus realised on appropriations-in-aid amounted to £4,046,159. The combined total of the amounts falling to be surrendered was £26,988,428. This amount was certified by the Comptroller and Auditor General. The accounts as certified will be reviewed by the Public Accounts Committee, as is the normal course, probably early in 1981.
The procedure followed was in strict accordance with established practice. Public moneys may be appropriated only on the authority of the Dáil, that is, expenditure may only be incurred within the limits of and the purposes of the amounts voted. Any sums for authorised purposes which are not expended, including any surplus of appropriations-in-aid realised, must be surrendered. While virement may be exercised with the sanction of the Minister for Finance, in regard to excesses and savings as between subheads, it relates to authorised expenditures, generally of a minor nature. Virement, or the swithching of moneys between subheads, was availed of in that way in 1979.
An amount equivalent to the provision of £22,804,000 for pay awards which was not drawn from the voted Supplementary Estimate for 1979 was included in the 1980 Supplementary Estimate for Health which was voted by the Dáil on 20 June 1980. This amount was paid out during 1980 in espect of retrospection, almost entirely to nurses.
The rates of social insurance contributions — employers' share — were increased as from April 1980. The employers in this instance are health agencies funded from the Department's Vote. The estimated amount required to meet the expenditure involved is £1.85 million.
In line with the provisions of the second national understanding and the approval already given on the social welfare side, a double payment is being made for one week in the amounts of the payments made to recipients of disabled persons maintenance allowances, infectious diseases maintenance allowances, blind welfare supplementary allowances and domiciliary care allowances for handicapped children. This will cost about £500,000 and is in addition to the amounts provided under the Social Welfare Supplementary Estimate.
I am seeking an additional sum of £7 million to meet capital expenditure on health projects in 1980.
The amount voted earlier this year for capital works was £27.5 million and, in addition, £0.5 million was available from the Hospitals Trust Fund making a total capital allocation of £28 million.
I had sought this £28 million in the context of the need for constraints in public expenditure in the current year and I had expected that by placing certain restrictions on the capital programme it would have been possible to manage within this allocation. However, despite these measures, this did not prove possible, due mainly to inflation and the fact that the output of work on the projects in progress in the restricted programme has been maintained at an unusually high level. It is estimated that inflation added some £5 million to the cost of schemes this year.
Accordingly an additional £7 million is required to meet commitments arising from this year's capital programme. I would like to explain that despite the restrictions imposed this year it was possible to maintain progress on 79 projects which were in course of construction at the start of the year and to allow a limited number of new works to start, the major works being Cheeverstown Mental Handicap Centre and the first phase of the development of St. James's Hospital, Dublin.
The 1980 Vote for Health provided for receipts amounting to £42.8 million. It is now expected that income will amount to £52.8 million. The increase of £10 million is made up of an increase of £8 million in receipts from health contributions and £2 million in receipts under EEC regulations.
The receipts from health contributions have been more buoyant than had been anticipated. The amount originally provided for in the original estimate was £35 million. It is now expected that the amount received in 1980 will come to about £43 million. When the original Estimate was prepared in 1979 there was no previous experience of the operation of an income-related contributions scheme which had commenced in April of that year. The position was also affected by the difficulties caused by the postal strike in that returns from employers were delayed. In the circumstances the income realised from health contributions in the first half of the contribution year 1979—80 was considerably below the level eventually reached. An upward drift in the overall level of pay also meant that the income from health contributions was further boosted. The increased receipts from health contributions in 1980 will mean that the level of Exchequer grant that would otherwise have been required can be significantly reduced.
As a result of negotiations with the British Department of Health and Social Security agreement has been reached that an increase will be made in their payments in respect of health services provided for persons for whom they are liable under EEC regulations. The additional receipts in 1980 over and above the amount provided for in the original estimate — £7.3 million — are expected to amount to £2 million.
While the increase in grant requirements as set out in the second Supplementary Estimate is very considerable, the major proportion of the increase on the non-capital services end is due to movements in prices and pay levels and to unavoidable expenditure on the capital side to meet commitments. I now ask the House to agree to the Supplementary Estimate of £33,161,000.