Skip to main content
Normal View

Dáil Éireann debate -
Tuesday, 23 Apr 2002

Vol. 552 No. 3

Other Questions. - National Health Strategy.

Derek McDowell

Question:

30 Mr. McDowell asked the Minister for Finance the discussions held with the Department of Health and Children regarding the funding necessary to implement the national health strategy; the way in which it is planned to provide the finance necessary; and if he will make a statement on the matter. [12399/02]

This question effectively repeats an earlier Priority Question to which I replied this afternoon. I confirm that the pace of implementation of the health strategy will depend on the availability of future resources and there will be no recourse to borrowing unless this can be sustained in terms of the longer-term current spending consequences.

Will the Minister comment on the Tanaiste's remarks last Sunday when she was launching the Progressive Democrats manifesto for the election—

Another fine piece of work.

I am sure that is almost as wel come as the endorsement of Senator O'Toole is to him. She said that it would be dishonest of any party to pretend that it would not be necessary to find new sources of income if it was to fund the health strategy.

One could make exactly the same point about funding the Defence Forces on the Curragh which also has to be paid out of budget funds. The same is true of the staff of the Houses of the Oireachtas. One has to pay all public servants and the costs are added up to give the total of public expenditure, including the pay of Dáil Deputies. The Deputy is hardly suggesting that a special provision should be made to borrow to pay Dáil Deputies. There is no sense in singling out the national health strategy.

Of course there is; it is much more expensive than anything else.

As I pointed out in an earlier reply, expenditure on health will be equivalent to 80% of income tax revenue collected this year. That is a fair amount of money.

The Minister told the Irish Medical Times that it is unsustainable.

Is anybody here suggesting that in the next five years we will be exponentially increasing health spending at the level of recent years? Surely we will get some return on the money and capital we have spent. Surely we will get a return on the extra 38% of employees in the health service in 2002 compared to 1997.

There are now some 90,000 people employed in the health service as opposed 60,000 some years ago. Surely there will be some return on that. They are already in the public service doing their jobs so the cost has been built in. The percentage increase above that will not be the same because it is already there. On behalf of the taxpayers of the country I am entitled to start expecting a good return in the health service. Perhaps Deputy Jim Mitchell can give some idea of the current state of the health service given his recent difficulties. I can see that there is nothing wrong with it.

I have had too much call to use the health service in the past three years and I can testify that if one can access it, it is very good. The Minister has doubled expenditure on the health service in real terms, yet we are not getting a return on our money. It could be doubled again and we would not be any further down the road. The real issue is value for money.

Deputy McDowell is correct that the Government gave the impression at the health strategy launch that another £10 billion will be spent on the health service in the next few years. That made the headlines the next day. Will the Minister inform us what extra provision is planned in each of the next five years for the health service and what steps will be taken to get value for money results?

The health strategy consists of 121 separate actions which it is proposed to implement up to 2010 at a great cost over that period. I stated what has been done to date and, as I pointed out in the recent article in the Irish Medical Times, when one gets the benefit of treatment in the health services, it is of a very high standard.

There has been an 80% increase in acute hospital activity since 1997 and day cases have increased by almost 50% in the same period, which points to a great increase in productivity. There is extra money, extra people and extra procedures are being carried out. The difficulties I perceive, with which I think the Deputies will concur, is that for the amount of money invested in a relatively short time – an increase of 125% – there is a corresponding increase in dissatisfaction with the health service. How did it go from being not higher than No. 8 in 1997 to top of the agenda in 2001 to 2002, despite a doubling of the budget? That is an obvious question to pose. In view of the amount of money spent in recent years I believe we will begin to see a benefit from it. We are now above the European average and our dependency ratio is lower than the rest of Europe so we should not have to spend as much as other European countries.

Will the Minister accept that there is a pattern here? It is very clear that we are not getting value for money in the health service, but that replicates what is happening in the national development plan. Only 33 km. of road have been built when 300 km. should have been built. What has gone wrong? Why is money not being spent wisely and results being achieved?

I am somewhat constrained in what I can say due to upcoming events. One of the major jobs over the coming years will be to get value for money in all areas of public spending. Procedures are in place to ensure that. The job of the Comptroller and Auditor General is to account for the money that is sent out and to make sure that nobody ran off with it. At the same time he conducts value for money audits. The Department of Finance also conducts a review of spending along with other Departments. In all areas of Government expenditure, not just health, we will have to start to cost basic needs because we have to be satisfied that we are getting value for money. Health has been singled out for the obvious reason that a large amount of money is being spent there and people are somewhat dissatisfied. Ensuring value for money is going to be an increasingly large job in the future.

Top
Share