Vol. 200 No. 8
asked the Minister for Health whether, under section 25 of the Health Act, 1953, a person in North Tipperary may, in lieu of accepting services made available by the health authority, arrange for the like services to be made available to him at the Limerick Regional Hospital; and, if not, whether this is the case because the Limerick Regional Hospital is not a hospital approved of by him for the purposes of this section.
3.
asked the Minister for Health if he will give an exact definition of (a) the hospitals referred to in Section 25 of the Health Act, 1953 as any hospital approved of by him for the purposes of the section, and (b) the approved list of external hospitals for medical practitioners in North Tipperary referred to by him in a reply of 7th March as being a list approved by the health authority and not by him; and if he will define the circumstances, medical and other, in which a patient may be sent to a hospital on the list referred to at (b) above, and in which a patient may be sent to a hospital of the type referred to at (a) above.
With the permission of the Ceann Comhairle, I propose to take Questions Nos. 2 and 3 together.
As regards the first question, the Deputy is under a misapprehension in thinking that the Limerick Regional Hospital could be approved under Section 25 of the Health Act, 1953, for the reception of eligible patients normally resident in County Tipperary (North Riding). Section 25 of the Act contains no provision for approval of any health authority hospital. The appropriate provision in the 1953 Act under which, emergency circumstances apart, a patient from North Tipperary may receive treatment in Limerick Regional Hospital is subsection (3) of Section 10, which reads as follows:—
Two health authorities may make and carry out any arrangement for the giving of institutional services by one of them on behalf of and at the cost of the other.
If a North Tipperary patient entitled to free hospital services, in lieu of accepting the services made available by the health authority in one of its hospitals, arranged, other than through the health authority, to be treated in Limerick Regional Hospital, he would forfeit his right to free treatment and would have no legal entitlement to any financial assistance from the health authority towards the cost of his treatment. If, instead of going to the Limerick Regional Hospital he were of his own choice to go to, say, one of the voluntary hospitals in Limerick, he would similarly forfeit his right to free treatment but, because the voluntary hospital is approved for the purposes of Section 25, the health authority would pay portion of the cost. I understand, however, that the North Tipperary health authority deals with patients entering the Limerick Regional Hospital from choice in exactly the same way as if that hospital were one approved for the purposes of Section 25; but there is no legal compulsion on it to do so.
As regards the second question, a health authority may, with the consent of the Minister, make arrangements under Section 10 (1) of the Act with any extern hospital which is not a local authority institution for the treatment of patients for which it has responsibility under Section 15 and must pay in respect of such patients such charge as is approved of or directed by the Minister. I have already mentioned that, under subsection (3) of that section, it may also make arrangements with any other health authority to use that other authority's institutions. Such arrangements do not need my sanction. Thus the list of extern hospitals with which a health authority has arrangements is settled by the Manager, to suit local circumstances and a health authority in the midlands would have a different list from a health authority in the south. I have no function in relation to these lists, provided they do not include any hospital, not a health authority hospital, of which I have not approved.
Such a list, settled locally, exists in North Tipperary and is published in Paragraph 4 of the health authority's pamphlet on Hospital and Specialist Services. It includes Limerick Regional Hospital. It was this list I had in mind in replying to the Deputy's supplementary question on 7th instant.
There is another list, the list of hospitals, nursing homes and maternity homes none of them a health authority institution, approved for the purposes of Section 25 and this is compiled by me. There is no local discretion to vary it. This list is printed as an appendix to the pamphlet to which I have referred, issued by the Tipperary (NR) health authority.
On 31st March last, a circular was sent by my Department to all health authorities, notifying them of a revision of the capitation charges payable in respect of extern hospitals approved under Section 10 (1) of the Act— broadly what are described as the voluntary hospitals—and the circular set out for convenience the amount of subvention which a health authority should in future pay in respect of a Section 25 case in any of these hospitals and in private hospitals and homes. This, apparently, was the list referred to by the county manager as not including Limerick Regional Hospital. It did not include that hospital because it had application only to institutions which are not health authority institutions.
I think that a certain amount of the Deputy's difficulty in this matter arose from a somewhat imprecise supplementary question which he put to me on 7th instant and which I interpreted differently from what he had in mind. I trust that this lengthy reply will clarify the matter. The net point appears to be whether Limerick Regional Hospital is approved under Section 25, the choice-of-hospital section, for North Tipperary patients. It is not, because legally it cannot be; but for practical purposes a North Tipperary patient who uses it in exercise of his choice is dealt with, from the financial aspect, as if the hospital were approved under the section.
Would the Minister clarify the position with regard to private choice? If a person residing within eight miles of Limerick in North Tipperary is willing to go to Limerick Regional Hospital will North Tipperary pay the contribution?
I would prefer the Deputy to put down a question for a considered answer. With regard to the particular matter raised by the Deputy, the position is rather confused and I have been trying to make it more explicit to my own mind as much as to anybody else's.
The Minister should be in a position to give a reply on this matter. If a person of limited income is living within eight miles of Limerick and a doctor decides to send him to Limerick Regional Hospital surely the Minister should be able to tell us if the North Tipperary county manager should pay the contribution?
I have been dealing with the question on the basis that the patient was a Section 14 case but I do not think it makes a lot of difference. The position is that the Limerick Regional Hospital is a health institution and Section 25 does not apply to health institutions at all. It applies to people treated in approved hospitals, voluntary general hospitals. It does not apply to public health hospitals and the whole issue has been bemused by reference to Section 25. The manager of Tipperary North Riding, having a proper regard for the status of his own health institutions, is rather reluctant to send patients outside North Tipperary and prefers to send them to institutions under the control of the North Tipperary Health Authority. If, however, a person, in the exercise of choice under Section 25, goes to a health institution he is prepared to accept responsibility in that case, but frankly I do not believe there is any legal basis for his doing so.
The manager in North Tipperary is prepared to accept patients into St. John's Hospital or Barrington's Hospital but he was not prepared until recently to accept them into Limerick Regional Hospital.
That is quite so, but under Section 25 he is empowered to allow a patient to exercise a choice in respect of certain hospitals which are approved hospitals. None of these hospitals is a local authority hospital. All are voluntary general hospitals, like Barrington's. Under Section 10 it is possible for Tipperary (NR) to make a specific arrangement with the Limerick Health Authority for the treatment of patients in the Regional Hospital, but no formal arrangement to that effect has been made. However, the manager of Tipperary North Riding and the executive officer of the Limerick Health Authority are prepared to accept that such an arrangement subsists. Accordingly, the Tipperary North Riding manager is prepared to subsidise to the extent that he is permitted the treatment in the Limerick Regional Hospital of a Tipperary patient who exercises a right of choice under Section 25.
There is no such thing as private choice in the Health Act.
Only in respect of approved institutions if they are not health authority institutions.
It is only in respect of certain institutions drawn up by the county managers.
They must be approved of by the Minister for Health. In certain cases, they are submitted to the Minister for approval but this power of approval extends only to hospitals which are voluntary general hospitals. It does not extend to any hospital run by the health authority. If a hospital is run by a health authority an arrangement must be made under Section 10.
The Limerick Regional Hospital was set up to cover a certain regional district but if a patient in North Tipperary, eight miles from Limerick, opts for treatment in the Limerick Regional Hospital, the county manager, for some unknown reason, declines to pay for that patient and says that he must go to a voluntary hospital such as Barrington's or St. John's. Does the Minister stand over the action of the county manager in that respect?
What the Minister stands over does not arise.
Of course it does arise.
Deputy Coughlan knows a lot about some things but he does not know much about the Health Acts.
Who does?
Your exposition of the whole matter is the most puzzling made in this House since 1953.
I would suggest to Deputy Norton that instead of interrupting he should study the replies.
I would suggest that he take the trouble to read the matter up on Saturday.
Would the Deputy allow me to speak?
Throw in your hand.
Might I suggest that this matter will never be resolved if we go on like this? The Minister is entitled to give a reply.
What has he been doing for the past 20 minutes.
Deputy Coughlan is misinformed in this matter. Section 25 does not apply to Limerick Regional Hospital because, as surely Deputy Coughlan knows, the Limerick Regional Hospital is a health institution under the Limerick Health Authority. If the matter is to be done properly, it can only be done under Section 10 but I would prefer that the Deputy should put down a written question on the matter and I will try to deal with it.
Limerick Regional Hospital has been sponsored by the people of Limerick and Clare.
I know Deputy Coughlan does not have much regard for the law but the law is there and I observe it.
If the law were administered rightly, the Minister would get a bigger lash than Deputy Coughlan ever got.
4.
asked the Minister for Health whether, under section 15 of the Health Act, 1953, a dispensary doctor in North Tipperary is entitled, in view of the fact that no beds are available in hospitals in North Tipperary and that there are long waiting lists for such hospitals, to send a patient for treatment to the Limerick Regional Hospital.
I presume the question has reference only to patients availing themselves of services of dispensary doctors under Section 14 of the Health Act, 1953.
I have had enquiries made about the arrangements which operate in County Tipperary (NR) in this matter and I understand the position to be as follows:—
Hospital services are normally provided in the hospitals operated by the health authority. If a dispensary doctor seeking admission of a patient to hospital contacts the county hospital at a time when a vacant bed in the appropriate department is not available, arrangements would be made by the health authority—not by the dispensary doctor—if the case were one of urgency, for the admission of the patient to Limerick Regional or other extern hospital and the health authority would bear the full charge for his treatment. Except in cases of emergency, dispensary doctors in North Tipperary are not authorised on their own initiative to send patients for treatment in Limerick Regional Hospital on the basis that the health authority would bear the full charge.
I am sure the Minister will understand it would be very hard for me to go up some boreen in North Tipperary and explain to people exactly what the Minister has pointed out in the past 20 minutes.
After all, the particular dispensary doctor the Deputy has in mind is not charged with the administration of the Health Act, but the county manager is and we must have some order, some discipline and some control in these matters.
