asked the Minister for Health the percentage of health expenditure taken up by the hospital services in this country and in the UK; the reasons for the higher ratio on hospital expenditure here; whether he is generally satisfied with the position; and, if not, what steps he is taking in the matter.
Ceisteanna — Questions. Oral Answers. - Health Expenditure.
6.
It is not possible to make valid comparisons of the kind the Deputy has in mind between the situation in the UK and here. The coverage of the health services differs substantially and there are also differences in the kinds of service included under the general umbrella of health services. The ratio of hospital expenditure here to total health expenditure from public funds is estimated at 73 per cent for the current financial year. In the United Kingdom as a whole for the same year it is 70 per cent, but, as I have said, the two figures are not directly comparable.
I am not satisfied about the level of costs of hospital services here. There is strong evidence that we are supporting an unduly large bed complement mainly due to comparatively slow patient throughput. Another factor is the fragmentation of our general hospital system into too many small hospitals. This is most in evidence in Dublin. There are other defects which are capable of improvement by better co-ordination of diagnostic support services and the development of the potential of consultant out-patient services.
The principal steps which I am taking fall under the headings of improved administrative structures and reorganisation of the general hospital system along the lines recommended in the Fitzgerald Report. The new health boards are already functioning and later in the year I hope to bring before the house draft regulations setting up the three regional hospital boards and Comhairle na nOspidéal provided for under the Health Act, 1970. These bodies will, I am confident, make a major contribution to increasing the effectiveness and efficiency of the hospital system. The changes necessary to recast the physical establishment of the general hospital system will take a period of years to achieve but an encouraging start has been made in Dublin.
Is the Minister not aware that, instead of efficiency and a tightening-up of expenditure, as he has stated a few moments ago, expenditure is escalating in all the health boards? The first thing they are doing is spending vast sums on new buildings and each of the health boards are appointing from six to eight executive officers whose salaries range from £3,500 to £4,500. Is the Minister not further aware that when those six or eight are appointed the boards will be looking for the appointment of eight, ten or 15 assistants to those? We heard the same thing in 1942 from the late Deputy Lemass about making CIE more efficient and cheaper to run when the board took it over. Does the Minister not realise that he and the country are being fooled up to the two eyes by those regional health boards he has set up already?
I would not agree with the Deputy at all. I have appointed one of the finest firms in the world with experience of hospital and health board administration. This McKinsey firm has been making recommendations in regard to the administrative structure of the health boards and I hope that as a result health administration will be efficient. As the Deputy may know, there are certain kinds of service where there must be encouragement to people by way of promotion and that in enlarging the health board area it is hoped to have certain kinds of officers who before could not be appointed to a small health area but who now can be appointed, which will give opportunities for promotion to staff beneath them, and as a result there will be a better programming and examination of services. As the Deputy should also know if he has read the McKinsey Report, the performance of the health board officers and administration is one of the things that will have to be reported to the health board in a form that it was never possible to do with a single health authority. It would take me far too long to state at Question Time all that is involved in this, but it indicates the careful thought we are putting into how these health boards should operate.
I want to inform the Minister that I have read the McKinsey Report and I doubt if those people, who are Americans, know very much about Ireland or Irish conditions, because conditions in America are very different from conditions here. However, is the Minister not aware that in all these health boards there is a line-up immediately, that there is a clash of opinion between the different counties and instead of co-operation there is wrangling and fighting on these health boards? With the limited resources at our disposal should we not be trying to provide better care and facilities for our patients, new hospitals, instead of extra staff and extra buildings for officials? Are we not starting at the wrong end altogether?
Would the Minister not, even at this very late stage, give serious consideration to the wisdom of not setting up the hospital boards at all and leaving the entire job to the health boards?
That is a separate question.