asked the Minister for Health (a) the amount of expenditure as estimated by each of the health boards for the current financial year and the total amount for all the health boards and (b) the amount by which the estimated expenditure by each health board was cut back by his Department and the total amount of the reduction under this heading.
Ceisteanna—Questions. Oral Answers. - Health Boards Expenditure.
12.
As the information requested by the Deputy is in the form of a tabular statement I propose, a Cheann Comhairle, with your permission to circulate it with the Official Report.
Following is the statement:
|
Health Board |
Estimate presented to Health Board |
Level of expenditure approved by Department |
Variation between estimate and allocation |
|
£m |
£m |
£m |
|
|
Eastern |
32.617 |
30.931 |
1.686 |
|
South-Eastern |
12.803 |
12.253 |
0.550 |
|
Mid-Western |
10.005 |
9.516 |
0.489 |
|
Southern |
19.515 |
17.662 |
1.853 |
|
Midland |
7.174 |
7.169 |
0.005 |
|
North-Eastern |
9.180 |
8.377 |
0.803 |
|
Western |
14.417 |
12.692 |
1.725 |
|
North-Western |
8.437 |
6.956 |
1.481 |
|
Totals |
114.148 |
105.556 |
8.592 |
The estimates were adjusted by the Department after discussions with officers of each health board. The estimates were shown to include overprovision for pay costs, insufficient allowance for estimated income, inclusion of capital items in a revenue budget, and provision for the running costs of welfare homes that could not be effectively commissioned during 1973-74.
The allocations made available are estimated to be sufficient to meet the cost of on-going services, including known increases in pay and capitation rates and for developments in services which have been approved. Certain additions to the allocations will be required later, for example, to cover the cost of payment of allowances to psychiatric nurses and general trained nurses when the cost of these has finally been settled. Any other necessary adjustments will be made in relation to the allocations for on-going services should actual experience during the year show that this is necessary.
Deputies will be aware, also, that in the budget proposals announced yesterday provision has been made for expansion of home care services and assistance for severely physically and mentally handicapped children, which it is estimated will cost £0.9 million in 1973-74 and will be borne in full by the Exchequer.
Would the Minister please give me two figures from the reply: the total amount of the estimated expenditure of the health boards as submitted to him and the total amount of the cutback made by his Department?
Before I give the Deputy the figures I want to say that these were, as in every other year, negotiated between the Department of Health and the Department of Finance in consultation with the health boards. The Deputy wants the figure for the south-eastern health board?
No, for all the health boards. I want the total amount and the cutback figure.
The estimate presented to the health boards is £114.148 million and the level of expenditure approved by the Department was £105.556 million.
I take it that the Minister is satisfied, in making that cutback of £9 million, that it will not injure the health services? I am sure he is aware that in the south-eastern health board all the members were informed by the CEO that the amount estimated was the minimum that could be decided without injuring the health services for that region. Is he now satisfied that this cutback will not injure the health services in that region?
I am sure that will not be so. As a matter of fact, as far as the level of expenditure is concerned there is an increase of £18 million on last year. The Deputy will also appreciate that any schemes proposed by the health boards and approved by the Department of Health will be taken care of as is usual by the Department of Health in a supplementary estimate.
As a result of this cut in the estimates submitted will the figure of £12 million in the Book of Estimates to provide for the transfer from local rates to the Exchequer be honoured?
Yes. I should also point out that the 25 per cent reduction in the health rate in 1973 to be operative this year amounted to nearly £9 million. Again, let me say that health boards present their Bills to the Department of Health; there is then a discussion and in 90 per cent of the cases there is agreement—I am talking about the CEOs and the health boards— that the reductions are justified. If there is a case of increased pay, or anything like that, or if there is to be further provision for the general medical service, that will be paid for by way of a supplementary estimate.
Could I ask the Minister a further question?
We cannot have a discussion on this matter.
The Minister has not got the exact implication in my question. As I understand it, the Book of Estimates includes a provision of £12 million to cope with the transfer of the health services from local rates to the Exchequer. Will there be any alteration in that figure of £12 million as a result of these cuts in the health board estimates?
These are not cuts.
Whatever they are, cuts or reductions.
These cuts, if you want to call them that, were made by my predecessor.
Does it mean that the £12 million provided in the Book of Estimates will be changed?
It will not change that figure.
With regard to the estimates of the health boards and the cutback of £3 million in the submitted estimates from the health boards to the Department, will the reduction of this £3 million mean that there will be a cutback in the services provided by way of community health services, community care services and the recommendations on the geriatric services in the Eastern Health Board area?
No, but I shall be dealing with that in the next question.
That would be more adequately dealt with in Question No. 13.
The Minister made a suggestion, which I do not accept, that this was a decision of his predecessor. He mentions a reduction of 25 per cent in the health charges on the rates per annum over the next four years. How much is that costing this year?
The 25 per cent reduction for this year will cost £8,975,000.
How much have the health boards been asked to cut back on their health estimates for this year on a national basis?
They have not been asked to cut back.
They have.
There is no use in pillorying me with that at all.
An argument seems to be developing now.
An argument is not developing. There has been a 25 per cent reduction in the health charges on the rates.
The Deputy must ask a question.
The local authorities on a national basis have been asked to cut back on their health estimates by £9 million.
The Chair fails to understand the nature of the question.
Would the Minister agree with my arithmetic in regard to this?
May I, for the third or fourth time, say that this is not a cut-back in the sense that I, as the new Minister for Health, cut back the services to diminish them? May I say again that figures are presented by the various health boards, they are negotiated between the Department of Health and the Department of Finance and then allocations are made to the boards? In most cases, so far as I am informed, these are agreed. The £3 million the Deputy talks about and the £3 million mentioned in some of the newspapers last week is not the real figure.
What is the real figure? Is "cut-back" a euphemism for reduction—
The Chair feels that this question has been adequately dealt with——
It has not.
There is an alternative, if that is so. The Chair is now passing on to Question No. 13. I have given more than ample latitude to all Deputies.
There are only 21 questions on the Order Paper.
That does not matter. The Chair will not permit Question Time to be abused.
I wonder who is abusing Question Time?
I should like to ask one question.
A number of questions have been asked on this subject.
I did not ask any question.
It is a very important matter.
Every question on the Order Paper is important. If Deputy Wilson will be brief I should like to facilitate him.
I shall. Is the Minister for Health saying that health boards are incompetent to estimate accurately?
No. If they are, they have been so since the 1970 Act, because this has been the practice every year. I was presented with the former Minister's estimates. These had been negotiated. What I am telling the House now, as I have already told Deputy Dr. O'Connell, is that this will not at all interfere with services or diminish them in any way in the present year.
13.
asked the Minister for Health the implications of the £3 million cut-back in the expenditure of the Eastern Health Board; and if reductions are being effected in the expenditure of other health boards.
14.
asked the Minister for Health if, in view of the recent statement by the Chairman of the Health Committee of the Eastern Health Board, he will explain the apparent cut-back in the allocations made by him to health boards.
With your permission, a Cheann Comhairle, I propose to take Questions Nos. 13 and 14 together.
When I assumed office as Minister for Health I found that the Estimate for my Department for the year 1973-74 had been under detailed discussion between my predecessor and the former Minister for Finance and that an overall figure had been agreed as a basis for the amount to be provided for grants to health boards. In view of the urgent need to finalise the Estimates for all services it was not possible to review in detail the provisions in the Estimates for the health services. On the understanding that such reductions as had been made were to correct overestimation and that the adjusted provision was sufficient to cover continuance of existing services and developments already planned for year 1973-74, the Estimates were adopted as the immediate basis of financing the services.
As Deputies will be aware, provision has been made in the Budget introduced yesterday for expansion in home care welfare services and for assistance of severely physically and mentally handicapped children who are living at home. These measures are estimated to cost £0.95 million in 1973-74 and about £1.9 million in a full year.
It will be appreciated from what I have said that not alone has there been no reduction in the Estimates for 1973-74 which had been finalised by my predecessor but further provision has been made for an expansion of services.
The reference in Deputy Timmons's question to a "£3 million cut-back" in the estimate of the Eastern Health Board does not appear to represent the position correctly. The board furnished an estimate to the Department in July, 1972, which indicated an expenditure of £30.064 million. Subsequently the estimates furnished to the rating authorities indicated a total requirement of £32.617 million. The allocation notified by my Department to the board was £30.93 million, which shows a difference of £1.686 million from the most recent figure and not £3 million as mentioned in the Deputy's question.
There was a report in the Evening Herald of last Friday. I do not know if the Minister for Health saw it——
We cannot have a statement on the matter.
No, you will not have a statement; you will have a question.
It certainly is a statement so far. This is Question Time, Deputy.
I am here since 1965; I am aware of that.
I must remind the Deputy.
There was a report in the Evening Herald of last Friday. I do not know whether the Minister saw it, but the chairman of the Eastern Health Board, Mr. Patrick Hickey, said that a letter had been received——
Is this a question?
I want the Minister to comment——
The Deputy is making a statement, and quoting moreover. This is not in order.
Did the Minister see that report?
I did.
Is the Minister aware that Mr. Hickey, chairman of the Eastern Health Board, said that a letter had been received intimating that the Minister intended making a £3 million cut in the health estimates for the current year.
I have no information about that. Neither have I any information to the effect that Mr. Nolan was taking the matter up with the Department of Health. I think Mr. Nolan is the chief executive officer.
The Minister has stated that he saw this report in the Evening Herald last Friday. Is he now denying what the chairman of the Health Authority said? Is it incorrect.
I deny that the £3 million figure was correct.
What is the correct figure.
I have said that, as between the original demand made by the Eastern Health Board and the amount allocated, there is a difference of £1.686 million.
A final question— arising out of the report in the Evening Herald did the Minister see where Mr. Hickey also suggested that the Coalition promise to remove health charges from the rates over the next few years might be based on a plan to make this large reduction in health expenditure throughout the country?
I do not know Mr. Hickey and I do not know what his party affiliations are.
You should, you know.
Fianna Fáil. He is a Fianna Fáil hack who is abusing his position.
Did the Chair hear the Minister for Finance's remarks?
The Tánaiste is in possession.
May I repeat that the saving to the ratepayers all over the country this year amounts to practically £9 million?
Which is exactly the same figure as the local authorities are being asked to take off the health estimates. That is the answer.
No, no.
It is, of course, Minister. Will you, for God's sake, admit it?
(Interruptions.)
If I may speak for somebody who is not here, I heard an offensive remark made about a public representative. The Chair may not have heard it, but I did.
Is it offensive to say he is Fianna Fáil?
The Chair regrets that the name of a person who cannot defend himself here should have been mentioned in the House. The Chair did hear the remark but would regard it as a political charge.
Is the Minister aware that seemingly a letter arrived from the Department of Health to the Eastern Health Board to the effect that the cut-back would be £3 million. This did happen and it was indicated that perhaps the acting, or assistant CEO, Mr. Nolan, and Mr. Hickey, the chairman, would see the Minister or his officials. May I ask the Minister would it be possible to give details of where the estimates submitted by the Eastern Health Board exceeded what was considered normal by his Department and if he can give us an assurance that essential services and some of the expansion——
This is a long question.
He is within your party.
Deputy Andrews must not reflect on the impartiality of the Chair.
Deputy O'Connell is also entitled to ask a question.
(Interruptions.)
Could I have an assurance——
The Chair has intervened with the Deputy. The Chair is in control of Question Time.
In the light of that could I have an assurance that there will be no cut-back in essential services and that, also, the services it is intended to expand in the interests of the community will not be curtailed?
They will not be, as I said in reply to a previous question. The agreed figure for health services all over the country this year has increased by £18 million.
I know that last year's estimates were cut by the Department. They are reduced every year. I know that.
That is the usual practice.
I am calling Question No. 15.
I think the Minister will agree that there must be some——
Question No. 15 has been called.