asked the Minister for Health if he is satisfied that the Southern Health Board and other health boards can carry out their functions properly within the substantially reduced budget imposed on them by his Department; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Health Board Financial Allocations.
1.
In my reply on 11th February to a question by Deputy MacSharry— Official Report, Volume 287, No. 10, cols. 1723 and 1724—I gave particulars of the financial allocations for the present year to the health boards which involve an average increase of almost 13 per cent over the final allocations made available for 1975 for direct expenditure.
While, as I then indicated to the House, economies would be needed, I think that the allocations will be sufficient for the Southern Health Board and the other boards to carry out their functions properly.
I should, perhaps, explain to the House that since the allocations were announced, there have been continuous consultations between my Department and the health boards on the extent and kind of economies which are needed in each case. These consultations are still in progress and I expect a full report on them next week, after which the formal decision on the amount available for each service will be made.
I have dealt with the specific case of the Eastern Health Board in a written reply yesterday to a question by Deputy Lemass.
Is the Minister aware that the IMA expressed concern because the health boards were being asked to stick to the budget imposed upon them by the Minister? It was their view that this would mean a less than adequate medical care service for patients. Is the Minister aware that in the event of the Southern Health Board, and other health boards, being compelled to stick to their budgets it will mean that substitutes will not be allowed to be employed on medical and nursing staffs in the hospitals during this financial year? Would he agree that this will mean a lack of medical care for patients?
That suggestion has been made with regard to substitutes and I do not see anything unusual in certain incidences. The Deputy, and the IMA, may be assured that any economies effected will not have a serious effect on personnel and, certainly, will not affect the standard of service.
Is the Minister aware that as a result of a circular issued by the CEO of the Southern Health Board to members of the board, and health committees, there is grave concern among the community that the less well-off sections will be hit as a result of the Minister's proposal? Is the Minister further aware that the amount being made available this year for health boards is a lot less in real terms than the amount they were allowed to spend last year? Would the Minister agree that this will lead to a curtailment of services for the less well-off?
I am aware that the health expenditure has gone up in real terms as distinct from what the Deputy said. As a proportion of GNP there has been a steady improvement over the last three or four years. I should like to emphasise that the budgets have not been based on the assumption that services would be damaged. I am asking the health boards to do the same as I am being asked to do by all sections in this House, to ensure that expenditure by the health authorities is adequate and ensure that economies will be effected not alone in the Department of Health but in other Departments. I am confident that economies can be made and the tentative response I got from some of the CEOs is to the effect that economies can be made without damage to the volume or level of service.
Does the Minister accept that the less well-off sections of the community will suffer as a result of the Government's decision in this regard? Is the Minister aware that the proposal of the Southern Health Board, and other boards, to set up further day centres for the treatment of mentally retarded children has been chopped? Those who have medical cards who would otherwise have got free transport to clinics will no longer be able to avail of that free transport and it is possible that the outcome of that will be that many people will suffer and have to spend long periods in hospital as a result adding further to the expenditure of the boards.
If a decision has been made by the Southern Health Board in regard to the treatment of handicapped children it has not come to my notice and if the Deputy has any evidence of that I should like to see it. I do not say that the estimates have been deliberately inflated but there is the possibility that they over-estimated and there is evidence to this effect in certain areas. The Deputy should realise that not alone am I responsible to ensure that services to which people are entitled are given to them but I have also a responsibility to the taxpayer. The Deputy will appreciate that, with the deduction of health charges from the health boards, approximately 98 per cent of health expenditure is borne by the Exchequer. It is not the intention to cut down the volume or level of the service but I must ensure that each £ is accounted for. I have no doubt but that the health boards can economise in certain respects, especially this year. I have no hesitation in admitting that this is a very difficult year. If we can economise and maintain the services at the same level as 1975, we will be doing a good job.
Deputy G. Fitzgerald rose.
I allowed a final supplementary from Deputy O'Leary.
Is the Minister aware of a change in procedure in relation to retarded children and the weekend service by taxi or mini-bus that was available to them? Is the Minister aware that last Friday week, without notice, this service was withdrawn from these people? It is obvious that as a result of that decision the weakest section of the community is being hit. Is the Minister aware of the vast amount being spent on administration? It should be possible to control that and any irregularities.
The Deputy continued to speak in spite of the fact that the Chair was calling the next question.
As far as the transport of patients is concerned, I dealt with that matter at length last week on a question put down by Deputy Crowley. It has been accepted that there has been abuse of the hire of taxis to transport patients to clinics and hospitals. I do not know to what extent, but the CEO is satisfied, and as far as I can gather, some members of the board are satisfied, that the system has been abused and there can be savings there. As far as facilities for patients are concerned, there will be no deterioration in the service.
Even allowing for a cutback in the abuse of the service, will the Minister give an assurance that the normal services will be maintained and that there will be closer consultation between the health boards and the Department to ensure that normal entitlements are not removed?
As I explained, consultations are going on between officials of the Department and the various health boards. They are discussing the estimates that have been prepared by the health boards and the allocations that have been made by me through the Department of Health. I will not have a full account of these for another week or so and then I will be in a position to assess the situation but the indications from some of the health boards are that economies can be made this year—I stress "this year"—in order to ensure that they will be able to provide the services on the same level as in 1975 with the amount of money they have been allocated and again bearing in mind, as I said last week, that the increased allocation for health boards for 1976 is between 12 and 13 per cent.
Question No. 2.
Would the Minister not agree that the health boards were told rather late of their budget? Already almost two months have passed without their being able to effect uniform economies so that economies for the remaining 10 months will be severe. Could it not be arranged to let them know their budgets well in advance?
It seems that at the moment the Chair has no control over Questions. Would the Minister answer Question No. 2, please?