I move:
That a sum not exceeding £541,860,000 be granted to defray the charge which will come in course of payment duting the year ending on the 31st day of December, 1980 for the salaries and expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain services administered by that Office, including grants to Health Boards, miscellaneous grants, and certain grants-in-aid.
I propose to combine the original Estimate and the Supplementary Estimate, which I will move later, for the purpose of explaining the financial provisions. The two Estimates combined provide a gross amount of £650,350,000 for non-capital requirements and £27,500,000 for capital purposes. The combined capital and non-capital provisions, totalling £677,850,000, are offset by appropriations-in-aid which are estimated at £42,800,000. The net provision sought between the two Estimates is thus £635,050,000.
The gross non-capital requirements amount to £650.35 million. This compares with a gross non-capital out-turn of the Health Vote of £498 million for 1979—an increase of 30.6 per cent. This increase of £152.35 million may be explained broadly as follows.
Increase in pay costs account for £124.8 million, that is, over four-fifths of the total increase. Budgetary increases in the rates of cash allowances account for £5.8 million, that is £1 million in respect of the extra three months cost in 1980 of the increases in rates approved as from April 1979 and £4.8 million for the 1980 budget increases. The balance of £21.75 million is attributable to extra costs in 1980 arising from improvements and developments of services in 1979, including changes in entitlement to services as from 6 April, 1979, the commissioning of new units of accommodation in 1979 and 1980 and provision for price increases in 1980.
Appropriations-In-Aid are estimated to produce £42.8 million in 1980 as compared with £35.8 million for 1979. The increase of £7 million is due largely to extra income which is expected to be realised from the scheme of pay-related health contributions which was introduced from 6 April, 1979.
The Supplementary Estimate accounts for £93.19 million of the increase in Vote requirements between 1979 and 1980. A total of £88.39 million of this is needed to meet the cost of pay settlements for nurses and others. The balance of £4.8 million represents the estimated cost of adjustments in rates of cash allowances provided for in the 1980 budget.
As I have mentioned, increases in expenditure on pay for health services personnel account for £124.8 million of the increase in the non-capital Vote requirements between 1979 and 1980. Of this total, £36.4 million is due to the extra full year cost of pay increases approved in 1979, including pay adjustments associated with the national understanding. Recent pay awards for nurses will give rise to grant requirements of £76.3 million in 1980 and the balance of £12.1 million is required to fund health agencies in respect of the cost of pay awards for certain medical, para-medical, non-nursing and administrative grades.
The overall capital allocation for health services amounts to £28 million for 1980, of which £27.5 million is being provided under subhead K of the Health Vote. The capital allocation for 1979 was £27.5 million. I will refer later to some of the projects on which this money is being spent.
In a year in which the Government have had to take many difficult decisions in relation to public expenditure generally it was inevitable that some financial constraints would have to be imposed in the health area giving rise in turn to difficulties for those involved directly in the provision of services. Health services are labour intensive and have been subjected for some time now to considerable demands for improvements in conditions of service for personnel. The figures which I have given show how big a proportion of the extra money we have this year will go to meet these demands.
The health services are there to meet needs which are of great importance to individuals and we are continuously under pressure in attempting from available resources not only to maintain existing levels of service, but also to make improvements to cover perceived gaps. They create new demands which can often be very expensive to meet. The phenomenon of rapidly increasing costs and the demands for increased levels of service is not peculiar to our country. It applies internationally and the resultant financial problems cause concern in countries with far greater resources than are at our command.
Despite the difficulties of the economic situation the Government have made available a reasonable share of overall Exchequer resources to finance health services in 1980. Before we take account of the large sum provided for in the Supplementary Estimate which I will move, about 20 per cent of the total non-capital Exchequer requirements are allocated to health. This compares with 18 per cent in 1975.
When account is taken of the very sizeable additional expenditure which has to be faced in 1980 to meet the cost of special pay claims, such as those provided for in the Supplementary Estimate which I will move, it will be appreciated that the Government have agreed to a commitment of a very sizeable share of national resources to meeting the cost of health services in 1980—indeed the greatest share that has been provided in any year up to this point of time. This must be accepted as a positive demonstration by the Government of an acceptance of the need to provide the best possible services that can be provided from our national resources.
I would now like to turn to the services themselves and deal with a number of recent improvements and with policies for the future. I will commence by reflecting on some of the groups who require and deserve our special attention. First, the elderly. At present, there are over 350,000 people aged 65 and over living in this country. Some 13,000 elderly people are in long-stay care. That means that most of our older people are continuing to live in their normal environment.
My policy for the elderly is to encourage them and to help them to stay in their own homes and in their own communities, to help them remain healthy and independent, and to encourage them to use their talents for their own and other people's benefit. Voluntary organisations in association with the health boards play the vital role in the provisions of these services.
While much valuable work has been done and continues to be done, I am in no way complacent about the services for the elderly. There is still, in too many cases, too wide a difference between the quality of life of the elderly and those who are in the working population. Many people on retiring from work are not able to cope with the change and this affects their health. Many of our old suffer from isolation and loneliness and many do not use the services which are there to be used.
We need all the time to review the role of our elderly in the community as a whole. With the structure of families nowadays the traditional cherished position of the old person has been steadily eroded and I am afraid that we have not been very successful in coming up with alternatives ways to make sure that a person does not become stigmatised and written off purely because of the number of years he or she has spent in this world. I would hope, therefore, not only to improve services where this is necessary but to bring about a somewhat different attitude to old people, both in their own perception of themselves and in the perception which others have of them.
During this year I will be establishing a National Council for the Aged. I hope that this body will not only draw together the many groups who are working with and for the aged but will help to put a new perspective on how we can help the elderly to cope with their problems and to take the opportunities which their leisure time affords them.
During this year also the Health Education Bureau will be publishing a booklet which will reinforce the positive aspects of ageing and give very useful advice to people on how best to maintain their health in their older years. This book emphasise that being old does not necessarily mean being dependent.
My Department and the Health boards are carrying out a review of the effectiveness of two services which have great significance for older people, that is home helps and meals-on-wheels. The objective of this review is to ensure that the service being provided is relevant and that it is done in a way which is both effective and acceptable.
Next year will be the International Year for Disabled Persons. There will no doubt be many opportunities over the next year-and-a-half to discuss this whole problem and I do not intend to dwell very long on it here today. However, I sincerely hope that through all of our efforts the process of accepting and integrating the handicapped person into our community will be considerably advanced as a result of what happens during the year. I will shortly be setting up a national committee to co-ordinate and promote the objective of the International Year for Disabled Persons. The committee will give a consderable amount of attention to considering how our attitudes to the handicapped can be improved so that the normalisation which the handicapped greatly desire will come closer to realisation. I expect to be in a position to announce the membership of the national committee within the next two weeks.
I have recently reconstituted the National Rehabilitation Board, which has a key role to play in furthering the well-being of the handicapped person in the community. I hope that the board can function as an effective co-ordinating body, as a setter of standards, and as a catalyst in improving the quality of life of the handicapped person.
Finally, in relation to the handicapped, I acknowledge the major contribution being made to the improvement of our facilities by the moneys made available from the European Social Fund. In the current year, we have been allocated £8.2 million. This represents an increase of £2.1 million over 1979 and brings the total amount we have received to £25 million. It has been particularly gratifying to see community workshops developed throughout the country, bringing to reality a concept which is particularly geared to the needs of the rural community.
Since 1974, my Department have exercised a lead responsibility in relation to services for children. In 1975 the Task Force on Child Care Services submitted an interim report. The implementation of the recommendations of that report is now almost completed.
In anticipation of the final report of the task force, and to prepare for the major work that remains to be done in this area, the Government have strengthened my Department both at ministerial and official level. Deputy Tom Nolan, Minister of State, has been assigned a special responsibility for children and family services. As soon as the Task Force on Child Care reports we will be in a position to respond quickly and to prepare the new Children's Bill which has been long awaited. I have no doubt that the implementation of the task force report will also involve a strengthening of the services both in the community and in residential facilities. I assure the House that the Government will continue to give this task the very highest priority.
It is generally agreed that any health services which can be provided in the community should be provided there rather than in hospitals or other institutions. For one thing, the cost of institutional treatment continues to grow and anything which can be done to minimise the impact of this cost is of course desirable. The cost factor is not, however, the only one nor even the most important. It is now generally accepted that it is in the individual's interest to be treated in the community where this is possible, and I am continuing to approach the problem of the provision of services by strengthening so far as possible the community care services which will enable treatment to be provided outside institutions.
With this in mind we have recently started a review of the organisation within the health boards for the delivery of community care services. This review, which is under the direction of a steering committee comprising representatives of my Department and the health boards, will begin with a review of the existing organisation by a firm of consultants. They will be reporting on the effectiveness of the present organisation of community care services, on how this is functioning and will involve discussions with the staffs providing the services to obtain their views on the manner in which it is working.
We are also undertaking at present a review of the general practitioner maternity and infant care service. It is appropriate at this stage to re-examine this scheme, which has been in operation since 1956, and to establish whether there are improvements which could be made in its operation.
Medical card holders and their dependants have for a number of years past been entitled to dental services. However, it proved difficult to recruit sufficient numbers of dental staff in the public dental service to meet the expanding needs and to enable a satisfactory service to be provided for the eligible medical card holders and their dependants. During 1979 a working party, representative of the health boards, the Irish Dental Association and the Department of Health, examined the existing dental services and made representations about the manner in which they might be improved.
Arising from this report a scheme was introduced in November 1979 under which the health boards referred eligible persons from their waiting lists to private dental practitioners who had agreed to provide services under the scheme. The scheme operated successfully for some months, but the Irish Dental Association have in recent months indicated that they do not wish to continue with it until certain matters concerned with fees under the Social Welfare scheme are brought to a conclusion. I have put proposals to the association and I hope that these matters can now be resolved quickly and that the association will be willing to participate fully again in this scheme, which has been extremely effective in reducing the lengthy waiting lists for dental treatment which had existed in almost all health board areas.
In September 1979 a new scheme was introduced providing for sight tests for medical card holders and their adult dependants. Formerly such persons had to attend at health board clinics to have their eyes tested. Under the new scheme sight tests can also be obtained, at the patients' choice, from ophthalmic surgeons or ophthalmic opticians in private practice. The new scheme has been very effective in reducing the waiting lists for ophthalmic services, which were until then common in all health board areas.
At the same time new arrangements were introduced for the supply of spectacles. Previously these were obtainable only from contracting opticians, generally one per county. New spectacles can be obtained readily from any practising optician who is in the scheme. These new arrangements are proving very acceptable, particularly to elderly and other patients who find it difficult to arrange travel to central clinics for fittings, adjustments or repairs.
The general medical service currently provides a choice of general practitioner for the 1.2 million people who are eligible for this service. It is a service which operates effectively and I receive very few complaints about it either from those for whom it is provided or from the doctors who are actually providing the service. It is estimated that it will cost £54 million in 1980, of which about £25.5 million is accounted for by the cost of drugs. The high cost of drugs continues to be a matter of concern to me and I am perhaps more concerned with the excessive and increasing recourse to drugs by the population as a whole. This has serious implications for health and welfare. I will be asking the Health Education Bureau to pay particular attention this year to the area of drug consumption.
Expenditure on drugs in the health services is at a relatively high level—estimated to total £50 million in 1980. This is the subject of detailed investigations at present and I will be pushing for measures aimed at reducing the high costs which we have to meet.
We are continuing to expand the facilities available to enable community health services to be provided effectively. Seven new health centres are expected to be completed during the current year and the planning of 17 others is in hand. Attention is also being paid to the provision of accommodation for community care teams so that these will be capable of effectively delivering services.
In relation to hospital services, the total sum provided in the public capital programme for hospital and other health projects in 1980 is £28 million. As I indicated earlier, £27.5 million of this will come from the Exchequer, the balance coming from the Hospitals Trust Fund. The total of £28 million compares with £27.5 million in 1979, £21.5 million in 1978 and £16 million in 1977.
The allocation of £28 million for the current year was fixed having regard to the general constraints on public expenditure this year and made it necessary to review activity on the capital side generally and to impose a degree of constraint on the overall hospital and health building programme. However, despite these difficulties I am satisfied that considerable progress has been achieved in our hospital development programme.
In the last three years the implementation of the programme of general hospital development gathered new force and saw the Government's policy of providing as rapidly as possible the most modern hospital service for our people proceeding with vigour. During that time the construction of the new hospitals at Beaumont in Dublin and in Tralee was begun and is now very well advanced, as is the construction of the major development of Letterkenny General Hospital. In other parts of the country the planning of the development of general hospitals has reached the final stages in many instances.
Construction of the developed Mater Hospital and St. James's Hospital in Dublin will commence this year. The planning of the hospital projects at Cavan, Castlebar, Mullingar, Sligo and Ardkeen in Waterford is at an advanced stage. At the same time the planning of the development of Galway Regional Hospital and Wexford and Kilkenny hospitals is being pursued. Planning is also going ahead for the provision of maternity units at Limerick Regional Hospital and at Our Lady of Lourdes Hospital, Drogheda, and for a new medical department at Tullamore hospital. Preliminary planning for the development of James Connolly Memorial Hospital, Blanchardstown, and Portlaoise hospital has also commenced.
Therefore, despite the current financial restraints, the momentum gained in the implementation of the programme of general hospital development has been maintained and will continue until our agreed aims are fully achieved.
This year, following consultation with all the bodies involved, I made the necessary order for the establishment of the board which will plan, build and administer the new hospital at Tallaght. The board will include representatives of the Meath and Adelaide Hospitals in Dublin, the Eastern Health Board and the University of Dublin. I am now about to appoint the members to the board so that it can begin its work without any further delay. Agreement has also been reached with Dublin Corporation and Dublin County Council for a suitable site which would be made available at Tallaght.
Another matter which remains to be resolved is the future organisation of general hospital services in south-east Dublin, Dún Laoghaire and County Wicklow.
The matter is complex and I have decided, to enable the views of the hospital authorities providing services in the area to be taken fully into account, that examination of the matter could best be undertaken by a group comprising representatives of my Department, the Eastern Health Board, and the hospital authority for St. Columcille's, Loughlinstown, St. Vincent's Hospital and St. Michael's Hospital, Dún Laoghaire. I expect the group to commence its work shortly.
Another area in which final decisions were outstanding was the future organisation of specialist services in Cork city. With the opening of the new Cork Regional Hospital at Wilton in 1978 it was essential, to ensure the proper future rationalisation and development of general hospital services in the area, that a detailed study of the specialist services required and how they should be provided and organised should be undertaken. Consequently, a group representative of my Department, the Southern Health board, the Cork Voluntary Hospitals Board, Comhairle na nOspidéal and University College, Cork, was established late last year to carry out this task. This group has now reported to me, setting out its recommendations for the short-term and long-term development of the services in the area.
I believe that the recommendations contained in the report will make for an effective and comprehensive service in Cork city in the future and in the mean-time will allow the existing services to be developed in a rational manner. I intend to have copies of the report made available to interested Deputies shortly.
Apart from the major hospital developments already outlined other significant improvements have been undertaken in hospitals throughout the country over the past three years. Time does not permit me to refer to these in detail but the projects were decided on following consultation between my Department and the hospital authorities and are generally in accordance with the priority afforded by these authorities.
During the period 1961 to 1978 the number of patients treated in our acute hospitals rose from 266,000 to 512,000, an increase of 92 per cent. This increase cannot be attributed to the increase in population as this was 19½ per cent over the same period. There is no sign of a levelling off of these figures and, while the position has been contained to some extent by a reduction in the average length of stay in hospital, many hospitals have to cope with problems of regular overcrowding due to pressure on beds.
The general hospital development programme will help to relieve pressure on hospital beds by providing improved accommodation in many areas. However, it would be unrealistic to believe that we can continue to provide and pay for additional hospital beds and facilities without any financial limit. Other developed countries are also faced with a similar problem.
I have initiated a study by officers of my Department to try to find out the reasons for the rising rate of admissions and what measures could be taken to relieve the position—for example, whether greater emphasis needs to be placed on use of day-beds or five-day wards and the provision of treatment on an out-patient basis.
Some months ago I circulated to all hospital authorities copies of two booklets published by my Department which were based on the report of a working group set up by my predecessor to consider the information needs of hospital patients and the arrangements for receiving people in hospital out-patient departments. The main purpose of the two booklets is to direct attention to the need to provide all necessary and useful information to hospital patients before admission and the importance of receiving them courteously and helpfully. I might add that the issue of the booklets is not to be taken as a reflection on hospital managements but rather as an encouragement to improve still further the arrangements for receiving and furnishing information to hospital patients and their relatives.
Since 6 April 1979 everybody has eligibility for hospital services other than the services of hospital consultants. Hospital services are now free of charge in a public ward or at a fixed charge in a private or semi-private ward of a public hospital. Subsidies are paid towards the charges made in private hospitals.
For the services of hospital consultants an income limit operates. Persons below this income are entitled to get these services without charge. Persons with income above the limit are liable for the fees of the consultants concerned. I have recently increased this limit to £7,000 based on income for the year ended 5 April 1980. Approximately 85 per cent of the population are within the limit and are entitled to full hospital services without charge.
The remaining 15 per cent of the population can for a small premium insure against the cost of consultants' fees with the Voluntary Health Insurance Board. Consequently, we have in effect a comprehensive hospital service. I have given some further data to Deputies in a hand-out and these are available to them for their comments on the Health Estimate.