Vol. 356 No. 4
I move:
"That Dáil Éireann calls on the Government to provide the necessary funds for each health board to make good the shortfall in their 1985 budgets so that they will be in a position to provide an adequate and satisfactory level of health care for the people in their respective areas."
The Chair understands there is an agreement whereby Deputy Dr. O'Hanlon will speak for 20 minutes and that Deputy Dr. Ormonde will also speak for 20 minutes.
It is unusual to bring in another motion so soon on this issue but because of the seriousness of the situation in each health board area we felt that it was necessary at this stage to draw the attention of the House to this matter and to call on the Government to provide funds to ensure that the health boards will be able to provide a proper level of care for our people.
Each health board is experiencing serious difficulties in the current year in trying to meet their commitments within the allocations given to them by the Minister. Before they came to power the Government stated that their policy would not militate against the less well off. Anybody who has seen what is happening, particularly members of the health boards and those working for the boards, know that the less well off are suffering most as a result of the Government's policies. There has been an unprecedented reduction in the level of service and the Minister admitted in the House that the health boards would be overspent by £10 million in 1984. The health boards believe that there will be a deficit of £37 million in 1985.
In reply to a question by me to the Minister for Health on 10 October 1984, he admitted that harsh measures had to be taken by the boards to remain within their allocation for 1984. He said:
The measures which were introduced by health boards in the area of institutional services included reductions in payroll costs by means of curtailing the filling of vacancies, restricting locum cover, overtime, on-call levels and night duty and weekend staffing levels. Stock levels are also being reduced and savings in purchasing and housekeeping arrangements generally are being effected. Certain health boards have closed hospital wards for limited periods mainly during the summer months.
Some health boards have found it necessary to secure limited reductions in expenditure in the community services area, mainly in the arrangements for providing dental and opthalmic services for adults.
That is an admission by the Minister that he was aware then that the health boards were experiencing difficulty in providing a proper and adequate level of service because it is obvious from what I quoted that if you reduce the staffing levels, overtime and weekend cover the patients will suffer.
The letter of allocation sent to the health board on 22 November 1984 pointed out that two-thirds of vacancies were to remain unfilled. Paragraph 11 referred to Building on Reality, which is now a discredited document. I do not know whether the portion dealing with health still applies and it is something which we could question. Paragraph 11 goes on to state:
The plan envisages... that the major change for the future will be a greater emphasis on disease prevention and community services. It is recognised, however, that a major constraint in effecting a significant shift of resources towards the areas mentioned will be the lack of adequate finance.
That, again, is an admission by the Minister's Department that there is not sufficient finance to provide a proper level of service, especially in terms of prevention.
Paragraph 12 states:
It will be noted that the decisions to be implemented to reduce expenditure relate largely to reductions in payroll costs.
How are the boards expected to do that? Are they to reduce further the number of personnel involved or locum and weekend cover, because all this will reduce service to an intolerable level?
When the North Eastern Health Board were discussing the budget for the current year they sent a resolution to the Minister pointing out that they believed the service would drop to an intolerable level during the coming year. The Minister in his budget speech emphasised that we enjoy an excellent level of health care. I do not think anybody agrees that that is the case now. The Minister also said:
While there will be a modest decline in real terms in the resources available for health services over the period of the plan, I am confident that we will be able to preserve not only the essential fabric of our services but to redeploy resources to develop some other essential services...
How does the Minister intend to do that in view of his admission that there is a massively reduced allocation available to the health boards and that there will be constraints on expenditure?
Later on in his speech the Minister said:
Surely for a member of a health board to say that, because of the measures needed to contain expenditure, lives will be endangered is totally irresponsible and will only needlessly alarm sick persons in the area?
I fail to understand how the Minister could make that statement because there is no doubt that lives will be at risk and will be lost if we proceed on the present lines. If the level of services is reduced by curtailing the number of staff, if wards are closed and waiting lists get longer, it is inevitable that the level of sickness and mortality will go up. We must try to avoid that here.
The Western Health Board have been experiencing many difficulties over the last couple of months in trying to reach agreement on adopting their estimates for 1985. An example of what they did last year is that one medical ward was closed for three months, one surgical ward was closed for two months, two gynaecological wards were closed for a total of three months, five units were closed for a total of seven months, one orthopaedic theatre was closed for two months and one thoracic/cardiac and urology theatre was closed for one months. In addition, opthalmic and gynaecological surgery and ENT services were all reduced. Out-patient departments were also closed down for limited periods. These measures resulted in an increase in the number of patients on the waiting lists some of which, — for example orthopaedic — were indeed excessive already. There is a three year waiting list for a hip replacement operation in that health board area.
The Minister's amendment asks us to delete the words in our motion and substitute:
...notes that the Government has provided in the 1985 allocations to the health boards sufficient funds to enable each health board to provide an adequate and satisfactory level of health care for the people in their respective areas.
Who decided it was adequate? It certainly was not any health board. Who decided that the allocations would ensure an adequate level of service? If a three year waiting list for a hip operation, the total suspension of the ad hoc dental service in certain areas and the suspension of the sight testing scheme is adequate to the Minister and the Government, it is totally unacceptable to us. The Western Health Board maternity unit is still not staffed. They have no scanner and I understand that there are patients whose lives are dependent on the use of that scanner. They do not wish to move out of the health board area to other areas where there are scanners. It is interesting that the chairman of the Labour Party did not consider the allocation adequate. He spoke and voted against adopting the budget as presented by the Western Health Board. It is obvious that he would not be party to the Minister's amendment.
Why does the Minister refuse to meet the Western Health Board? It would be a useful exercise if he met them. He met our health board on three occasions to discuss the closure of a hospital. I quote from the CEO's letter when he sent the budget to his members:
This will result in some cases in the dismantling of the fabric of the health services in this health board area which were so painstakingly developed in the past and is to be regretted...
...These measures are so severe that they will have a considerable impact on the level of health care provided by the board in 1985 and will cause hardship to patients as well as to persons awaiting hospital services as waiting lists will increase further.
We have pointed out to the Minister over the last two years that he was dismantling the health services which had taken so much hard work by so many people — Ministers, health board officials and various other staff working in the field of health care — to build up.
I shall quote from a letter from the chairman of the North Western Health Board about the board's revenue budget:
During the course of the year a number of factors outside the board's control further adversely affected our financial position. These include:
(a) The court decision on road traffic accidents which forced a change in the practice of hospitals charging for persons subsequently hospitalised.
(b) Increased employers' PRSI contributions.
(c) The withdrawal of food subsidies.
(d) An over-estimation by the Department of Health of the income which would be derived from the £100 admission charge to hospital in certain circumstances.
(e) An over-estimation by the Department of Health of Board income from social welfare contributions, by residents in long-stay institutions.
(f) An increase in expenditure on pensions due to a change in the operative dates for the payment of pension increases.
These measures amounted to £0.6 million. That is an indication of the problems the board faces. While this motion relates specifically to health boards, a letter which was sent from the Meath hospital in Dublin is indicative of the problem faced by all hospitals. It states:
Due to financial cut-backs by the Department of Health it has been decided by the medical board of the hospitals to close some wards.
This will mean changes in the waiting and admission lists, and delays in administration.
Please ignore the notice sent to you and do not attend for admission until you hear from us.
We are most appreciative of your co-operation and recognise the inconvenience these changes will cause to you.
The hospital authorities recognise the inconvenience this will cause. If a patient is suffering from a serious illness and there is a long waiting list for admission to hospital, his life is at risk. For the Minister to tell the House that some health board member was wrong to make that suggestion is unfair. In answer to a question I put to him on Tuesday, 19 February the Minister stated:
The operation of the ad hoc dental scheme has been suspended in all community care areas of the Mid-Western, Southern and Western Health Boards. In the North-Eastern Health Board it is in operation in Cavan-Monaghan community care area but has been suspended in Louth and Meath.
The sight testing scheme has been suspended in all community care areas of the Mid-Western, North-Eastern and Southern Health Boards.
I fail to understand how the Minister could put down an amendment to our motion stating there was sufficient allocation to provide an adequate service. There is not an adequate service. Has the Minister any policy for health services? Is it just an ad hoc cutting of the allocations across the board? Has he any idea of what he would like to do other than telling the health boards to reduce the number of staff and overtime — in other words, close down wards, hospital beds and out-patient departments?
Prevention involves the promotion of a healthy lifestyle but it also entails the prevention of specific diseases, the early detection and treatment of disease, rehabilitation and prevention of long term disability and social handicap. One cannot talk in terms of prevention and promotion of good health if the health services are dismantled. In the past they were merely sufficient to cater for the needs of the people as is evidenced from the fact that we spend the second lowest per capita of the EC countries on health care. Greece spend a lesser amount. The level and quality of service is directly related to the amount of money spent. I ask the House to support our motion that the Government provide the necessary funds to ensure there is a proper level and quality of health care available to those who need it.
I welcome the opportunity to speak on the motion. The shortfall in 1985 will amount to £37 million and I am glad of the opportunity to highlight again the deliberate attempt by the Government to dismantle the health boards and the health services. The Minister makes no secret of his desire to have the health boards and all other bodies pertaining to health under his direct control. One need only think of his treatment of Comhairle na nOspidéal. He has insisted that all agencies must first approach the Department of Health in the matter of funding for any consultant post. In that way he is depriving Comhairle na nOspidéal of their statutory right to regulate the number and type of consultant posts. They are another organisation who are living on borrowed time in so far as the Minister is concerned. What is to be noted especially about all these cuts and shortfalls is that they are being made by a Labour Minister who in opposition was perhaps the most outspoken Member of the House in relation to the then allocations to the health boards. Is it not a question of poacher becoming gamekeeper? The Minister, too, was the most outspoken in opposition in relation to the retention of food subsidies but we know how he and his Labour Party colleagues performed recently on that matter. Not only did they row in behind their Coalition colleagues on the removal of the subsidies but they announced them to the people, I mention these matters to indicate that, in the light of this sort of performance from the Minister for Health, we can hardly expect any more from him in so far as the sick and needy are concerned. One of the Minister's first actions as Minister was to remove medical cards from pensioners and this move was followed later by the removal of medical cards from students. Those actions set the scene for the Minister's term of office.
The eight health boards are to receive about £600 million in 1985. This represents a shortfall of about £40 million in terms of their requirements. The average increase is only about 3 per cent at a time when inflation is about 7 per cent. In real terms there is a sharp shortfall.
The Minister is reported to have ordered the health boards, in December 1984, to slash their pay budget by about £20 million. This is the equivalent of about 2,000 jobs. It is difficult to believe that to be the action of a Government who went before the people on a commitment to correct unemployment. That now infamous document, Building on Reality, contained a projection that unemployment would level off at 220,000 and would then begin to decline this year, but let us compare this with the reality. The figure has increased from 217,000 to 234,000 and this does not include the recent 800 jobs lost in the Travenol firm at Castlebar, nor does it include the 370 job losses in Clarks Shoes, nor the 170 jobs lost in Carlow.
The motion deals with shortfalls in allocations for the health services.
I am referring to job losses in the health services and I consider it appropriate to include these in the over-all job losses. How could we distinguish one from the other?
It would be more in order for the Deputy to confine himself to employment in the health services.
Before I deal specifically with each health board and the effect of the shortfall in their financial allocation, I wish to refer to the situation of the voluntary hospitals in Dublin and elsewhere. I am doing this on the basis that each health board this year have been allocated a set amount in lieu of payments to the voluntary hospitals. In my health board area a figure of £14 million had been set aside as payment for the Dublin voluntary hospitals and that is why I submit that these hospitals are a matter for discussion in the context of this debate.
Cappagh Orthopaedic Hospital, Ireland's main orthopaedic hospital, was forced to discontinue hip and knee replacements in the latter weeks of 1984 because they had not got sufficient funds to by the replacement joints. In Dublin's Mater Hospital 80 beds were closed down in mid-December.
I do not wish to cut in on the Deputy's time but the motion before the House deals with health board services.
I put it to you as I began this section of my contribution that each health board area had an amount set aside for payment to the voluntary hospitals, that the figure for the South-Eastern Health Board was in the region of £14 million and that on that basis the voluntary hospitals are directly involved in this discussion.
I cannot see how they are involved.
They are part of the health services.
The motion before the House deals with hospitals that are funded directly by the health boards.
I accept that, but funding to the health boards has a direct bearing on the operation of these hospitals.
A passing reference may be permissible but an in-depth discussion on the voluntary hospitals is not in order.
In deference to the Chair I will confine myself to a passing reference to each of the hospitals in Dublin affected by the cuts. Our Lady's Hospital for Sick Children in Crumlin is planning to introduce five-day wards or, in other words a five-day sickness syndrome to Irish medicine. St. Vincent's Hospital, Elm Park, will be short about £1 million this year while the Adelaide Hospital will be short to the tune of about £500,000. Deputy O'Hanlon referred to the Meath Hospital. That hospital, too, is planning five-day wards, while some of their wards are to close this year.
If the Deputy had wished to go into that, he should have included it in the motion, but there is no reference in the motion to voluntary hospitals.
In that case I shall refer to an Eastern Health Board hospital, the James Connolly Memorial Hospital at Blanchardstown. That hospital are planning to close in the region of 60 beds this year in an attempt to deal with some of the £1.5 million deficit facing the hospital. A decision has been taken not to reopen a 40-bed medical unit which has been closed since June last.
Deputy O'Hanlon and I met a deputation from that area last week who were complaining about the failure to have an orthopaedic unit opened at that hospital. At a time when the hospital are participating in the north Dublin accident rota system, they are not in a position to provide orthopaedic beds for badly injured patients.
The shortfall in respect of the Eastern Health Board for this year will be in the region of £5.35 million. In these circumstances they have been asked to reduce their pay budget by about £2.6 million which would be equal in job terms to about 260. The Department of Health have been implementing the policy of not filling two out of every three vacancies in the health board areas. This is a blanket decision in which no account is taken of the importance of the position in question. It could well mean that should a future sister's position become vacant and be not filled, neither the surgeon nor the operating theatre could function.
That is how ludicrous the situation has become.
The remainder of the Eastern Health Board's shortfall will come from the nonpay area and it amounts to £2.75 million. To date, in spite of numerous meetings, the Eastern Health Board have not been able to make any impact on this.
That is not correct.
There is no big general hospital in the area and as most of the hospitals there are long-stay hospitals, there is nothing to shift to the community care section as suggested in this now infamous document Building on Reality 1985-1987— it should be “unreality”. My health board, the South Eastern Health Board are faced with a deficit in the region of £3.95 million in 1985. Our deficit being carried forward from 1984 is in the region of £1.095 million which is the first charge on the 1985 allocation. Since 1981 we in the south east have had cuts amounting to in excess of £10 million to our health board region. This represents a continuous fall in resources available to the board when demand for services continues to increase and many of the board's services are inadequately staffed, housed and equipped. If the allocation for 1980 was updated by the changes in the £ since then — judging by the performance of the £ versus the $ today and for the last couple of days things will be much worse — to the present day value we would have a shortfall in the region of £17 million in 1985. Our allocation should be about £100.66 million but we are getting £83.59 million, a difference in excess of £17 million. This gives some indication of the real reductions in expenditure since this Government came into power.
I have spoken about the options being considered by the South Eastern Health Board in relation to this. Among these options is the non replacement of locums, an option which a number of other health boards are considering also. As I have said many times, most of our county hospitals operate a two-man service with two surgeons, two physicians, two radiologists and two anaesthetists. If one of these people goes on leave and is not replaced, as is being suggested now, the other person is on duty 24 hours a day, seven days a week. One man cannot possibly provide that service. All he is in a position to provide is an emergency service. I ask the Minister if an emergency service only is what we are committed to providing for this country. If that be so, then let us stand up and say it and let us stop conning the people. We are not in a position to provide any other service as things stand.
The Southern Health Board are faced with a shortfall in the region of £9.5 million and to date they have been unable to come up with any acceptable solution to reduce this deficit, despite repeated meetings. Among the matters they considered was a 5 per cent cut in pay which obviously was rejected by all concerned. Another suggestion from the Southern Health Board was to abolish pay for maternity leave. This is the kind of thing that faces these health boards. The Minister jumped in very quickly in relation to that one. He will not make the financial allocations available to them to run the services and when they try to make alterations in the system he says they cannot do that. The Minister cannot have his cake and eat it. Either he makes decisions or he allows the health boards to do so. He cannot have it both ways. Many jobs remain unfilled in the Southern Health Board and many wards have seen partial closure both in the summer and at Christmas. In their total allocation for equipment in 1984, £50,000 was allocated for both new and replacement equipment. In a budget of £118 million which is the Southern Health Board's budget £50,000 is peanuts. It would not go any way towards providing one X-ray unit in the entire region.
The Deputy is mixing up voluntary hospitals and the health boards.
I am not.
It was £50,000 for the voluntary hospitals.
Continue, Deputy.
The figure I have from the Southern Health Board is £50,000 for replacement or new equipment in 1984.
It was hundreds of thousands of pounds.
That does not include the £500,000 the Minister found suddenly last week when it suited him to do so.
We put hundreds of thousands of pounds into Tralee last year.
Well done, Tánaiste.
Fifteen beds out of 50? Let the Minister stop the codding.
The Midland Health Board have come up with a rationalisation scheme to live within their allocation. I wonder if the people in the Midland Health Board area know that this rationalisation will mean the closure of the maternity unit at Tullamore and the transfer of these facilities to Portlaoise. Also I wonder if they are aware that the orthopaedic unit for Athlone which was promised by the Taoiseach to the Minister for Defence, Deputy Cooney, will now not go ahead but will be transferred to Tullamore. It is fine to provide orthopaedic facilities for the Midland region wherever they are provided, but unfortunately the reality is something else. The Minister and his Department have refused repeatedly to fund orthopaedic surgeon positions for the Midland Health Board. The North Western Health Board will have a shortfall in the region of £2.6 million for 1985. For the first time ever no separate sum is mentioned for the GMS in the North Western Health Board and it is being left to the health board to decide what sums of that total allocation they will budget for this service. The North Western Health Board have decided to allocate a budget for the ambulance service which is the same as for 1984. Again, in real terms this will mean a significant cut which must be reflected in a reduction in the quality and quantity of the service provided. In no region is an effective ambulance service more necessary than in the north west.
I am sure that many of my colleagues who will contribute in this debate will deal with the other health board areas. However, I would like to refer to the scandal of the unopened units around the country. We have spent about £7 million to build units which now lie unopened. I listed them here last week and I list them here again because maybe eventually I will get through to the Minister and the Department on this. An amount of £7 million has been spent on these units and they lie idle because of no staffing and no equipment. I refer to the maternity unit at Galway which was built at a cost of £4 million and lies unstaffed and unopened today. The 30 bed maternity unit at Cahercalla near Ennis, built at a cost of about £750,000, lies idle and unopened because of inadequate staffing. The 14 bed gynaecological unit at St. Luke's in Kilkenny has been lying idle for four years because the Minister has refused to provide the funds to staff it. The 26 bed geriatric assessment unit at Ardkeen has lain idle for about two years. The Government in their document Building on Reality 1985-1987 promised to care for the aged and their institutions. As I have said, these are lovely sentiments but unfortunately the reality is something else. To date the Minister's only response to all this has been to increase the public hospital charges by 20 per cent, nearly three times the inflation rate. This will add a further burden on the public hospital sector because many of the entitled patients who up to now opted for VHI are priced out of this facility and will be forced back into the overburdened, underfinanced and understaffed hospital services.
In conclusion, if this Labour Party have any conscience, then I urge them to support our motion here tomorrow night. They must see the hardships that are being inflicted on this sector and on the sector they claim to represent.
I move amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"notes that the Government has provided in the 1985 allocations to health boards sufficient funds to enable each health board to provide an adequate and satisfactory level of health care for the people in their respective areas".
In moving the amendment to the motion before the House, in the first place I wish to point out that one of the main elements of the Government's social policy as outlined in the national plan is the provision of almost 20 per cent of total non-capital public expenditure for the health services in 1985. The expenditure for 1985 on our health services will be more than £23 million per week. Any local "shortfalls" must be viewed in this context.
If I may define a shortfall, it is the difference between what the Department of Health know quite well is more than adequate to provide services in an area and what a health board at the beginning of the year think they would like to have in order to run the services for the next year. It is based purely on argument and on forecasted expenditure to the end of the year. This business of a shortfall being a perceived result is nonsense. It is put out by those who want an easy time and by an Opposition who have little else to think about. For example, the Southern Health Board said at the end of 1983 that they would be short about £5.6 million but at the end of 1984 when all the work was over it worked out at about £1.6 million. That is the reality. Some dreadful nonsense goes on about what is perceived to be shortfalls. In many respects it is an excuse for a good deal of laziness in the preparation of Estimates by many of the health boards. I will come to that later.
On many occasions I have referred to the spectacular growth of expenditure on health services during the past decade or so. In 1973-74 net expenditure was about £143 million, representing about 5.2 per cent of GNP. In 1982 the figure had increased to £952 million, representing almost 8 per cent of GNP. The expenditure level in 1985, which can be supported by the Estimate provision, will reach almost £1,100 million in net expenditure terms. When direct income from patients receipts and so on accruing to the health agencies is reckoned with, the amount available for expenditure on health services in 1985 will reach a total of £1,200 million. This compares with an overall gross total of about £1,130 million at Estimates stage last year. It will be £70 million in 1985, despite the propaganda of the Opposition in this regard.
While pay and price inflation have been significant factors in pushing up the cost of our health services during the years, a substantial part of the extra costs have arisen from improvements in the scope and the range of the services. For example, our acute hospital services are as good as any in western Europe. They have improved considerably since I came to office. Our psychiatric service is being steadily improved. A feature of this service has been the value in terms of improvement in the standards of accommodation in most mental hospitals by the expenditure by this Government of £6 million on schemes of refurbishment. Increasingly we have the provision of pre-hostel training units and rehabilitation wards for such patients. Our services for the mentally handicapped are good and are being developed progressively with particular emphasis on community services. I have spent a great deal of money on this: I have taken money from the acute hospital area and have put it into the area dealing with the mentally and physically handicapped and into psychiatric hospitals. There are not many votes in that area and there is very little publicity about it but the money is being transferred to it and that is where it will remain.
Our general medical services provide a first rate general practitioners service and medicines for almost 40 per cent of the population. Four out of every ten people have medical cards and that is a record in terms of the general population. Moreover, we have succeeded in bringing our health services and our health indicators into line with the developed wealthy countries. The range of our services has grown at a rapid rate, taking on board the ever-growing technological advances and other developments.
However, we have reached a point where growth in expenditure on health services must be at least contained in the overall national interest. We must rationalise the very significant amount of resources in financial and personnel terms to eliminate unnecessary and wasteful expenditure. We are ensuring that essential services are maintained and developed. As I have mentioned, the gross expenditure level in 1985 which can be supported by the financial resources available, of which about 86 per cent will come from the Exchequer, is £1,200 million. The allocation for the health boards and other health agencies for 1985 has been determined in an equitable manner on the basis of the resources available to me. Furthermore, despite all the whipping up of health board reaction and local hospital and patient fears by the Opposition and by some vested interests——
Who?
I know them. There are a few in Galway and in some health board areas. I will not name names but I know them. I am not aware of any single instance in 1983, 1984 or 1985 where necessary and urgent treatment was not or could not be provided for any person in need of such treatment. The health boards have been allocated a total of £781 million for the current year as compared with £737.3 million at this time last year. Deputy Ormonde said £600 million but he was wrong. The figure is £737 million and it is inclusive in both cases of the amounts provided for general medical services. I did not take medical cards from old age pensioners. That decision was taken by Deputy Woods when he was Minister for Health. He decided they should be removed from old age pensioners——
That is not so.
He gave them medical cards.
The decision was taken in the middle of 1982 and Deputies opposite should stop playing politics. On the breakdown for the individual boards, the particulars which are set out in tabular form have been circulated to Deputies. However, I will refer to the average percentage increase of 5.9 in respect of the allocation given to health boards for this year as compared with last year. This is the actual cash amount notified last December to the health boards. Deputy Ormonde was talking a lot of rubbish when he said the percentage increase was 3 per cent. It is 5.9 per cent which compares with an anticipated rate of inflation of 5.75 per cent.
The Minister can publish all the figures he likes but the facts are something else.
Health board expenditure is being maintained and there should be no more hysteria. The health boards have the money and there should be no great problems.
The Minister should come to the Cork Regional Hospital.
There is no point in allocating money to health boards on a current basis if the hospitals are incapable because of their age and structure of running a service. We are putting an enormous amount of capital moneys into hospital structures and this is making them more efficient.
And leaving them idle also.
They are more efficient. This year we will be spending £58 million on capital works, the same amount next year and we will be spending £61 million in 1987 for that purpose. Since I became Minister for Health I have expended a total of £115 million in capital development.
We are still waiting for a new hospital in Waterford.
This is a record for any Minister for Health in the history of our country and the results are evident to all Members. The Opposition talk about unopened units. I did not build one unit in December 1982, in 1983, 1984 or 1985 for which I am not prepared to provide revenue.
Will the Minister open the geriatric unit in Ardkeen?
Deputy Haughey and Deputy Woods went around this country spending capital moneys here, there and everywhere, on CAT scanners in Galway, on maternity this and maternity that, but not one provision in the Estimates for the running costs. The buildings look spectacular and when they are empty they look even more spectacular. I have tried to pick up on some of the promises made in every constituency——
What about the nurses' home?
A new hospital was promised at every crossroads——
What about the third CAT scanner in St. Vincent's?
The Minister, without interruption please.
When speaking to the chairmen and chief executive officers of health boards in Newbridge last November I said that a clear strategy was needed to enable the financial situation over the next few years to be coped with while, at the same time, taking such steps as were feasible to give effect to the strategy identified in the national plan in relation to the development of the health services. I referred in this connection to certain points stressed in the plan, such as the taking of positive measures to promote health and to prevent illness. I am surprised the two doctors opposite do not recognise the correlation. Many millions of taxpayers' money are spent in our health services every week because of the abuse of drugs, particularly alcohol — the number of persons in our psychiatric hospitals because of alcohol-related problems have to be seen to be believed, hundreds die and thousands suffer in hospitals because of smoking; and road traffic accidents and personal violence in our community have escalated. It is not more money and more hospitals that we need but a change in our lifestyles. To that extent we are putting the cart before the horse in dealing with our health strategy. Wherever possible we should provide services on a community or outpatient basis so as to bring about a redistribution away from institutional services.
Deputies opposite find something obscene about a five-day hospital. I welcome five-day beds because there is no need for half the people to be in hospital over weekends at enormous cost to the taxpayers and to the community at large. We need a five-day system in operation because many thousands of people do not require to stay in hospital over the weekend. I have spoken about the closure of outmoded or non-essential institutional facilities. I have closed some and there are others which should be closed in the interests of medical care and rationalising services and I have no doubt that that will go ahead even though, as usual, the Fianna Fáil Party will take local opportunistic advantage of that situation. There is little we can do about that because that is the nature of that political response.
The Minister is closing everything, whether outmoded or not.
We need to maintain a range of care and welfare services with particular reference to children at risk and the needs of disabled and other disadvantaged persons have to be given particular attention. Finally we need to increase the efficiency and effectiveness of our service. I have ensured that my Department have been active in recent times in the pursuit of ways and means of achieving greater efficiency in our health services.
Studies which have been completed relate to conservation of energy, to patient transport, to housekeeping arrangements in hospital and to the purchase and storage of supplies. These studies have revealed various possibilities for cost containment and the reports of the studies have been made available to the health boards so that they can apply them to the circumstances of their own areas. Further studies relating in particular to purchasing arrangements are now in progress.
I intend to explore, with the Voluntary Health Insurance Board, the extent to which the board's schemes could be restructured to further the objectives of shifting the emphasis of care as far as possible from an in-patient to an out-patient or community setting. The VHI broadly share that objective but our job is to do it together. Incidentally, I might mention that despite increases in hospital charges — and this is a public announcement — the increases in VHI premiums as from 1 March 1985 will be limited to 7½ per cent which is rather less than the 8 per cent, 10 per cent and even 12 per cent that had been mooted in January of this year. This contrasts with the increase when Fianna Fáil were in office of 41.5 per cent in March 1982. I managed to reduce that figure to 11½ per cent in 1983 and 13.5 per cent in 1984. This clearly shows what can be achieved when the rate of inflation is reduced overall and when effective controls are introduced. The very major benefit to some 300,000 subscribers of tax relief on premiums will continue.
I also made some suggestions as to the measures that might be considered by the health boards to secure reductions in costs. These included the elimination of unnecessary admissions to hospitals and institutions; the identification of surplus facilities; changes in the role or usage of certain in-patient facilities such as extension of day wards, increased use of out-patient facilities, and the introduction of five-day beds, to which I have already referred; reductions in pay costs by non-filling of vacant posts to the maximum possible extent while avoiding the disemployment of permanent staff, and the reduction in locum cover, restructuring rosters to improve efficiency and reductions in the volume of premium pay.
The health boards and other major health agencies have been asked to draw up action plans detailing measures needed to avoid exceeding approved allocation levels in 1985. Discussions are on-going involving senior officers of my Department and the management teams of health boards and the managements of major voluntary hospitals in relation to the implications of the measures which are considered necessary.
I would like to describe now the stage reached by the health boards in their budgetary arrangements for 1985. There is a general agreement that the situation is very tight although the extent of the difficulties appears to vary from board to board. I have already acknowledged publicly that there will inevitably be restrictions in the level of resources which will be available for health services in the next few years. I have also said, however, that I am confident that we can still continue to provide effective health care within the resources available. I am still of this view, given that these resources are used in the most effective and efficient manner possible and given the full co-operation of all concerned, particularly those whose activities are responsible for generating significant expenditures.
I am, therefore, extremely heartened — and hopefully this will take some of the wind out of Fianna Fáil's sails — by the fact that three health boards, the Midland, North-Eastern and NorthWestern have agreed——
How does the Minister, Deputy Cooney, feel about that?
——proposals for 1985 aimed at delivering their services on a satisfactory basis within the approved allocation level. Indeed, the Midland Health Board have produced a most rational and cost effective plan for the hospital services in their area to which I have recently given my approval.
A fourth board, the South-Eastern, have made good progress in deciding on the measures needed to achieve the same objective. Discussions are currently taking place between senior officers of my Department and the management team of the Southern Health Board. Deputy Ormonde mentioned a forecast overshoot of £5.5 million for 1985 in the South-Eastern Health Board. That is a load of nonsense.
I did not. I mentioned a figure of £3.9 million.
May I make the point without interruption?
Deputy Ormonde, please allow the Minister to make his contribution without interruption.
The Minister referred to my speech and I should be allowed to——
Please allow the Minister to continue without interruptions.
On a point of order, in my contribution I gave the figure of £3.9 million.
That is not a point of order.
I wish to assure Deputy Ormonde that the figure he gave is probably wrong to a factor of three.
The figure I quoted in my contribution was £3.9 million, which is the shortfall for the South-Eastern Health Board.
I maintain that the figure used by the Deputy is wrong to a factor of three. Discussions are currently taking place between senior officers of my Department and the management team of the Southern Health Board. In that regard a figure of £9.5 million was mentioned. I will not put a factor on it, because I might surprise the House, except to say that the £9.5 million is almost irrelevant at this stage in the context of the discussions which my Department, at assistant secretary level, have just had with that health board.
This is the Southern Health Board allocation for 1985.
The Deputy should allow the Minister to continue.
I will talk privately to the Deputy afterwards and he will be surprised. These intensive discussions have also ensured the development of an accounting procedure which will enable the board to maintain services to the people of Cork and Kerry now and in future years. Discussions have taken place also with the chief executive officer of the Eastern Health Board and these will be progressed. A figure of £5.5 million was mentioned as a possible overshoot in 1985 in respect of the Eastern Health Board. This figure is very much inflated and will prove to be above and beyond what will be needed in 1985.
The chairman of the Labour Party voted against it.
The Mid-Western Health Board will meet shortly to consider their chief executive officer's report on the 1985 budgetary situation. The House is no doubt aware that the Western Health Board failed narrowly last week to agree budget proposals for 1985 which were put forward by their chief executive officer. In the case of that health board I have arranged detailed discussions between senior officers of my Department and the board's management team. In fact, they are in Galway today. I have no doubt that considerable progress is being made.
Why refuse to meet them?
I have no doubt that when the management team come before the health board again the situation will be somewhat different. I have no reason to believe that these discussions will not be successful. I am sure this will come as a great surprise to consultants such as the Deputy's colleague, Dr. Donnelly, but they will all learn as they go along not to indulge in rhetoric. When the consultations are over between my Department and the Southern Health Board, the Western Health Board and the other health boards, the boards problems will be much more easily dealt with. I cannot make any further comment at this stage. I appreciate the concern of many health board members about protecting basic and essential services. I have no doubt that we can live within the allocations in 1985.
For the first time in many years no Supplementary Estimates were rushed through the Dáil in 1983 and 1984. There were no mid-year cuts either. We went through last year without many problems——
There are massive problems everywhere.
——apart from the usual political propaganda. There were no mid-year cuts in the health boards and there will not be any mid-year cuts this year and there will not be any Supplementary Estimates towards the end of 1985——
There will be no services.
——just as there were none in 1983 and 1984. I urge the health boards who have not already finalised their 1985 budgetary arrangements to do so without further delay, because delay inevitably accentuates these difficulties. I want to remind the House that, despite efforts which were made time and again by the Opposition and by some professionals in the services who should know better, to present quite another picture, not one person has lost his or her job as a result of the allocations which have been made to the health agencies in recent years.
As I have already made clear to the health boards and put on public record, no compulsory redundancies need be involved during 1985. This strategy is dependent on full co-operation from the staff on redeployment, retraining and, where necessary, relocations. There are now some 59,700 "whole time equivalent" persons employed in the health services. I am not in any way adopting a stand-off position. I am not available to be subjected to political abuse from any chairperson of any health board or from any members of health boards, be they politicians, members of the medical profession or members of the nursing staff. I will discuss any problem on a rational basis, but I will not present myself as a political cockshot for cheap political abuse.
Despite much of the outcry about cut-backs and the imminent decimation of all health services, the fact is that I have, for example, set aside moneys for the development of the health educational programmes by the Health Education Bureau — there is an increase in the budget there of 40 per cent — for the development of cardiac surgery services in the Regional Hospital, Cork, which will cost several hundred thousand pounds initially and will be very costly on an ongoing basis. Money will be and is being provided. I want to thank the Ford Motor Company for a generous contribution of £250,000 to assist in getting that service under way.
I have provided substantial additional moneys for the mentally handicapped services in Galway, Roscommon, Dublin and Louth for example. I have deliberately and consciously endeavoured to give every possible help to the Brothers of Charity and the Brothers of St. John of God who do enormously good work and who use money effectively. The money is being made available. Deputies can ask the individuals concerned.
I have made money available for the medical card guidelines. Two of our doctors involved in the GMS work in this area. We all know that 40 per cent of our people are now covered by the GMS. I have increased the income eligibility guidelines by over 7 per cent from 1 January 1985. That fully compensates for the changes in the cost of living during 1984. I am introducing individual schemes, for example, a measles immunisation programme. That will start in October after the school holidays. At present we have about 40,000 cases of measles a year and we estimate that the cost of the disease to the economy as a whole is of the order of £2.7 million. The ultimate aim of the programme will be the eradication of this disease. This will mean a substantial saving in financial terms but, more importantly, it will avoid the appalling suffering involved for all of those who would otherwise have incurred the disease.
Despite all the constant abuse heaped upon me by Deputies who do not reflect in many respects the real situation on the ground, there is no problem about the opening of Cahercalla. They know what to do. We have exchanged correspondence and the health board know precisely what to do. A Leas-Cheann Comhairle, as a member of that health board you know what we are talking about. In relation to the Galway maternity hospital there is a very simple solution. You tell the staff where they work. It is already opened to the extent of one quarter. There is no question of employing 30 or 40 extra staff. Births are constant by and large in the region. We can reach an agreement with that health board quite easily. There is no way that I will put hundreds of thousands of pounds of additional resources where the money is not needed. The same applies to the utilisation of the general geriatric assessment unit in Ardkeen. The problem about St. Luke's in Kilkenny can be resolved as it was resolved in the Carlow situation. Deputy Ormonde knows that. This is called the effective utilisation of taxpayers' money to deliver the outstanding health service we have.
They are being dismantled.
We are talking about £23 million a week and that is a great deal of money for a small country of this size, with a population of 3,500,000. We are talking about £1 million a week in capital expenditure.
Minister, your time is up.
The money is being well spent. The demands for health specialties are insatiable, the demands of local interests are insatiable and the demands of vested interests are insatiable, but my job is to deliver an effective health service. I have no doubt that when people look back on the period——
Your time is up.
——December 1982 to September-October 1987 they will say that that was done although the public perception of it and the political perception of it now may be somewhat different. I recommend the acceptance of this amendment and the rejection of the motion proposed this evening.
Deputy Lyons, by agreement is to conclude at 8.20 p.m.
I support this motion. The Minister stated that Fianna Fáil removed the medical cards from the old age pensioners. That is an untruth and I hope that when replying somebody will correct it. We in Fianna Fáil issued medical cards to old age pensioners and this Coalition, when they were five weeks in office, removed those medical cards from old age pensioners.
I am afraid the Deputy is wrong.
The Minister seems to want a clap on the back for saving money at the expense of dismantling the health service. The Minister has told us about how far he has succeeded with the Southern Health Board. To date the figure is down to £7 million. We all know that the non-paying area of the Southern Health Board is cut below the minimum level of service and safety. It is expected that in 1985 another 200 jobs will be lost in the Southern Health Board area and this will add further to the unacceptably high level of unemployment over which this Government are presiding. The closing of wards and sections of hospitals is not the solution but it is the policy of this uncaring Minister and this uncaring Government. The joint Programme for Government stated that in carrying through their programme of reform the Government would ensure that the existing level of health care would be maintained and that in particular care would be taken to ensure that any adjustments would not militate against the less well off. In November 1982 the Labour Party said that any attempt to worsen the health services would be resisted with all the power at their disposal and now a Labour Minister is worsening the health services. Most of our economic depression has been created by the policies pursued by this Government. In these circumstances it is reasonable to conclude that there will be a greater need for community care and welfare. Yet we have a situation of a contracting health service. We are witnessing the dismantling of a health service that was painstakingly built up by successive Ministers for Health, particularly the leader of our party, Deputy Haughey as Minister for Health. The ad hoc dental service and the sight testing scheme have been suspended. Are these some of the cutbacks that the Minister is gloating about when he talks about reducing costs?
The North Infirmary Hospital in Cork serves the north side of the city and much of the county area comprising a population of anything up to 100,000 people. It is the only general hospital on the north side of the River Lee yet the budget from the Department of Health ignores the importance of that hospital to the people of the north side of the city. In 1983 the casualty department of that hospital treated 31,000 people. The hospital needs to be upgraded. It has submitted plans and details to the Minister. The Minister would be well advised not to turn his back on the North Infirmary Hospital and on the people of the north side of the city. This hospital should not stand as a monument to the failure of the Government. This hospital requires spending to ensure that it continues to serve the needs of the people.
Health boards throughout the country are under pressure by having to pay supplementary benefit to social welfare recipients who are not getting their cheques from the Department. Is the Minister guaranteeing the overdrafts for the health boards to pay these supplementary benefits? Will the Minister relieve that pressure on the health boards and ensure that the Department of Social Welfare issues the cheques when they are due?
The Deputy has two minutes left.
I would remind the Minister of correspondence that is with him or his Department and which is certainly with the elected Members of the Cork region. It relates to the regional hospital and indicates that the medical staff of this hospital are gravely concerned by the present financial crisis facing the health services and in particular the hospital services. They say that they are aware that priorities will have to be identified to ensure that as far as possible unavoidable cutbacks cause minimal harm to health care, delivery, and standards. They are particularly concerned because of wrong priorities that have been adopted in times of financial difficulty in the past. The regional hospital was planned and built to provide specialist medical services to the people of Munster——
From what is the Deputy quoting?
It is a letter that is already in the Department from the medical staff of the regional hospital. I am sure it is in order.
Once we know what it is.
Do not be wasting my time, a Leas-Cheann Comhairle.
You have wasted some of your time, which is now up. I am calling on Deputy Morley.
As a health board member I welcome the opportunity to contribute to this debate. Before I touch on the main purpose of my speech I must say it pleased me to hear the Minister speak of his efforts to solve the difficulties of the Western Health Board. They are in real difficulties but I am afraid they will not be solved by talk. It is known generally that we are spending too much money on health services but the amount was exaggerated out of all bounds. We were told that expenditure could be pruned without affecting the level of services.
Ireland has the lowest per capita expenditure on health services in the EC, with the exception of Greece, and the further pruning is affecting all health boards, with the Western Health Board feeling the brunt. Not only have they received the lowest percentage increase this year but the peculiarities of population and terrain make it necessary that the area would be given special community medical care.
In that region we have the highest percentage of dependent people anywhere in the country, with Mayo a special case. Despite that, the number of medical cards has been reduced in Mayo in the last two years because of cutbacks. The terrain is difficult and we have people older than 65 years living alone in remote areas. These are the difficulties the health board are faced with, but they have been told they will have to prune £4 million from their estimates this year having had to cut out £4.5 million last year. This, of course, will affect the quality and the range of the services.
The acute hospital programme has to bear the brunt of the cuts to be made by the health board which means ward closures in those hospitals, as we had last year. This year wards will have to be closed indefinitely. We have been told to cut down our medical and nursing staffs, stock and equipment and replacements of machinery, such as ambulances. An orthopaedic unit has been waiting for three years to be equipped but we still have the Department refusing to provide staff required for the opening of some units. The Minister referred to the maternity unit and said half of it is open.
They said it was not open at all.
Money was not available to put that hospital into use after it had been built. It was hoped it would be properly equipped and staffed.
They said they were opening half of it although earlier they had said it would not be opened at all.
They were able to do that by shutting down an older establishment. It is the poorer section who will be most severely affected by these cuts. More than 62 per cent of the County Mayo population are medical card holders and if we are to have these cuts we must concentrate on building up and maintaining community medical services.
No matter how you look at the Minister's cutbacks in the hospital service they will have to be seen as a dismantling of the general health services. Strangely the Minister has begun with the acute hospitals and some outpatient units are being closed.
Deputy Lyons referred to supplementary welfare allowances. I hope the Government will give some attention to this because it affects the poorest of the poor. This year Counties Mayo and Galway will be required to fund 83 per cent of the cost of this service whereas the national average is only 37 per cent. We have not had fair play in this section since 1975 and instead of owing money we should have had a surplus of £2 million. This is a clear case of inequity in the central Government's treatment of a local authority. I hope that the Minister and his colleague Minister will give the matter some attention in the very near future. This is an anomaly which should have long since been eliminated.
