asked the Minister for Health if he will give details of the directives that both he and his Department have given to each Health Board in the country to reduce their expenditure in 1985; the reasons for this, the effect that it will have; the total amount of money available to each health board in the country for 1985; and if he will make a statement on the level of services that he hopes to provide within each health board during the forthcoming year.
Ceisteanna—Questions. Oral Answers. - Health Board's Expenditure.
6.
The health boards have been advised that budgetary strategy for the years 1985 to 1987 should be determined in the light of the decisions contained in and the thrust of the health sections of the national plan. 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 these areas will be the overall level of funds available. The Government decisions to reduce expenditure in the health area relate largely to reductions in payroll costs. Health boards have therefore been requested to concentrate the necessary reductions in budgerary allocations on this area of expenditure and on institutional services.
However, the question of the specific measures necessary to contain expenditure within the approved levels is a matter for each health board.
The Minister told us that the main thrust of the Government's recommendation to the health boards was a reduction in the payroll costs. Does the Minister accept that a number of vacancies will be left unfilled as a result of that during the coming year? At the meeting he had with the CEOs and chairmen of the health boards in Newbridge in November, a number of areas where there could be staff reductions were suggested to the health boards, for example, a reduction in overtime and locum cover. Does the Minister accept that this will have the effect of reducing the level of services which will be available?
When I came to office I found that, going back to 1980-82 —in 1979 the situation was out of hand altogether — massive sums of money were spent on overtime and on the employment of temporary and locum staff, payments for weekend working and other premium payments. It is in those areas that reductions have occurred. One was talking about an expenditure of millions of pounds at that time. The number of vacancies which have been left unfilled are very few despite the embargo. By and large, the health boards, with the possible exception of two where we have residual difficulties — the Southern and Western Health Boards — they are all in line with their expenditure targets for 1985.
Does the Minister accept that the health boards were told to leave two-thirds of the vacancies unfilled unless they could find the money to fund the filling of those vacancies? In view of the fact that they received a reduced allocation, the health boards are not able to do that. When the Minister talks about overtime in the health boards, does he not accept that the average working week is 40 hours and that the health services operate on a 24 hour a day basis, that is 168 hours a week? In the health services, 128 hours of the working week is overtime and for the Minister to suggest that they should be able to do away with overtime is a red herring.
I accept that, by and large, the health services operate on a 24 hour basis. I have encouraged health boards not to admit patients on a Friday afternoon, keep them through Friday night and all day Saturday. Apart from assisting them in their religious services on a Sunday, nothing happens to them apart from perhaps looking at the Match of the Day on television. Some tests are then done on Monday and Tuesday. That kind of practice was rampant but it has been stopped as far as possible. We now have five day week beds and there is nothing wrong with that. Procedures will be done between Monday and Friday except in cases of emergency. In some places there were two or three hospitals providing emergency services over the weekend but that, too has been rationalised. In fairness to the health boards, the bulk of the measures required have been taken and the budgets are now on target. Through the seventies, the health boards did not believe what successive Ministers said and in September or October they demanded and received more money. Since I came to office there have been no supplementary estimates. Between 1976 and 1982 Ministers for Health came into this House and looked for money from the Oireachtas. We are talking about £40 or £50 million. However, all that has now stopped. People are settling down. I want to thank the 60,000 people who are providing the health services. Some of them are not very happy, but they are doing it. They are doing a good job.
Some hospitals are practically halving the time patients stay in hospital. The Minister is trying to establish the practice of patients not staying in hospitals over the week end. We have to agree to that. Would the Minister agree that the hospitalisation of patients in the general hospitals needs to be re-examined in view of all the changes the Minister has proposed regarding bed requirements and so on?
One of the problems my Department have at national level is that we are a small Department with a small staff. Only 350 people work in the Department of Health. We had great difficulty in finding out what was going on. We have begun to find out. The data are now coming in. We have got the information from the health agencies. It is very difficult to know what is going on in some of the voluntary hospitals. I am not sure some of them know themselves. That is the way things are, and much money is spent. Now that we know, I can assure the Deputy that the services are being provided on a more rational basis. Expenditure is at a reasonable level. No one is suffering due to lack of hospital services.
In a previous reply the Minister referred to the Western and Southern Health Boards and the directives given to them. Would the Minister care to make a statement on recent events in the Southern Health Board as a result of his directive?
That is a separate question.
No, it is not.
One only has to read the papers to know there are two days work in that sort of question.
It is relevant to this question.
Ceist 7.
7.
asked the Minister for Health if he is aware of the concern in each health board that services will be reduced to an intolerable level in the current year; and if he will make a statement on the matter.
I am aware of the difficulties involved for health boards in containing their non-capital expenditure in 1985 within approved budgetary levels. Unfortunately in some instances exaggerated statements have been made concerning the implications of the budgetary situation for patient care.
I am pleased to say that a number of health boards have developed a strategy for 1985 which has as one of its main objectives the containment of expenditure within approved allocation levels while at the same time preserving the essential fabric of the services. I am satisfied that it should be possible for all health boards to chart a similar course.
This is the same as the last question.
It is a different question and a different answer. In case the Minister was answering the last question if you will allow me, a Cheann Comhairle, I will read out my question.
I asked the Minister would there be a reduction in the level of services. The Minister did not say whether or not there would be a reduction on the level of services. In reply to the last question he told us he had advised hospitals not to admit patients on Friday. He said the budgets were on targets. I wonder if a deficit of £5.6 million in the Southern Health Board is on target. Does the Minister believe it is something to boast about that there was no supplementary estimate when services are being curtailed? If wards are closing down, the sight testing scheme is being abolished and elderly people who live alone and watch television or read newspapers cannot get their glasses repaired or their eyes tested, and the ad hoc dental scheme is being abolished in a number of areas does the Minister accept that there is a reduction in the level of services?
The last people on earth who would want to reduce the level of services are the health boards. The latest position I have is that the Midland Health Board are well within target now that we have approved of their package. It is within the improved allocation for 1985. In the North Eastern Health Board area the budget within the allocation was approved on 28 January. The North Western Health Board have approved their budget which reconciles with the allocation. The Western Health Board approved measures which would allow expenditure to be contained within the allocation. We had a problem with the Southern Health Board. I had proposals from the South Eastern Health Board. By and large we have had no great difficulty. There is nothing particularly wrong with a hospital saying they do not need to have a certain number of beds filled, for example, in July and August when staff go on holidays or during the Christmas period. As the Deputy knows as a member of the medical profession, if we had 50,000 beds they would be filled by the medical profession. They would be filled anyway. This is one of the realities of acute medical beds. Provide the beds and they will be filled. We have a limited number of beds. There is nothing wrong with a health board saying there is no need to fill all those beds. For anybody who has acute medical or surgical or psychiatric needs, there are lashings of beds. They do not all have to be filled.
Is there a reduction in the level of service? The Minister has told us if there is no need to have a ward open in July it can be closed. A number of wards have been closed as a result of cutbacks even though the medical board believed they should not have been closed. Does the Minister believe the abolition of the sight testing scheme means a reduction in the level of services?
I am entirely unhappy with the decision——
Yes or no.
——of the health boards generally on the dental and opthalmic side. Some fairly easy decisions have been taken.
The Minister accepts that there is a reduction in the level of services.
When a health board decides to stay within their budget that is a health board decision. We in this House devolved responsibility onto them. No matter how unhappy I may be about some aspects of those decisions I must accept them. I say to the health boards: "There is £150 million for 1985. You must deliver the services within that framework". I am quite sure that no health board could comfortably deliver the services, including the dental and opthalmic services, without reductions in those services.
The Minister accepts that there is a reduction?
In some areas.
Did the Midland Health Board confirm to the Minister that they are able to provide the same services as they provided last year in view of the fact that there is a £1.9 million cutback?
That is a separate question.
No. I beg your pardon, a Cheann Comhairle, the question relates to boards in general. With all due respects——
Please, Deputy, that is a general question.
It is not a general question. I beg to differ with the Ceann Comhairle and I do not want to be disorderly.
The Deputy may beg to differ——
I will read the question.
Question No. 19 deals with this. The Deputy may disagree mentally with the Chair——
Not mentally.
——but he will have to accept the Chair's ruling.
The question asks if the Minister is aware of the concern in each health board.
Question No. 19 deals with it.
Am I not in order?
Why not?
Because Question No. 19 deals with it. I am ruling the Deputy out of order. I am calling Question No. 8.