asked the Minister for Health the extra funds being made available to the Southern Health Board to provide cardio-thoracic services at the Cork Regional Hospital.
Ceisteanna—Questions. Oral Answers. - Cork Regional Hospital.
8.
I have accepted that cardiac surgery should be established in Cork Regional Hospital as soon as possible in the current year and I am committed to providing the funding for this service. My Department are at present in discussion with the Southern Health Board with a view to establishing in detail the facilities required and level of resource necessary to enable this service to commence as soon as possible.
Does the Minister mean that he will provide a special grant or finance for these services beyond what the Southern Health Board receive?
I can assure the Deputy that the requisite finance both on the capital side — and in this instance there is intensive capital expenditure required — and the estimated staff costs are provided for this year. I expect that the consultant who was appointed by the Southern Health Board as a cardiac-thoracic surgeon will return permanently to Cork — he is currently on sabbatical — on 1 July 1985 and will then commence practice. It will take some time before that service gets fully off the ground but it is well under way. We did receive an injection of capital funds on a private basis as well towards the centre.
9.
asked the Minister for Health if he will state in respect of the years 1982 and 1983 the number of: (a) public patients and (b) private patients treated (i) by each consultant and (ii) in total, in Cork Regional Hospital.
The information sought by the Deputy is not available to my Department. I am taking steps to ensure that the information will be collected in future.
Does this mean that no records are being kept by the Southern Health Board? If that is the case would the Minister agree that it constitutes a serious omission on their part, that there is inadequate financial management on the part of the board when they cannot identify the level of practice within the different hospitals?
The position is that the Southern Health Board do not keep records of the numbers of such patients treated in particular departments of the hospital or indeed treated by individual consultants. If patients in category (1) and category (2) ask to be treated as private patients of course they become liable for fees, as in the case of category (3) patients, and they are then regarded as private patients of the consultant concerned. The information has not been collated to date. I have now directed that the information be collected in future so that we have all of that type of information available to us in relation to the health services.
How does the Minister intend that this information will be collected in view of the fact that all patients are entitled to free maintenance in hospital? If patients opt for public ward accommodation and then decide to make an arrangement with their consultant to be treated as a private patient, how does the Minister envisage that this information will be collected or what power has he to ensure that the information will be forthcoming?
We are talking about the level of in-patient and out-patient attendances at the Cork Regional Hospital. I hold the view very strongly that where a patient goes in for in-patient or out-patient facilities he or she is registered as category (1) or category (2) and, if he or she opts out and goes private, the health board and the hospital should record the fact that he has gone private, when we would then know who was treating whom. We would then have fundamental information necessary in that regard. As we well know, the very large number of persons eligible for free consultancy services as category (1) or category (2) patients who opt for private care, is a matter of concern. I am always interested why they opt or feel they should opt. That information should be available to the Department of Health on a computerised basis particularly in the case of a regional hospital spending £26 million of taxpayers' money every year.
Will that be applicable to all hospitals in all health board areas?
That is my ambition, although it may not be for another two-and-a-half years.
It could be clumsy to operate?
No, there is a thing called computerisation.
I know, but the Minister would need their co-operation.
There should be no difficulty.
Would the Minister have to make it mandatory?
We have a situation whereby consultants are entitled to provide private care for 15 per cent of the population—currently it is about 18 per cent. That is part of the common contract agreement. If somebody opts from category (1) or category (2), such as a medical card holder, and wants to receive private treatment — some do, strange as it may seem — on that basis I want to know (a) who they are, (b) how many there are and (c) what proportion of a consultant's work is devoted to categories (1) and (2). That is all. It is a matter of particular interest and also of importance in terms of the common contract agreement, which is a very unusual contract.
10.
asked the Minister for Health when a cardiac surgeon will be appointed to Cork Regional Hospital by the Southern Health Board.
The appointment of a cardio-thoracic surgeon was made by the Southern Health Board to Cork Regional Hospital on 1 January 1984.
11.
asked the Minister for Health if he will give an estimate of the money being earned by consultants in private practice in Cork Regional Hospital.
12.
asked the Minister for Health if he has been in contact with the Southern Health Board regarding the level of private practice in Cork Regional Hospital; and if he will make a statement on the matter.
13.
asked the Minister for Health if he will make a statement on reports published earlier this year by the Southern Health Board stating that they are unable to keep a record of the number of patients treated privately in Cork Regional Hospital; and if he has discussed the matter with the health board.
I propose to take Questions Nos. 11 to 13, inclusive, together. Under revised eligibility arrangements introduced in 1979 all persons in the State are entitled to accommodation and treatment in a public ward of health board or public voluntary hospitals without charge. However, persons with an annual income in excess of £12,500 are liable to pay fees to their consultants. Many of those entitled to treatment without charge opt to become the private patients of consultants and so become liable to pay fees to the consultants. As the hospital does not collect the private fees of consultants or charge for the use of hospital equipment in treating private patients the Cork Regional Hospital does not at present keep records of the number of private patients treated.
That will go on the computer also.
Do the Department of Health monitor the fees that private consultants charge in such cases, or are they free to charge as they like?
I regret I do not have statutory power at present to enable me to collect information regarding such matters, particularly payments made by the VHI. I do not have statutory power. That Act was implemented in 1957. I am contemplating whether or not I should have it.
The Minister stated that everybody in the State is entitled to free maintenance in a public ward, that some of these people may opt for private treatment by a consultant and that the Cork Regional Hospital, to which this question refers, do not have a record of the people who are treated as private patients. The Minister said it was not possible to collect that information. Does he intend to get that information and what power has he to obtain such information, because it would appear to me that that would then constitute the answer to Question No 9?
I have powers to obtain full information regarding the number of persons who opt. As of now it appears I do not have power to find out the precise payment made by each person to a consultant. That is a matter of a private contract between the individual patient and the consultant. The only other source of information in that regard would be payments made by the VHI. A number of category (2) persons with income under £12,500 a year are members of the VHI and their payments would be made through that board. The information, therefore, should be available from the VHI. I do not have the information regarding payment in excess of VHI charges.
Is the Minister referring to a private contract?
Yes.
In view of the statements made, is the Minister considering a review of the common contract with consultants? Did I also detect that the Minister is considering some form of control on professional fees charged by consultants?
The House should appreciate that there is nothing to prevent a private citizen from contracting with an independent contractor — a medical consultant — to perform a medical procedure provided it is done in accordance with professional registration procedures. Therefore, there will always be an element of private practice but, where it impinges on public facilities and where such facilities are used, the Houses of the Oireachtas, the Department of Health and the health boards are entitled to full information as to what occurs and to be paid for the use of those facilities. It is within that framework that I will be reviewing the common contract.