I move:
That a sum not exceeding £1,153,476,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1986, 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 a grant-in-aid.
Allowing for appropriations-in-aid at £100 million, the net non-capital grant provision is £1,095.316 million, an increase of £81.5 million on the budget allocation for 1985.
The capital provision included in the Estimate amounts to £58.160 million.
The gross estimated expenditure of £1,274 million represents an increase of £79 million on the corresponding figure for 1985. It comprises £793 million in respect of pay, £416 million in respect of non-pay, excluding cash allowances, and £65 million in respect of cash allowances. About 86 per cent of the gross expenditure will be met from Exchequer funds.
I have, on many occasions, referred to the spectacular growth in expenditure on health services over the last decade or so. In 1973-1974 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 1986, which can be supported by the Estimates provision, will reach almost £1,200 million in net expenditure terms. When direct income from patients receipts etc. accruing to health agencies is reckoned the amount available for expenditure on health services in 1986 will reach a total of £1,274 million. This compares with an overall gross total of about £1,195 million at estimates stage last year and is an increase of £79 million.
There have been major improvements in the scope and the range of the services in recent years. For example, our acute hospital services are as good as any in Western Europe, providing emergency and casualty services on a 24-hour basis and access to high quality diagnostic and treatment services to the entire population. Acute medicine continues to develop and our services have managed to embrace recent advances, offering, for example, techniques like organ transplants, open heart surgery, haemodialysis and intensive care — particularly neonatal intensive care where there have been major developments in the last ten years or so.
Our psychiatric services are also steadily improving. In the wake of the recent planning report there is now a new drive to develop a more community oriented system with the objectives of better and more human patient care. A particular feature of these services has been the value in terms of improvement in the standard of accommodation in most psychiatric hospitals by the expenditure by this Government of £6 million on schemes of refurbishment.
We can also point to a comprehensive range of services for the mentally handicapped, being progressively developed with a particular emphasis on community services.
Our general medical services provide general practitioner service to almost 40 per cent of the population, currently totalling some 1,322,000 persons. Over £100 million will be spent on the general medical services in 1986. Apart from general practitioner services the community health services programme provides a range of other services including home nursing, family planning, dental ophthalmic and aural services as well as domiciliary welfare and the refund of drugs schemes.
Additionally, the Irish health services provide a range of personal special services, normally not embraced by a health care system, but absolutely vital to maintaining the independence and dignity of many of the disadvantaged groups in society.
Services under this heading, to meantion but a few, include, disabled persons allowances; domiciliary care allowances for handicapped children; home help services; meals on wheels; capitation payments for children boarded out; adoption services and welfare homes for the elderly.
In summary, we have succeeded in bringing our health services and health indicators broadly into line with the developed countries, many of which are wealthier and therefore in a better position to devote resources to health care.
In general, health boards and hospitals have faced up realistically to deciding what has to be done to keep expenditure within allocation limits in 1986. Some of the decisions taken were difficult and will undoubtedly impact on services and personnel. I do not accept the view that large scale disruption of services is likely to arise. The funds available, if properly used, will be sufficient to maintain essential services.
The capital allocation which I have received for 1986 is £58.16 million. This is an increase of over £1 million on the capital funds available to me in 1985. This allocation will permit me to continue with the programme of improvements already in progress and to undertake a limited number of additional projects.
The major general hospital schemes in progress at St. James's, the Mater, Cavan and Mullingar will continue to be developed. In addition, work has already commenced on a major scheme at Castlebar General Hospital which will provide additional ward accommodation, X-ray, theatre, OPD and kitchen. Tenders have been invited for the provision of a new OPD and theatre suite at St. Colmcille's Hospital, Loughlinstown, and the provision of a replacement maternity unit at Our Lady of Lourdes Hospital, Drogheda, should shortly go to tender. The urgent improvement works which I have approved for Ardkeen Hospital in advance of the overall development of that hospital are scheduled to be completed during this year.
The planning of proposed developments at Tallaght, Kilkenny, Wexford, Sligo and Naas will be continued and, in addition, smaller improvement works involving, for example, improvements of out-patient facilities and day hospitals, will be undertaken at other hospitals.
The programme of improving standards in the major psychiatric hospitals and the provision of new day hospitals and day care centres for psychiatric care will be continued. Tenders are currently being processed for the development of small psycho-geriatric units to improve standards at St. Brendan's Hospital, Dublin.
In the case of the mental handicap services, the intake of patients into Cheeverstown Hospital, Templeogue, has already commenced and further facilities at the centre will be commissioned throughout the year. When fully operational, the centre will provide 130 residential places and 150 day care places. It is expected that a day care centre for adults at St. Michael's House, Belcamp, will open shortly.
Work on the provision of additional accommodation for the physically handicapped should shortly commence at St. Laurence's Cheshire Home, Cork, while work is nearing completion on a major development scheme at Barrett Cheshire Home in Dublin. Construction work is well advanced on the provision of new residential accommodation at St. Joseph's School for the Deaf, Cabra and a major development scheme has commenced at St. Mary's School for the Deaf, Cabra. Planning is proceeding on a development at St. Mary's School for the blind. It is expected that building work on this project will commerce later this year.
The provision of facilities for the care of the elderly will continue to be a priority. Construction of the new geriatric unit at St. Oliver Plunkett Hospital, Dundalk, is expected to be completed at the end of the year and building is in progress on the provision of a new 100 bed replacement geriatric unit at Sacred Heart Home, Carlow. Funds are being provided for a scheme to upgrade accommodation at Leopardstown Park Hospital and planning will continue in respect of other major projects, at Dungarvan and elsewhere, for the care of the elderly.
We will continue to push ahead with a major programme of systems development. This will yield many benefits: in improved patient care, in more accountable management, and in the rapid provision of information relevant to research and policy formulation.
In the health area I published last April a report on the health services for the period 1983-86, copies of which were circulated to Members of the Oireachtas. This report set out in some detail the structure and financing of the health services, the rationale for the state of progress of the legislative programme, significant developments in each of the health care programmes and more general information on eligibility for services and other matters. This publication was significant and long overdue.
Given the labour intensive nature of health care, we have examined in great detail the manpower strategy.
Since the health boards were established in 1970 there followed effectively a decade of exceptional employment creation in the health service until almost 66,500 persons were employed in July 1981. At present there are approximately 62,500 people employed directly in the health services implying a reduction of some 6 per cent in overall numbers since 1981. The impact of this on the ground is a challenge to health services personnel to increase productivity by maintaining the overall quality of service while reducing the number of man hours worked. I will deal with this matter in detail if there are any inquiries.
It is interesting to note that there are over 500 different grades in the health services and many of these, such as nurses, doctors, dentists and the various paramedical grades are unique to the services. Large numbers of staff in other employments also play a significant role in the efficient running of the various health care programmers, such as catering, maintenance, clerical and administrative staffs.
At 31 December 1985, 36.69 per cent of the population were covered by medical cards as compared with 36.75 on 31 December 1984. The income ceiling for hospital service cards was increased to £14,500 on 1 June 1986. This revised figure applies to income earned in the year ending 5 April 1986.
In accordance with the medical card guidelines a married man aged 66 years or over can have up to £105.50 per week, or £111.50 per week if over 80 years, and be entitled to a medical card. The limit will be higher if he has dependants or outgoings in excess of £10.50 per week in respect of his house.
I have increased the income ceiling for health contribution purposes to £14,000 with effect from 6 April, 1986. The effect of the increased ceiling is to increase the maximum contribution payable from £130 to £140. With the introduction of the land tax the existing method of collecting health contributions from farmers needs to be reviewed. This is under active consideration at present.
The present structuring of VHI insurance coverage provides for full recoupment of hospital in-patient expenses but only limited cover for general practitioner and other out-patient expenses. The out-patient cover applies only after a threshold of £105 for a single person and of £170 for a family has been reached. The current thrust of health policy in Ireland, as in many developed countries, is to reduce costly in-patient services and as far as possible encourage the provision of services on a community or out-patient basis.
In line with this policy I have been anxious to encourage the development of VHIs primary care coverage so as to influence patients to make greater use in appropriate circumstances of primary care rather than hospital treatment. Accordingly, I have recently commissioned consultants to examine existing models for voluntary insurance in other countries which might be suitable for adaptation to meet our policy requirements. I have also asked the consultants to provide an analysis of how suitable models would operate under Irish conditions. The VHI are co-operating fully in this exercise. I hope that all this will lead to the early introduction by the VHI of a comprehensive general practitioner and out-patient scheme. I think that such a scheme would be warmly welcomed and subscribed to by the general population.
As Deputies will be aware, the Children (Care and Protection) Bill, which I introduced early last year completed its Second Stage some weeks ago. I hope to see a major advancement on the Bill in the near future.
I am pleased and gratified that the Bill has stimulated so much discussion. I have also been heartened by the generally favourable reception that it has received. Many suggestions have, nevertheless, been made for changes in the Bill, and I am reviewing the provisions of the Bill generally prior to Committee Stage.
The new Dentists Act was passed by both Houses of the Oireachtas in 1985 and has led to the appointment of the new 19 member Dental Council with wider powers particularly in the disciplinary area.
The passage of the Nurses Bill through the Oireachtas in November 1985 marked a watershed for the nursing profession. The new legislation allows the composition of An Bord Altranais to truly reflect the profession as it has developed in recent years. The members elected to the profession's own self regulating statutory body are drawn from all the major disciplines of nursing and represent the practical, teaching and administrative areas. I have every confidence that the new 29 board members will successfully combine their many skills and talents and will work together along the lines mapped out for them in what has been described as a visionary piece of legislation, the Nurses Act, 1985. It is expected that the new board will meet in the first week in September and in the next five years will make a distinctive contribution.
I intend to introduce the new Tobacco (Health Protection) Bill shortly. The provisions in the Bill will help to establish non-smoking as the normal social behaviour and should help to deter young people from taking up smoking. Of particular importance is the banning or restriction of smoking in certain public places.
New Tobacco Products Regulations on smoking have been made and will also be operative this year and will include stronger health warnings on cigarette packages and media advertisements, a rotational system of health warnings, increased controls on point of sale advertising, the elimination of outdoor advertising at point of sale and tighter controls on sponsorship of events by tobacco companies. They have been widely welcomed.
The Health (Amendment) Bill, 1985 — to amend the Health Acts, 1947 to 1970 to enable health boards to charge for services provided for certain victims of road traffic accidents — has recently been passed. Accordingly health boards and hospitals may now offset the loss of revenue, estimated at £4 million in a year, which they suffered as a consequence to the Supreme Court decision on Article 6 of the Health Services Regulations 1971.
Since the passage in early 1985 of the Health (Family Planning) (Amendment) Act, which came into operation on 1 October last, my Department has been in regular contact with the health boards. Boards have submitted to the Department their assessment of the current availability of the various types of family planning services within their own functional area. These assessments have been accompanied by an outline statement of the proposals of the appropriate health board with regard to future local developments which are anticipated in the area of family planning services generally. They are being discussed with the Department of Health.
The text of a Bill to provide for a statutory scheme of control of clinical trials has been circulated to all Dáil Deputies and Senators. The Bill has been initiated in the Seanad. The principle of a statutory scheme of this kind has been widely welcomed despite some incredibly mis-informed comment about it. There has already been in existence a voluntary scheme operated by the National Drugs Advisory Board whereby proposals for such trials have been notified to the National Drugs Advisory Board in the first instance. However, for the sake of the reputation of the pharmaceutical industry itself as well as to provide public assurance that satisfactory standard controls operate in relation to these trials, it is important that there should be a statutory basis for these arrangements.
The Bill has, as I have said, been initiated in the Seanad and I will, as is usual with me, entertain all reasonable suggestions for its improvement, provided that its integral design is not fundamentally interfered with.
The 1986 allocation to the Health Education Bureau has been increased to £2 million, which compares with, £1.75 million for 1985. The additional allocation is necessary for the bureau to widen its health education campaigns in a number of areas including the development of an educational campaign with regard to AIDS. The bureau also intends to intensify anti-smoking publicity to complement the new legislation to strengthen controls on the promotional activities of the tobacco companies to which I have already referred. In addition, funds are necessary to broaden and develop the lifestyles education programme in schools, including sex education and anti-drug abuse attitudes.
We are making progress in the area of drug abuse and shortly I hope to be able to announce progress on the provision of a walk-in out-patient facility in the inner city area of Dublin. A planning brief for this badly needed unit has been agreed and negotiations are in progress concerning the purchase of a suitable premises for this new facility.
The take up on the measles immunisation programme has been outstanding. In six months a national up-take of 90 per cent was achieved and I should like to thank those involved in making that programme a success.
Negotiations on the general medical services are proceeding. We have been gravely concerned about the increasing costs of the GMS in recent years and it is vital that we have agreement with the medical profession on this question. I am actively pursuing the prospect of bringing the negotiations to a conclusion. It will not be for lack of efforts on my part and I trust the profession will co-operate.
The FICI Agreement was signed recently. This will result as from 1 August in a 10 per cent reduction in the price of drugs at present on the market. The agreement also entails an increase in the rebate paid by manufacturers to the State in respect of GMS sales from 4 per cent to 5 per cent. I am very pleased about this agreement. It is a critical one dealing with a major industry and it shows what can be done where there is co-operation on both sides in negotiations.
More than 30 small health centres were completed during 1985-86 at a cost of £500,000 per annum. Many of the health centres were in very bad condition and work was urgently needed to help in this area. New major health centres were opened in Blanchardstown, Loughlinstown and Blessington in the Eastern Health Board area. A further seven centres are being planned at present for Dublin. I have also approved the development of major new health centres and community care officers in Athlone and Portlaoise. Planning for a centre in Carlow is practically completed and a major new and innovative project is being planned for Waterford. In addition, other centres are being planned for areas throughout the country. With regard to the review of services for the elderly, we are undertaking another major review. There will be no delay in bringing forward our policy guidelines. As Deputies are aware, I promised this in my Estimate speech last year.
With regard to the psychiatric services, I do not propose to go back over the major debates that have taken place here. I have been in touch with the Western, Eastern and South Eastern Health Boards on the matter. We have reached substantial agreement regarding the provision of hostel, day hospital, acute and longer stay units in the various counties. I have stressed my anxiety to provide the necessary capital funds to facilitate the immediate provision of these facilities. We have reached agreement on the designation of specific areas for mentally handicapped and the psycho-geriatric patients in those hospitals. I hope in the near future I will get the agreement of the health boards concerned regarding the siting of the acute psychiatric units in Carlow and Roscommon. Meanwhile, I shall continue the funding of these facilities on a month-to-month basis. I have had ongoing discussions with the trade unions on the matter.
I am extremely concerned with regard to the problem of alcoholism. As we know, alcohol abuse and alcoholic psychosis accounted for 7,100 admissions to our psychiatric hospitals in 1983, or almost 25 per cent of total admissions. This is a very grave problem and one we in Ireland are reluctant to tackle. It will require major action in the health services.
With regard to services for the mentally handicapped, this year we have had an overall expenditure of £107 million, compared with a sum of £100 million at Estimate stage in 1985, which indicates an increase in line with inflation. Where any of the agencies have individual problems I shall be quite willing to meet them to discuss such matters. However, the majority of the services for the mentally handicapped are ongoing. There have been major improvements on the capital and current sides, apart from one major policy change, namely, the interruption of the planning process for Loughlinstown and Enniscorthy. This was for valid reasons, particularly to dilute the intensely institutionalised character of the proposals. With regard to new developments, I refer to the provision of the 70-place adult special care unit at Belcamp in north Dublin.
With regard to the Green Paper on Services for Disabled People, we had a major conference on 21 May 1986 on the training and employment aspects of that paper. I should like to thank the many organisations who assisted us in that regard. Their response was very productive and was of benefit to us in considering what developments might be carried out.
With regard to residential care for the physically handicapped, I am pleased we made available a total of £1.45 million in capital grants, including a sum of £750,000 for the development of a new Cheshire Home at Monkstown, County Dublin. The new home will provide accommodation for 26 severely physically disabled people. This is vital in the greater Dublin area. The emphasis will be on independent domestic self-help accommodation for each resident. In addition, we have made moneys available to the Barrett Cheshire Home in Dublin. A grant of £200,000 was made available towards that project. A further sum of £500,000 is being made available towards the provision of 28-single bed accommodation units in the Cheshire Home in Cork. These are major developments. I am very pleased the Cheshire Home Foundation have co-operated so magnificently with the Department of Health in this matter.
Major work is on going in respect of general hospitals. In the mid-west area the new theatre suite at Croom Orthopaedic Hospital is nearing completion. Major renovation works are under way at St. John's Hospital in Limerick, and work is in progress on new theatres and structural works for the orthopaedic unit at Tullamore. We are going ahead with major development schemes at Limerick Regional Hospital and at Nenagh, Kilkenny and Navan hospitals.
In the Eastern Health Board area we have made major progress. On the north side of Dublin the first phase of the development of the new Mater Hospital is almost complete and is expected to be commissioned on a phased basis in 1986 and 1987. I intend to proceed as quickly as possible with the commissioning of Beaumont Hospital which has been referred to on many occasions in this House. This is a much needed facility which will replace inadequate accommodation at both Jervis Street and St. Laurence's Hospitals. I am concentrating particularly on opening the acute psychiatric facility at the hospital as part of the sectoral psychiatric service provided by the Eastern Health Board. The planning brief for James Connolly Memorial Hospital has been prepared and I am giving consideration as to how this development can be slotted into the programme.
On the south side, a major phase of the development of St. James' Hospital is currently under construction and is expected to be completed in 1989. Planning is proceeding on the development of the new Tallaght Hospital which will incorporate the services currently provided by the Meath, Adelaide, Harcourt Street and the orthopaedic service at Dr. Steeven's Hospital. A planning brief for the development of St. Vincent's Hospital is nearing completion.
Apart from the six major Dublin hospitals, major improvement or development schemes have been completed or approved at St. Michael's Hospital, Dún Laoghaire, the Rotunda Hospital, Cappagh Hospital, Harcourt Street Children's Hospital and the Meath Hospital while planning is proceeding on developments at Naas Hospital, Temple Street Hospital, St. Michael's Hospital, Dún Laoghaire and St. Columcille's Hospital, Loughlinstown.
The rationalisation plans for the south side of Dublin provide for the transfer of services at Sir Patrick Dun's Hospital, Baggot Street Hospital and services other than orthopaedics at Dr. Steeven's Hospital to St. James' Hospital Services which had been provided at Mercers Hospital have already transferred to St. James' Hospital.
Sir Patrick Dun's Hospital was originally scheduled for closure in 1989. With the co-operation of the parties concerned, I am confident we will succeed in having an orderly closure and transfer of patients. Already we have completed the closure of St. Patrick's Infants Hospital, Blackrock, with ongoing care being provided for the children concerned. In the Southern Health Board area progress is evident. We have had excellent co-operation with the South Infirmary and Victoria Hospital which have been amalgamated. The services now provided by the Eye, Ear and Throat Hospital will be transferred to other hospitals in the region with the ophthalmic services going to the Cork Regional Hospital and the ear, nose and throat service going to the South Infirmary/Victoria Hospital.
I am particularly pleased with what happened in the Midland Health Board area as regards Portlaoise, Tullamore and Mullingar. The paediatric service in Portlaoise is well under way and we are providing a service for the entire region pending the completion of the new development at Mullingar. This means that for the first time ever the people of the Midlands have a fully fledged paediatric and orthopaedic service. Many Deputies challenged me as to the provision of that service but the proof of the pudding is in the eating and I am pleased to record that the unit now has two full time consultants. I want to commend the officers of my Department who have worked long and hard to bring about the rationalisari tion of the services in the Midlands. I am very happy this has been so successful because it means no more comments for narrow vested interests of a political nature will be made in the future.
The Mid-Western Health Board agreed with my proposal that the old geriatric hospital at Edenvale be closed and the resources used to open the new maternity unit at Cahercalla and the renal dialysis unit at Limerick Regional Hospital. This has now been done and for the first time the mothers of County Clare have a top class modern maternity facility while patients with renal failure no longer have to travel long distances to Dublin, Cork or Galway for dialysis. New renal dialysis units have been opened in Sligo and Letterkenny. This service has been long over due.
The North-Eastern Health Board recently submitted a proposal to close the County Infirmary in Navan for inpatient use and to use the resources to open the new children's unit in the orthopaedic unit in Navan, to initiate a geriatric assessment service at the geriatric hospital in Trim and to establish a psychiatric day hospital at the County Infirmary in Navan. The proposal looks sensible and will have my support.
The new maternity unit at the Galway Regional Hospital has been opened. I hope to visit it shortly to see it in operation. In the South-Eastern Health Board area I am making additional funds available for the establishment of a consultant staffed paediatric service at Wexford General Hospital. This will be in operation very shortly and will provide a much needed and valuable service for the area. I am satisfied that the funding from the Exchequer of two bodies responsible for health research is by no means the most efficient means of disbursement of such funds. The amalgamation of the two bodies under a single statutory authority would be very successful.
I thank the Chair and Deputy O'Hanlon for their tolerance while I read a very lengthy script, but I thought I had longer than 30 minutes to make my contribution. I hope to deal in my reply with the reorganisation of the health services which is referred to in the final page of my script.
