Dáil Éireann debate -
Wednesday, 22 Oct 1986

Vol. 369 No. 1

Adjournment Debate. - Health Board Decisions.

Dr. O'Hanlon

First, a Cheann Comhairle, I thank you for granting me permission to raise this matter on the Adjournment and I thank the Taoiseach for coming into the House at this late hour to deal with it. Today during Question Time I asked the Taoiseach, in view of his reported comments in the Irish Independent of 18 September that some decisions made by health boards were pretty perverse, if he would elaborate on that statement which he made at a rally of Fine Gael in Clondalkin on 17 September. That was rather intemperate language, not the sort of language one would associate with a Head of a state. It caused a lot of anxiety to members and staffs of health boards as they believed that the Taoiseach was pointing the finger at them. What I would have liked the Taoiseach to tell me today was which board or boards he was pointing the finger at and to give us examples of the perverse decisions they made.

The Taoiseach in his reply quoted mainly statistics as to the increased allocations made to the health boards over a four year period, a 24 per cent increase in the non-capital allocation. While on all sides of the House we would be concerned at the high cost of health care — 19 per cent of non-capital expenditure in the current year — I do not think that the remarks of the Taoiseach were justified.

The Taoiseach quoted a figure of an increase of 24 per cent in the non-capital allocation between 1982 and 1986 but in answer to a question in this House, Question No. 496 on 19 February 1985, the Minister for Health stated that there was a real decrease in every health board area, except in the Eastern Health Board area, in the period from 1982 up to and including 1985. The only reason the Eastern Health Board area did have a small increase is because they operate in a rapidly growing area with a rapidly growing population and because they provide a wide range of services nationally. The situation is that the health boards had a real decrease and this has been admitted by the Minister for Health. Yet, the Taoiseach tells us that there has been a 24 per cent increase and that they should be satisfied with that.

The estimated deficit this year between the eight health boards is between £25 million and £30 million some of which has been carried over from last year. In fact, only one health board area last year had a credit balance. Some of the boards are in a very serious situation. The South Eastern Health Board, the Southern Health Board and the Eastern Health Board, for example, have very serious problems with their deficits because of a lack of funding by the Government. All the health boards have problems. There are problems in the acute hospital service where wards have been closed down, where there are long delays for outpatient services and where people are being discharged earlier than they normally would be discharged. In the community care services there is no dental service available for adults who have medical cards. In many parts of the country there is no optician service. In our constituency, a Cheann Comhairle, I recently met a widow on the lowest income in the land going off to the credit union to see if she might borrow the money to enable her to attend a dentist as there was no dental service available to her under the health services.

The health boards have a statutory obligation to provide a service and because of insufficient funding by the Government they are unable to do so. It was wrong of the Taoiseach to blame the health boards and at a party rally to state they were making pretty perverse decisions. I would submit that the perverse decisions have been made by the Government and imposed on the health boards by edict. The Government, apparently on the eve of the budget, made the decision to close eight hospitals. There was no reference whatsoever to the health boards and on 30 January the Minister for Health on behalf of the Government announced that eight hospitals were to be closed. That was the first anybody knew that these hospitals were to close. Included among those hospitals were St. Dympna's in Carlow and St. Patrick's in Castlerea, both of which are psychiatric hospitals. This caused great anxiety not alone to the members and staffs of the health boards but also to the patients, the patients' relatives and public generally. It was stated in this House that those hospitals were to close by the end of June. In fact, they are still open. Much unnecessary anxiety has been caused to the people and the health boards by that decision of the Government which I would consider a perverse decision. Certainly, it was not made by the health boards because they did not know anything about it. There had been no consultation whatsoever with them.

While Beaumont is not a health board hospital there have been a number of U-turns by the Government, including one to reverse a decision of the previous Government, that the consultants be allowed build their own private outpatients' hospital on the site. Apparently that decision has since been reversed and the consultants are to get that permission. The Minister in a reply to a question in this House stated that work was to commence on a nurses' home in the autumn of 1984 but then he announced that a nurses' home would not be built there. One of the problems the health boards have is that they do not know what is happening. It is not that the health boards are making perverse decisions but they are in a critical position because they do not know the direction the Government are taking or their policies.

At regular intervals the Minister promised to introduce a Green Paper on the health services but in reply to a question on 15 May he said that he did not now intend to publish a Green Paper. He told the House on that occasion that he intended making submissions to the Government. Today in Questions Nos. 281 and 282 tabled by me I asked the Minister, about an extraordinary statement by the Secretary of his Department at a meeting of the World Health Organisation at Dromoland Castle where he said that it was the first time a policy direction had been announced publicly. He produced a 39-page document outlining the future policy. I do not know if he was articulating official Government policy or the policy of the Fine Gael or Labour Parties. In answer to those questions the Minister said:

I have now decided that this preliminary statement should be developed into a consultative document for dissemination to all concerned with health in its broadest terms. This will be available shortly.

An Ceann Comhairle

The Deputy has travelled a long distance from Clondalkin.

Dr. O'Hanlon

My question to the Taoiseach today related to his remarks about pretty perverse decisions being made by health boards. He did not deal with that issue and said he did not wish to get involved. He said he had no desire to prolong the controversy or to give any credibility to those cases by referring to specific examples. In my view it is important that he should refer to specific examples. I have given a reason why there may be confusion in the Taoiseach's mind about health boards because those organisations, staff and members, admit to being confused about what is happening in regard to Government policy and about precipitive decisions made, such as the closure of hospitals on 30 January last. An announcement about those closures was made in the House on that date.

Today the Minister made the statement I quoted and it appears from that that we are to have a Green Paper. The kernel of the problem as far as health boards are concerned is that they do not know what is happening. An element of confusion exists but I do not think it justifies the Taoiseach's statement that health boards are making pretty perverse decisions. The Taoiseach, when asked to elaborate on that statement, should have given examples of those decisions and indicated to us the boards who are making such decisions. The boards are entitled to know because the Taoiseach's statement, as reported in the newspapers, points the finger at all health boards. I do not think it is right to point the finger at any health board because they have a statutory obligation to provide health services but they have not been given sufficient funds to do that.

In reply to a question in the House earlier this year the Minister told me that there was a real decrease in each board, with the exception of the Eastern Health Board and the Southern Health Board, the two organisations who are catering for expanding cities.

The Taoiseach

There was a real decrease in what?

Dr. O'Hanlon

He said that the percentage change in allocations in real terms showed a decrease.

The Taoiseach

In which year?

Dr. O'Hanlon

Each year, 1983 over 1982, 1984 over 1983 and 1985 over 1984. He said there was a decrease in real terms and that is one of the causes of our difficulties. Health boards are expected to operate with a real decrease in their allocation. They are being asked to provide a greater level of services in that they have been asked to develop the community care services and must cater for the greater demand for existing services. That demand has come about because of Government policies, particularly in regard to employment creation. Unemployment increases the demand for health services. I should like to give the figures in relation to the North Western Health Board as an example. The decrease in 1983 over 1982 was - 2.8 per cent, in 1984 over 1983 it was -3.4 per cent——

An Ceann Comhairle

I do not think the Deputy's question gives scope for a complete health discussion.

Dr. O'Hanlon

I am anxious to give this information to the Taoiseach because it was he who said that health boards in the last four years received a gross increase of 24 per cent. He used that figure to justify the remark he made at Clondalkin. It is only right to point out that there has been a real decrease and that health boards are not making perverse decisions, as accused by the Taoiseach. In fact health boards have behaved in a responsible way in that they have maintained a level of services, not an adequate one, with a grossly reduced allocation from the Government. There has been pruning in some areas such as in the amount of stock carried, the use of transport and in energy costs. Two years ago health boards reached the stage where they could not prune any more without reducing the level of services.

We are entitled to get clarification of the Taoiseach's statement in Clondalkin. He should give us examples of the pretty perverse decisions he spoke of and indentify the health boards and the decisions. If he does not do that he should withdraw the remark. It is not sufficient for the Head of our Government to make such intemperate remarks and try to justify them in the House on the basis of a gross global figure that is not in accordance with what is happening in health boards. It is not good enough for him to say that he has no desire to prolong the controversy or to give any credibility to the cases by referring to specific examples and that Deputies on all sides should be aware of the type of cases he was referring to. As a members of a health board I am not aware of what the Taoiseach had in mind and I should like clarification of his statement.

The Taoiseach

I understand Deputy O'Hanlon's concern about this matter because his own health boards is one which has not offended in this respect and his experience would not correspond to the points I made. I readily accord that the North-Eastern Health Board has an excellent record and nothing I said relates in any way to that health board. Unfortunately, this is not true of everywhere else.

I have not in front of me the exact figures back to 1982. I have figures from 1983 to 1986 showing the total current expenditure on the health services as rising by about 17.5 per cent or 18 per cent and the consumers price index rising by exactly the same figure. Certainly since 1983 there has been no reduction in the real volume of expenditure on the health services. I believe the same is true since 1982 but I have not the exact CPI figure and I do not want to make any statement which I cannot stand over.

In respect of the last two years, quite contrary to what the Deputy has said, there have not been real reductions in allocations to the health boards. Last year, 1985, the increase in the CPI was 5.25 per cent. No health board got an increase of less than 5 per cent — within a fraction of 0.25 per cent, there were no reductions. The average was nearly 6 per cent and in some cases increases of up to 7.75 per cent were given. In 1985 overall the health boards got an increase in real terms of 0.5 per cent.

Dr. O'Hanlon

I was quoting from a reply to a question.

The Taoiseach

This is a detailed reply and I am giving straight facts. The actual figures are here. I will give the figures. In 1985 the figure was £781 million, while it was £737 million the previous year. That was an increase of 5.9 per cent, while the CPI increase was 5.3 per cent. In 1986, however, during which the CPI is estimated to rise by 3.5 per cent the increase to health boards is 6 per cent. I was erroneously informed when I said 8 per cent. That is the total increase in current health spending. The amount actually going to health boards is an increase of 6 per cent and I am glad of the opportunity to correct that. It represents an increase this year of 2.5 per cent in the volume of resources available currently to health boards and any suggestions that there has been a reduction during the past couple of years is incorrect. There has certainly been no reduction since 1983. There was a small increase last year and there is a significant increase in resources this year, the figures being £826.64 million in 1986 as against £781 million last year. That is a 5.9 per cent increase in a year when the CPI is estimated to have risen by 3.5 per cent. Do not let us pretend things are other than they are. This year has seen a significant increase in the volume of resources to health boards and there was a small increase last year. Attempts to suggest otherwise are simply not correct.

Dr. O'Hanlon

I am using the Government's figures given in an answer to a Parliamentary Question.

The Taoiseach

I am giving the figures as they relate to these two years for health boards. The earlier figure related to total health expenditure. Since 1983 every health board except the North-Eastern Health Board have submitted estimates for the years ahead which are well in excess of the allocation accorded to them. They have then proceeded to classify the differences as shortfalls or cuts because they look for more than the amount provided and call that a cut, even though they have had real increases in the past couple of years, and over the period as a whole there has been no reduction. The Southern Health Board, for example, projected cuts of £9 million a year in 1984 and 1985. The reality was a figure of £2 million which was accommodated by the usual overdraft accommodation and overrun of balances. The £9 million figure proved to be fictitious and was known to be fictitious at the time it was produced. The Deputy is pressing the issue. I do not want to get involved in naming particular health boards but——

Dr. O'Hanlon

I want to know——

The Taoiseach

The Deputy has made his contribution and I am making my reply.

An Ceann Comhairle

The Taoiseach listened to the case being made by the other side and Deputies should give him the respect of listening to him now.

The Taoiseach

I would prefer not to get involved with any particular health board in matters of this kind but the Deputy has pressed the issue and suggested in some way that my credibility is at stake. I prefer in those circumstances not to make reference to particular boards but as the Deputy has challenged me and brought me here for an Adjournment debate I feel I ought to reply to the points he has raised.

The Western and South-Eastern Health Boards have indulged in the following type of hype. They have threatened to disemploy staff, to close wards, withdraw medical cards and close nurse training schools because of the alleged cuts, which were not cuts at all but excessive demands by them over and above the allocations to them, which in fact in the last two years involved real increases. At the end of the year, of course, none of these things has happened. This type of excercise has been very political indeed. The Deputy is well aware of the members of his party who have engaged in it in collaboration with people who are not directly involved in politics but who have an interest in getting more money for their sector, as have so many sectoral interests. The combination of those kinds of approaches has led to this type of hype.

I think I am justified in making a critical reference to this kind of behaviour. I do not think it is proper behaviour for a public authority, even with a number of politicians on it, to disturb staff by threatening to disemploy them, to worry patients or potential patients by threatening to close wards, to disturb greatly less well off people from whom they are threatening to withdraw medical cards and to upset the nursing profession by threatening to close nurse training schools when there is no need to do so and when no such events would happen within the amounts actually provided. Therefore, I regard the way in which some health baords have acted under political inspiration as undesirable and I think I am entitled to say so.

I did not wish to mention particular health boards but the Deputy asked the question and brought me here on the Adjournment and I have given him a straight answer. I hope the Deputy is satisfied. The facts as stated fully justify the comment I made. I think we are too mealymouthed in this country. We spend our time pussyfooting around, never telling the truth about different kinds of behaviour or abuses. Everybody knows there is massive absenteeism running to three or four weeks per person which is far beyond the average amount of actual sickness per worker. Yet if one makes a reference to it it immediately becomes a major political issue. I do not operate like that. I believe that in politics you should come out and tell the truth bluntly. If any public body is behaving in a way which is not proper to its function, then it is right that I, as head of the Government, should make appropriate comments. It is the failure of politicians to confront these issues and the sweeping of things under the carpet that have this country in the mess it is in.

We are talking of health boards, of which there are eight. Does the Deputy know the total cost of travelling and subsistence expenses for the eight health boards? Would he like to hazard a guess at the figure?

Dr. O'Hanlon

About £11 million.

The Taoiseach

Does the Deputy think that is an appropriate figure, that this is the way the money should be spent? Does the Deputy feel that amount is fully required and that wards could be kept open if there were more prudent use of these kinds of resources by some of the the health boards concerned? Can the Deputy defend that volume of money on people dashing back and forward to meetings when much of that money could be used to keep wards open?

Dr. O'Hanlon

Does that include public health nurses and community care? On a point of order——

An Ceann Comhairle

It is not a point of order.

The Taoiseach

I am arguing that total travelling expenses are a very large figure. Those are the kinds of things we want looked at. There has been an enormous increase in the total spending on health and employment in health services over the last ten to 20 years. It has been grossly excessive. We are spending 40 per cent more of our national output on health than neighbouring Britain with its national health service which is supposed to be extraordinarily good. Although we are a much poorer country than Britain, we are actually spending per capita almost 90 per cent of what Britain is spending, although our income per head is far lower. Over-expenditure on health is the most striking aberration in the public expenditure of this country.

There is no area in which spending here is so out of line with other countries. In education there is also a high level of spending but in that case we have 25 per cent more people in the educational bracket. We do not have 25 per cent more people sick. This is an area, therefore, in which prudence is required. We are very fortunate in having a Minister for Health who is willings to take on and tackle these problems and who has provided the resources. This year there is an increase of 2.5 per cent in the volume of resources. He has tried to ensure that health boards act prudently but he is up against political attempts at the expense of staff, patients, potential patients and nurses to hype matters in such a way as to disturb and worry people for political reasons. I do not believe that is the right way to do things.

The whole question of the operation of health boards needs further consideration in the light of that. I do not regard it as good democracy to frighten people with false scares for political reasons. That is the worst kind of democracy. It is the kind of democracy of which we have had too much and it is time a stop was put to it. It is time to speak the truth and come clean on these things.

Mr. N. Treacy

It is time people were told about the cutbacks.

The Taoiseach

I have given the facts and they are perfectly clear. Although I would have preferred not to have been dragged into the matter of naming particular health boards, given the attempt by the Deputy opposite to suggest that the remarks I made were inappropriate and unjustified I am glad of the opportunity to vindicate myself in that respect.

The Dáil adjourned at 10.30 p.m. until 10.30 a.m. on Thursday, 23 October 1986.