asked the Minister for Health the breakdown of the expenditure of the £6 million approx. withheld from the North-Western Health Board for payment to voluntary hospitals.
Ceisteanna — Questions. Oral Answers. - Voluntary Hospitals Payment.
8.
Voluntary and joint board hospitals provide services on behalf of health boards. These hospitals operate on the basis of approved budgets which are funded and controlled directly by my Department.
The £6 million referred to by the Deputy has not been withheld from the North-Western Health Board. It is an estimate of the proportion of approved expenditure incurred by voluntary hospitals in providing hospital services for patients from the North-Western Health Board area and is based on the estimated bed-days used by those patients.
Is the Minister aware that 350,000 patients were treated in voluntary hospitals in 1985 and in hospitals run by the North-Western Health Board and that only 228 people were referred to the voluntary hospitals by the consultants from that board? Therefore, is it fair that the board should be made to pay for the patients referred to voluntary hospitals privately by consultants or GPs? Many of these patients could have been treated in the board's own hospitals. Will the Minister introduce a system whereby the responsibility will rest with the board for patients referred to voluntary hospitals on the authorisation of consultants through the health boards?
We cannot have a debate.
A total of 4.3 per cent bed-days in St. Laurence's Hospital are attributed to the North Western Health Board; 16.8 per cent of beds in St. Luke's are attributable to the North-Western Health Board and 4.5 per cent of bed-days in the Children's Hospital are also attributable to the board. The allocation for acute hospital services which are not normally available in the area covered by the North-Western Health Board is made on a careful basis. I can make available to the Deputy the data in relation to all of the health boards and voluntary hospitals in the Dublin area.
Surely the Minister will accept the information from the board which I have produced here?
I did not want to interrupt Deputy Conaghan because he is a very orderly Deputy, but he was obviously reading out a short speech on the subject and he is going to repeat it now. I will make no progress on Question Time if I do not stamp out this practice.
With due respect, we have got to try to extract information from the Minister.
The Deputy was given information.
Is the Minister further aware that the consequences of the current Border referral system of admissions and payments is denying many patients the right to treatment? The Minister must bring in a system which will reverse this position. In effect, the North-Western Health Board paid £5.5 million over and above what they should have paid for referrals in 1985. They made 228 referrals in that year but paid for 3,207 who were referred by consultants and GPs.
That amounts to debate.
We are asked to accept cutbacks and a run down of services within the region.
I cannot allow the Deputy to continue. I must ask Deputy Conaghan to conform to the rules.
I will give an example very briefly. St. Luke's Hospital were allocated a budget of £767,000 in respect of patients from the north west. This was because nearly 17 per cent of bed-days from the north west are accommodated in St. Luke's. The allocation is made on that basis. It is the only possible way we can allocate the money.
The Minister stated that £6 million was not withheld. Was this money paid to the health board who then paid it out to the voluntary hospitals? If the North-Western Health Board—
This money is paid to those hospitals on an apportioned basis.
In other words, it was withheld by the Department and paid by the Department to the hospitals.
In transfer.
What input had the North-Western Health Board into making up how much should be paid to the voluntary hospitals?
The health board are consulted. From many health board areas patients are referred up frequently for procedures which could be done at a local level. Where they are referred up the hospitals in the greater Dublin area with particular specialities demand to be paid. We cannot have them on the never never waiting to be paid by the health board some time in the future. If, for the sake of argument, a consultant in Monaghan refers a patient to Jervis Street Hospital in Dublin we must pay that hospital.
This question concerns the North-Western Health Board.
The Minister has put his finger on the nub of the question. Does he not agree that this is an unfair bookkeeping exercise?
This question concerns the North-Western Health Board.
Yes, of course it does. It concerns every single health board area.
I am not going to open up a discussion on this.
The question I would like to ask is whether this is an unfair book-keeping exercise on the part of the Department.
Will the Minister please answer Question No. 9.
A Cheann Comhairle——
I have passed on to Question No. 9, Deputy.
May I raise this matter on the Adjournment?
I will communicate with the Deputy.