Deputy Conaghan has been given permission to raise a matter on the Adjournment. He has eight minutes and the Minister has four minutes.
Adjournment Debate. - North-Western Health Board.
A Cheann Comhairle, I thank you for allowing me time to raise this issue. At the outset, I want to put on record that I am not against the involvement of voluntary hospitals in the health services. The question at issue is what seems to be an unfair bookkeeping exercise operated by the Department of Health which has an effect on the funding of health boards.
We are all aware of the severe cutbacks in the funding to the health boards by the Department over the past number of years. As a member of the North-Western Health Board, I wish to have the matter clarified in relation to the method adopted by the Department on payment to voluntary hospitals for services carried out by them on behalf of the board. This issue was discussed at a recent health board meeting and it would appear from information given that the amount being debited against the North-Western Health Board is far in excess of the number of referrals by that board to voluntary hospitals here in Dublin.
In 1985 some 3,500 patients were treated in voluntary hospitals from the north-western region, but only 228 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 3,272 patients who had been referred to voluntary hospitals by consultants or their own GPs with no direct contact with the health board? In view of this, will the Minister not agree there needs to be a better system of accountability and some plan adopted to ensure that, when patients are being referred outside the region for treatment, they would have to be authorised and cleared through the board's hospital system. If one were to take the number of patients, 228, authorised by the board for treatment in Dublin hospitals, then we should only be debited with £0.5 million
Another issue that has created a problem in relation to the current system is that many admissions are unable to be made due to the fact that people are being referred outside the board authority. Therefore, many patients in need of treatment are put on a long waiting list and are unable to get the treatment which they need, despite the fact that many patients are being referred by doctors to Dublin for consultancy and for services which could be provided within the hospital service in the north-western region.
Tonight I wish to get a commitment from the Minister that he will see to it that the boards will have greater control, that there will be better lines of communication developed between the voluntary hospitals and the health boards in relation to referrals and that a proper bookkeeping exercise will be introduced whereby each health board can identify what they are being asked to pay for.
I believe the health boards should have an input into making up how much should be paid to the voluntary hospitals for any services given by these hospitals to the health boards. What would anyone think of any private commercial company who operated a bookkeeping exercise such as this? Rightly or wrongly, I am inclined to believe the Minister and his Department are using this system in order to hold back extra finances over and above what would normally be owing by the North-Western Health Board or any other health board to the voluntary hospitals. I cannot accept the Minister's statement today that £6 million was not withheld from the North-Western Health Board. I would ask him to clarify that point.
I thank the Deputy for the opportunity to put the matter once more in its proper perspective. It is now the best part of 60 years since this particular approach was adopted. The Book of Estimates this year has identified quite clearly on page 211, subhead G.4, grants on behalf of health boards to certain other health bodies — £296 million. There are further details on page 215 relating to hospitals and homes other than hospitals and homes administered by health boards. In that case the amount provided is £238 million. In the case of homes for the mentally handicapped administered by voluntary bodies the figure is £57 million. These are very substantial sums of money. These voluntary hospitals and homes are dealt with directly by the Department of Health.
If a patient comes, as patients do come, from the North-Western Health Board area to, say, St. Luke's Hospital in Dublin for cancer treatment, the budget of the hospital has an attribution of £767,000 for treating patients from that health board area. In the same way if patients come from Donegal, Sligo or Leitrim to the Mater Hospital, having been sent there by consultants, there is an attribution of 2 per cent of bed-days for patients from the North-Western Health Board. In the case of the Mater, £0.5 million of their budget is compiled from that area.
There is an alternative. I am not suggesting that in the short space of time available I could flesh out that alternative. There is the penalty of choice whereby the health board are given the money and they pay the voluntary hospital in Dublin for patients sent from their area. The question arises: would the health board pay? I very much doubt it. They would say it is the problem of the voluntary hospital. They would ask why they should have to pay for people who are referred outside their area. That is the alternative — a penalty of choice. The Coalition Government in 1974 and succeeding Governments decided that the Department would accrue those moneys and allocate them into the system in a fair and totally equitable way. For very sound administrative and economic reasons there are no financial transactions between the health boards and those providing services in the voluntary hospitals.
I can appreciate that in the North-Western Health Board area there may be a view that only those who are sent up by the health board should actually be paid for. Would the people of Donegal, Sligo and Leitrim want to devolve that absolute penalty of decision on a health board and take it away from consultant staff who would send people to other areas? Some people are referred to Portiuncula in Ballinasloe from Leitrim and £33,000 of the Portiuncula Hospital's budget comes from the area. We attribute the money to it on that basis.
I assure the Deputy that £6.1 million is given to those hospitals by the Department of Health on behalf of patients from the North-Western Health Board area. It is distributed among the hospitals and it applies to all the health board areas. There is no question of a cut. That does not arise. There is no question of taking this money away from the health boards.
Occasionally a patient from the Inishowen Peninsula goes to Altnagelvin and the health board pay directly. If the health board wished, we could deduct the money from the allocation for 1987 and pay the money to the Northern Ireland authorities on that basis. I am sure all hell would break loose if I were to advance that as a solution to the problem.
It would cost more.
There is still a very good arrangement which I and my counterpart in Northern Ireland recently reviewed and endorsed. The arrangement is thoroughly understood by health board managements. The excellent management in the North-Western Health Board area may say they want this money and that they will decide who will go to Dublin or who will not. All the consultant staff would have to agree. People would have to be denied referral. Perhaps this overall problem could diminish if many of the procedures which are referred to Dublin could be done locally. Frequently, for a variety of reasons, consultants refer people to Dublin. If more of these procedures were carried out locally there would be a heavier budget burden on the health boards. It cuts both ways.
I continue to be slightly mystified by the question because what happens is common knowledge to the health boards. If people want to change it drastically and dramatically, I am open to any proposals in that regard, but there are penalties involved on either side. I have enough around my neck at the moment without taking on this.
The Dáil adjourned at 9 p.m. until 10.30 a.m. on Thursday, 13 November 1986.