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Dáil Éireann debate -
Tuesday, 9 Jun 1987

Vol. 373 No. 4

Ceisteanna—Questions. Oral Answers. - Health Budget.


asked the Minister for Health (a) the percentage of the total health budget which is spent on non-medical areas; (b) the percentage of reductions in expenditure in the present financial year on non-medical areas; and (c) the percentage reduction in expenditure in this financial year in medical areas.

As I explained in reply to a question by Deputy Michael Keating on 21 May 1987, the financial systems in place do not allow for the apportionment of full costs over specific categories of staff. Moreover, any attempt at delineation of medical as opposed to non-medical areas must be open to question.

However, if the Deputy is concerned that there may be an imbalance in the application of allocations by the health agencies in 1987, I should like to state that these agencies have been directed to make every effort to spread any reductions in staff over all grades and to retain front line staff where possible. From the reports I have had of the measures being taken to effect necessary economies, I have found no evidence that my direction is not being followed.

If it is not possible to decide which parts of the health services are administrative and which provide medical services, how can the Minister say that only 10 per cent of the health service expenditure goes on administration? He said the health cuts were supposed to have been spread throughout the service — I am looking at the speech he made on the Private Members' Motion introduced by the Progressive Democrats two weeks ago — and he named three methods of reducing numbers in the health services. I submit that those three areas affected are, almost exclusively, front line health servicing personnel and not administration. I am quoting from this speech——

The Deputy must surely be aware that quotations at Question Time are not in order.

I will not quote.

You may not proceed along those lines.

Could the Minister confirm that the non-filling of some vacancies, the reduction in the number of current temporary employees and the reduced scale of locum cover almost exclusively affect personnel providing medical cover?

The definition of medical and non-medical areas in the health services is open to a very wide interpretation. For example, on the pay side, the strict interpretation might refer to the cost of doctors only, while a liberal interpretation might include porters and domestics employed in hospitals, mentally handicapped homes, et cetera. On the non-pay side, certain foods could be medically prescribed for a patient. Two per cent of the total staff employed by the health agencies are involved in administration at the various regional headquarters. A further 8 per cent of the total staff are in administrative categories engaged in the direct delivery of service to patients either in the institutions or in community care.

As regards reductions in the number of persons working in the health services, 9.2 per cent of the total number of reductions are in the clerical and administrative area which is broadly representative of the number working in the area of the service.

Can the Minister tell us what percentage of the total health budget is spent on drugs? Would he not agree that he has failed to reduce expenditure in the general medical area? This is an area which could most easily and painlessly have produced substantial savings.

I do not accept that we have failed miserably this year. Negotiations are taking place with the federation of Irish chemical industries about the cost of drugs. On the question of generic prescribing, this is a much broader area and is not covered in the question.

As regards the reduction of expenditure in the non-medical area, why is the Minister prepared to stand over the decision, particularly in the Eastern Health Board area, to reduce the supply of medical appliances, for example, to mentally and physically handicapped children who had their quota of incontinent pads reduced from 120 or 160 to 60 per month? That kind of reduction in the welfare side of the community health service is totally unacceptable. Will the Minister agree that there is an urgent need to review the guidelines?

As there is a question on the Order Paper relating specifically to the matter raised by the Deputy I feel that, in fairness to the Deputy who tabled that question, I should not answer the supplementary now.

Is the Minister aware that in the case of more than 1,200 mentally and physically handicapped children who are in many instances totally incontinent, the parents have been told by the Eastern Health Board that their quota of incontinent pads which roughly amount to 160 per month is being reduced to 60 and that they can pay at least £40 per month out of the domiciliary care allowance for the balance? Will the Minister agree that whatever else is happening in the health services this cannot be allowed to continue?

The Deputy is getting into a lot of detail on a matter which is worthy of a special question. I should like to remind Members that many questions have been tabled today appertaining to Health. I would be grateful for the co-operation of Members to have as many as possible dealt with. Consequently, I appeal for brevity.

I do not think it is fair to the Deputy who tabled the question that I should answer Deputy Desmond now. However, I should like to tell him that the practice referred to by him of providing such equipment for children is not the practice in any of the other seven health board areas.