asked the Minister for Health the additional financial resources, if any, which have been made available to the health boards to enable them to provide adequate community care services in such areas as psychiatric services, facilities for the disabled, health promotion and district health nursing; and if he will make a statement on the matter.
Ceisteanna—Questions. Oral Answers. - Community Care Services.
5.
In determining their overall budgetary strategy for 1988, health boards were asked to make adequate resources available to ensure the protection of key community services such as services for the old and housebound, services for the handicapped and child care services. I am satisfied that the overall level of funding available in 1988 is sufficient to enable them to do so.
In regard to health promotion, the Deputy will be aware that I recently established a health promotion unit within my Department. I have asked the boards to make special provision in 1988 for the development of specific projects in the area of health education and to liaise closely with the health promotion unit in this respect.
Will the Minister respond to the specific question whether he had made additional financial resources available for community care? I am sure the Minister is aware that the overall allocation has been reduced. Does he intend to make or has he made additional resources available because it is clear from the Eastern Health Board— and perhaps others — that community care services are on the point of breakdown as a result of lack of resources?
In the letter of allocation which accompanied the moneys made available to health boards, I stated very clearly that the thrust of current health policy should shift emphasis to the promotion of health and primary care. In this regard, I asked health boards to ensure that adequate resources would be allocated from within their budget to further these objectives. I particularly considered that resources should be specifically allocated to health education projects. Details of such projects should be identified to the promotion unit of the Department of Health in determining their overall budgetary strategy for 1988 and health boards should ensure that key services for the old and housebound are protected. These services include community nurses, home help and meals on wheels, services for the handicapped, child care, particularly day care and preschool services for deprived and disadvantaged communities and aftercare services for children leaving long term residential care, to make sure that these are maintained at 1986 approved levels in real terms.
While it may appear correct to the Minister that he asked the health boards to maintain certain services, surely he must realise that he has an obligation and responsibility in this matter? In the Southern Health Board area, with which I am familiar, is the Minister not aware that restrictions in capital allocations are now so severe that psychiatric nurses on the public health side are curtailing their activities in terms of visits to homes? Any statement the Minister makes in relation to ensuring there is adequate community care in relation to the psychiatric services is quite unacceptable as the health boards, because of the rigorous financial curtailment, are not in a position to allow the work to be done on a community care basis. Will the Minister accept that there is a necessity for further cash allocations, to the Southern Health Board in particular?
In relation to nurses curtailing their travelling, I must also point out that in the letter of allocation I said that to assist in the maintenance of services, health boards should ensure that the travelling expenses of care staff in the community, i.e. public health nurses, etc., should be restored to the 1986 levels. We want to ensure that there will be no shortfall in the level of activity among the staff working in the community. The psychiatric services are going through a period of change in which there is development in the community sector and many health boards have made arrangements to develop sectors for the delivery of psychiatric services in the community.
Surely the Minister must agree that the terms of that circular are really only pious platitudes? The community care services are on the point of collapse. The Minister referred to home help but is he aware that in the Southern Health Board area home helps, who are supposed to be one of the keystones of the community care programme, are paid 75p per hour and have been paid that amount for the last five years? The Minister must accept that this area is neglected by the health boards and that he has no real control over how they spend their moneys which are going on acute services rather than on community care. Surely the Minister must make additional moneys available for the development of the community care programme?
I accept that the home help service is provided and has always been provided more as good neighbourliness than as a service which is rewarded with remuneration comparable to other services. As the Deputy rightly points out, the situation has been the same for five years. There has been no reduction in the level of funding.
Arising out of the Minister's response, I would like to put to him that a prominent public health nurse operating in the south-east region indicated this week that with the mileage cut and the increase in area, and more especially with the threatened closure of the district hospitals, it was no longer possible to maintain a viable public health nurse system. What steps has the Minister in mind to provide an adequate public health nurse system in the south-east region and, indeed, throughout the country?
As I have already said, the travel allowance for public health nurses has been restored to the 1986 level — I have asked the health boards to restore it to the 1986 level. I am unaware of any district hospitals closing in the current year in the South Eastern Health Board area.
Four in the south east.
Arising out of the Minister's reply where he indicated that he requested that the childcare services should, by and large, be maintained at least at the 1986 level, is he not aware that in the Eastern Health Board area, for example, the school medical examinations have had to be done away with? This is a very shortsighted step in view of the fact that they were able to identify early, illnesses which might lead to greater disablement among children and also more costly medical expenditure furthere down the line. Is the Minister happy with this situation, and does he take any responsibility for it? Has he any proposals in relation to this and the other areas which so many of the Deputies have been able to point out which indicate that community care is not being protected or maintained at the standard at which it was?
Could I ask the Minister——
Let us hear the Minister's reply to Deputy Mary Flaherty's question.
The question of the schools medical service in the Eastern Health Board area is a separate question.
The childcare services and the community care services——
The childcare services are being provided for and are being provided for adequately. In relation to the whole area of child abuse, I am glad to say that in spite of the financial difficulties of the country we have provided a specialist service in both Temple Street and Our Lady's Hospital in Crumlin for the investigation of child abuse, with 16 new head of staff.
A final supplementary on this question from Deputy Proinsias De Rossa.
The Minister is trying to pull the wool over our eyes here yet again. Does he not accept that as it has been the policy of various Administrations since the early seventies that community care would be given priority as against institutional care, he has a responsibility to provide the resources required to provide that service in the community? Virtually all the community services, ranging from the district health nurses, the psycho-geriatric services, the home-help care services — all of these services — are at crisis point because of lack of resources and lack of staff. Will he not now give an undertaking to provide the resources needed to ensure that these services are developed?
Far from pulling the wool over the Deputy's eyes, I am glad to say that the percentage of the moneys allocated to the health boards for community care is increasing and will increase again this year.