Deputy Joe Sherlock gave me notice of his intention to raise on the Adjournment the subject matter of the situation that has arisen in the Cork region as a result of the shortfall in funding to the health board with particular reference to the Mallow General Hospital. The matter is in order. The Deputy has some 20 minutes to present his case. The Minister has ten minutes to reply.
Adjournment Debate. - County Health Board Funding.
At the outset let me thank you for giving me the opportunity on this Adjournment Debate to raise the vital issues which are confronting the health board and particularly the people of north Cork at present. At the most recent meeting of the health board the chief executive officer painted a grim picture of the board's situation. Facing a deficit of £3 million, its overdraft sanction of £2.8 million was exhausted and so there was no way forward for the executive of the board but to cut general hospital services and this, in effect, means that people in need of acute general hospital services cannot be provided for. This particularly affects elderly people, children who are in need of ear, nose and throat treatment and it affects the orthopaedic service where there is such a long waiting list for implants.
I will now refer to the Mallow situation in the context of the budget allocated to the board. I am calling upon the Minister at this time to satisfy me on the conflict that exists between replies which I have received here and the replies given to me by the board executive. The Minister today advised me that the Southern Health Board are the responsible body to decide within their allocation the level of resources to fund Mallow hospital. In the year 1987 the Mallow General Hospital services were cut by 25 per cent. That meant a figure in excess of £235,000. Prior to that the executive of the board proposed to take out Mallow as an acute general hospital and that was rejected by a vote of the Southern Health Board by 25 votes to one. Yet when it came to allocating the budget for the area hospitals we found that in that year the budget for Mallow was reduced by 25 per cent and that was an unjust, inequitable decision by the executive of the board. The figures are there for the Minister to see. I would ask him to explain why such a massive deficit should be proposed for Mallow.
I come next to a question that I have failed to get satisfactory answers to for some time. On 27 October 1987 the Department of Health notified the chief executive officer of the Southern Health Board as follows:
I am directed by the Minister for Health to state that the 1988 level of net expenditure (i.e. gross expenditure less minor income from patients etc.) approved for your Board under Section 31 of the Health Act 1970 is £125.880 million.
Following on that, during the year there were various amounts added to it for pay increases and so forth. That is what the statement said. In my interpretation and in the interpretation of others that is a revenue expenditure for the Southern Health Board. At the end of the same document it says that the allocation notified in paragraph 1 included a specific amount of £0.75 million to allow for the commencement of a phasing back into the system of beds in the Cork Regional Hospital. Conflict No. 1 arose when I looked at the figures supplied to me by the board in 1989 and found that the finance officer of the Southern Health Board gave out a document dated 9 January 1989 and in that document he said:
For comparison purposes, the total allocation for 1989 is £131,820,000.
That is before the additional £800,000 came in and that was 9 January 1989. He said that compared with the revised allocation of £131,400,000 for 1988 or a net increase of £420,000. The same document shows that there were revisions there; there was the refund of drugs, writing off of loans and pay awards etc. When they came in it totalled £3,280,000; but the figure from which the finance officer subtracted the required figure was £130,600,000. At the next meeting, I asked the chief executive officer of the board to explain that anomaly. Unfortunately he could not explain it but after some hugger muggering with the finance officer, the finance officer said that there was no problem, that it was for the CT scanner for the regional hospital. I asked him if £800,000 was the correct figure and he said yes, that he could have told me that earlier on. I put a question to the Minister for Health on 14 February 1989. The Minister for Health, Deputy O'Hanlon, advised me that the total cost of providing the CT scanner for the Cork Regional Hospital in 1988 was £647,500 and that the cost was met out of funds specially allocated. At the same time I asked the question as to whether there was a capital allocation for the board and was advised by the chief executive officer of the board that there had been no capital allocation for eight years for works. I got a reply from the Minister on 14 February 1989 when he said that an additional capital payment to the board for 1988 amounted to £1,195,000.
While I am dealing with the subject of conflicts which have bothered me very much, let me refer to another figure. This again is a reply which I got from the Minister on 2 November 1988. I asked the Minister if his attention had been drawn to the proposals from the management of the Southern Health Board to locate maternity services for the Cork region on a site at the Erinville Eye, Ear and Throat Hospital which involved capital investment and the reply was:
There is agreement in principle that maternity services in Cork should be located on a single campus. The possibility of concentrating facilities on the St. Finbarr's site was examined by a committee representative of the Department and the Southern Health Board. However, the capital cost of that option was considerably greater than developing a maternity service on the Erinville/Eye, Ear and Throat Hospital site. The Eye, Ear and Throat Hospital will be made available to the Southern Health Board following the transfer of ophthalmic services to the Cork Regional Hospital which is taking place at present.
The basis of the reply was that the capital cost of retaining St. Finbarr's was greater than what was originally proposed. That reply from the Minister was dated 2 November 1988.
On 29 November 1988 the Southern Health Board passed a motion on the maternity services in Cork city to the effect that a general hospitals committee recommended that a comparative feasibility study be carried out at St. Finbarr's by an alternative design team regarding a central maternity unit for Cork city bearing in mind that the present buildings of Erinville/Eye, Ear and Throat Hospital could be sold. That was on 29 November and yet the reply given on 2 November was that the cost would be too high.
I asked the deputy chief executive officer of the board, Mr. Christy Walsh, why I received such a reply on 2 November when the alternative comparative feasibility study had not been carried out at that stage and he said the Minister had no figures before him, that he based his reply on builders' estimates of the cost per foot of the building. The decision to carry out the alternative feasibility study was made by the board on 29 November. I would advise the Minister that there is no record in the Southern Health Board of a motion having being passed giving power to the executive of the board to spend £20,000 on the first study. No decision had been taken by the board giving that power. I would like to know where that £20,000 came from. I would also like to know where the £20,000, or probably more, came from for the alternative feasibility study which has now been carried out.
The people of Mallow are continually crying out for efficiency in the health board area and for recognition for the valuable work being done in Mallow hospital. The hospital which exceeded its budget by £1 million in 1988 got special recognition from the Department this year. The letter of allocation states that in the determination of the allocation now notified the Minister has recognised the key role that Cork Regional Hospital must play in the provision of acute hospital services. Accordingly, the allocation referred to provides for the provision of the average 1988 level of services. If the average level of services was to be provided why was there a reduction of £750,000 in the budget for the regional hospital, the amount that had been added to it in 1988? Why does the Minister not recognise that there is in excess of £600,000 in charges outstanding in the regional hospital from 1987 and 1988? I would also point out to the Minister that there is a figure of £840,000 — the health board's figure — outstanding in health contributions. There are also youth employment and income levies but they have nothing to do with the revenue of the board. The executive of the board have blatantly refused to be efficient in the carrying out of their duties and they find no difficulty in practically closing Mallow hospital, the most efficient hospital in the health board area.
I would refer the Minister to a statement made by the consultant staff of Cork Regional Hospital on 1 March 1988. They claimed that an income in excess of £2 million could have been generated in 1987 from patients who were treated privately in Cork Regional Hospital. The deputy chief executive officer tried to refute that allegation but he made a very bad job of it. The consultants made that statement and they should either substantiate or withdraw it.
In 1987 the Southern Health Board rejected by 25 votes to one the closure of Mallow hospital. The people of north Cork have raised £150,000 for capital works in the hospital. Last year alone £56,000 was collected by these people. I would ask the Minister to recognise that Mallow General Hospital is an efficient hospital serving a population of 72,000 people. In excess of 3,280 operations were performed there last year, 15,000 people attended the casualty department and 8,000 attended the outpatient department.
In 1980 Mallow General Hospital which is now fighting for survival played a heroic, life-saving role after the Buttevant rail disaster. The Taoiseach, Deputy Charles Haughey, paid tribute to the professionalism, skill and care shown by the staff. In 1987-88 he accepted the recommendation of Comhairle na nOspidéal, who had carried out a thorough investigation, to upgrade Mallow General Hospital to a double consultant hospital. On that occasion when the Taoiseach visited Mallow with the present Minister for Finance, Deputy Reynolds, they were very loud in their praise of the role that Mallow General Hospital played in the aftermath of the Buttevant rail disaster.
The people of north Cork are entitled to general hospital services. The sociological argument is that the hospital is within easy access of many people who wish to visit relatives and friends. The people demand that Mallow hospital receives a fair budget and that the number of beds be increased to at least 80. Even though that may not be done immediately it is what we should aim for. There should be adequate provision for the accident and emergency department. The Minister should direct the executive of the Southern Health Board to recognise the democratic decisions of the board and also the authentic voice of the people of north Cork who need general hospital services in their area.
The reduction in the number of staff and beds in that hospital has been so great that the health board executive will decide that the hospital is not viable. I have been told by people of good standing in the community that they will back the hospital financially. If the community decide that, as a result of the motion passed, that the hospital be retained as a double consultant hospital and that negotiations be entered into between the Minister for Health, the Southern Health Board and the staff of the hospital about its future staffing and financial provisions, will the Minister give me that assurance when in turn, I can assure him he will get value for money?
I will deal with a few of the points raised by Deputy Sherlock.
In relation to the maternity services in Cork, I should say there is not any conflict between the reply given by me to a question in this House and the information furnished to the Deputy by the Southern Health Board. Officials of my Department and of the Southern Health Board examined the possibility of developing a combined maternity service involving the Erinville Maternity Hospital and the Eye, Ear and Throat Hospital in Cork which would cost £3.2 million. The Deputy said that the Southern Health Board members themselves, which was their right, decided that they should reexamine the provision of services at St. Finbarr's Hospital. There is not any conflict there.
In regard to the difference between the £647,000 for the CAT scanner and the £800,000, I should say that the total of £800,000 is accounted for by the fact that, along with the CAT scanner, other equipment was purchased for the regional hospital in Cork last year — general and cardiac ultra-sound equipment. That expenditure brought the figure up to the level of £800,000.
With regard to the general services within the Southern Health Board area I should say that the members of the health board do have a role to play. Deputy Sherlock referred many times to what the executive were imposing. The executive are obliged, under the provisions of section 31 of the Health Act, to live within their allocation, a sizeable one in the case of the Southern Health Board, the second largest in the State, whose allocation stands at almost £132 million for 1989. The members of the health board do have a responsibility and indeed the facility to make their views known and take decisions. Only when board members are not prepared to take decisions is the chief executive officer charged with the responsibility of taking decisions himself.
I have said many times in this House that the funding of Mallow Hospital is the responsibility of the Southern Health Board. My responsibility as far as financing is concerned, is to allocate the amount voted for the health services by this House to the eight health boards and the voluntary health agencies in as fair and equitable a manner as possible. As a member of the Southern Health Board the Deputy will know that it is a matter for each health board and agency to decide how their funding should be distributed in line with their statutory obligations and priorities.
As I have said, my Department allocated almost £132 million to the Southern Health Board to fund services in 1989. It is the responsibility of the Southern Health Board to decide how this substantial amount of money can best be used to provide health services for the people of Cork and Kerry. As the Deputy will be aware, I met the chairman and senior officials of the Southern Health Board on a number of occasions recently to discuss the board's financial position. I have asked the board to examine all the options open to them to ensure that as comprehensive a service as possible is provided for the people of Cork and Kerry within the allocation of £132 million. Indeed, I have offered my assistance and that of my Department to the board in what I recognise to be the difficult task of maintaining services within their budget.
As the Deputy will be aware, I also met a number of delegations from the Mallow area. At no stage did I suggest that acute hospital services should be discontinued or that Mallow Hospital be closed.
With regard to allocations to Mallow Hospital I should say that the relevant figure for 1988 was £2.237 million and for 1989 the corresponding figure is £2.160 million. That figure has been determined by the executive of the Southern Health Board and represents a reduction of £77,000 between the years 1988 and 1989.
While I have informed the Deputy that at no stage did I ever suggest that Mallow Hospital should discontinue acute hospital services, equally, I am sure the Deputy would agree with me that the role of Mallow Hospital in the overall provision of hospital services in the Cork area needs to be determined and defined. Primarily that is a matter for the Southern Health Board and its members and should be done in conjunction with an examination of the services provided by the other hospitals in Cork. The Southern Health Board will have the assistance of officials of my Department if there are any points they want to raise with them. But primarily it is a matter for the health board themselves which I am sure Deputy Sherlock, as a member of the Southern Health Board, will know. Indeed I am sure he will have a valuable contribution to make in that respect.