At the outset, I should like to ask if the House would be agreeable to my giving my colleague, Deputy Begley, five minutes of my time.
Adjournment Debate. - Southern Health Board Financing.
Acting Chairman
Yes, you are entitled to share your time. I take it that this is acceptable? Agreed.
I thank the Chair for allowing me raise this very important local issue on the Adjournment here tonight. This debate is taking place in the shadow of a crisis unprecedented in the public service. I wish to inform the House that every member of the staff of Tralee General Hospital will receive a letter in the post tomorrow evening informing him or her that they may have no wage packet at the end of the week — in other words that their wages may be deferred. In business terms this means that the Southern Health Board are virtually in receivership. The Minister for Health is the man responsible for inflicting this humiliation on what is considered one of the finest hospitals in the country. That position is unprecedented since the foundation of the State.
The Minister may not have heard what I have been saying but I am calling for a clear-cut statement on what action he proposes to take on the issue. Whatever the Minister does tonight, it will unfortunately be of little value to the temporary staff who have been let go today from Tralee General Hospital. I understand that this is only phase 1 of the temporary staff lay-offs and that it is intended to lay off all the temporary staff over the next few weeks.
There is widespread concern in County Kerry over the crisis in Tralee General Hospital and in the public health services throughout the county. Indeed some of the Minister's colleagues in the county have expressed their total opposition and indignation at what is happening to our health service. The chairman of the Southern Health Board, Mr. Jackie Healy-Rae, a great stalwart of Fianna Fáil, has laid the blame fairly and squarely on the Minister's shoulders. He has accused the Minister of the disastrous handling of the health services.
The Southern Health Board, agents of the Minister — have clearly failed to provide a proper health service for County Kerry and the Minister by his non-interference has clearly washed his hands of the problem. The Minister has ignored the noises and protests of the Southern Health Board, Kerry County Council and indeed most of the Oireachtas Members from County Kerry. However the Minister has ensured that Cork Regional Hospital will not and cannot be touched or affected by any cutbacks. However, he may not realise that Cork has 50 per cent more acute beds than Kerry per head of population. That is most unfair.
The budget for Tralee General Hospital has been reduced by £535,000 for 1989. This is to be achieved by reductions in acute medical and surgical services and by the closure of hospital wards. In 1987, 60 acute beds were closed in Tralee General Hospital and the present number is barely adequate to meet the neeeds of the population in Kerry which is in the region of 120,000. I would further like to remind the Minister that there is a large influx of tourists during the summer and this must be borne in mind. On a number of occasions extra beds had to be brought into use to cope with emergency admissions. For example, during one weekend in March this year 50 patients were admitted as emergencies and 25 emergency operations were performed. Previous attempts at reducing bed numbers were unsuccessful and the wards had to be reopened. As further closures are proposed the number of patients attending the hospital is increasing every year. Last year there were 41,000 attendances at the outpatients and 20,000 visits to the accident and emergency department. The waiting lists for outpatient services and surgery continues to increase. The hospital functions at present by early discharge of patients. The average length of stay is 5.27 days, one of the shortest, if not the shortest, in the country. Indeed early discharge is necessary because of reduced bed numbers and can cause, as the Minister knows well, major problems for the patients and their relatives because in many cases, patients have to travel very great distances, in some case over 90 miles. The follow up community services after discharge are very much understaffed and underfunded.
As an initial step to reduce costs by £0.5 million, it was suggested that one medical and one surgical ward would be converted to five day wards, operating from Monday to Friday inclusive. This would result in an estimated cost reduction of £250,000 per annum. The alternative would have been the permanent closure of another ward which, as I pointed out earlier, would have been totally unacceptable. The proposal to reduce 60 beds from seven day to five day beds is also totally unacceptable and is not workable as was the case over the past six weekends when the hospital authorities could only close one ward or 30 beds on three weekends because of the pressure of patient numbers. The hospital could not close the required number of beds on any weekend.
I would like to remind the Minister that this hospital has provision for a bed complement of 425 acute patients but the maximum number of beds open at any time was 289. Surely there should be some review as to who is responsible for the planning of this hospital which has been only partly opened and is likely to stay that way. We also learned today that, because of the lay-off of two temporary physiotherapists, the outpatient physiotherapy service will be terminated. Over 10,000 treatments were administered by this department to outpatients in 1988. This is totally unacceptable. I do not have to point out to the Minister that physiotherapy is important for patients who have left hospital and need treatment especially for orthopaedic or cardiac complaints. This will be a major loss to the people of Kerry. It is unacceptable.
It is proposed to amalgamate the telephonist and ambulance control service so that one person could operate both. This will lead to major problems. It would not be sufficient to have one person handling the controls in an emergency when there would be a number of incoming calls. I think this is a very serious situation. I would like to point out that there is a cost involved in moving the telephonist service to the ambulance control and that is estimated to be in the region of £25,000. I see no reason that this should be done.
I would like to point out — as I and other Kerry Deputies have pointed out previously — that the waiting list for the orthopaedic department is totally unacceptable. For example, there are over 200 people waiting for hip replacements and they will have to wait two to three years for this operation. In addition, 25 patients are waiting for knee replacements and it is estimated that that waiting list could take five years to clear. There is no provision for ENT services in the hospital. All ENT operations have to take place in Cork, for which there is a three year waiting period. I would like to remind the Minister that a local doctor was quoted recently in the newspaper as saying that there was no point in sending people to Cork or referring them to Cork because they would not be treated anyway. For a simple tonsillitis operation young people have to go to Cork. It is ridiculous that even a simple operation like the removal of tonsils cannot be carried out in Tralee hospital. There is obviously no plan in the Southern Health Board for the administration of the health services there, and certainly there seems to be no national plan. It seems to be just a random series of cuts which have to be enforced by the health board without considering their effects on the unfortunate patients. There is great fear that the inevitable result of the cutbacks and what is going on in Tralee hospital will lead to deaths. That is an indictment of the Minister and his Government and all those people in this House who would allow these cutbacks to continue.
I would like to ask what the Minister proposes to do about the crisis in the Southern Health Board. Is he prepared to allow them go into receivership? Is he prepared to provide extra funding for the Southern Health Board? I want to point out that last night over 600 people converged on the conference centre in the Brandon Hotel in Tralee for a public meeting on health. They made their feelings known in no uncertain manner. These people are becoming increasingly concerned and my fear is they will not confine their protests to the conference centre in Tralee but that in a few weeks they will be on the streets; and they will be before this House unless something is done now.
I want clear answers tonight from the Minister, if he can or is prepared to give them, to the many serious problems I have outlined. There is no point passing the buck to the Southern Health Board. The Minister and his Government have the ultimate responsibility to provide a proper health service. Again, I appeal to the Minister to do something about the crisis in the Southern Health Board. If he does not, people will die, if some have not died already because of the cutbacks. People have to leave hospital before they have fully recovered. People are leaving hospital the day following serious operations. When I was at the hospital last weekend I saw a woman stagger to the lift and then to the front door. She should not have been allowed out of the hospital. All this is happening because of the cutbacks. Before I hand over to Deputy Begley I would appreciate some firm, straight answers from the Minister tonight on what he proposes to do to rectify what is happening.
I would like to have a few minutes if possible.
The Deputy has approximately five minutes.
I am sure the Minister will accommodate Deputy Foley by giving him two minutes and I will shorten my contribution. I thank Deputy Deenihan for giving me some of his time.
The Minister must be aware of what is going on in the hospital in Tralee. As Deputy Deenihan pointed out so ably, we have long queues waiting for operations, and almost instant discharge after operations and, as a result, readmissions of the patients almost immediately. A few weeks ago, on 7 March, I asked the Minister if he had satisfied himself that enough money was being allocated by the Southern Health Board to Tralee Hospital, County Kerry, in comparison to the moneys allocated to County Cork. The reply was that it is the responsibility of the Southern Health Board to decide from within their allocation the level of resources to fund services at Tralee hospital. In other words, the Minister answered the question and that was end of story. Lo and behold, the chairman of the Southern Health Board, Councillor Jackie Healy-Rae announced to the Kerry County Council meeting that the Minister directed the Southern Health Board to give priority to the Cork Regional Hospital. Why was the Minister so dishonest with the House? He said it was a matter for the Southern Health Board to allocate the funds and at the same time a letter was with the Southern Health Board telling them to give priority to the Cork Regional Hospital, in other words to downgrade the Kerry people. The Minister should be ashamed of himself. At least he should have the courtesy to tell the truth in this House — that he had directed extra money to Cork at the expense of Kerry. A parliamentary question should be answered in a positive way. I put it in my question for written reply but the Minister had not the guts to tell me more money was supposed to go to Cork, yet his party colleague, Councillor Jackie Healy-Rae, chairman of the Southern Health Board, declared emphatically at a council meeting that the Minister alone directed him and the officials of the board to spend more money in Cork. Of course, that suited the vast majority of the officials of the Southern Health Board because they are all from Cork and it suited the Cork people generally.
It is not good enough that children in Kerry should have to wait almost three years for a tonsils operation. A public meeting was held in Tralee last night and a local GP said, he will now have to prescribe stronger drugs to kill the pain suffered by all those people waiting for hip and other orthopaedic operations. How can the Minister stand over that? Has he any concern for the people of Kerry? Not to put a tooth in it, this has resulted in a straight fight between Cork and Kerry and the presence of the three Fianna Fáil Deputies here tonight — Deputy Foley, Deputy O'Donoghue and Deputy O'Leary — is indicative of their concern.
I will not repeat myself because Deputy Foley has asked to contribute, but I appeal to the Minister when he comes into the House again, at least to tell the truth and not to pass the buck to the Southern Health Board when he alone is responsible for the present fiasco in County Kerry.
I thank Deputy Begley for giving me some of his time.
There are seven acute hospitals in the Southern Health Board area, six in Cork and one in Kerry, the Tralee hospital. This hospital has been subjected to the most unfair treatment by the board, especially in view of the fact that when it was decided to close the Edenburn Hospital in 1988, 60 long stay patients were accommodated in the Tralee hospital and the Southern Health Board, according to the figures available, had not increased the budget of the Tralee hospital in proportion. The net expenditure for the Southern Health Board area for 1989 is £132.6 million, of which £8,384,900 is allocated to the Tralee hospital against £8,337,900 from 1988. Here, I believe, lies the problem, because as the other six acute hospitals in Cork have in excess of £46 million based on 1988 figures.
No serious effort has been made by the Southern Health Board management to draw up a national plan to resolve the serious financial position of the board which started in 1985 and continued into 1986 with massive overruns. The easy option is always taken and in this case it is the Tralee hospital which is being treated unfairly. Is it because we have a minority membership on the board?
The latest news today is that ten staff from the Tralee hospital are to go from Monday next including two from the physiotherapy unit and that means the collapse of this excellent service. The Tralee hospital has a very excellent staff, and they have been hard pressed to work under the strains of the past 12 months. Morale has reached an all time low and they have cried halt. I am satisfied that our position in Kerry will not improve under the ambit of the Southern Health Board and I appeal to the Minister to consider Kerry as an independent unit to control its own health services, even if it means amending legislation.
Because the Southern Health Board do not have a national plan, we have a crisis in the three hospitals and in the health services throughout Kerry. I would ask the Minister to have his officials examine the overall apportionment of the budget of £132.6 million allocated to the Southern Health Board with regard to Kerry.
Deputies will be aware that my responsibility as Minister for Health as far as financing is concerned is to allocate the amount voted for the health services by this House to the eight health boards as fairly and equitable as possible. Having received its allocation each health board must decide on the distribution of its funding in accordance with its statutory obligations. It is a matter for each health board to establish its priorities and to allocate resources in line with these priorities.
The Southern Health Board's allocation for 1989 is £132.65 million. This represents an increase of £1.25 million on the figure for 1988. The board's management determined that this allocation was about £3 million less than what would be required based on 1988 expenditure levels. This is not to say that commensurate service cuts would be required.
The chief executive officer, in formulating his budgetary strategy, took the view that the scope for considerable savings in the special hospitals and community care programmes was limited. As regards the latter, health policy over the last few years has been to protect community services in as far as possible. Nevertheless, the CEO proposed a modest reduction of £110,000 to minimise the effect on services in this key area.
The board's psychiatric services have undergone major rationalisation over the past year and this process is continuing. As one would expect, this reduces the scope for further savings in the current year, but a target of £700,000 was set by the CEO, mainly to be found from improved efficiency.
In the rationalisation of acute hospital services in recent years, the key role the regional hospitals must play has been recognised. The allocation takes account of the fact that the major high technology specialty should be protected in Cork Regional Hospital. If the board were unhappy about that, they could have made the decision to come back and ask if they wanted to diminish the high technology services.
What could five Kerrymen do against 15?
Nevertheless the regional hospital in Cork, like other hospitals, has to contribute its appropriate share towards the savings to be generated through efficiencies.
The Southern Health Board decided to reject the CEO's proposals in respect of the general hospital programme and it is this rejection which has led to the current situation. It is always preferable to adopt a planned approach to meeting budgetary targets, even though it involves making difficult and often unpopular decisions. The alternative, the unplanned approach, has a far more damaging effect on services. A chief executive officer must, however, observe his budgetary obligations under the Health Act and must take whatever options are available to him. In forcing management to adopt this alternative approach the board are not, in my view, acting in the best interests of the people who live in its functional area.
That is part of the cause of the problem. There may be a few more causes. Deputy Spring, who is a member of the board, was Tánaiste in the last Coalition Government. Fine Gael and Labour allowed overruns of £55 million by the health boards in the last two years and now we have to deal with that. That is one of the reasons the Southern Health Board have difficulty. Where were the Fine Gael members of the board then and where was Deputy Spring?
It was a Fianna Fáil health board and they were calling for more.
The Minister is on a loser.
Deputy Deenihan talks about ignoring the Southern Health Board. The previous Minister for Health refused to meet the chairmen and CEOs of the health boards for four years. Three times I have met the chairman and CEO of the Southern Health Board since this year's budget. I accept that the former Minister for Health gave them money, but it was money which was not allocated by the Minister for Finance. That is one of the reasons there is a problem in Tralee at present.
I have met the chairman, CEO and other representatives of the Southern Health Board on a number of occasions this year to discuss the board's financial situation. On each occasion I have emphasised the commitment of this Government to restore the national finances to a sound footing and the need for all public agencies to play their part in this essential task. I have stressed the necessity for the board to live within its allocation and to ensure that it provides services in the most cost-effective manner possible. I regret that the members of the Southern Health Board have not been prepared to shoulder their responsibilities in the way that members of other boards have done.
The Southern Health Board allocated £8,384,900 to Tralee General Hospital to fund services in 1989. This is £47,000 more than the allocation in 1988. I accept that the general hospital's commitments have increased this year with the transfer of long stay patients from Edenburn. I cannot understand, however, how a hospital with a budget of £8.4 million cannot provide a high level of acute hospital services for its catchment population. A comparison of cost per patient treated and cost per bed day with other comparable health board hospitals shows that Tralee is more expensive. Two comparable voluntary hospitals, the Mercy Hospital in Cork and Portiuncula Hospital, Ballinasloe, can provide services much more cost effectively then Tralee. Tralee has a generous staff complement by any standards but one must query if these staff are being used effectively.
Let us consider the position in Castlebar where they had 12,000 admissions in 1988, the same number as Tralee. What is the difference in the staffing ratio? There are 66.5 clerical/administrative staff in Tralee and 44 in Castlebar. The maintenance staff at the new hospital in Tralee is 19 but only two at Castlebar. There are 50 typists in Tralee and 30 in Castlebar. There are ten physiotherapists in Tralee and five in Castlebar. What is the allocation to the two hospitals with the same number of admissions last year? It is £8.3 million to Tralee in 1988 and £6.6 million to Castlebar.
They have no outpatient services in Castlebar.
If we look at the non-pay element, 77 per cent of the allocation in Tralee goes on pay, 85 per cent in Castlebar. This means 15 per cent is going on non-pay in Castlebar and 23 per cent in Tralee. In my view Tralee has sufficient money to provide a proper level of service for the people of the Kerry area.
The non-pay costs of the hospital constitute a relatively high proportion of total costs. I am not satisfied that the substantial allocation to the hospital is yielding value equivalent to that of comparable hospitals. It is the responsibility of the staff of the hospital and health board management to ensure that every pound of taxpayers' money is being as well spent in Tralee as in any other hospital.
I would like to refer to a number of specific issues raised by Deputy Deenihan. He claims it is intended to close a further 30 long stay beds in the hospital.
Not long stay, sevenday wards.
My information from the health board is that the Deputy's information is incorrect and that a long stay ward has not been closed nor is there any proposal to close 30 long stay beds. The claim that the out-patients' department is to close is also untrue. I understand that the board's management propose to cease the provision of outpatient physiotherapy services at the hospital. In-patient physiotherapy services will not be affected.
The successful management of the health services requires the co-operation of health board members and health board managers. I appreciate that boards are faced with difficult choices in living within their allocation but decisions must be faced if the national goal of economic recovery and growth is to be achieved. I would remind Deputies that 20 per cent of Exchequer funding is going to the health services and the Southern Health Board receive the second highest allocation in the country at £132 million. The next board have only £100 million. There are 40 acute hospitals funded and only ten of them receive more than the hospital in Tralee. Six of those are the major voluntary hospitals, mainly in Dublin. Most boards have faced up to their responsibilities and have supported management in the task of controlling expenditure and living within the allocation. I regret that the members of the Southern Health Board have chosen to go another way. I would ask the Deputies to talk to their own Fine Gael and Labour members of the board and ask them to face up to their responsibility. The action in which they are indulging will not benefit the health services or the country.
The Dáil adjourned at 10.20 p.m. until 10.30 a.m. on Wednesday, 26 April 1989.