That a supplementary sum not exceeding £32,898,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1989, for the salaries and expenses of the Office of the Minister for Health (including Oifig and Ard-Chlár-aitheora), and certain services administered by that Office, including grants to Health Boards, miscellaneous grants, and a grant-in-aid.
The original net Vote for Health for 1989 was £1,144.905 million, including a capital provision of £35,000,000. This is a very significant provision, representing almost 20 per cent of total State spending on services and should lay to rest the perception that pervades the environment that good health services are not available to the population. This perception could not be further from the truth. We have an excellent service with essential treatment at the highest level available on demand and most elective treatment available within a reasonable timeframe. Over one million people have at their disposal, without charge, a comprehensive general practitioner and medicines service. Over 500,000 in-patients pass through the acute hospital system in a year getting the most sophisticated high technology services up to and including transplant. Over 1,500,000 out-patient attendances are serviced each year. Over 5,000 orthodontic cases are carried out and over £130 million is spent on our services for the mentally handicapped. These are not features of a negligible service, as some would have it. Rather they are features of a first rate service provided by dedicated competent people and in a most caring way.
The movement of this supplementary sum is a sign of the Government's commitment to the maintenance of this service and to the provision of funds for its improvements in specific areas and in a prioritised way as funds allow. Specifically it provides £15 million for the cost of improved acute hospital services including improvements in the sectoral accident and emergency services in Dublin; £25 million being the additional cash requirements of the General Medical Services (Payments) Board due to, inter alia, the delay in the introduction of the new GMS contract and the once-off additional cost of two months' doctors fees. It also provides £8 million being the cost of additional expenditure on demand-led schemes such as the drug refund scheme, the disabled persons' maintenance allowance scheme, the cost of the measles, mumps and rubella campaign and the hepatitis immunisation programme. It also provides £2.1 million for the cost of discharging liabilities associated with the winding up of the Hospitals Joint Services Board; £300,000 for the cost of additional expenditure on orthodontic services; a figure of £5 million to cover the cost of additional expenditure on capital services; a figure of £1 million to cover the cost of a special health cash allowances bonus payment, less £23.5 million additional Appropriations-in-Aid; less the token Supplementary Estimate taken earlier this year amounting to £2,000, leaving us now with a net Supplementary Estimate of £32.898 million.
In my Estimates statement to the House in July last I pointed out that the health services over recent years had seen a number of developments which indicated that, while the services were generally successful in meeting demand, difficulties arose in some specific areas due to a number of factors. These factors included changes in the investigation and treatment of patients. I do not have to tell the House about the level of high technology available to patients at present or indeed the new developments coming on stream on a regular basis. Other facets of these difficulties were increased day surgery activity, the changing demographic picture and the major challenge of AIDS, a condition which, as the House knows, is increasing, is a very serious public health issue, constituting a major challenge to our services with the number of patients suffering from AIDS doubling every ten months. Unfortunately, this is something that will continue for a few more years.
To relieve all of these pressures the Government decided to approve the use of an additional £15 million for the general hospital sector. Those £15 million were allocated as follows. First, a figure of £1.5 million for the introduction of sectoral and accident and emergency services in the Eastern Health Board area. That included the opening of the six hospital accident and emergency departments in this city on a 24-hour basis, whereas formerly there had been a rota over the past 12 to 15 years between the three hospitals on the north side and the three on the south side. That allocation also included a figure of £1.7 million for operations this year to reduce waiting lists, particularly for ear, nose and throat complaints and hip replacements. I am glad to say that we are seeing the waiting lists being reduced. We will not be able to reduce them all this year but we shall continue to do so next year. Hopefully we will be able to bring the various waiting lists into line.
I suppose it would be no harm to mention to the House a few specific procedures. The question was raised earlier today at Question Time of the number of patients on waiting lists for some specific procedures. For example, there are some 3,374 patients awaiting cataract removals; for hip replacements, there are 1,993; for heart surgery, 675, and in respect of glue ears there are 1,810. It is important to remember that these figures must be treated with caution in view of our experiences in Temple Street Hospital and with the Midland Health Board. For example, in Temple Street Hospital a consultant was appointed to carry out a review of all patients on the waiting list. To date, 171 patients have got an appointment, three telephoned to say they were not coming, 58 did not attend and 110 attended. Of those 110, it was found that 19 no longer needed a service. Therefore, it will be readily seen that approximately half the patients on the waiting lists did not need a service. That was the ear, nose and throat service in Temple Street Hospital. Despite that, the in-patient waiting list at that hospital has been reduced by some 200 since August last as a result of the intervention.
A somewhat similar position obtained in the Midland Health Board area when 470 patients were transferred to the Midland Health Board from the Royal Eye and Ear Hospital who had been on the waiting list. The Midland Health Board decided to contact each of those patients asking them whether they wished to continue their treatment. Thirty-six patients replied saying that treatment was not required and 73 did not reply at all. That reduces the figure from 470 to 361 in respect of the number of patients awaiting surgery. Of course, when examined, it may be that some of those patients will not need treatment either. That was my purpose in pointing out that we must treat such lists with caution.
Again, of that allocation of £15 million, £9 million is being provided to cover the cessation of bed closures, the restoration of beds, the opening of additional beds and a figure of £2.8 million for the acceleration of planned opening of new beds, including the purchase of new equipment.
The Supplementary Estimate of £25 million in respect of the GMS is being sought on foot of a number of factors. Firstly, the GMS is a demand-led scheme. The cost of meeting patients' statutory entitlements is determined by the numbers eligible, the level of illness and the nature and extent of treatment provided by GPs. One of the principal advantages of the new GMS contract is that it introduces a greater degree of certainty into the forecasting of costs.
The new contract came into effect by 1 April last for the vast majority of GMS doctors. This was later than had been hoped for. As a result, there were a number of teething problems associated with the introduction of the new scheme, due in part to uncertainty as to when it would, in fact, come into operation. This delay has led to some increase in the original forecast of costs.
A second factor underlying this Supplementary Estimate is the once-off cost of introducing the new contract. As Deputies may be aware, payment of fees under the old GMS contract was made two months in arrears, due to the need for checking and calculation of claims. Payment of capitation is made on a current month basis. In terminating the old contract there was, therefore, a once-off additional expenditure of two months' doctors fees.
The third factor which has affected the 1989 cost of the GMS has been a significant increase in drug prices. The vast majority of our drugs are imported from Britain. Price levels there have increased significantly and this has affected our drug costs here. Under an agreement between my Department and the Federation of Irish Chemical Industries, there is a strict control on the prices charged for drugs here relative to their UK price. As part of that agreement there was, in addition, an 18-month price freeze which terminated last October. The recent increases in UK prices have significantly increased the drug Bill, both in the GMS and in the drug schemes operated by health boards.
While the agreement with the FICI proved a useful means of capping drug prices here relative to the UK, I believe that it is time to consider alternative strategies to reduce drug costs. I have given 12 months' notice to FICI under the terms of the agreement and I am having a detailed examination carried out on all of the alternative options to such an agreement as a matter of urgency. I would expect that negotiations with all of the affected parties to any new arrangements on drug purchasing would commence early in the new year.
An amount of £8 million is included in the Supplementary Estimate to meet the cost of certain demand led drug schemes. Specifically £4.5 million is included to meet the additional cost of the drugs refund scheme. This requirement has arisen due to an increase in drug prices and to an increase in the number of claims.
A sum of £2.5 million is included to meet the cost of the MMR programme and the cost of immunising high risk health service employees against hepatitis B and £1.5 million is included to meet the cost of an increase in recipients of the disabled persons' maintenance allowance.
I have recently reviewed the operation of the community drugs schemes for which my Department are responsible. I am concerned that there may be some hardship in relation to the existing drug refund scheme whereby people must pay the full retail price of required drugs and await subsequent reimbursement some weeks later. I hope to introduce the new scheme shortly. We are finalising negotiations with the Irish Pharmaceutical Union whereby patients will not have to pay in excess of £28 per month for their drugs and then have to wait some months to be reimbursed.
The Hospital Joint Services Board were set up under the Corporate Bodies Act, 1961, to provide central laundry and sterile supplies to hospitals. Over the years there were some difficulties, including financial ones, and the board decided to sell their assets as a going concern by public tender. This was done and the residual debt of the board after the sale was £2.1 million which is provided for in the Supplementary Estimate.
The House will be aware that in 1981 I established a small working group under the chairmanship of the then Minister of State, Deputy Terry Leyden, to review the delivery of the dental services. The working group concluded that there were many difficulties in the dental services area. As a result we decided in the current year to provide £300,000 to ensure that 500 top priority patients in the eight health boards would receive orthodontic treatment. We intend to continue this scheme to ensure that an adequate and proper dental scheme is provided for people.
The water flouridation programme continues to expand and to bring the benefits of a flouridated water supply to an increasing percentage of our population.
As part of the Supplementary Estimate I am seeking an additional £5 million for the capital programme. The need for this extra provision has arisen for a number of reasons. Many of the projects in the health capital programme involve payments over a number of years and some of these liabilities are maturing for payment in 1989 at a faster rate than was originally envisaged. In addition, considerable capital expenditure has had to be incurred this year on the replacement of hospital equipment in emergency situations and in doing necessary fire precautions work.
The need for this expenditure cannot always be anticipated but it is vital for patient safety that equipment is replaced when it becomes unserviceable and that hospital buildings are maintained to the highest safety standards.
It has also been necessary to accelerate the programme of computerising systems in the health services and this has meant setting aside a bigger than normal component of our total capital resources for this purpose.
An additional yield of £8 million from health contributions has arisen in line with the general buoyancy in income related revenue and the receipts under EC Regulations will now be £15.5 million over and above the original forecast.
These latter receipts represent the reimbursement by the UK authorities of the cost of health services provided in Ireland to UK social security pensioners, to dependants of Irish migrant workers and to temporary visitors from the UK.
The gross amount necessary to cater for these increases has been reduced by the £23.5 million additional appro-priations-in-aid. Specifically the main reason for this increase is that the final accounts for both 1985 and 1986 were in fact settled and paid by the UK authorities in the course of the year and that currency rates were more favourable than expected.
I commend the Supplementary Estimate to the House.