I move:
That a sum not exceeding £1,254,664,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1990, for the salaries and expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain services administered by that Office, including grants to Health Boards, miscellaneous grants, and a grant-in-aid.
The gross non-capital provision in the estimates amounts to £1,389.214 million. Allowing for Appropriations-in-Aid at £163.75 million, the net non-capital grant provision is £1,225.464 million, of which £7.6 million is national lottery funded. The net non-capital provision represents over 21 per cent of total Government expenditure on supply services as compared with under 20 per cent in 1989.
The net non-capital grant provision represents an increase of £82.332 million on the corresponding out-turn figure for 1989.
This year sees a signficant improvement for those in receipt of health cash allowances. Increases of between 5 per cent and 10 per cent in these allowances have been provided for. The provision takes account of certain special pay awards and phase III of the general pay increase under the 1987 agreement on pay in the public service.
The level of non-capital expenditure approvable on the basis of the subhead provisions in the Estimate is £1,391.975 million. It comprises £873.154 million in respect of pay, £441.601 million in respect of non-pay, and £77.220 million in respect of cash allowances. When account is taken of the directly generated income of health agencies the total expenditure in 1990 will be £1,502.975 million.
The capital provision for 1990 is £37.7 million. Of this, £22.7 million is being provided from the Exchequer, £12 million by extra-Exchequer receipts comprised of £11 million equipment loans for new facilities, £1 million from sales of properties, and £3 million is being made available from the lottery. In addition, a provision of £3.5 million was made for systems development and related services in the health agencies. Funds will be spent on priority projects which are designed to maintain and improve the infrastructure of the health services.
The 1990 capital programme makes provision for expenditure on all the major components of the health services, including general hospitals, psychiatric services, services for the handicapped and community health and welfare services.
My Department are at present in the process of drawing up a comprehensive five year capital programme covering all the major components of the health services and I expect to have decisions made on this programme in the context of the 1991 Estimates.
I believe that when the health services in 1990 are reviewed it will be seen as a year of consolidation and renewal. It will also be seen to be year in which a number of very important initiatives were taken to shape the services for the future.
When I made a statement to the House on 6 February 1990, I outlined a detailed action plan for the year. I set out in considerable detail a range of initiatives which would be taken this year. I am very pleased to confirm that very good progress has been made on this action programme. In the short time available to me this evening, I would like to report to the House on those aspects of the programme which have been priorities during the first half of this year.
First, I made a firm commitment that overall hospital activity throughout 1990 would be maintained at the latter half of 1989 levels. I also gave an undertaking that the agreed cost of the additional activity arising from the 'flu epidemic would be met in such a way that it would not intrude on the services to be provided this year. I am glad to report that both these commitments have been honoured in full and that health boards and hospitals have been enabled to maintain acute hospital activity at the agreed levels.
In my February statement, I indicated that a number of initiatives would be taken to improve efficiency in the health services. In particular, I mentioned that studies would be undertaken by Professor David Kennedy on the acute hospital services in Dublin and that Mr. Noel Fox would conduct an efficiency review of acute hospital services.
In regard to the efficiency review, I expect to receive a report on the first phase of Mr. Fox's assignment around the end of August. I will, in due course, make a full statement on the action which will be taken on foot of the report.
Professor Kennedy has submitted an interim report. He has made recommendations on steps which can be readily taken to streamline acute hospital services in Dublin. He has identified a number of areas which need urgent attention, including the development of improved diagnostic, treatment and rehabilitation services for the elderly. He has also strongly recommended the development of new structures for the planning and delivery of health services in the Dublin area.
Professor Kennedy has identified the best practices in use in hospitals and has recommended that these be quickly extended to all acute hospitals in the Dublin area. The measures to be taken by the acute hospitals in Dublin include:
—the adoption of an admissions policy in each hospital, supported by an intensive bed management policy;
—the introduction of one-day and five-day wards, specifically to deal with planned admissions;
—senior medical staff to become more involved in decision making in accident and emergency departments when decisions are being taken on further hospital treatment; priority to be given by medical staff to their accident and emergency commitments on the days when they are on take;
—more effective diagnostic support for accident and emergency departments and improved liaison with general practitioners;
—a more systematic approach to planning of discharge for patients in need of follow-up care; and
—improved public education on the use of hospital services.
I accept these recommendations and have already asked each of the acute hospitals in Dublin to produce a plan to implement them in advance of the seasonal increase in emergency admissions during the winter. The implementation and impact of these measures will be closely monitored by my Department, working with a term drawn from the membership of the Kennedy Group.
I am particularly anxious to act on the recommendations made by Professor Kennedy in relation to the improvement of services for the elderly. While there will be some additional resources required to implement fully what is necessary, I believe that we can make considerable progress on a number of fronts without further delay.
Earlier this year, I made available £4.5 million additional funds to health boards to develop home and community-based services for the elderly. Important improvements in services are taking place throughout the country, such as expansion of day care places, appointment of additional public health nurses, extension of home nursing and improvement of staffing ratios in existing homes for the elderly.
Because of the extent and rate of expansion of the population of elderly people in the greater Dublin area, a substantial share of the additional funds has been allocated to the Eastern Health Board. Further funds will be made available to provide additional places in nursing homes, which will help to relieve pressure on the acute hospital services in Dublin as advocated by Professor Kennedy.
My Department have already had discussions with a number of the major Dublin hospitals about the provision of a comprehensive specialist medical service for the elderly. I have been encouraged by the positive response of the hospitals and their commitment to finding ways and means of developing such a service within their existing resources. My Department are developing proposals for a pilot project in rehabilitation of the elderly and I am having discussions with the National Medical Rehabilitation Centre to explore the contribution which they can make in this field.
I also accept the conclusions drawn by the group as to the unsatisfactory nature of the organisational structures in Dublin, and changes to bring about significant improvements to deal with this are under active consideration at the moment.
Medical consultants are one of the key groups in the delivery of hospital care. The recent report on the pay and conditions of medical consultants by the Review Body on Higher Remuneration in the Public Sector, under the chairmanship of Mr. Dermot Gleeson, presented a clear analysis of many of the problems associated with the provisions of services at consultant level. It looked at the question of pay and conditions for consultants in a comprehensive way and clearly points to the need to consider the issues together rather than in isolation. I do not wish to pre-empt the discussions with the medical profession, which now are being arranged, but I believe that these recommendations provide a satisfactory basis on which to structure the future relationships between patients, consultants and management.
Last year I announced the introduction of a new drug cost subsidisation scheme to alleviate the position of people with limited eligibility and a requirement for long-term prescription medication. I am very pleased to announce that my Department have now reached agreement with the contractors' committee of the Irish Pharmaceutical Union on the introduction of this scheme, and that acceptances has been recommended to the members. I hope to make a full announcement, giving details of the scheme, when balloting is completed later this month. The implementation of this scheme will be of particular benefit to those with chronic conditions, such as asthma.
A new three year agreement was negotiated between my Department and the Federation of Irish Chemical Industries on the price of drugs. This agreement provides a satisfactory basis for the control of drug prices on the Irish market, and will have immediate benefits for both the Exchequer and the private purchaser.
Our presidency of the EC was very successful from a health perspective, and I am confident future Presidencies will build on the positive and constructive work that we achieved: Tobacco — A directive harmonising reduced tar levels in cigarettes was adopted; Cancer — A 50 million ECU Europe Against Cancer Programme for 1990-94 was agreed which will focus on cancer prevention, health information and education, training of health professionals and research; Drug Abuse and AIDS — The EC Council of Health Ministers agreed programmes to develop plans and strategies in these areas: and completion of the internal market where considerable progress was achieved relating to foodstuffs and medicinal products.
I adopted Youth and Positive Health as the theme to run through our Presidency. I put a special emphasis on health education and the promotion of positive lifestyles among our young people. This initiative was widely supported by all the EC Health Ministers and will now form the basis for future policy programmes.
In conclusion, I have outlined briefly the initiatives which are being taken to get the maximum return from the investment by the State in the health services and to improve those services in a number of key areas. The action programme has already brought beneficial results in the hospital and community care sectors, and when fully implemented, will have created a significantly improved environment for a first class health service.
I believe that with the resources made available by the Government, and the policy initiatives detailed in this statement, the right standards of health care which our society rightly expects will continue to be provided.