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Dáil Éireann debate -
Thursday, 7 Feb 1991

Vol. 404 No. 8

Ceisteanna — Questions. Oral Answers.

The five questions we are about to embark upon are the questions nominated for priority for which 15 minutes only is provided under Standing Orders of this House.

As this is the first occasion I am in the House with my three colleagues, the Minister of State, Deputy Chris Flood, Deputy Richard Bruton and Deputy Ferris, who have assumed new responsibilities I would like to wish them well in their new posts.

Joe Sherlock

Question:

1 Mr. Sherlock asked the Minister for Health if he will list the health boards which have indicated that they are unlikely to be able to maintain services this year at the 1990 level; the additional resources, if any, he intends to provide to enable medical and health services to be maintained; and if he will make a statement on the matter.

Richard Bruton

Question:

5 Mr. R. Bruton asked the Minister for Health whether his attention has been drawn to the shortfall in the budgets provided by him to the health boards; if he has assessed the likely impact of these shortfalls on services available to the public; and if he will make a statement on the matter.

I propose to take Questions Nos. 1 and 5 together.

Since the 1991 allocations were notified to the health boards on 18 December last, my Department have kept in constant touch with the boards, who have been engaged in drawing up service plans for 1991. I am aware that, while the allocations may not enable all health boards to maintain the level of throughput achieved in 1990, boards will, at a minimum, be in a position to provide services at the level prevailing in the latter part of 1989 which, in fact, was the approved level of service for 1990. Many boards were operating last year at activity levels considerably above this approved level. With management of the targeted levels of activity and enhanced commitment to the achievement of value for money, particularly through inter-agency co-operation, I am satisfied that health boards will be in a position to provide a satisfactory service throughout this year.

Will the Minister answer Question No. 1, that is, list the health boards which have indicated they are unlikely to be able to maintain services at the 1990 level?

As the Deputy says, the health boards have indicated they may not be able to maintain activity at the level of 1990. What I told the health boards when I gave them their allocations was that we expected them to work at the approved 1990 level. As the Deputy appreciates, the health boards went beyond the 1990 level in 1990 for a number of reasons.

Will the Minister not agree that yesterday in the House he boasted of the achievements in 1991 of growth in the services and that it is inconsistent of him today to tell the health boards to wind back all those achievements to the 1989 level? Will he tell the House why these health boards are reporting an aggregate shortfall of £20 million? Can he further confirm that the increase over the outturn in 1990 in his allocation for 1991 in percentage terms is minimal?

Yes. In the House yesterday I pointed out to the Deputies that the Government have provided £1,426 million, the largest amount ever provided by any Irish Government since the foundation of the State, for the health services whereas in 1987 in the Department of Health we received just over 18 per cent of the total Exchequer funding for the health services. In the current year we are receiving 22 per cent which is a very sizeable increase and a very large percentage of what the Exchequer is providing for public services. I am sure Deputies will appreciate that it is an indication of the Government's commitment to maintain services at a high level.

In regard to Deputy Bruton's question about the level of service in 1990, Deputies will appreciate that this time last year there was a 'flu epidemic. That epidemic caused increased pressure on the service. There was a 14 per cent increase in admissions to hospitals and that, thankfully, has shown no sign of being repeated this year. All the evidence is that there will not be a 'flu epidemic this year.

I thought the Minister would state that the factual position was that three out of eight boards rejected the allocation by a majority decision and that one other health board has yet to make a decision. Will the Minister try, for once, to explain how he arrives at the view that a health board, such as the Southern Health Board, could maintain the 1989 level of service when the additional funding for 1990 included that for dental treatment, care of the elderly and the 'flu epidemic and when the level of service provided in 1990 was on the increased allocation?

I have to appeal for brevity for the obvious reasons.

I am coming to the point. All in all, at the end of 1990 the health board, in their assessment, showed that they required £152 million and the decision made by the Minister to allocate £149 million——

I am sorry Deputy Sherlock. This is not good enough at Question Time when dealing with Priority Questions.

With due respect let me ask, does the Minister realise that the allocation to the Southern Health Board would mean providing for 1,000 less patients in the Cork Regional Hospital at this time?

Deputy Sherlock is right that a number of health boards have rejected their allocation. There may be some confusion in the House because Deputy Ferris says that is the first time that happened since the Health Act, 1970. In fact it happens every year. Deputy Sherlock is a member of a health board as is Deputy Ferris. I was a member of a board for 17 years and I am aware of it happening on a regular basis. On initial examination of the budget boards reject the proposals put forward by management and when they go back and have another look at them they accept the budget. Only one board, the Southern Health Board some years ago, did not accept the recommendation of the management.

In regard to the Southern Health Board one has to compare like with like, and the original allocation to that board was £143 million in 1990. It is £149 million this year, an increase of £6 million. I am satisfied that that should be sufficient for them to maintain their services at the approved 1990 level.

(Interruptions.)

A final and brief supplementary from Deputy Richard Bruton.

Is the Minister aware that the £20 million shortfall in the budgets of the health boards will result in longer seasonal and some bed closures, the closure of geriatric beds for which he expressed particular concern to see growth, and to the postponement of locum substitution for nursing? It will, according to all the health boards, seriously affect their services.

There will be seasonal closures this year. It is important to point out to the House that seasonal closures have nothing to do with a lack of funding. Seasonal closures have been a part of hospital activity for as long as I can remember. I, for one, would expect hospitals to close wards if it was only to wash the walls or paint them. I was a house man and I know all about it. A whole corridor was closed for a month back in the good old days in the sixties.

Would the Minister agree that the additional services he asked the board to provide, the increase in wages which came under the Programme for National Recovery, and the rate of inflation leave the board in a situation where it cannot provide that level of service?

I accept that the increase in salaries does take up much of the increased allocation. However, the Government were adamant that there should be more value for money, something that Deputies talked about for years. We now have the benefit of the Foxe report and are discussing its implications with the health agencies. I am glad to say that there has been substantial progress in that regard. As far as value for money is concerned we have already got a better deal for drugs with more efficiency in the use of drugs. I believe there are savings to be made there in the current year.

I have to advise the House that five minutes now remain to deal with the three remaining Priority Questions.

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