I move:
That a supplementary sum not exceeding £50,438,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1991, 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.
On 26 February 1991, my predecessor Deputy O'Hanlon outlined to the House the Government's policy regarding the management of the health services in 1991. The policy, as outlined in February, was based on a number of key principles, including: the maintenance of services at a level not less than that which was approved in respect of 1990; the provision of assistance to health boards in meeting the cost of demand-led schemes where these proved to be higher than initially anticipated; and the pursuit, by health agencies, of all possible opportunities to maximise the use of available resources prior to the consideration of additional funding. We remain committed to those principles.
Given the current economic situation it is vital that all sectors of the public service contribute to the containment of expenditure at levels consistent with our economic targets. To this end, a package of corrective measures was introduced in July of this year. This Supplementary Estimate is net of savings achieved as a result of that package of measures. Despite the acute pressure on the public finances the Government are honouring fully the commitment which they made in relation to the funding of the health services in 1991.
I would now like to refer briefly to the main elements of the Estimate before the House. This year, for the first time, the cost of all the schemes, generally regarded as demand-led, has been included in one subhead of the Health Vote-subhead G.2. This subhead provides for expenditure on: disabled person's (maintenance) allowance; disabled person's (rehabilitation) allowance; capitation fees to vocational rehabilitation centres; mobility allowance for handicapped persons; infectious disease (maintenance) allowances; blind welfare allowances; long term illness scheme; drug refund schemes; domiciliary care allowances for handicapped children, and maternity cash grants.
The boards are statutorily compelled to meet the costs incurred by every person who establishes eligibility under the various schemes. In addition, changes in the manner in which eligibility for the disabled person's maintenance allowance is assessed coupled with the changes in the social welfare code have led to an escalation in the cost of this scheme. These schemes have, therefore, put a lot of pressure on the resources of health boards.
Expenditure under the disabled person's maintenance allowance has increased due to an increase in the number of recipients. This has arisen mainly from the introduction of the equality legislation in 1989 and the outcome of the Healy case which established the right of spouses to claim the allowance in their own right. The effect of these combined, has resulted in a greater number of spouses claiming DPMA both at the full and reduced rates. The number in receipt of this allowance has increased by some 5 per cent over 1990 levels.
Prescribing trends in the drug schemes have shown an upward trend during 1991 resulting in higher than anticipated costs in these schemes, notwithstanding savings which have been achieved through changes in the drug refund scheme. The expenditure trend of the long term illness scheme has been influenced by the drug prescribing patterns evident in the general medical services scheme. While the number of persons covered has increased by some 3 per cent to about 47,000 persons, the main factor responsible for the increase in the cost of this scheme is the increase in the cost mix of drugs prescribed, from less expensive items to newer, more costly, items.
The drug refund scheme has been affected in a similar way by a change in the drug prescribing mix. In addition, the drug cost subsidisation scheme, which was introduced in 1990 to alleviate the circumstances of patients requiring medication for an extended period, now covers some 19,500 persons compared with 12,000 on commencement of the scheme.
Because of the increased expenditure on these schemes and to make provision for the bonus payments in December, an additional provision of £8.6 million is being made available to health boards. I am pleased to be in a position to provide this assistance to the health boards, thus avoiding the need for health boards to reduce expenditure on other services in order to meet these costs. This is a significant development in the arrangements for the funding of health boards and eliminates one of the major budgetary uncertainties which have affected the boards in recent years.
A feature of modern health care is the increase in the range and scope of medical conditions amenable to treatment. A number of these treatments are highly specialised and it is not always feasible to provide them in this country. We are continuing to support hospitals in keeping abreast of medical developments, as in the case of liver transplants. Nevertheless, the need to send patients abroad to receive specialised medical care has increased considerably in recent years, although the overall numbers are still relatively small. An additional provision of £1.3 million is being made available in order to meet the costs incurred in 1991.
Earlier this year, following a series of discussions with the Irish Haemophilia Society regarding the plight of those haemophiliacs who had contracted the HIV virus, the Government decided to provide further financial assistance for haemophiliacs. The House will recall that a sum of £1 million was allocated by the Government in 1989 and this sum was disbursed to individuals and their dependants through the HIV-haemophiliac trust.
This year the Government approved the provision of further assistance of £8 million. Certain aspects of the Government offer required to be cleared by the High Court. This has now been done and I am pleased that, as agreed with the Haemophilia Society, the first payments are being made this week. The balance is due to be paid early in 1992. A total of 102 persons and/or their dependants will benefit from the settlement. Under the arrangements agreed with the Irish Haemophilia Society and its legal advisers, the £2 million to be paid this year, which is provided for in this Estimate, will be divided equally among the claimants. The balance of £6 million will be paid early next year.
This Estimate makes a provision of £1.5 million from lottery funds in respect of capital expenditure on essential equipment replacement. It will be used to fund a range of top priority items, including the provision of a replacement cobalt unit and major X-ray equipment at Cork Regional Hospital. Following the failure of the cobalt unit at Cork Regional Hospital earlier this year, it was necessary to make immediate arrangements for the ongoing treatment of some Cork patients at St. Luke's Hospital in Dublin. Arrangements are currently in place for the provision of this specialised treatment and additional funding will be available to cover the cost to St. Luke's. The commissioning of the new cobalt unit in Cork will bring a welcome end to this necessary but somewhat difficult arrangement for patients from Cork. I am, of course, very grateful to the staff of St. Luke's for the care and dedicated attention given to those patients. The capital provision in this Estimate will also be used to fund the purchase of operating theatre and anaesthetic equipment in a number of hospitals. I am very much aware of the need for additional funds for the purchase of new and replacement equipment and I hope to reflect these priorities in the allocation of capital in 1992 and subsequent years.
An amount of £17 million is included in the Supplementary Estimate to meet the additional expenditure of the general medical services scheme. This will bring the provision made for this purpose in 1991 to £172.712 million. This compares with an initial provision of £155.7 million.
The major contributory factor to the increase has been the continuing escalation in the cost of drugs prescribed. The cost of drugs has continued to increase, despite the price reductions which resulted from the agreement with the Federation of Irish Chemical Industries, negotiated in August 1990. The major cause of this increase in costs is the prescribing of newer, more expensive drugs, rather than an increase in the volume. There are several reasons for the increase, including accelerating advances in treatment therapies and the diffusion of sophisticated drugs and medicines from tertiary hospitals into the community. Despite this trend, we are still relatively low prescribers when compared with other EC countries, but we must continue to identify and realise opportunities for savings in the total drugs bill. In the February review of the GMS scheme several of those opportunities were identified and they are now being implemented.
The National Therapeutics Advisory Committee have been established, a particularly important initiative. The committee, representative of hospital doctors, hospital pharmacists, general practitioners, community pharmacists and management, are charged with examining all factors involved in influencing prescribing; advising on mechanisms to bring about greater co-ordination and offering professional advise to doctors on cost-effective prescribing. I ask everybody involved to work together to make the best use of the resources available. The Government are considering other initiatives in that respect.
The major commitment given by my predecessor on behalf of the Government last February related to the maintenance of services in acute hospitals at the level approved in respect of 1990.
The additional provision being made in this Estimate for acute hospital services is £15.458 million, which is made up of the £7.713 million contained in subheads G.1 and G.4 and the freeing up of £7.745 million in subhead G.1 as a result of the provision of additional lottery funds under subhead G.9. The health boards and hospitals have been able to maintain their bed levels, as I said earlier in reply to a Dáil question——