Seán Barrett
Question:17 Mr. Barrett asked the Minister for Health when he expects the review body to report on the impact of the recently announced health charge increases.
Ceisteanna — Questions. Oral Answers. - Review Body on Hospital Charges.
Donal Carey
Question:37 Mr. Carey asked the Minister for Health the nature of the terms of reference of the review committee announced to deal with the increased health charges of February 1993; and when he expects the result of the review to be available.
I propose to take Questions Nos. 17 and 37 together.
The terms of reference of the review group on public hospital charges are: (a) to carry out a cost-benefit analysis of the charges; (b) to investigate any anomalies or inequities in the operation of the charges and (c) to examine the effect of the charges to determine whether they act either as a barrier to necessary services or as an incentive to inappropriate use of services. The group will report to me later this year.
Will the Minister's colleague, Deputy Michael Ferris, who stoutly defended the increase in charges, be a member of the review body?
The review body will not consist of politicians but of officers of my Department and representatives of health boards. It will take into account all the issues I have outlined. As I explained in the presence of the Deputy opposite at an important health gathering over the weekend, these charges were introduced to raise revenue for other initiatives. I hope to have a better understanding of the impact of the charges on the use of the services when the review group reports at the end of the year.
The Minister must acknowledge a number of anomalies in the increase in charges with particular reference to general practitioners. Given that the increase in charges has been inbuilt into the non-capital allocation to health boards for the current year, the Minister does not expect the review committee will recommend any changes, and if it does recommend changes, the Minister will not act on them, at least in the course of the current year.
The review group will consider more than simply the charges. I want to see how best the services can be delivered. I indicated to the Deputy that people have various comments to make on the charges. Some general practitioners regard them as far too generous in that I am encouraging people to use out-patient departments at general hospitals rather than use general practice; some health board officials believe they are too generous in that for a charge of £60 a family will have access to accident and emergency services or out-patient services for a year, thereby encouraging people away from general practice; while others feel it is a barrier to people using these services. I want to find out what the true position is so that there will be the best use of resources and the best standard of care for patients.
In view of what the Minister said about the need for this review to educate him on the matter, in effect he put the cart before the horse in terms of these charges. He used a blunt instrument by imposing across the board increases in charges without any knowledge of their impact. Having done so he decided to review the matter because he was not fully aware of the effects on the community.
I am not sure what Deputy Flanagan had in mind when he talked about a blunt instrument. I am sure his party gave very careful thought to the impact of the charges when they allowed the enabling legislation to be enacted in this House in 1987 and did not vote in favour of the motion to annul the charges. They had much time to reflect on that matter in the intervening years.
We never made promises about the charges. The Minister made promises to the electorate.
The Deputy opposite should be careful in what he is saying. I made no promises whatsoever in relation to charges. I am determined to have the best possible quality of care for people. The provision of an extra £30 million in this year's budget, increasing the total voted expenditure for health services by 12 per cent in a very difficult year, is proof of my commitment in this regard. I hope that underscores my intentions in relation to the report on the charges.
(Carlow-Kilkenny): In view of the Minister's present difficulty, what changed his mind from the time when in Opposition he said these charges were fundamentally unjust and, on another occasion, that they were immoral? Why is the Minister going through such contortions, showing he is anxious to do what is good but has great difficulties with his conscience?
That is hardly relevant to this question. I am calling a final supplementary from Deputy O'Donnell.
Is it not the case that the Minister's decision to review the recent increase in hospital charges resulted from the huge opposition by his fellow Labour councillors around the country who were unable to defend such a stance by a Labour Minister?
Since coming to office I have taken a number of initiatives and this is one that has gained much publicity. It is interesting that both parties opposite had no difficulties in relation to these charges in the past.
(Carlow-Kilkenny): The Minister had difficulties with them.
Deputy Browne was not a Member of the House at the time his party allowed the legislation to introduce these charges to go through this House. It was part of the so-called Tallaght strategy, now forgotten. The party has gone on to a new plain and all is well.
(Carlow-Kilkenny): The Minister opposed the charges.
Not only did Fine Gael allow the enabling legislation to go through but it then refused to vote in relation to the imposition of the charges and was content to allow them to stand for a number of years without let or hindrance.
The Minister is now imposing the charges.
I have a difficulty with these charges but I had to make a decision in relation to the provision of resources to the area of mental handicap, which received £8.5 million, and in relation to additional initiatives — I believe I did the right thing. I want to review the impact not only of increases but of charges generally and their interrelation to the provision of services. A review is being carried out and I will bring to this House in due course the result of decisions made by my colleagues in Cabinet.