Vol. 443 No. 3
15 Mrs. Doyle asked the Minister for Health his views on whether health boards have sufficient resources available to provide adequate staff to meet requirements in institutions caring for psychiatric patients; and if he will make a statement on the matter.
23 Mr. Browne (Carlow-Kilkenny) asked the Minister for Health whether current doctor, nurse and general staffing ratios in geriatric long-stay hospitals throughout the country are sufficient to meet patient requirements and international standards; and if he will make a statement on the matter.
54 Mr. McGrath asked the Minister for Health how current staff/patient ratios at long stay geriatric or psychogeriatric hospitals compare with the situation ten years ago; and if he will make a statement on the matter.
61 Mrs. Doyle asked the Minister for Health whether the required staff ratios are being met in mentally handicapped units; if health boards have sufficient resources to provide the necessary staff in all such instances; and if he will make a statement on the matter.
91 Mr. Creed asked the Minister for Health whether he has satisfied himself that adequate staffing levels are maintained at all levels in general hospitals throughout the country; his views on whether there are areas that require extra staff at present; and if he will make a statement on the matter.
106 Mr. Carey asked the Minister for Health the staff/patient ratio in special hospitals, psychiatric hospitals and other such hospitals in the year 1980 and the relevant figures for 1993; and if he will make a statement on the matter.
151 Mr. Durkan asked the Minister for Health whether he has satisfied himself that nurse/patient ratios are adequate in both general and psychiatric hospitals; and if he will make a statement on the matter.
I propose to take Questions Nos. 15, 23, 54, 61, 91, 106 and 151 together.
The management organisation and provision of the health services referred to by the Deputies are the responsibility of the various health agencies involved in the delivery of such services, that is, health boards, voluntary hospitals and mental handicap agencies. This necessarily involves the identification of staffing requirements and deployment of staff having regard to the particular service needs and within the overall context of the budgetary and employment constraints which apply.
Under existing procedures, it is a matter for each agency to identify and submit to my Department, on a monthly basis, prioritised applications for the filling on a permanent basis of all new and replacement posts. My Department's review of the proposals is undertaken bearing in mind the service and personnel criteria, with particular regard to the availability of financial resources.
In relation to staffing levels generally in the health service, the following table, based on information extracted from the annual Health Service Personnel Census, shows the growth in health sector employment arising from the controlled implementation of Government approved health service initiatives between 1988 and 1992.
|
Year |
Employment (Wholetime Equivalent) |
|
1988 |
56,357 |
|
1989 |
58,438 |
|
1990 |
59,850 |
|
1991 |
59,497* |
|
1992 |
60,459* |
*With effect from 1991, the inclusion in the Census of employment in commercial and noncommercial state bodies (1,124 in 1991 and 1,154 in 1992) under the aegis of the Department of Health ceased.
The December 1993 census is currently being compiled. It is anticipated that, when completed, it will reflect over 1,200 additional posts arising from approved development, across a range of services, including acute hospital services, child care services, services for the elderly and the mentally handicapped, dental services and implementation of EC Directives on student nursing and on food hygiene. This developmental process and enhancement of existing service will continue this year and, it is expected, will result in a further growth in health service employment in excess of 1,600 posts.
The Minister reminds me of a parent who tells children in midsummer what they will receive at Christmas if they are very good. Does he accept that the position in relation to staffing in special hospitals — whether they be long-stay geriatric, or many mental institutions, those still operating as psychiatric institutions is totally unsatisfactory? Does he accept that the staff-patient ratios all fall short of what they should be and that there is grave danger of a serious problem as a result? Although the Minister may dress it up as much as he likes will he accept that concern has been expressed by people working in those services? Will he indicate how he proposes to deal with that problem?
The Deputy will be aware of the significant extra resources put into the health services over the past two years——
And extra needs as well.
——absolutely, and I am glad to be able to expend extra money. No doubt the Deputy will be able to admonish his colleague, Deputy Yates, the next time he accuses me of being a spendthrift, and points out that he wants a £200 million cut in public expenditure. Indeed Fine Gael policy depends on which Member is on the Opposition benches and which Minister is answering. Deputy Durkan referred to services for the mentally handicapped. He is aware that the additional resources allocated to those services this year will be £25 million over and above the figure available when I assumed office. That was the commitment my party and the Government gave in advance of the election and I am glad it has been acted on.
There is a continuous process of integrating psychiatric patients in the community as far as possible which is supported by Government. I hope to continue it and include all those patients capable of being integrated so that we will have the best, most humane form of treatment for all those in need of our health services.
Notwithstanding what the Minister said, is it not a fact that this is wishful thinking because, while extra funds may be made available, needs are outgrowing——
Is the Deputy saying we should spend more?
It is a simple as this, it is the responsibility of the Minister to look after our health services——
What is the Deputy's responsibility?
Part of the Minister's function in replying to questions should not necessarily be to look across at the Opposition and ask them where he should spend it. Will he confirm that there are glaring gaps in those services and that it is up to him to address them? The Minister reciting a long history of what occurred since he assumed office is of no benefit to this House, or to patients in those institutions. Will he now address the serious problem of patients at present in institutions who may not be transferred to community care? I refer to those in special hospitals and to mentally handicapped people. Is the Minister satisfied that the necessary resources, particularly in terms of staff and ancillary facilities, are being made available?
I disagree with the Deputy, I do not believe that the short history — and remember I have been in office for 16 months only — of service delivery is unsatisfactory but I intend remaining in office for a long time.
I realise it is of great concern to patients. I have been glad to visit health institutions all over the country to hear the concerns not only of patients but of staff over the past 16 months. Further resources are being made available to improve our health services, and I am also gratified by the very positive response to the national health strategy which forms a framework for health service delivery——
——in four years' time?
I know the Deputy does not want to acknowledge it but it is happening. I know he is afraid of being consistent when some of his colleagues demand substantial cuts in public expenditure. However, I agree that elements of the psychiatric services need extra resources. Those working in the psychiatric services certainly would be more content with the capacity of the current administation to provide those resources than they were with the previous one.
Whatever about resources intended for these services, will the Minister say whether the report of the inspector of mental hospitals has been published and, if not, why?
That is a specific question about which I do not have details in front of me. I am determined to have last year's report completed and published this year; that would mean the publication of three reports within 18 months. Indeed I have expressed within my Department and publicly my dissatisfaction at the gap. That matter is now being addressed.
That concludes Question Time for today.
