Vol. 499 No. 1
69 Ms McManus asked the Minister for Health and Children the plans, if any, he has to avoid widescale hospital bed closures during 1999, as happened in 1998, while hospital waiting lists continue to grow; his views on whether there is a serious problem with productivity in hospitals; his further views on the adequacy of the current level of funding to meet the health needs of public patients; and if he will make a statement on the matter. [1922/99]
In considering the delivery of service in the acute hospital sector, it is appropriate to examine the overall level of service provided in the sector rather than to simply focus on the number of beds available at any given time. This reflects major changes that have been taking place in medical practice, resulting in reduced average in-patient lengths of stay, a continuing shift in the delivery of care from an in-patient to day case basis and the increasing provision of treatment at out-patient level.
In developing and delivering service plans, the implementation of an appropriate mix between in-patient, day case and out-patient care is a major consideration for local management in seeking to maximise overall activity. As part of this process, activity in the acute hospital sector is planned over a 12 month period having regard to anticipated levels of emergency admissions and the overall resources available. In achieving the activity targets set out in the annual service plan, temporary bed closures would form a part of the normal bed management function performed by local management as part of their efforts to optimise the overall activity delivered within the resources available. They also, of course, facilitate staff annual leave, refurbishment works and the scaling down of elective activity at times of low demand, such as the high summer period and at Christmas. I am confident, however, that, given the level of increased funds I have made available to the acute hospital sector this year over last year, the level of temporary bed closures will be kept to a minimum.
The total number of discharges, both in-patient and day case, in the acute hospital system for the period January to October 1998 was 676,635 which was an increase of over 3 per cent over the same period in 1997. In other words, irrespective of any temporary bed closures that occurred during that time, over 3 per cent more patients received treatment in our acute hospitals. It is in this context that the performance of acute hospitals in 1998 should be judged. In agreeing service plans for 1999 with agencies in the acute hospital sector, my fundamental concern is to ensure that they will again deliver a level of service to patients commensurate with the funding being provided to them.
The ability of the acute hospital system to provide treatment to an increased number of patients in 1998 bears out my view that the system is continuing to perform productively. This is also evidenced in a recent OECD comparative study on health expenditure which found that hospital productivity here has increased significantly over the past 15 years. The report found that, over that period, the average in-patient length of stay had reduced by 29 per cent, better management of resources had allowed the average bed occupancy rate to rise to 85 per cent and the level of day care treatment had almost quadrupled since 1986.
As a result of a combination of these factors, the total number of cases being treated in acute hospitals in Ireland has been rising by 3 per cent each year since 1987, against a background of a reduction of in-patient bed numbers in the late 1980s. This again emphasises the inappropriateness of available bed numbers as an accurate measure of what is happening in the acute hospital sector.
While the OECD report makes it clear that the acute hospital system is being managed well, my policy is to ensure that the productivity of the system continues to be optimised to the benefit of patients everywhere. That means ensuring that the system is appropriately resourced to provide high quality services that respond efficiently, effectively and equitably to the needs of the population.
In this regard, I have provided additional funding of almost £71 million in 1999 to meet the cost of specific acute hospital service developments in areas such as accident and emergency services, cancer services and cardiovascular services, to commission new units completed under the capital programme under which investment is now at a historically high level, to meet costs associated with rising birth rates, to replace medical equipment and to seriously address the problem of unacceptably lengthy waiting times for particular procedures as part of my strategy of implementing the report of the review group on the waiting list initiative. The strategy in the waiting list review group report is a comprehensive one aimed at addressing the problem of hospital waiting lists in a broad based approach which also encompasses the primary health and continuing care dimensions of the problem.
I am conscious of the conflict between available resources and the competing demands for ever increasing expenditure on health and social services. In recognising that, the scale of increase in overall resources devoted to the public health services in 1998 and 1999 reflects the strong commitment of this Government to addressing the genuine needs that exist. In 1999, non-capital expenditure on health will be £3.4 billion, an increase of approximately 10 per cent on the 1998 outturn level when hepatitis C compensation payments are excluded. This follows on a similar increase of 7 per cent in 1998 over 1997.
When considered in the context of overall Government spending policy, these significant increases represent a major statement of priority on our part. In working with health boards and hospitals to maximise the impact of this investment on the health and social status of the population, it is my intention to continue to develop services and to seek improvements wherever possible in the delivery of care.
Does the Minister not accept that he is a member of a Government which undertook in its programme for Government to tackle the waiting lists? Given that commitment, he cannot stand over a situation where waiting lists are escalating while the forthcoming year will see the closure of beds purely for budgetary reasons. This is, essentially, what the Minister has said.
It is not.
Does the Minister not accept that, allowing for the fact that there will inevit ably be bed closures for refurbishment and so forth, he is now saying that bed closures will be used as a financial mechanism to be turned on and off, particularly where budgets are already under what is required? Tallaght Hospital is one such example. Does he not accept that where the budget for this year is £4 million below what is required, there will be bed closures? The public simply cannot believe that a Government can stand over the loss of beds when people are sick and dying for want of an operation.
The Minister's general attitude is unacceptable in terms of looking at previous Governments and what was done in the past. I wish to cite the example—
The Deputy must ask a question.
I ask the Minister to consider an example, which the Leas-Cheann Comhairle will appreciate in his professional capacity. At a time when beds were being closed, a patient with pancreatic cancer – one of three such patients – was obliged to wait three months for an operation. That would not have happened 20 years ago.
I ask the Minister to look again at his policy of refusing to provide beds at 100 per cent capacity when people need them, purely because of financial and accountancy problems which he does not appear to be able to solve.
On her first day as her party's spokesperson on health the Deputy asks me not to compare the performance of this Government with that of previous Governments. While it might make the Opposition uncomfortable, I intend to continue to do so, simply to put the scale of the problem in context. It will also allow people to decide about who is making the resources available to deal with these problems. I will continue that practice regardless of how uncomfortable it makes people feel. I am sure we could have a good debate about it.
The Deputy referred to the widescale closure of hospital beds. There is never a widespread hospital bed closure programme during the course of a year. The number of bed days lost is a small percentage, in management terms, of the overall capacity of our hospital system. It is 3 per cent or 4 per cent at the maximum over the course of a year from 1 January to 31 December.
The Deputy asked why there should be bed closures given the existence of waiting lists. The Deputy has the report on the waiting list initiative and knows when the under funding started. She will also be aware that the rate of increase is slowing down to the extent that we now have a strategy to deal with it, which did not exist previously. I will take my hat off in some respects to some Deputies opposite from smaller parties in Governments who could make their presence felt. It is amazing that the funding for the only public patient initiative was reduced when Democratic Left and Labour were in Government. It is amazing that people in that Government who claim to have greater care for public patients over private patients would allow real cuts in the waiting list initiative allocation during the period 1995-7. That would jolt the ordinary man in the street and it may be one of the reasons that party is on the other side of the House.
Since coming to office we have provided a 50 per cent increase in the first year. I intend to spend £20 million on the waiting list initiative, specifically in relation to surgical procedures, apart from the extra £9 million for services for the elderly this year, as part of our comprehensive approach to dealing with the issue of getting more public patients dealt with. That is the reality. Some two and a half times more money will be spent under this Fianna Fáil led Government than was the case under the waiting list initiative in 1995-7 when Democratic Left and Labour were in Government. At that time a Labour Minister for Finance oversaw three budgets with a total public expenditure programme of £40 billion.
I will continue to make those political points because they are valid and objective facts and allow the people to understand exactly who is putting in the commitment and who is matching resources with rhetoric. I will not be pigeon-holed or stereotyped by political opposition at any time. I will let the facts speak for themselves.
On the question raised by Deputy McManus, we still have a persistent, if understandable, suggestion from the Opposition, for rhetorical reasons or for political reasons, that there are cutbacks in the health service. It is becoming tiresome when members of the media are not prepared to ask them where is the cutback in the health system that is providing for a greater level of activity, as statistics show. The number of procedures carried out and the number of patients dealt with in our hospital system was greater in 1998 than at any period in the history of the State.
A phenomenon every Minister for Health has to face in every democracy I am aware of where there is an advanced health care system is that the level of demand continues to increase. In the case of infinite expectation and finite resources which the Labour Party and Democratic Left found was as much a political reality in Government as in Opposition, there is only a certain amount of money to go around. That has been an increasing cake under this Fianna Fáil-Progressive Democrats Government at the unprecedentedly high level of £3.4 million this year. An objective argument could be made at any time for increased resources for the health sector. This Government has provided a 10 per cent increase this year and a 7 per cent increase last year at a time when overall public expenditure policy is 4 per cent per annum. That shows that we are putting more money into the health services and that it is an absolute priority. That is not to say there are not problems or that there will not continue to be problems. We are putting more money into the health services and we will continue to do so in both current and capital services.
Is the Minister aware that a 3 per cent increase in procedures on average in our acute hospitals does not reflect the need for the total number of increased procedures, in the context of the increase in the population and the longevity of the aged? Is he aware of a widespread and developing view that he is not competent to manage the health services? Is he not aware that the more he shouts and bulls in this House, the less convincing he becomes in persuading people he is on top of the job he has been appointed to undertake?
I am sorry the sensitivities of the Deputy opposite are upset because I am prepared to state my case candidly.
Talk about people and patients.
I represent people the same as Deputy Shatter. The Deputy has lowered the level of his argument to the tone of my voice. I do not shout but I will make my point as persuasively as I can. I am not shouting, snarling or barking but speaking. I do not refer to any of his physical attributes in that respect. The Deputy may not like my accent but it is the one I inherited and I am proud of it.
The number of day cases has quadrupled since 1996. There are 250,000 people undergoing a procedure. Formerly they would have had to stay in hospital overnight or for a number of days but they can now be treated on a day case basis. In 1990 there were 125,000 such people, there are now 250,000.
The simple reply to the question put down by Deputy McManus is that the role of our acute hospital sector is changing. The type of service provided in 1998 is not the same as that provided in 1988 or previously. The reasons are the impact of technology, a greater number of procedures, a greater ability to recover because of the type of procedures being used and the level of care and professionalism provided in our health services. This is much to the credit of those who work in the health service.
If the Deputy is asking why X number of beds this year and X number of beds last year should mean different levels of activity or that we are not committed to the health service, she is not taking into account the changing nature and role of the acute hospital sector in the development of the health service generally. On the question of why public patients are on the waiting list, one of the reasons, as outlined by the people I asked to investigate the matter, is that there are inappropriate placements in the acute hospital sector, which constitute 4 per cent or 150,000 bed days per year and which, if available, would help get more procedures through the system.
Despite what the Deputy has been trying to say to the public for the past two weeks, there is a strategy. I am making allocations, not on the basis of anecdotal evidence as was the case with my predecessor, but on the basis of a comprehensive overview, the first which took place in relation to that initiative since 1993. Increased resources are being provided.
In 1999, some £25 million in additional money was provided for services for the elderly. In 1997, the rainbow coalition provided an extra £3 million for services for the elderly, none of which was for new developments but rather to cover the extra cost of existing developments. I will not take lectures from the Deputy about concern for the elderly, based on that response. I am prepared to defend my position and the position of this Government.
A Cheann Comhairle—
I have a brief supplementary question.
I suppose I have to welcome the verbosity of the Minister since he has been absolutely silent for the past six weeks when we had a crisis in accident and emergency units. He has found his voice again.
A question please, Deputy.
My accountability is to this House.
It is my turn now. The Minister has had more than his fair share.
I was not silent for six weeks.
This is verbal diarrhoea.
I was not anywhere for six weeks.
Just let me speak, the Minister has had his opportunity. Maybe it is time for the Minister to start listening.
I ask Deputy McManus—
On a point of order, I was not anywhere for six weeks. This is another lie nailed by the Opposition.
This is shameful. The Minister seems to think he can solve every problem by bluster. I want a real answer from the Minister. I do not want to hear what is going on all around the House, I want a straight answer for a change.
Will Deputy McManus ask a question please?
I will ask a question. There is increased productivity. Will the Minister tell the House who is benefiting most, the public patient or the private patient? Is he aware that we are now in a totally new scenario in which public patients, for the first time in my recollection, are being prevented from putting their names down on a waiting list to see a consultant? That is no one's fault but the Minister's. He cannot blame the past. This has not happened before. Consultants are actually closing the books on public patients who want to see them and those patients do not know how long they will have to wait, whether it will be months or years. They are not even given the chance to know that much.
I will answer the question. First, there is no evidence in the Department to support that suggestion.
The Minister does not know the answer.
Second, the medical card holding population represents 32.5 per cent of the population and as a result of our improvements in the eligibility limits for those over 70 that will rise, again a welcome initiative by this Administration.
Over 40 per cent of in-patient procedures, over 41 per cent of the total procedures, involve public patients. As a result of my negotiation of the consultant contracts, there are far more specific obligations on consultants to ensure that the 11 sessions for which they are contracted for public patients are abided by, and hospital management are to ensure that is done. The evidence suggests that there are many who exceed that base requirement. There are others of whom the same could not be said but I do not accept the point that in some way public patients will not get a better deal under this Administration.
I reiterate that the only public patient initiative which exists to ensure that public patients get more resources is the waiting list initiative, which we have increased by 250 per cent over that available under the previous Administration.
Will the Minister acknowledge that since he took up office, waiting lists have escalated with the announcement of every set of quarterly figures? Will he also acknowledge that waiting lists continued to spiral from September 1998 to 31 December 1998? Is the Minister in a position to tell the House the total number of people on the in-patient hospital waiting lists as of 31 December 1998? If the Minister does not have that information as we come to the end of January, why does he not have it?
The reason I do not have that information is that the agencies are given at least six weeks in which to bring forward that information and then it has to be compiled. The same situation existed in my predecessor's time. If the Deputy reads the report on the waiting list initiative, he will know that the cause for the spiralling of waiting lists from 1995 to 1997 by 33.3 per cent was precisely that—
I am asking about the current position.
I am quoting the report. The Deputy does not want to hear the facts. He can stick with his perceptions, I will deal with the facts.
The lists have increased by 10,000.
The figure went up by one third as a result of the money made available by the last Administration, ending up at 32,000 people at the end of 1997, based on the waiting list initiative money allocated by Deputy Noonan in 1997. The present figure is 35,000.
The Minister had all the answers in Opposition.
As a result of the £20 million we are putting in this year, two and a half times the amount Deputy Quinn provided when he was Minister for Finance in 1997, together with £9 million extra for services for the elderly, we will reduce that figure. I confidently predict that, if we can maintain industrial harmony in our health sector, the figures will greatly improve.
Deny that waiting lists will go up further.
Is the Minister aware that the waiting list figures at University College Hospital Galway stand at over 4,000, more than twice the figure of 19 months ago when he became Minister? What will he do about that?
The number the Deputy gave is incorrect.
It is correct.
Between 1995 and 1997, the Deputy's party in Government gave £1.6 million to University College Hospital Galway. Since we came into office, the Minister of State, Deputy Fahey, and I have authorised a £60 million capital programme to provide a hospital fit for a city the size of Galway, something about which the Deputy knew nothing when he was in Government.
Written Answers follow Adjournment Debate.
