Dáil Éireann debate -
Thursday, 22 Apr 1999

Vol. 503 No. 5

Written Answers. - Hospital Services.

Bernard J. Durkan

Question:

109 Mr. Durkan asked the Minister for Health and Children the degree to which general hospital service needs are met; if these needs have taken cognisance of demographic changes; and if he will make a statement on the matter. [10652/99]

Minister for Health and Children (Mr. Cowen)

I am pleased to say that I am providing revenue funding of £1.679 billion in the current year towards the provision of a comprehensive general hospital service. This figure represents an increase of £151 million or 10 per cent over the provisional out-turn for 1998. Included in this amount is £20 million to tackle waiting lists, £17.3 million for general service developments, £11.5 million to new unit facilities, £6.7 million to support a range of developments under the cancer strategy and £5.5 million under the cardiovascular strategy. The increased level of resources is indicative of the commitment of this Government to investment in provision of a quality health service.

I am also pleased to report that a three year programme of capital investment for the period 1998-2001 will see an additional £525 million invested in the health services compared to the 1995-1997 period when only £309 million was spent.

On taking office I recognised the urgent need to invest additional capital resources in the development of the health service infrastructure. In this regard I am pleased to report that a package of major hospital developments – which are at construction or planning stage – will be funded in 1999. These include the Mater, St James's Hospital, Naas, St Vincent's, Elm Park, Limerick Regional, Tullamore, Portlaoise, Clonmel, Cashel, Mayo Portiuncula and University College Hospital, Galway. I am also providing £10 million in the current year towards the cost of replacing medical equipment and for minor capital works in the general hospital system.

In terms of activity, the number of patients treated annually in the general hospital system continues to rise. Provisional figures for last year indicate that some 540,000 in-patients were treated in public hospitals. A further 270,000 patients were treated as day cases, an increase of 8 per cent over the previous year.

One by-product of advances in medical technology is that people are living significantly longer. This means that they are likely to continue to present for treatment, often for unrelated illnesses, as they grow older. On average those over the age of 65 years consume four times more hospital and community resources than the rest of the population. The National Council for Older People has projected an increase of nearly 30 per cent in the population aged over 65 from 1991 to 2011 and, even more significantly, an absolute increase from 74,000 to 130,000 in the number of persons aged over 80 years in the same period.

At the other end of the age structure a significant increase in the number of births is now taking place. In 1997 there were 52,000 births which was 4,000 or 8.5 per cent up on the 1994 number. There is evidence that this increase is continuing and putting additional pressure on maternity and paediatric units.

Therefore, the changes in demography which are particularly pronounced in relation to the very young and the old are placing significant pressure on health care costs because these two groups are the most intensive users of hospitals and other services. Against this background I was very pleased that for the first time a sum of £2 million was included in my Deparment's Estimate this year specifically in respect of demographic pressures.

It would be my Department's intention to continue to refine the extent to which demographic pressures are taken specifically into account in agreeing the level of funding to be made available for the health services.

Bernard J. Durkan

Question:

110 Mr. Durkan asked the Minister for Health and Children the degree to which special hospital care and needs are being met; the extent of the projected needs in these areas as set out by the voluntary organisations; the degree to which it is proposed to address these needs in the short-term; and if he will make a statement on the matter. [10653/99]

Minister for Health and Children (Mr. Cowen)

I assume the Deputy's question relates to special hospital care and needs in the psychiatric services.

The policy governing the provision of psychiatric services, including in-patient care in psychiatric hospitals, otherwise referred to as special hospital care, is based on the recommendations of the report on the development of psychiatric services, Planning for the Future, published in 1984. A key recommendation of the report which is central to psychiatric service policy is that all psychiatric hospital admissions, where possible, should be to acute psychiatric units attached to general hospitals. This policy is supported by voluntary bodies representing the interests of persons with a mental illness as part of a broad approach to the development of a modern psychiatric care through a shift in the provision of psychiatric care from a predominantly institutionalised service to one which is delivered to patients in the community and is integrated with other health services.

The development of acute psychiatric units attached to general hospitals is being actively pursued with a total of seventeen such units now linked to general hospitals and a further ten units in the planning stage of development.

111.

Mr. Durkan asked the Minister for Health and Children the number of permanent residential places identified as being required in the special hospital services areas; the proposals, if any, he has to address this issue; and if he will make a statement on the matter. [10654/99]

Minister for Health and Children (Mr. Cowen)

I assume the Deputy's question relates to residential places in the psychiatric services and, in particular, to residential places in the community for persons with a mental illness.

The report on the development of psychiatric services, Planning for the Future, published in 1984 contained recommendations relating to the provision of residential accommodation for persons with a mental illness. These recommendations together with other wide ranging recommendations have formed the framework of successive Government policy on the development of psychiatric services. The report recommended, in 1984, that the requirement for community residential accommodation in a catchment area of 100,000 population with a backlog of existing long-stay patients would initially be approximately 100 places with one quarter to one third of these places in supervised community residences. The report estimated that the long-term requirement would be lower than this and would probably be in the region of 60 places per 100,000 population.

Considerable progress has been achieved since the publication of Planning for the Future in the implementation of the recommended levels of community residential places. In 1984 there were 121 community residences providing 900 places. In 1997 the number of community residences was 391 providing 2,878 places which compares favourably with the recommendations of the 1984 report.

In relation to the transfer of persons with a mental handicap from psychiatric hospitals, my Department, in conjunction with the health boards and voluntary organisations, has been engaged in a programme to transfer persons with a mental handicap from psychiatric hospitals and other unsuitable placements to more appropriate care settings. It has been the policy of my Department for some fifteen years that persons with a mental handicap should not be admitted to psychiatric hospitals unless they have an underlying psychiatric disorder which cannot be appropriately treated elsewhere.

In 1996 the national intellectual disability database identified 329 people with a mental handicap in psychiatric hospitals who had been assessed as requiring a transfer to more appropriate placements in the mental handicap services, and a further 634 people who were assessed as being appropriately placed in their current service. Updated information in relation to 1998 will shortly be available, with a further report on 1999 data due later this year.

Funding has been made available in 1999 to continue this programme and I will continue to address this issues in the future.