Dáil Éireann debate -
Thursday, 10 Apr 2003

Vol. 565 No. 2

Adjournment Debate. - Hospital Services.

Mr. Costello

I seek an explanation of the dramatic reduction in hospital services across the board in the Dublin metropolitan area, particularly in the Mater hospital in the Taoiseach's constituency. All we seem to get from the Government is the suggestion that the Minister for Finance is imposing the hatchet, which bewilders the Minister for Health and Children, who is critical of the Minister for Finance. They have had a public spat in the media which the Taoiseach denied. The Taoiseach himself seems helpless when it comes to a hospital in his area, though that is the hospital which employed him when he was a civilian, so to speak.

If there are 120 bed closures, which is over 20% of the Mater's total capacity, one cannot but have a massive reduction in services and staff as well as the ability to bring in patients, from long-term patients on waiting lists to accident and emergency patients. All those services have been affected in the Mater and in other Dublin hospitals. That will lead to demoralisation in the services; such a traumatic effect on a hospital's ability to provide the service it is used to providing means it is hard to get back to a situation where there is proper trust and credibility, not to mention morale. That is the danger of the present situation. A month ago an accident and emergency case was treated in the car park of the Mater; we cannot go on with that situation.

I am dealing with the case of a double amputee at present who has been in the Mater for nine months and has nowhere to go. The local authority has no interest in providing any essential repairs and the Mater, in the best interests of the hospital, can see the patient has no future if released. That is the kind of hard choices the hospital is finding very difficult, as are hospitals all over the country. There are no proper community services nor is there proper integration of health and accommodation services, particularly when specific adjustments must be made to homes and the local authority cannot act due to the cutbacks.

The Government took office on a promise of eliminating the hospital waiting lists within two years. That now sounds like a sick joke, as the waiting lists will probably double in size within two years. Why has there been such a dramatic reduction in services? Why has the situation become so drastic in the Mater, the oldest hospital on Dublin's northside?

Mr. B. Lenihan

I will address the matter raised by the Deputy, but regarding waiting lists, the operations of the national treatment purchase fund have resulted in reductions on some waiting lists.

Regarding the Dublin hospitals, as the Deputy is aware, the Eastern Regional Health Authority is charged with responsibility for commissioning health and personal social services on behalf of the population of the region and also on behalf of those outside the region who are referred for specialist treatment. The approved level of spending nationally for health services in 2003 is in excess of €9 billion. Of this, over €500 million relates to capital spending, with the remaining €8.5 billion available for revenue spending.

While this level of funding is very significant, it is recognised that the authority and the health boards have had to take some difficult decisions in the current year on their service provision and priorities. Nevertheless, it must also be recognised that even in the prevailing economic climate, the health services have once again received the highest increase in funding across all Departments, a clear indication of this Government's commitment to maintaining the quantum and quality of services in difficult economic circumstances.

The Eastern Regional Health Authority has a total of €1.154 billion available to purchase acute hospital services in 2003. This figure includes additional funding of €9.450 million to support the consolidation of acute hospital services agreed and funded in recent years. This is the basis upon which the authority developed and agreed its own 2003 service plan with the Department. Additional funding has also been provided to meet the costs associated with the recruitment of additional consultants in emergency medicine and consultant anaesthetists, and for cancer, cardiology and renal dialysis services.

The authority accepts that 2003 will be a difficult year for the acute hospitals sector, as increases in funding over last year will be limited. There is a clear need for tight management of cost and activity in 2003 in the context of working within available resources.

Discussions between the authority and the major Dublin hospitals to agree service provision plans for this year are well advanced. There are, however, some issues that still need to be addressed to ensure that the hospitals operate within budget. The chief concern of all parties has been to minimise the impact of financial issues on patient service provision.

The authority has emphasised that, at a minimum, the same total level of services which the ERHA approved for the Dublin academic teaching hospitals last year will be provided by the hospitals this year. However, because acute hospital activity in 2002 was significantly above the approved level, there will be a percentage reduction in some services this year to enable the hospitals to live within their 2003 funding levels. The hospitals are also planning to implement a number of cost-saving measures that will not impact on activity levels. The authority is confident that the planned level of activity is deliverable within a reconfiguration of bed capacity. All opportunities to maintain activity levels will continue to be explored by the hospitals and the ERHA, including substituting less expensive day-case work for in-patient activity and funding elective procedures from waiting list funding. The overall mix will reflect a more efficient and cost-effective throughput of activity.

I point out that additional funding was made available to the Eastern Regional Health Authority this year for cancer, cardiology and renal services. The authority has indicated that these essential services will be protected at the 2002 approved levels. The authority and each of the major Dublin hospitals will continue to work together to ensure that in delivering services, the availability and standard of patient care is accorded the highest priority.