Priority Questions. - Hospital Accommodation. – Dáil Éireann (29th Dáil) – Tuesday, 24 Jun 2003

Priority Questions. - Hospital Accommodation.

Liz McManus

Question:

83 Ms McManus asked the Minister for Health and Children if his attention has been drawn to the serious concern expressed by staff and parents of patients at Our Lady's Hospital for Sick Children at the implication of the recent decision to close a 25 bed surgical unit at the hospital; if his attention has further been drawn to the fact that, if the unit remains closed until the end of 2003, it will mean 2,000 fewer procedures taking place; if he plans to provide additional resources to allow the 25 bed unit to be restored; and if he will make a statement on the matter. [17789/03]

Mr. Martin

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 level of services to be provided at Our Lady's Hospital for Sick Children in 2003 is, therefore, in the first instance a matter for the authority and the hospital, having regard to the level of resources available.

The approved level of spending nationally for health services in 2003 is over €9 billion. Of that, over €500 million relates to capital spending, with the remaining €8.5 billion available for revenue spending. While that level of funding is 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. This is 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. That figure includes additional funding of €9.450 million to support the consolidation of acute hospital services agreed and funded in recent years. That 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. There is a clear need for tight management of cost and activity in 2003 in the context of working within available resources. The chief concern of all parties is to minimise the impact of financial issues on patient service provision. 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 operate within approved 2003 funding levels. I am aware of the concerns expressed regarding the closure of beds at Our Lady's hospital. I would like to stress that all opportunities to maintain services will continue to be explored by the ERHA with the hospital management at Crumlin. The emphasis will be on ensuring that the availability and standard of care provided is accorded the highest priority.

I assure the Deputy of my commitment, and that of the authority, to the redevelopment of Our Lady's Hospital for Sick Children, Crumlin. I recently met with the New Crumlin Hospital Group, which is composed of parents of children who attend the hospital regularly. It was this group that commissioned the recent Pollock report on facilities at the hospital. As this House is aware, I have supported the establishment of a project team to advance the preparation of an outline development control plan for the Crumlin hospital site. I have also emphasised the need to address a number of key development priorities, including the areas of haematology/oncology, cardiology and the provision of the new MRI facility. I look forward to these developments being progressed over the coming months.

Ms McManus

Given that the Minister for Health and Children has declared a vote of no confidence in the Eastern Regional Health Authority and is setting out to dismantle it, will he consider giving a more informative and specific reply since he has ultimate responsibility for what happens in our hospitals? Does the Minister consider it acceptable that 25 beds, one in ten beds, in a major children's tertiary hospital are closed and, it appears, will be closed for the remainder of the year? It would appear that approximately 2,000 procedures will not be proceeded with. The ripple effect of these closures in the hospital is considerable regarding the care of desperately sick children. Does the Minister accept he has a responsibility to address this issue? Does he recall that at the Joint Committee on Health and Children he criticised the hospital for making this decision? He seemed to consider he was expert enough in the area of hospital management to declare it was wrong to close beds, but at the same time he refused to provide any alternative route to saving money for the hospital. He said at that time that he was working with the Eastern Regional Health Authority and the hospital in all these issues. What is the outcome of this work? How does he intend to ensure these beds are reopened and that no further bed closures occur in this hospital?

Mr. Martin

The announcement last week of the reform programme on health was not about no confidence in the Eastern Regional Health Authority—

Ms McManus

Yes, it was.

Mr. Martin

—and it would be wrong to assert that this was so.

Ms McManus

That is exactly what it was.

Mr. Martin

It is well known that the reform programme had its genesis in the health strategy and that people were asked to look outside the box and to come up with a greenfield solution to a structural reform of the health service which would help realise the objective of the health strategy. That is the context in which the reforms were presented. It was not a case of saying we will take out this board or that board as such an approach would be erroneous. Under existing legislation, the Eastern Regional Health Authority is the statutory authority and it has to deal with the agencies under its remit with an even hand. It also has to deal with the agencies in the context of the 1996 accountability legislation.

Some Members have expressed concern about that legislation and its impact upon services but nonetheless it is a real constriction on the ERHA and other health boards because there has to be some sense of dealing even-handedly with all the agencies under their remit. Some hospitals came in on budget while other hospitals significantly exceeded their budget. Most people would accept that if one took the view that we could ignore the 1996 legislation and signed a cheque equivalent to the amount by which hospitals had exceeded budget, clearly that would have implications for how other agencies and hospitals would manage their affairs. The 1996 legislation was brought in by the rainbow Government, supported by all parties and successive Governments which had a hand in the preparation and formulation of the 1996 accountability legislation but it has a real impact on how we manage. Its real impact is that it has to be used as a first charge on the following year's activities. I would be concerned in a hospital such as Crumlin, which is our national tertiary service for children, to see if the ERHA within its existing allocation can work with the hospital to try to resolve the difficulties to the end of the year within the context of the legislative framework I have outlined to the House. It should be borne in mind that activity levels in the hospital have increased very significantly in recent years—