Senator Killilea has until 8.20 to make his case. The Minister has ten minutes to reply. I want no interruption.
Adjournment Matter. - Western Health Board Budget Allocation.
I appreciate that. I want to say at the very outset that I appreciate your kindness towards me in this very important matter, a matter that is very relevant to the people of the west of Ireland. It is significant that at this stage both Houses of the Oireachtas are simultaneously discussing health cuts and obviously it is a matter of great feeling throughout the community. My subject is quite specific because I am speaking exclusively about one health board, the Western Health Board. So that all Senators may understand the predicament in which we find ourselves in that health board, I want to give a brief outline of the situation at this moment.
When the budget for 1985 with the proposed cut-backs of £4.4 million was presented to the Western Health Board about December last they saw the danger signals and they could foresee that it was impossible for them as a board to implement those cuts. The sanctions that we as a board were expected to implement were, to put it mildly, rather severe. The CEO of the Western Health Board explained the situation to the board and said we had a projected loss of approximately £4.4 million.
£4.04.
I thank Senator Higgins. It is a very important point. I would refer to the facts as submitted to us by the CEO at that original meeting. He gave us the figures of the shortfall going back to 1979 with the most relevant ones from 1983, where we had a shortfall in the three years of the Coalition Government, under the present Minister for Health, Deputy Desmond, of £9.49 million. We had got increases in our budget over those three years of approximately £8 million. That gave us about 25 per cent of the total increase that would be needed to meet inflation over those three years. That is the relevant point.
I do not want to become political about this matter because I want to outline to the Seanad tonight — indeed to the Minister present although I am sure he is aware of it, not certainly from anything I have said but through his knowledge of the working of the Department — the position of the Western Health Board. We found it impossible to go through the motions of making this cut. Our CEO gave us four options by which we could save the £4.04 million and he explained the seriousness of them. The first was that the Sacred Heart Homes in Castlebar and Roscommon and St. Brigid's Home in Loughrea should be closed. That was Option A. Option B was the closure of St. Patrick's Psychiatric Hospital in Castlerea and two homes for the aged. Option C was either closure of three of the board's district hospitals and a complete shutdown of the ambulance service. Option D was the closure of the Roscommon County Hospital and St. Anne's Child and Family Guidance Centre at Salthill, Galway. Option E was the closure of all the board's homes for the aged, plus St. Brendan's Home, Loughrea plus St. Anne's Child and Family Guidance Centre, Galway and the District Hospital in Clifden. That is what was presented to us if we had to apply the cuts; it meant adopting one of those options. That to me is a serious situation.
(Interruptions.)
I think you rejected them.
I am coming to it. The Western Health Board unanimously rejected all of those suggestions. The fact of the matter is that we are still £4.04 million short.
Mr. Higgins
You did——
Senator Killilea without interruption.
As a responsible board we proceeded to request a meeting with the Minister for Health last December. We got no response to that request and at the January meeting I suggested that we send a telegram to the Taoiseach, the Chief Executive of this country and ask him if he would ask the Minister for Health to meet us. We got a response to the telegram in writing for the following meeting which said that the Taoiseach had arranged with the Minister for Health that a few officials from the Department would meet the CEO and the four programme managers. That was not acceptable to the board at all because we were performing a public function. We made another proposal to the Taoiseach that he might use his influence with the Minister for Health to meet us. We got an acknowledgment of the letter; we got no response to our request. Reluctantly, the Western Health Board, on a vote on the issue of whether we would accept the cuts or not last week, rejected it by 13 votes to 11 and we are now at the mercy of the Minister as to whether we should be abolished as a board. I am speaking on behalf of many members of the board of all political persuasions. A man for whom I have tremendous respect and whom I admire for his contribution here on other isssues this evening, Senator Higgins, voted with me and many other members on a proposition by a Fine Gael member of the health board not to accept the cuts. That is something new. It was an honourable performance by a very honourable board. The professional medical people responded consistently in a very fair-minded way. They accepted cuts last year and the year before and played their role admirably. But they certainly could not at this stage accept this new burden.
I must commend the board and the CEO for their patience, endurance and tenacity in trying to resolve this problem with the Minister for Health. The Minister for Health did not see fit to meet the Western Health Board to discuss this problem. Rumour has it that he sent down a bevy of officials this week from the Department of Health. I believe there was no one left in the Department even to answer a telephone call: they were all down in the west trying to resolve the problem of the health board. I may thank people like Councillor Joe Burke and Senator Michael Higgins who brought that response. I do not know what we will get from it. The Minister from the constituency who is here tonight, was, I suppose, sent in by the Minister for Health because he himself funked coming into this Chamber. This is a scruffy response to a very reasonable plea.
(Interruptions.)
I do not think "funked" is a word that should be used.
"Funk" is a word that can be used for a man who has no courage: the Minister for Health certainly has no courage. If you or anybody else can find a more appropriate word I will withdraw it. Perhaps Senator Michael Higgins may have a nicer word.
I believe the Senator is operating within a limited vocabulary.
But it is a very clear one. Now we are faced with the seriousness of it. We were faced at the last three or four meetings, on account of these savage cuts, with the prospect of having to close the TB Unit 1 in Merlin Park Hospital. It was rejected practically out of hand. We have the situation which the Minister present knows about concerning the maternity wing of the Regional Hospital — not a "bob" despite the promises made by him and by his secretariat at a health board meeting last year when he came to meet us.
We have the situation concerning the CAT scan in the Regional Hospital in Galway. We made a plea for the aged people who are in our long term homes to give them £1 a week of an increase which would cost £100,000 next year. The Department of Health or the Minister for Health — not Minister Donnellan but Minister Desmond — wrote back and said, "If you want to give them £1 a week, find the money yourselves". We have not enough money to keep the hospital running. That is the situation we are in.
There were many other suggestions by the CEO in his efforts to try to sort out the situation. He went even further at the last meeting and made certain reasonable suggestions. We resent any effort by any Minister for Health of any Government to attack or bring down the framework of the services of the health board in the west, or indeed any health board, but particularly our own. If the day has come when we must close a service like that which we have given in Unit 1, the TB Unit of Merlin Park Hospital, I and many members of the health board want nothing to do with it as public representatives. We spent too long trying to build up those services and we will not have a Minister coming in here to ask us to abandon them. That is the situation we have been placed in. I appeal to this House, just as others are appealing in the other House tonight to ask the Minister to bring sanity back into his whole performance in health matters. His attitude towards the west, and towards the Western Health Board in particular, leaves a lot to be desired. As Senator Michael Higgins said, it is like a war of economic attrition against the people of the west to prevent them from continuing the services that they so desperately need.
There are Senators here tonight who are members of that board and they realise that every word I speak concerning this matter is true. When the gun was put to their heads the board decided they could not implement the cuts and in fact by that vote placed themselves in a situation in which they can now be abolished by the Minister. What is going to happen? Has the Minister present been told by his Minister, Deputy Desmond, that he is going to facilitate us in some way to take us out of this impasse? I ask him as Minister and as a Deputy who in his time served the people of all County Galway, will he allow the Minister for Health to walk on top of us and continue to walk on top of us in the west of Ireland? He is a man without compassion and a man who has said he has no compassion for us during his infrequent visits to our district.
That is not fair.
It is fair. The Minister for Health has met the North-Eastern Health Board four times this year. Why could he not come to meet us just once to listen to our case, which is a genuine case? Why does the Senator say it is unfair? It is not unfair. It is a reasonable request to ask any Minister to come to speak with us when we have such a problem.
I say it is unfair to say he is without compassion.
He is without compassion. Tell me one compassionate act he has done for us. We have the hospital in Castlebar up in a heap. We know about it. We have the CAT Scan in Galway and no money for it. We have the maternity unit in Galway and no money for it. We have areas in the health board where we have not enough money to keep the services going for 1985. Where is the compassion of this Minister? He is an absolute disgrace to the health service. These services were hard-won by many members, some of them present, some of them long since dead and gone. He has brought the health services of the west of Ireland to an appalling condition. Public representatives, medical people of renown, not alone nationally but some of them internationally, have pleaded with him to come and discuss the situation. I beseech the Minister, particularly as a man who has served all the county, to go to the Minister and to go to the Taoiseach and assure them that we are not insane people in requesting that the viability of our health services be maintained.
I am glad Senator Honan is going to contribute. She will be the first woman in Fianna Fáil to contribute on family planning.
If we had less of the family planning and a little more of the services that we already have, we might be better off as a nation. Family planning has very little relevance to the facts I am giving.
The Senator should stay within the terms of the motion.
Family planning has taken the attention of the public away from the real facts and the real facts are as I have stated. We have a health service in the west of Ireland, in the most westerly part of this island which is stagnating and retarded by the attitude of a Minister and, I must say by the attitude of the Coalition Government. It is a deplorable position. I think the health of the people already in the world is far more important than the prevention of bringing them into the world, which seems to be the topical subject for the last two weeks, within this House today and in the other House last week and, indeed, throughout the country. I ask the Minister of State, Deputy Donnellan, if he is worth his salt — he should be worth some sort of salt — to go to this Government and plead with them and with the Minister for Health for a change of heart or else let him resign from his post as Minister as a serious protest against the attitude of this Government, just as his fellow Fine Gael councillors, his fellow Coalition partners cast their votes last week in the health board to abolish themselves on a matter of principle.
The Senator's time is up. I ask him to resume his seat.
I beseech Minister Donnellan at this late stage to put some sanity into this crazy Minister who seems to have no understanding of the needs of the health services.
I think you should withdraw the word "crazy".
Sorry, I withdraw it.
It is not my intention to follow the example of Senator Killilea. The non-capital allocation which the Minister approved for the Western Health Board for their direct expenditure is £110.17 million. This compares with an original allocation of £105.13 million for 1984. The Western Health Board's situation is no worse than other boards. Incidentally, I would like to compliment boards who have already approved of budgetary arrangements for 1985 within the resources available. They have displayed the degree of responsibility and co-operation that is needed in these difficult times. I would like to pay tribute to the Western Health Board's management team who obviously with skilful management of resources, succeeded in reducing substantially the potential overrun for 1984. Unfortunately, there was an overrun which is a substantial factor in the board's difficulties in 1985. It was, however, made clear to all boards in 1984 that no funds could be provided to meet expenditure overruns in that year.
On 16 November last the Minister met the chairman and chief executive officers of health boards in Newbridge, County Kildare. He explained in some detail to them the main thrust of the National Plan in so far as it related to the health services and to the necessity to plan expenditure for the years 1985, 1986 and 1987 within the resource levels which will be available for the health services. He pointed out that the liability which the Government are prepared to accept in respect of expenditure on health services in each of the three years was identified in the national plan. Accordingly, the allocations for the health boards and other health agencies had to be determined at levels which reconciled with the Exchequer's commitment in each year. He emphasised that no additional funds beyond those provided in the national plan would be available to him and that he was expected, as Minister for Health, to ensure that the health policies set out in the plan were achieved within the expenditure limits which had been settled.
At the Newbridge meeting the Minister referred to the need for health boards to draw up action plans setting out how it was proposed to plan expenditure and services in 1985; in particular, to ensure that the approved allocation levels would not be exceeded. He asked that these action plans be submitted to his Department. He envisaged that discussions would then take place with officers of the Department and the health boards in regard to the details of the plans and the services implications of measures which the boards considered necessary to implement. I am pleased to report that three health boards, namely, the Midland, the North-Eastern and the North-Western——
Tell us about the Western Health Board.
I am just coming to it and I have some very good news: it may not be satisfactory to the Senator. These three boards have agreed budgetary proposals for 1985 aimed at delivering their services in a satisfactory way within the approved allocation levels. A fourth board, the South-Eastern, has made good progress in deciding on the measures needed to achieve the same objectives. Discussions are in progress between senior officers of the Department and the management team of the Southern Health Board where good progress has been made in arriving at conclusions as to how best the situation can be coped with. Discussions took place on Tuesday between officers of the Department and the management team of the Western Health Board at which substantial progress was made. I understand, as a result, the chief executive officer is preparing a report to his board for a meeting next Monday which — hopefully — will enable the board to agree on an operational budget. But Senator Killilea and people like him present at the meeting will probably turn it down again.
Do not invite interruptions.
When the Minister was originally asked to meet a deputation from the Western Health Board he did not refuse to do so but he felt that it would be more advantageous to arrange discussions initially between senior officers of the Department and the board's management team. Any further delay in agreeing on the budgetary arrangements for 1985 will make the situation more difficult to resolve.
In the circumstances I urge the Western Health Board to face up realistically to the situation and to give the necessary support to the chief executive officer and its management team to enable them to set about making detailed arrangements for the control of budgets for the various hospitals throughout the services within the allocation levels assigned to it. I understand that the Minister is prepared to meet the board later on to discuss progress in adhering to targetted levels of expenditure and to discuss specific problems arising in the area if the board wish to do so.
For the information of the Seanad and particularly for the information of Senator Killilea, I should like to give an example of the number of people that are employed in the Western Health Board. For instance, in 1974 there were 4,295 people employed there and today there are 6,348 employed. The cost of running the Galway Regional Hospital is a little over £26 million. The number of people employed there in 1974 was 1,074 compared with 1,448 today. In Merlin Park Hospital in 1974 there were 523 people employed; today there are 667 employed there.
Senator Killilea referred to the CAT scanner in Galway. I should like to remind him — and I think he was a member of the board at that time — that this was not a priority with the Western Health Board. I suggest to the Senator that if he requires fuller information as to how it arrived there he should contact the then Minister for Health, Deputy Michael Woods.
I should like to give, for the information of the Seanad and for the information of Senator Killilea in particular, the cost of the health services in the country in general. For instance, in a voluntary public general hospital the average cost per week is £871.48; in a voluntary special hospital it is £802 per week; in a regional hospital it is £842 per week; in a county hospital it is £647 per week; in a district hospital it is £287 per week; in a long-stay district hospital it is £287 per week; in a health board long-stay geriatric home it costs £159 per week and in a health welfare home it costs £85.90p per week.
The cost of the health services in 1973 for the entire country was £143 million; the cost in 1984 was almost £1,100 million. The number employed in the health services in general in 1970 was 40,000 and in 1984 the number was 60,000. The amount of money the Western Health Board received in 1980 was £73.39 million and the amount they are given today is £110.17 million. I would advise Senator Killilea——
There is no need to advise me on this.
— to participate actively — the Senator could do with some advice — in Galway County Council and as Senator because at the rate the Senator is carrying on he may not be in there too long.
The Minister should not encourage interruptions.
The Senator is more interested in gallivanting around the world on some type of junket or another.
(Interruptions.)
The Minister should not encourage interruptions.
If Senator Killilea is going around the world, he is not gallivanting.
The Minister, without interruption.
There are one or two members of the Western Health Board who have tried to make this matter a political issue.
(Interruptions.)
The Senator is the product of a political party who may know where they came from but certainly do not know where they are going. The results of the last week prove this. For total proof of it the Senator should listen to the comments by Deputy O'Malley on RTE Radio this morning on "Good Morning Ireland". It is clear from the figures which I have quoted that there is a massive amount of money being spent by this Government on the health services and the Western Health Board gets its share of this.
The Seanad adjourned at 8.25 p.m. until 10.30 a.m. on Thursday, 28 February 1985.