Seanad Éireann debate -
Thursday, 22 Feb 1990

Vol. 124 No. 2

Adjournment Matter. - Health Research Board Funding.

Mr. Norris

I would like to welcome the Minister to the Seanad and to say that I do not propose engaging in what has become the national pastime, O'Hanlon-bashing. I understand some of the difficulties and constraints under which he operates, but this is a very particular problem which I sought to raise at a time when it was immediately critical and featuring in the newspapers. It was brought to my attention by the fact that the Provost of the university I have the honour to represent in the Seanad felt constrained to resign as a result of the cutbacks in funding to the Health Research Board.

The Health Research Board was established by the Minister for Health under Statutory Instrument 279/86 and commenced operations on 1 January 1987. This new health research board evolved from a merger of the former Medico-Social Research Board, which was established in 1965, and the Medical Research Council of Ireland (MRC), which was established in 1937. At the inaugural meeting of the HRB on 7 January 1987 the then Minister for Health, the then Deputy Barry Desmond, pledged that the level of funding for the new board would not be diminished and that, in view of the wide responsibilities being assigned to the board, additional funding would be sought to support its activities. That is the premise on which I am basing my argument.

I draw the Minister's attention to the fact that the chairman of this new board was, in fact, Professor Watts. He had a difficult job. He had the job of uniting two previously separate strands. In his difficult job he was given an undertaking, that undertaking, admittedly, having been given by a member of a previous Government. I do, however believe that the present Minister for Health is at least morally bound to continue the commitments that were given. Indeed, in the letter — sections of which I propose to read into the record — from Professor Watts where he tendered his resignation from this board he indicated that he felt the discussions conducted with officials of the Minister's Department had taken place in what he described as a "creative atmosphere". He clearly felt that some degree of indication was given to him that there would be additional funding for this very important venture. In this he was disappointed.

Basically, I have to ask the Minister today the usual question in adjournment debates of this kind. Is it not possible, even at this stage, to find money for this very important purpose? I accept that the Minister is in the situation that he has got to prioritise, and prioritise in quite a drastic situation, and that his Department bears the brunt of quite a lot of the cuts. But I hope to be able to demonstrate that this is an area where some indication of movement by the Government would be welcomed by the academic community, by the medical community and by the general community, who are well served by the programme of the board.

I want to place on the record the facts of the situation. In 1987 the budget allocation was £2.3 million. In 1988 this was maintained at £2.3 million, but in 1989, despite the undertaking that the research board had felt they had received, it was savagely slashed by £1 million to £1.3 million. In 1990, it was retained at £1.3 million. Not only does this reflect a continuance of the £1 million cut, but it actually represents a worsening of the situation when one takes into account the effects of inflation. You have a 43 per cent cut in the budget, almost 50 per cent gone, and you then have this compounded by the erosion effect of inflation and the fact that the £1 million cut is continued.

I would like to draw the Minister's attention to the fact that no other research agency or institution sustained a parallel cut at that period of this magnitude on what was already regarded as a minimal base budget. I would also like to point out that there is an inconsistency in the fact that the grant was higher in 1987 and 1988, when the economy was arguably in a worse situation, and now that the economy is improving we do not have any amelioration of the board's position. The board's corporate plan for 1989-91, which was submitted in March 1989, sought an allocation of £2.5 million for 1990. An absolute minimal level of support for a viable medical and research programme is estimated by the people responsible as being £2 million.

I would like to make an additional point about the £1.3 million, because it may appear as if it is a figure in which there is a margin of appreciation, some degree of room for manoeuvre. There is not, because, as the Minister well knows, that £1.3 million is already committed for ongoing research. This is a very important point, because it means that as a result of budgetary constraints no new research commitments can be undertaken. That has a number of serious implications. Firstly, the cutting off of the possibility of the engagement of young graduates in research and, secondly, of course, the benefits that will be derived by the wider community from this research work.

I would like to point also to the fact that the programme of research within the area of health services generally was intended by the board to have been a principal element in their research programme for 1990 with a view to increasing the effectiveness and efficiency of the health service generally. In anticipation of a viable funding level in 1990, initial applications were invited from health boards, hospitals, colleges etc. By the closing date of 17 November last 91 applications had been received. They are now all closed off.

That last paragraph I have just read on to the record is a substantial part of my argument. The health services research area was to be a major point — in other words, the efficiency and accuracy of delivery of health services was to be a major element. It is capable of being argued that an element of this money was to be used to make the health services more efficient and therefore more cost effective. I have to ask the Minister if it is not in fact a major and principal responsibility on him, particularly in the current situation of economic difficulties, to ensure that the health services are efficient and if he is not concerned that research schemes that would, in fact, have this impact, that would help the health services to be efficient have now been abandoned. It is clear that as a result of this cut back there will be virtually no funds available for new projects throughout 1990 or for research fellowships. As a result up to 100 of our brightest young graduates will be forced to emigrate, thereby creating a brain drain. We are also clearly going to abandon any pretence that we have a viable medical and health research programme in this country.

The Minister ought to be aware of the comparative European situation. For example, figures can be adduced which demonstrate very convincingly that Ireland is at the lowest level in the European Community in terms of Government funding for research and development for the protection or improvement of human health. I have a list in front of me. We have France, Germany, the United Kingdom, Italy, Spain, Netherlands, Denmark, Belgium, Greece, all ahead of Ireland, proportionately, in terms of the amount of spending. They are maintaining or increasing their levels whereas we are going down from a figure of several million pounds to just £1 million, until we are in the situation where the officials of the Health Research Board feel we are heading towards either a situation of relegation or closure for the board. I find this a matter for every considerable concern.

Could I point out the fact that a number of projects involved are ones with which the general public would find no difficulty at all in having a great degree of sympathy. For example, one of the research programmes is in terms of sudden infant death syndrome, another was about bone marrow transplantation, another was about respiratory illnesses. If, through the application of health research findings in the health services, one cot death could be avoided, that steps could be taken to prevent the recurrence of a spina bifida birth, that the life of a teenager could be prolonged through new knowledge becoming available on bone marrow transplantation, or that improved treatment methods became available for the elderly suffering from respiratory illnesses in the present smoggy conditions, then surely the Minister would agree with me that this very meagre allocation for research should be increased. In terms of budgetary allocation we are really talking in pennies, because I understand this is about one two thousandth six hundredth of the general Health Estimate. So it really is very small. I am sure the Minister will agree with me that there is an important and sustainable argument for making proper funding available for this Medical Research Bureau.

I would also like to point to the Minister's own attitude in the matter. We are in the unusual sitution that we have a Minister who is professionally qualified in this area. Therefore, one has to listen to his views with some respect, particularly when they are placed on the record. The Minister, I understand, is actually on record as saying — and he will be able to correct me if I am misquoting him — that he acknowledges that an active and expanding medical research programme is absolutely essential. I am quoting from recollection of the Minister's words, but the phrase I am perfectly certain of is an "active and expanding medical research programme." Can the Minister, stand over those words with an easy conscience in the light of these cutbacks?

I would like to anticipate some of the Minister's argument, because I imagine that he may suggest that under the health services generally there is, in allied areas, a certain amount of research going on. The Minister knows, as well as I do and as well as some of my colleagues who have assured me on this point, that a lot of the material that is categorised as research is nothing more than information gathering and analysis under the auspices of sections of the health services. That really does not qualify under any international definition of medical research.

The kind of things, as the Minister I am sure will agree, that do qualify are the kind of things that the medical research board were involved in. There was bio medical research on subjects like heart disease, stroke, mental illness, diabetes, asthma, muscular dystrophy, cystic fibrosis, multiple sclerosis, rheumatoid arthritis and the nature and cause of depression. These are examples of ongoing research that will continue if the Minister is able to find the money. We have programmes concerning the genetic epidemiology of schizophrenia and psychiatric disorders. Time is short, but the Minister is aware that certainly until recently it was widely felt that schizophrenia had a higher incidence in this country, particularly on the western seaboard, than most other European countries. There is mental handicap, child health and a major epidemiological study to ascertain if vitamin supplements can reduce the risk of neural tube defects, that lead to spina bifida, in mothers with a previously affected baby: epidemiology being the scientific study of the distribution of disease. If we can prevent one incidence of spina bifida as a result of this, surely the Minister, as a doctor and as a caring person would agree that this would be worthwhile.

Then there is the question of travellers health status. A study of the birth and mortality rate of travellers and the health of travelling children, including how travellers utilise the available health services, is the kind of research that is vitally important. There is the programme of laboratory research, in which I would have a particular interest because, of course, a major element of this is being carried on in laboratories situated in my own university in Trinity College, where they are focusing principally on the development of anti-cancer and anti-leprosy drugs and on virology studies.

The Minister, I am sure, will remember with affection as I do a former distinguished colleague of mine, Dr. Barry with whom I often had the privilege of having lunch, a most delightful and charming man. He was one of the leaders in discovering drugs which are now effective against leprosy. With what great pride we, as Irish academics, realised that we were to the forefront of medical research. Is the Minister actually happy to stand over a situation where we are saying basically that we are not capable of supporting a decent level of research? Perhaps I have been a little bit rarified in what I have said in the last few remarks; I think I can see the Acting Chairman getting ready to indicate that my time is coming to a close, so I would like to——

Acting Chairman

I was getting ready to indicate that the Chair would prefer if the Senator did not name people outside the House.

Mr. Norris

My reference was inadvertent but I was mentioning him in a way. He is no longer alive but he is a very significant part of our medical research history. I am sure it is possible to mention people like Alfred Nobel. I will not quite put Dr. Barry in that category but he was a very distinguished doctor who reflected credit on the country. However, if it is inappropriate to mention him I will withdraw my reference to him.

I would like to indicate again a couple of the projects which have been cancelled as a result of this cutback. I am quoting now from the Sunday Independent of 10 December 1989 where it says “among the projects cancelled were ways and means of delivering an effective health service to an urban population (Tallaght), prevention of osteo-arthritis of the hip, home-care of patients with Alzheimers Disease and the development of better communication skills among mentally handicapped children.” Could there be better areas for research either on a scientific or on a humane basis? I am sure the Minister will have no difficulty in agreeing with me, particularly in a situation like Tallaght, where we have a population in a potentially beautiful area of the city that has many social problems, many problems of deprivation, a high level of unemployment, difficulties in its transport and difficulties with the absence of an effective and proper town centre. Here we have a project which was intended to assist the Minister in delivering an efficient health service to this deprived area. I am sure, as a caring and compassionate man, the Minister will agree that this was an important project as was the prevention of osteo-arthritis and home care of patients with Alzheimer's Disease. Of course, conditions such as Alzheimer's Disease are diseases with which many of us were, until recently, unfamiliar. It is a very tragic situation, one that has been highlighted recently in the media and one with which people are increasingly finding themselves in sympathy. Is it appropriate that all these programmes will be cancelled?

I notice the cancellation of another project here — the Third World Collaborative Research Project, which was an investigation into the pathogenesis of the dengue virus which was underway as part of the European Community tropical medicine programme. This is a virus which has a wide geographical distribution in tropical and sub-tropical areas and is responsible for very high morbidity and mortality among children. I draw this particularly to the Minister's attention because of the fact that we are in the position at the moment of holding the presidency of the European Community. I wonder if the Minister feels it appropriate to celebrate this elevation of our country and its people within the political system of Europe by cancelling our programme which is part of the European programme on tropical medicine?

Finally, in my little list there was a programme on drug misuse in Dublin, where they were seeking to establish a drug reporting system for Dublin and London which could possibly be used as a model for other European cities. The Minister, I know, is deeply concerned about the problem of Acquired Immune Deficiency Syndrome for example. The construction of this kind of model might well have been of use in dealing with that situation.

In summary, I have to say that it is a matter of very considerable regret to me that I have to raise this matter. I believe the Minister will have difficulty in sustaining an argument for the reduction in funds that I have outlined. I appeal to him to do what he can to discover funds, whether it means applying to the lottery or whatever source is available, to allow us to take our place as Europeans in the community of those committed to research. To hearten him, can I just tell him what I overheard this morning in one of the by-ways of the corridors of power? It was a remark made at the Oireachtas Joint Committee on Women's Rights, where somebody alleged that the way things happen with regard to lottery funding is that it is on the basis that if a Minister decides that something is a priority, he than just applies to the lottery, and there is then a Government decision. Perhaps there is an avenue for the Minister who might make a direct approach, armed, as I hope I have armed him, with the kind of material I have placed today on the record. Perhaps such an application, which I believe the Minister will find in his heart to support, would at this late stage be positively received although, to my great regret, it will not be possible to reverse the decision of the Provost of Trinity College to resign from this board. My final point is that a man of international distinction and reputation holding one of the highest university appointments of this land, does not lightly resign from a body to which he has so clearly committed himself and his reputation.

Minister for Health (Dr. O'Hanlon)

I am glad of the opportunity of coming into the Seanad this evening to speak about the recent events and the Health Research Board. I am glad because it provides me with an opportunity to set the record straight on a number of matters which Senator Norris referred to and which have surrounded the 1990 allocation to the board. Indeed, it has caused some controversy.

If Senators consider all aspects of the background, they would realise that the Government have taken a reasonable stance in this instance. As Senators will be aware, the Health Research Board was established in August 1986. It arose from the amalgamation of two then existing bodies, the Medical Research Council and the Medical Social Research Board. Both of these bodies were distinguished by their traditions and achievements in the area of medical and health services research. When the new health research board took office in January 1987, their remit included the development of programmes in medical research and also in epidemiological research. The 1987 allocation, as Senator Norris pointed out, was £2.3 million. In 1989 this was reduced to £1.3 million as a consequence of the extremely severe financial difficulties facing the Government. While this presented a major difficulty to the board it was in large measure overcome by my Department taking over responsibility for some of the board's activities which were peripheral to the core functions of the board in the area of information systems and extramural research.

This relieved the board of responsibility for activities costing £600,000. It is a matter of great disappointment to me that members of the Health Research Board would have gone public — and, indeed, that Senator Norris who did some research into this subject — did not state the reality of the situation which is that, in effect, the board were not reduced by £1 million, but by £400,000. We took on board £600,000 worth of their activities. The board's 1990 allocation as contained in the Book of Estimates is £1.3 million, the same as in 1989. In consequence of this allocation, the Chairman of the Board, Professor Watts, resigned from his position on 23 November last. While I understand the disappointment of the board at the level of allocation which it was possible to provide from Exchequer Funds in 1990, I regret very much that Professor Watts felt it necessary to respond to this situation by resigning from the board. I am, of course, very much aware of the major contribution which he has made to the work of the board. I would like to record my appreciation of his effort and his commitment as chairman. Unfortunately, the board's difficulties have led to the use of emotive terms by commentators, some of whom have presented a most unbalanced picture of the position. I will refer to one of them: the fact that while the allocation on paper in the Book of Estimates was reduced by £1 million, the fact that we took up £600,000 worth of the expenditure meant that it was in real terms only a reduction of £400,000. I have to say that I do not feel that the use of phrases such as "opted out" of medical research and "perform at the level of a Third World country" which have been used in the context of this situation, accord with the facts.

Indeed, the term "severely slashed" was used by Senator Norris here referring to the £1 million reduction, when in real terms the reduction was less than half that. I would at this stage like to stress that in the context of the health services the Government accord due importance to the role played by research of all kinds. I wish to emphasise that the situation which has arisen by the Government's inability to increase Exchequer provision over the 1989 level in no way represents a downgrading of the status accorded to me or by the Government to this most important area. Indeed, in this context I would remind Senators of the importance attached to the role of information and evaluation in the health services and the importance attached to them by the commission on funding, for example. Health service and medical research are clearly an important element of such evaluation.

As I have already mentioned, when it becomes clear that the level of funding which would be provided last year would be considerably less than in the previous year, I agreed to take over a number of the functions being carried out by the Health Research Board in order to alleviate the full impact of this reduction. These included the assumption of responsibility by my Department for the hospital in-patient inquiry scheme, as well as the national psychiatric in-patient scheme and the Kilkenny health project.

The effect of these transfers was to relieve the Health Research Board of these responsibilities, leaving them free to concentrate on the funding of purely clinical and health services research. I fully appreciate the importance of the contribution which can be made to health care by appropriate research and the need to foster research talent in this area. I would greatly desire to strengthen this area and to expand it in scope and in line with priority needs.

However, it must be realised that such aspirations have to be placed in the context of the financial reality in which we find ourselves. When Senator Norris says that the Minister is morally bound to provide more funding for the Health Research Board that, unfortunately, is competing with priorities as other people would see them, such as the front line services where people believe that more money should be made available. Certainly, we would like to make more money available if the financial situation of the country was different. Of course, there is no need to remind the Senators that we still have a difficult financial situation in this State. Indeed, faced with the severe financial constraint the Government have sought to reconcile the many and conflicting demands of health needs with the scarce resources available to meet them.

This has resulted in the necessity of establishing priorities. Within this context it is a fact of life that urgent service provision must come first. I will point out to Senators that we are already spending the huge sum of £1.5 billion in the current year providing health services for our people. From this some £760 million are directed towards providing services in general hospitals. There can be no doubt that this represents a very substantial investment. This also represents a very substantial investment in research which is carried out as an integral part of the ongoing delivery of these hospital services. Research forms an integral part of the hospital service, especially in the teaching hospitals associated with medical schools. It also forms part of the responsibilities of every consultant. In addition, the non-consultant hospital doctor grade is primarily a training grade. The encouragement of research activity forms part of the training process for the various specialities, especially at senior registrar level.

It is perfectly reasonable to say that the Government are making a substantial commitment to medical research through their investment in hospital services. The Government have sought at every opportunity to protect the level of services which can be afforded. This, in turn, is reflected in the training and research opportunities available to medical staff. Of course, I should also say that there is direct funding from the State to other research projects which are not funded directly by the Health Research Board. Indeed, the Health Research Board are not responsible for all the funding either from the State or from the private sector to a number of research projects that are in place.

When we compare what we are spending with other European countries, it is important to recognise that in other European countries they include very often in their costs the cost of laboratory services and the salaries of those working in them. In this country, these are in the general costs of the health services and are not directly included in the activities of the Health Research Board. I consider that, having regard to all the circumstances, the provision of £1.3 million for the Health Research Board for its activities in 1990 is reasonable. This allocation will enable the board to continue its existing level of activities following the rationalisation last year of the non-research functions to which I referred earlier.

The board will, in addition, be in a position to start new activities later this year and to replace projects which are drawing to a close. Indeed, they are presently scrutinising a number of projects to start. I would agree with Senator Norris about the value of the project in Tallaght, but the position about that project and, indeed, the other projects that the Senator mentioned is, that they have not been cancelled but they have not been developed and assessed. There were declarations of intent to carry out research. They are presently being researched. I am glad to say that the diverse projects which the Senator referred to are continuing with European Community funding.

Furthermore, I am aware that the board are carefully reviewing aspects of some of the activities which they fund at present with a view to securing even better returns from the expenditure involved with the likelihood of freeing up resources to devote to more new and important activities. I know that the board are also considering using some of their accumulated assets to develop new activity in the current year. I am also satisfied that in accordance with the corporate plan presented to me by the board last year, they will be in a position to generate significant non-Exchequer income to support a high quality research programme. I am quite satisfied that opportunities exist for the board to organise or undertake commissioned research, from which it will be possible to derive an additional source of income. Indeed, the board are already doing so. I am also confident that the prestige of the board will be a factor which can attract private sector investment and high quality research projects whose quality and importance are supported by involvement.

The scope for joint funding of research by the board in other private or voluntary research interests is immense, given the right degree of organisation. The board will also be aware that the Government, through my colleague the Minister of State for Science and Technology, Deputy Michael Smith, apart from domestic sources of funds, are pursuing changes in the approach of the European Community to the funding of medical research, so the direct cost of research projects can be met from Community funds. In addition, I have had discussions with the Minister of State for Science and Technology as to ways and means whereby the interests and activities of the Health Research Board might be supported, and how we might benefit from an association with the science and technology development programme. I hope that we will be able to report progress in this regard.

I would like to assure Senators that the Government are committed to supporting the future development of health research and place a high value on it. The level of direct Exchequer support which can be provided to the board on foot of this commitment must be determined in the light of the availability of resources and the pressure of other necessary activities. I will be giving more detailed comments to the board on its plan shortly. As Senators may be aware, Professor Maurice Fitzgerald has been elected by the board as its new chairman. It will be his task to carry forward the board's plans and activities. I wish him every success in his new responsibilities. I am sure that under his leadership the board will develop and progress towards the objectives shared by his predecessor, Professor Watts.

I assure Senator Norris that the Government are committed to funding the Health Research Board to enable them to carry out their functions adequately given the present difficult fiscal situation. I repeat my regret that Professor Watts felt it necessary to resign from the board. However, the continuing financial difficulties which we are facing and the level of demand for public expenditure on health is such that the Government are unable to contemplate an increase in the board's allocation in the current year, 1990. There are so many demands that the Senator will be aware of on the Exchequer that there simply has to be a system of priority allocation. It is the role of the Government to carry out this process of according priorities. Difficult though it may be, the Government are resolute in carrying out their responsibilities in this area.

Mr. Norris

I would like to thank the Minister for his courteous reply and say that I extracted one small comfort when he spoke of the current year. I hope that he will use his ingenuity to secure further funding for supporting the institution.

The Seanad adjourned at 5 p.m. until 2.30 p.m. on Wednesday, 28 February 1990.