Health boards all over the country are over spent by approximately £100 million. Given the stringent constraints on them can the Government pick up the tab or, would it be appropriate to look within the system itself, at the resources, expertise and manpower in hospitals, to see if there is any way we could introduce an element of self-financing, rationalisation or cost effectiveness to the health board system?
I realise that I could be accused of looking for privatisation of the service, but that is the furthest thought from my mind. The time has come, however, when we must address the administration of health board hospitals to see how they can become enterprise conscious and, by doing so, introduce an element of self-financing into their operations.
I have been a member of the Southern Health Board since last June. Faced with deficits of £3.7 million in the Southern Health Board budget we are all looking for a way out of the dilemma. I called recently for a feasibility study into ways of generating additional finance for the health board. As a result of that call and the publicity it generated, it was made known to me through various sources that in a major hospital within the health board service work was being carried out in laboratories of this hospital for a private operation and that no moneys were accruing to the health board from this. I understand that the money generated could be as much as £100,000 per year. I asked for an investigation into the matter and this investigation is currently under way. A report is to be made available at the next meeting of the Southern Health Board. This raises questions as to the level of control that exists in hospitals, and particularly in the laboratories.
Subsequently, I received further information relating to a major hospital in Dublin where it was said laboratory work was being carried out and that the private work, the VHI work was being dealt with separately from public authority work and that such information was being transmitted by modum to a private office from which bills were being sent out to patients. I understand that the level of this work could range from £3 million to £6 million per year. That is a significant sum of money. This raises the question: are the board of this hospital aware that a private company exists within the hospital itself to handle information on private patients, to transfer that information to a private clinic from whence invoices are sent directly to patients? Do the Department of Health know that equipment and staff are used for private investigations? Is a reasonable sum being paid back into the system? These questions deserve answers.
I am asking the Minister to carry out a major investigation into the operation of laboratories in hospitals throughout the country. The Minister can imagine the morale of those who are working within the system. They are highly qualified and highly efficient, and it is their perception that the equipment, resources and personnel of the hospitals are being used, with no pay back to the hospital itself. If this practice exists, then it makes the whole operation highly questionable: who authorised the carrying out of this private work and why is adequate recompense not being made?
It has been suggested to me that if a private investigation was carried out into all these operations significant sums of money would be made available to health boards all over the country. I would ask the Minister to introduce a system of control which would ensure that a reasonable return is made to each health board and hospital for resources, personnel and equipment being used. Putting it at its lowest in this major hospital in Dublin, if we say the figure is £3 million surely it is fair to suggest that for the personnel, equipment and expertise being used, £1 million should be paid back into the resources of that hospital. Think what that sum could do in terms of the operation and resources of that hospital. I encourage hospital boards and health boards to engage in outside work, but I also encourage them to ensure that a profitable return is made to the board as a result.
I would like to contrast what is happening in hospitals with what is happening in third level education. The Government encouraged the third level sector to introduce an element to self-financing. I can give two examples from the Cork area with which I am familiar. University College Cork generates £7.5 million per annum by way of contract work; the Regional College in Cork generates £1.5 million. These are very significant sums of money which can be ploughed back into the system ensuring additional resources in each of these establishments. We should arrive at a situation in health boards where if staff, are involved in extra duties, they would be given additional payments and a fair and equitable return would be made on the use of health board resources.
Extra specialist services are an extremely important and expensive item and every effort should be made to have them fully utilized rather than having them duplicated throughout the public sector. It has been suggested that some of the equipment used in the diagnosis of unusual or special diseases could be adapted for environmental monitoring of pollution levels, for example, and for useful commercial services. In UCC, at the moment, work could be farmed out from health boards all over this country, and with proper interaction between the health services and the local authorities, we could save significant resources. Many successful private companies are involved in mediscans, cholesterol level testing, prognosis and drug screening. Who would be in a better position than the health boards to interact with industry? Prognosis could be carried out on a contract basis negotiated between the health boards and the groups.
In Cork we have companies like Irish Steel and a major concentration of the pharmaceutical industry. The health board should negotiate with these companies with a view to setting up services such as advice on healthy living, prognosis and checking for any after effects of treatment.
Finally, we must aim at ensuring that only those who need specialist services are referred to hospitals. It is alleged that many people are referred to hospitals at present who do not require these services and they are clogging up the system unnecessarily and being extremely expensive. GPs have been accused in the past of not carrying out proper diagnosis in their surgeries and causing a cluster of people arriving at outpatient clinics. The GPs for their part say there is not proper computerisation in the laboratories in the health service and that as a result, it is impossible for them to make an instant diagnosis resulting in further referrals. By addressing this issue the Minister may bring about major savings to health boards and may, in fact, clear the logjam that is at present part and parcel of the health board system.
