I welcome the opportunity to address this House on the Government's commitment to the provision of our health services in the areas highlighted by the distinguished Fine Gael and other Senators, accident and emergency services, waiting list or times, psychiatric services and preventative measure in the general health services.
The Government has already put in place a range of programme improvements and funding expansion which means that today there are more people being treated by the health services, more people employed in the health services and more capital projects planned or underway than at any time in the history of the services. I assure the House that the Government is totally committed to ensuring that we have a health service which is responsible in meeting the health service needs of our people despite what has been said this evening.
The health service is the focus of considerable ongoing attention which intensifies when the standards expected of the service are not met. It is seldom, however, that the improvements in the services are given proper acknowledgement. Since the Government took office, there have been many positive developments which must be acknowledged. Not least among these is the unprecedented level of capital and revenue funding which is being provided for these developments.
When the present Government took office in 1997, the revenue provision for health was £2,754 million. The provision for the current year amounts to £4,297 million, which represents an increase of 56% in funding. This increase in long awaited resources has allowed for a major acceleration in the development of a range of health services.
The Government has also recognised that, in moving forward, the current health infrastructure is inadequate for the delivery of a truly modern and efficient service. Under the national development plan £2 billion in capital spending has been made available to develop health facilities of the highest order, which will include addressing geographic imbalances in the health system. The inclusion of health in the NDP was a statement of priority in its own right since it is recognition, for the first time, of the central importance of health facilities in Ireland's social and economic infrastructure. The £2 billion provided is almost treble the capital resources provided over the previous seven years. The first fruits of the NDP are seen in this year's Estimate where there is a record capital provision of £231 million.
I appreciate that funding, while vital, is only the starting point in accomplishing radical improvement. There is always scope to improve standards of customer service and all those engaged in the health sector must put this concern at the centre of all of their operations. It has been highlighted in the debate that more needs to be done in certain areas and further planning needs to be assessed. The way the service is organised, managed and delivered is undergoing considerable change and these improvements must continue.
Patients availing of health services, in every area of the country, are entitled to expect a quality service. We want to see performance rewarded and health agencies have been informed that this is the basis on which additional funds will be made available. The Government will continue to work with all concerned in investing resources and energy into the improvement of services. We will take all opportunities to bring the necessary services on stream quicker and will lead reform for the benefit of the public patient.
I believe that we already have a strong health system and that it compares well internationally. The challenge is to modernise it further so that we can compare with the best in the world. I make no apology for such an aspiration. We can harness our already skilled staff, our growing resources and our committed managers to achieve this objective. We have begun this process already. Substantial initiatives have been taken in many areas of both the acute and non-acute health services sectors to ensure that services are reformed, reorganised and properly geared to meet the needs of our population.
I do not propose to dwell on them at length, but briefly they include the recently launched cardiovascular health strategy, which provides for achieving an integrated approach to the prevention and treatment of cardiovascular disease. An initial investment of £12 million this year is the first in the history of our services. There has been investment of £4.9 million in 1998, £5.5 million in 1999 and £3.6 million in 2000 in cardiac services, including cardiac surgery, to support the objectives of the wider cardiovascular strategy. The continuing implementation of the national cancer strategy with funding this year of £2.98 million, is already improving the availability of cancer treatment services throughout the country. More than £41 million has been allocated under the strategy since 1997. A plan for the development of renal services is being prepared which will involve an investment of £20 million over the next three years, £6 million of which will be spent this year.
A medical manpower forum is being established to review key aspects of medical staffing in our public hospitals. There will be a review of the adequacy of bed capacity in both the acute and non-acute settings. This review will identify capacity issues against the background of substantial increases in demand as a result of changing demography and advances in medical treatment. It is my intention that the results of this review will be addressed in the context of next year's Estimate. There was an investment of £53 million up to the end of 1999 for persons with intellectual disabilities, with a future investment of £38.7 million in the current year increasing to £45.7 million in 2001. This compares more than favourably with the contribution of the last Government with its minimum investment of £12 million. There is continued investment in services for persons with physical and sensory disabilities. Additional revenue funding of £20 million is being provided in the current year.
There is a committed approach to tackling hospital waiting lists so scandalously neglected by the Senators' party when in Government. The funding for waiting lists was cut back from £20 million to £12 million at one stage. The new hospital at Tallaght has been opened. Within the time period of the NDP, and because of the additional resources now available under the plan, major projects will proceed, including the joint Mater/Temple Street development, St. Vincent's Elm Park, phase I, St. James's Hospital, phase IH, Cork University Hospital and St. Joseph's Hospital, Clonmel. Other works and planning will be undertaken in the Dublin maternity hospitals. In addition, planning will continue on the Mater Hospital phase I and Crumlin hospital – new theatres. Projects in the Border, midland and western region will include Tullamore, phases I and II; University College Hospital, Galway, phase II and Portlaoise General Hospital and Castlebar General Hospital, County Mayo.
There is ongoing investment in child care services. Funding made available in 1998 and 1999 provided for additional much needed staff resources. This investment is being built upon through the provision of additional funding of £30 million for this service in the current year. There will be a continuation of the established programme of developing services for older people which has gained momentum since the Government took office.
I now turn to the specific issues raised by the Senators in their motion. I am happy to do this even if only to refute their charges against the Government's record on these issues. A major commitment of the Government when coming into office was to address this area. Strategies for cancer and cardiovascular services, to which I have already referred, clearly span the acute and non-acute sectors. However, specific attention must also be paid to performance within acute hospitals. The Government is providing for an all out assault on waiting lists. Waiting lists for a number of procedures are unacceptable and will be reduced. In reviewing the overall performance of the current system, in-patient waiting lists represent just 4% of the total discharges from acute hospitals. While waiting lists are unacceptable and must be addressed, let us not forget the level and quality of service provided to the other 96% of patients.
The new Eastern Regional Health Authority has already established a dedicated team to address this issue and my colleague, the Minister for Health and Children, Deputy Martin, has agreed accelerated work plans for addressing waiting lists with each health board. A total of almost £33 million will be spent on addressing acute hospital waiting lists this year. During the first quarter of this year waiting lists fell by 2,485, which was not noted by the Opposition. This was an encouraging reduction, particularly since, traditionally, elective work suffers in the early months of the year as the number of emergency medical admissions increases. Last month the Minister announced a targeted initiative to deliver an additional 7,600 waiting list procedures by the end of the year to accelerate progress in this area even more quickly. These procedures will be over and above the waiting list activity agreed with agencies at the start of the year. This latest initiative will cost £10 million.
In many ways, the availability and quality of hospital services set the context for the perception of the health services as a whole. There is no escaping the fact that certain key areas, particularly waiting lists and accident and emergency services, are critical to the public perception of the health services. Only when the performance in these areas is improved and hospital services are integrated properly with primary and community care services will our health services be seen as meeting the best standards. What is also clear is that problems in areas, such as waiting lists and accident and emergency services, cannot be solved in isolation. Integrated solutions are the key. This will involve continued development and refinement of appropriate roles for acute, primary care and community services.
For example, the £35.4 million in additional funding this year for services for the elderly has a key role to play in putting in place the community facilities, home help and nursing supports required to allow older people to move out of the hospital setting once the acute phase of their treatment is completed. This investment will be complemented by dedicated funding of £5 million for tackling difficulties in accident and emergency services. This funding will go in large measure towards increasing the number of sub-acute beds, particularly in the Dublin region, to allow acute hospitals to free up beds occupied by the elderly and chronic sick. Integration of strategies for the development of services for older people and accident and emergency services offers the best means of meeting the policy aim of supporting older people in the community and achieving the best possible performance within hospitals.
This Government has provided additional funding to acute hospitals providing accident and emergency services to enable them to implement a range of initiatives in the medium term aimed at addressing the difficulties being experienced in their accident and emergency departments. This additional funding amounted to £2.3 million in 1998, £2 million in 1999 and a further £2 million in the current year. It has enabled hospitals providing accident and emergency services to continue to implement a range of initiatives aimed at alleviating pressures in accident and emergency departments, particularly during periods of peak demands which occur most frequently during the winter months. These initiatives include measures to free up beds for emergency admissions through the provision of alternative step down facilities for patients occupying beds in acute hospitals for lengthy periods. They allow for the provision of enhanced staffing levels, the development of rapid diagnostic systems for common emergency presentations, continued development of treatment/observation areas in accident and emergency departments and improved access for general practitioners to urgent specialist opinion.
Difficulties in accident and emergency departments are most acutely felt in hospitals in the eastern region, which deals with in excess of 45% of all accident and emergency attendances. The Eastern Regional Health Authority has already decided that improvements in accident and emergency services are a priority and has established a dedicated team to examine in detail the existing services in the region as a whole, including paediatric services, and to bring forward a comprehensive policy for the development of accident and emergency services in the region generally.
The team will review issues affecting accident and emergency services in terms of the principles of access, time, appropriateness and quality. It will be seeking to ensure that patients presenting at accident and emergency departments within the region have access to an appropriate service that deals with their needs in a timely and comprehensive manner.
The review will address a variety of issues to include the examination of services within accident and emergency departments and the examinations of policies procedures and protocols for emergency services. It is hoped that examination of these areas will generate solutions for current problems occurring in some hospital accident and emergency departments, such as long waiting times for diagnosis and treatment, long waiting times on trolleys for patients awaiting admission and overcrowding in accident and emergency departments arising in part from delays in admission of patients.
A review of alternative options for care will also be conducted. These options will include the development of out of hours GP services at community centres or in a hospital setting and the development of satellite and community based units for minor injury and illnesses. The initiative of the authority in this vital area of health services provision will result in a much improved service for patients presenting at accident and emergency departments.
The role of primary care, and in particular of GPs, is also of central importance within the overall system. Under the NDP there will be very significant development of primary care involving investment in multi-purpose health centres. These will be local hubs for the provision of a range of primary care health and personal social services leading to a more comprehensive and integrated service to patients. Under the Programme for Prosperity and Fairness, the Government is committed to establishing at least four primary care pilot projects which will allow for the development of 24 hour, seven day services. A sum of £1 million has been made available for this purpose in the current year.
Already the GP pilot project in Carlow, CAREDOC, is operating successfully as are initiatives such as DUBDOC in Dublin, centred around St. James's Hospital. A further pilot project in the Northern Eastern Health Board is due to commence in July. The roll-out of a properly evaluated primary care model will be of major importance in allowing patients to access health care at the most appropriate level.
I note the Senators' outdated terminology when talking about mental health services. These services continue to improve and much progress has been made in the past number of years. It is acknowledged, however, that much still needs to be done. The commitment to transfer all existing admission acute units from psychiatric hospitals to units in general hospitals continues.
The advantages of providing acute services in general hospital settings are obvious. Apart from the substantial improvements that such units offer in terms of structure, decor, furnishings and general comfort, the close proximity to and the availability of general medical and surgical services to those suffering from mental illness are obvious. Furthermore, the availability of psychiatric teams to the general hospital through liaison and consultation services is an important input to the general hospital services.
At the end of the period of the national development plan in 2006, it is hoped that the programme of acute psychiatric units will be significantly advanced. This will mean acute admissions to the old psychiatric hospitals will become a thing of the past. Approximately £150 million capital will be provided over the lifetime of the national development plan for mental health services. A significant part of this funding will go towards the development of acute psychiatric units linked to general hospitals as a replacement of services previously provided in psychiatric hospitals. The plan will also provide for more community facilities such as mental health centres and community residences which will accelerate the phasing out of the old institutions.
Additional funding of £12.25 million is being made available to the mental health services in 2000 to develop community mental health services, to increase forensic psychiatry services, to provide rehabilitation services, to increase child and adolescent services, to provide liaison psychiatry services in general hospitals and to enhance staffing levels. This additional funding represented a 100% increase on the additional funding made available in 1999.
It is intended to accelerate the provision of community based mental health services for persons with mental illnesses throughout the country. Such residential accommodation in 1994 stood at 368 providing 2,685 places. This total increased to 398 in 1999 with 2,923 places. Between 1994 and 1998 the number of day hospitals and day centres increased from 159 to 176.
Additional revenue of £2.9 million is being allocated in 2000 towards the further development of community based mental health services, including the improvement of the psychology and social work services. The lack of multi-disciplinary teams in many areas of the mental health services has been highlighted by the Inspector of Mental Hospitals in his most recent report. It is necessary to develop special rehabilitation programmes for patients who have spent long periods of time in hospital in order to facilitate their transfer to more appropriate accommodation in the community.
In pursuance of this objective £250,000 has been allocated to the Western Health Board to fund a dedicated rehabilitation team which will commence a rehabilitation programme for long stay patients in St. Brigid's Hospital, Ballinasloe. If this pilot project is successful, a similar approach will be considered for other hospitals.
A start was made in 1999 on strengthening forensic psychiatry services. It is necessary to increase the number of consultant forensic psychiatric teams to adequately deal with the level of psychiatric morbidity within the prison system and to facilitate better management of disturbed behaviour within the mental health services and thus prevent unnecessary admissions to the Central Mental Hospital. A total of £1.35 million additional revenue was allocated in 2000 towards substantial improvements in the forensic psychiatry services in Dublin, Cork and Limerick.
Priority is being given to the development of mental health services for both older people and children and adolescents. Revenue resources totalling approximately £2.5 million were made available by the Department in 1999 to enable improvements to be effected in these services.
An additional £1.1 million was allocated to further developments in child and adolescent psychiatry services this year. This funding will provide for the appointment of additional consultants in child and adolescent psychiatry and for the development of multi-disciplinary teams to focus on specific areas, such as attention deficit/hyperactivity disorder – AD/HD. A working group has been established by the Department to review child and adolescent psychiatry and to finalise a plan for the further development of this service. The group held its first meeting on 15 June.
The increase in the number of people living to advanced old age requires the development of specialist mental health services to meet their specific needs. In this area, services have been expanding in recent years and £1 million in additional funding has been provided for the mental health services in 2000 towards the provision of additional consultants in old age psychiatry.
It is intended to allocate additional resources to enable these services to be further developed over the next few years. It is also intended to increase the level of capital funding available for the development of mental health facilities in the community as part of the national development plan in order to make services more accessible.
At national level, priority is being given to education awareness and to promoting a better understanding among the public of mental health, thereby facilitating a greater and more positive acceptance of the transfer of mental health services from institutional to community-based settings. Links with the voluntary sector continue to be strengthened, both at national and local level, and an additional £300,000 has been made available this year to strengthen these links and services. There is ongoing co-operation between the boards and several voluntary organisations such as AWARE, GROW, Schizophrenia Ireland, the Samaritans and local branches of the Mental Health Association of Ireland.
Any suggestion that the Government is failing in its commitments in this area is outlandish. Evidence of our work in this area is crystal clear to anybody who cares to take even a cursory look at developments.
As regards preventative measures, a number of significant programmes are under way in this area. I would like to highlight some of these, the first being the national breast screening programme. In March 1997, the then Minister announced the introduction of a major action plan to implement the proposals contained in the national cancer strategy. Included in the plan were proposals for the introduction on a phased basis of a national breast screening programme. Phase 1 will cover the Eastern, North Eastern and Midland Health Board areas and will target 120,000 women in the 50-64 age group, which represents approximately 50% of the national target population.
The decision to proceed on a phased basis is a reflection of the complexities involved in the screening process rather than the costs involved and my Department's key objective is to ensure that the programme meets the necessary quality assurance criteria. It is for this reason that the national breast screening programme must be driven by international quality assurance standards and best practice.
Specifically, the phasing will take account of the following critical success factors: the achievement of acceptable compliance levels among the target population; ongoing evaluation of the programme from a quality assurance perspective; and availability of the necessary clinical expertise to conduct the programme. The service is being delivered by two central units, the Eccles unit on the Mater Hospital campus and the Merrion unit on St. Vincent's Hospital campus, with outreach to the community by means of three mobile units. Limited screening commenced in both units in March, without publicity, to test equipment, systems and procedures. Decisions in relation to subsequent phases of the programme will be guided by the experience gained from putting phase 1 of the programme in place. Phases 2 and 3 will involve the extension of the programme to the rest of the country. The steering committee has recommended that phase 2 of the programme should follow phase 1 as soon as possible.
My Department is conscious of the importance of early access to symptomatic mammography services, and of the provision of an equivalent standard of excellence in both symptomatic and screening mammography services. At the request of the Minister, Deputy Martin, a review of the symptomatic breast cancer services has been undertaken by the National Cancer Forum. The Minister has received the report of this group, which he is considering. He proposes to make funding available under the national cancer strategy to develop further symptomatic breast cancer services throughout the country.
My Department also recently raised the issue of mammography referral practices with the health boards. The Department's key concern is to ensure that all women, irrespective of age or where they live, have timely access to symptomatic services. A critical factor in this regard is referral by GPs to local diagnostic mammography services in the first instance. This should result in a reduction in average waiting times at all mammographic units, thereby improving access for women and at the same time ensuring that expertise levels are maintained and developed in diagnostic units around the country.
Improvements will be taking place in the dental treatment services scheme, which Senators have alluded to. Medical card holders will be entitled to receive a dental examination and a range of treatment from the dentist of their choice. This year over £32 million is being provided for the scheme. In addition, it is proposed to extend entitlement to dental services to children up to the age of 16 who have attended national school, with effect from 1 August 2000.
Ophthalmic services are also being examined and improvements will ensue, with funding totalling £3 million having been provided this year for the implementation of improved services.
The maternity and infant care scheme provides for pre-natal and post-natal care, free of charge for all women regardless of means, and for their babies up to six weeks of age. The report of the maternity and infant care scheme review group advised that a system of combined care, i.e. where the expectant mother is under the care of both her general practitioner and hospital obstetrician, is the best and most convenient form of ante- natal care for the majority of mothers. The report contains 109 recommendations, including a revised schedule of visits for mother and baby.
The national cervical screening programme is another scheme dealing with preventative medicine which is under way. These new developments represent progress, but they have not been highlighted by the Opposition.
Child health is another area that is receiving attention from the Department. The report, Best Health for Children, published in the latter half of 1999, is a review of child health services undertaken by the chief executive officers of health boards.
Further improvements have been made in immunisation programmes. The unsatisfactory uptake of childhood immunisation is a matter of concern and my Department is working with the health boards to develop strategies to maximise the uptake. Boards have been asked to make every effort to devise strategies tailored to local needs, employing innovative approaches, if considered necessary, in order to achieve significant improvements in uptake. If a 95% uptake can be achieved, the eradication of a range of serious diseases will be achievable.
In relation to MMR immunisation, which is of particular concern, the office for health gain has recently developed a new campaign to heighten public awareness about this issue, and this was launched on 20 June. New vaccines are coming on stream to protect against group C meningococcal disease and we hope to have them by September.
Despite what has been said by a number of Senators, much progress has been made since the Government took office. We are not saying that everything is hunky dory; naturally there are problems. No service is perfect but we are examining the matter in a pragmatic, phased and rational manner. We are not throwing money at the problem for the sake of doing so. We have a plan and are working with health boards and the voluntary sector to achieve results. Appropriate health care provided by professionals in proper settings is the cornerstone of an effective health care system. The Government is fully committed to the development of a comprehensive health service that is capable of responding fully, quickly and effectively to the health service needs of the people. We are proud of our record since taking office of delivering on our commitments in the health area. Much has been achieved and important developments have commenced under the Government. We also recognise that there are problems with the health services and we do not wish to understate these, as I said. However, we do not wish to exaggerate their magnitude as this only serves to undermine the confidence the public has in the services.
Senator Henry referred to all the advertisements in the newspapers for personnel at present. However, this is the time of year that health boards advertise for staff and they are having difficulties in some areas. However, that is not unex pected. The Senator also mentioned the obstetrician and gynaecology services where there is only one gynaecologist. Progress has a price and there is a price that people will pay. People expect better services but, in the long term, they may only be provided in bigger units. This aspect must be considered; people must be given what they request.
It is essential that the opportunities the resources now available provide are fully realised and that real and lasting improvements are delivered. The challenge facing everybody working in the health sector is to ensure that the public gets the maximum benefit for their resources and that the delivery of a quality health service to all who need it is achieved. This should be achieved in the short term rather than in the long term. This is the only Government that will ever deliver on the health services. Our track record speaks for itself in spite of the comments of the former Minister, Deputy Noonan, in relation to his tenure of office. The situation left much to be desired when we entered office.