I welcome the Minister for Health and Children, Deputy Mícheál Martin, and his officials. The purpose of today's meeting is to consider the Estimate falling within the remit of the Department of Health and Children, Vote 33. A proposed timetable has been circulated for today's meeting. It will allow for opening statements by the Minister and Opposition spokespersons to be followed by an open discussion on the individual subheads by way of a question and answer session. Is that agreed? Agreed. I invite the Minister to make his opening statement.
Estimates for Public Services, 2001.
Vote 33 - Department of Health and Children.
This is the second occasion on which I have addressed the committee as Minister for Health and Children on my Department's Estimate. As on the previous occasion, I am in the happy position to report a record increase in health spending of almost £1.1 billion, representing an overall increase of more than 25%. In ongoing revenue terms, the spending level for 2001 is almost £5.125 billion, representing a 26% increase on the equivalent figure in the 2000 Revised Estimates Volume. On the capital side, the 2001 spending level is increasing by 17% to £271 million. Money alone cannot make the total difference, particularly in such a complex system as health. I have, therefore, sought to address a number of critical strategic and operational issues central to the provision of an effective, efficient and quality orientated health care system.
My Department is reviewing the original 1994 health strategy document, Shaping a Healthier Future. I aim to have a new five to seven year strategy document by July next. I am confident that this new strategy will be the focal point of our delivery of health services in the next five to seven years. I have had a generous reaction from all those invited to contribute to informing and directing this document and for this reason it will be central to what we can plan for and achieve together.
Without wishing to pre-empt its contents, I can say that the guiding principles underpinning the new strategy will include a more people centred system, the need to take full account of cross-sectoral issues affecting health status, and the importance of developing integrated sets of quality services which can be accessed on the basis of need. It will also place a strong focus on equity. In preparing the strategy, the key themes on which we have been focusing include funding, eligibility, health promotion and population health, quality, information systems and e-health, delivery systems, including human resource issues, health futures and the role of the voluntary-statutory interface.
Economic and social changes have created new challenges, raised expectations about what a good system of health care should provide, and increased our demand for transparency, equity and accountability in the way services are delivered. The issue of value for money, efficiency and effectiveness is central to our ability to continue to attract the level of investment necessary to improve our services in the way I would like. In this regard and on behalf of the Government, I engaged consultants Deloitte and Touche to undertake a value for money review of health spending, organisational structures and service delivery mechanisms. The report will be submitted to Government shortly and I am confident that its recommendations will greatly assist in achieving the fullest possible value for the current and future investment in our health services.
The staffing of our health services has, more recently, been another of those critical issues affecting our ability to meet the increasing service demands across all programmes. There are now well established manpower initiatives covering all professions and disciplines, including medical, nursing, health professionals and others. Their remit is to identify and plan for attracting people to posts and encouraging others already in place to improve and enhance their skills so as to meet their full potential, to the ultimate benefit of patients. Investment to date in these initiatives is producing strong and encouraging responses. In the case of student nurses, this year's intake, at 1,500 students, is the highest for some time; the NCHD placements are similarly encouraging. The number of whole-time equivalent posts now approved in the health service is 86,500. Provisional health census figures for 31 December 2000 indicate that the number of whole-time equivalent nursing staff employed in the public health service has increased by 1,864 over a three year period, from 27,426 to 29,290.
The ongoing recruitment of nurses from abroad is also impacting positively on the vacancy situation. Since last June a total of 1,456 working visas-work authorisations have been issued to nurses from non-EU countries up to 31 May. Not all these nurses have yet taken up employment here as there is a time lag between the issue of the work visa and their arrival in this country. When they do, the vacancy situation will be further improved.
There are difficulties still facing the system and we must continue to tackle the issue of recruitment and retention in a flexible and practical way. While I see the solution to these issues as fundamental to the restructuring of the delivery of our health services, significant progress has been made in improving many areas of our services. I am encouraged by the progress made in many of the health programmes. In respect of consultant posts, some 268 additional consultants are in place compared to the position in 1997. There is now one consultant per 2,300 population compared with a ratio of one per 3,000 eight years ago. On the nursing front, a 50% increase in training places was provided for, with some 1,300 extra nurses working in the health service since last year. For a service that seems to be continually under pressure on many aspects of service delivery, as Minister for Health and Children, it is of paramount importance to me to acknowledge the enormous amount of excellent, dedicated work done throughout the service given the current demands in relation to facilities and staffing and also the understandable expectations of our citizens.
I will now address the detail of the Estimate before us for 2001. I have secured a significant increase in funding for health services for 2001. Given the composition of the package on the services side, it will allow me to continue with substantial improvements in almost all sectors. The budget day package alone, at £194 million, is the largest ever secured for developments in the health service. This package covers 34 separate service programmes. Together with the no policy change element, the overall funding provides for an increase of approximately £1.1 billion in current spending in 2001. I will not have the time to cover all the issues contained in such a large Estimate increase. I propose, therefore, to cover some of the more significant funding issues in the time remaining.
I have referred to some of the fundamental issues requiring both immediate and continuous investment. The health infrastructure is recognised as in urgent need of improvement at all levels. Government has committed over £2 billion in capital spending over the life of the National Development Plan, 2000-2006. Last year £231 million was secured in the first phase of the plan. In 2001, a sum of £271 million is available, an increase of over 17%.
In the acute hospital area, a number of vital projects will come on stream this year. These are as follows: St. James's Hospital - cardiac and bone marrow units; Temple Street - accident and emergency and day ward; St. Joseph's, Clonmel - phase 1, including accident and emergency, day unit, wards, operating department, etc.; Mayo General Hospital, Castlebar - phase 2, including accident and emergency, day unit, orthopaedics, obstetrics, acute psychiatric unit, etc.; Portiuncula - theatres and ICU; Cork University Hospital - radiotherapy unit. Acute psychiatric units will be commissioned in Ennis, Nenagh and Kilkenny. Health centres will be opened in Clonaslee, Ballynanty, Cootehill, Carlingford, Drumconrath and Macroom.
The Government has introduced a programme to provide for an additional 110 places in high support and special care units and to provide a comprehensive service for children in need of special care and protection. I made it clear when I took office that I was committed to shortening waiting lists and have both put the resources and commitment into making it happen. The number on waiting lists at the end of last year stood at approximately 28,000, a drop of 9,000 when compared to the previous year. Some 1,800 came off the waiting lists in the last three months of 2000. The waiting list figures should be seen in the broader national context and against the background of a hospital system with over 870,000 in-patient discharges in 2000. This represents a 5% increase for all hospital discharges or, in terms of people, an extra 42,000 patients treated.
Significant reductions have also been made in waiting times. Between December 1999 and December 2000, the number of adults waiting for cardiac surgery for more than 12 months decreased by 66%, the number waiting for ophthalmology services for more than 12 months decreased by 50% and the numbers waiting for orthopaedic services decreased by 45%. It should be noted, however, that the vast bulk of hospital activity is carried out on patients waiting less than three months for in-patient or day case procedures. These reductions have been achieved in a period of high levels of medical admissions and in spite of unprecedented problems such as nursing shortages which had closed operating theatres in some major acute hospitals. However, as I mentioned, initiatives introduced by my Department to recruit medical and nursing grades both at home and abroad are paying dividends.
The implementation of the national cancer strategy was estimated to cost £25 million when launched. The sum allocated for the strategy in 1997 was £6 million. Since then there has been some £54 million invested in cancer prevention, treatment and care services - this involved investing £11 million last year and a further £19 million this year in these services. All the commitments made in the action plan for the implementation of the strategy have been fully funded and implemented or are in the course of implementation. The main implementation elements of the strategy included the areas of cancer prevention, early detection and screening, additional consultant appointments in key areas of cancer treatment and care, and cancer research.
There has been considerable and tangible progress to date under the national cancer strategy. The strategy has been progressed far beyond the original commitments made in the action plan for its implementation in terms of the development of radiotherapy services, symptomatic breast cancer services and key consultant appointments. Statistics available from the National Cancer Registry show that the number of primary treatments for cancer has increased significantly year on year since 1994. In 1994, there were 12,682 primary surgery treatments for cancer. By 1998, this had increased to 16,470. The number of patients receiving chemotherapy-hormone treatment has also increased significantly from 3,796 in 1994 to 4,974 in 1998. These figures have been added to since 1998. These figures refer only to treatments given for the initial disease, not for any recurrence or palliative purposes.
HIPE data show that the total number of treatments for cancer has increased from 36,442 in 1997 to 50,063 in 1999 - a staggering increase in just two years. This increase is indicative of the fact that more specialist consultants were treating cancer patients and reflects a more active and aggressive approach to the management of cancer. A substantial increase in drug costs has resulted from the more complex treatment options offered to patients. This was not envisaged when the strategy commenced and following consultation with the chief executives and regional directors of cancer services I have made additional funding of £6 million available to health agencies this year for this purpose.
The National Cancer Forum, at the request of my predecessor, Deputy Brian Cowen, produced a report on the development of services for symptomatic breast disease. The report indicated a need to reorganise and develop breast disease services in centres of excellence to ensure every effort is made to reduce the number of women who die from breast cancer every year. The foundation for this reorganisation began this year when I made £4 million available to enable a number of agencies to commence the development of at least seven of the centres of excellence recommended in the report. Members are aware that hospitals are experiencing increased pressure on elective beds because of the growing number of admissions through accident and emergency departments. Available data indicate that about 70% of admissions come through these departments in major hospitals. A growing proportion of bed capacity is being taken up by the elderly whose stays are longer than average. This reduces the capacity of hospitals to meet the overall level of demand for acute hospital care. Against this background, I initiated a review of bed capacity in the acute and non-acute sectors on foot of the Government's commitment in the PPF. The review was conducted by my Department and the Department of Finance in consultation with the social partners. It involved the development of a long-term investment strategy for the acute and non-acute sectors and included a detailed assessment of future bed requirements in response to increasing demand and changing demographics.
The shortage of beds in a non-acute setting has also caused problems as acute hospitals have not been able to discharge patients in sufficient numbers and quickly enough to cater for new patients requiring admission. To meet some immediate difficulties in this area, I have provided a £32 million investment package aimed at alleviating service pressures and maintaining services for patients in the acute hospital sector, particularly over the winter period.
I do not mean to be discourteous, but may I briefly interrupt the Minister? It is now 2.22 p.m. and the Minister was due to finish at 2.15 p.m. I wonder if there is much point in his reading through the document.
Was the Minister aware that he only had 15 minutes?
I was not.
A timetable was circulated which stated that the Minister could speak for 15 minutes and spokespersons for ten.
At what time did we commence?
The Minister has about three minutes remaining.
We did not start at 2 p.m.
No.
We started at about 2.05 p.m., if not later. I wanted to make the significant elements of this extensive Estimate available to members of the committee. If certain members do not want to hear the important details, that is fine by me.
That is not fair.
We are abiding by time constraints and ask that the Minister does the same.
I am doing so.
The Minister should not make presumptions about our commitment.
I am not making any presumptions.
The Minister is making presumptions.
I am not.
He is and it is outrageous that he should deny it.
It is the role of the Chair to interrupt me to say my time is up. I will not take any nonsense from any quarter today.
The Minister should not make presumptions about members, given that he is unable to manage his timetable, or even take responsibility for it.
Not all the killer whales are in Cork Harbour.
The Minister should take responsibility for his timekeeping.
The Deputy should allow the Minister to conclude his statement.
I am not dealing with any nonsense.
Substantial provisions have been made for old people in this year's Estimate. In 2000, £35 million was provided for services for older people and this year a further £57 million has been made available to support continued development in a range of areas. Increased payments are being made to home help staff as such payments have been unacceptably low for far too long. A list of improvements made to services for the elderly is included in the statement I have distributed.
Since taking office, the Government has identified the provision of improved services for persons with an intellectual disability and those with autism as a priority in the area of health and social services. Recent information provided by the national database of intellectual disability shows that 1,350 residential places and 752 day places are needed between 2001 and 2003. Additional revenue funding of £28 million in 2001, with a full year cost of £35 million in 2002, is now available to enhance the level of services for those with autism or an intellectual disability. Capital funding amounting to £45 million has also been made available this year to support the expansion of services.
Services for those suffering from a physical or sensory disability will benefit from an additional £22.7 million in 2001. A sum of £18.6 million has been provided for improvements in mental health services. Significant developments have been provided for in the areas of child, adolescent and old age psychiatry. Over £500 million is spent on the GMS scheme annually, with 1,800 general practitioners providing services under the scheme, an increase of 150 in the past two years. This year an additional £33 million is being provided to improve and enhance child care services. There have been significant improvements in foster care programmes.
I also wish to discuss with the committee the implementation of the meningitis C programme. Funding of £25 million was provided in 2000 and £41 million has been provided in 2001 to enable the completion of the programme. Results to date have been very encouraging, with a 57% reduction in the incidence of meningitis C among target age groups. This is clear evidence of the value for money provided by immunisation schemes. I thank the Chair for his tolerance and forbearance and commend the Estimates to the committee.
In 1980, when this country was much poorer than it is now, 7.8% of GDP was spent on health. In 2000, this figure had dropped to 5.1% of GDP and 6.05% of GNP, which is probably a fairer measure. While it must be acknowledged that Irish GDP has increased rapidly in recent years, economic growth has not enabled us to rise any higher than twenty-second of 29 OECD counties in terms of health spending. From a low base in the early 1990s, health spending has more than doubled, but it remains far behind the European average of more than 8% of GDP. The money contained in this Estimate does nothing to restore health service spending to 1980 levels, despite the fact that the Exchequer has a budget surplus of £6.4 billion.
These failures are more than regrettable for the thousands waiting for hospital beds, for doctors, nurses, therapists and paramedics working within the health service and for those who rely on medical expertise and care. It is deeply disappointing for those who believed the Minister's press releases and expected a reforming and revitalising response to concerns. Instead of the stimulating injection expected, the Estimate will act as a sedative to the ailing health service. At best, it will simply maintain the unacceptable status quo and, at worst, there will be a rapid deterioration of the health system's critical condition.
Let us look at the facts contained in these figures and examine a few key areas which give the lie to any assertion of change or improvement. The total net increase in this year's Estimate over last year's is £850 million, an increase of 17%, which is good. An examination of the £850 million, however, shows us that £421 million, or 49.5%, is used to pay salaries. I fully concur with the need to pay good salaries and have no quibble with such payments, which are essential in any Estimate. I have a problem, however, with the amount set aside by the Government for health spending after the allowances for salaries have been removed. The increase is now reduced to £429 million and the reality is that the Estimate simply aims to continue existing programmes, to pay staff and little else.
The Estimate does not contain a sign of a financial outlay that would allow the realisation of the reforming and revitalising zeal the Minister often articulates. When asked to put his money where his mouth is, the Minister fails miserably. While spending has been increased by the Government, no contribution has been made to improving health care or reforming the health service. Spending has been increased, but health care has not been improved. Strategic planning is lacking. The Estimate makes no allowance for a sign of such planning, but this is no more than we have come to expect.
In the Dáil on 8 May, the Minister said it was time for a strategic look at health services. He went on to argue, however, that "seven years after the previous strategy is an opportune time to look forward in terms of a new strategy". Despite demographic changes and a rapidly changing health environment in the five years during which the Government has been in office, the Minister has only now started to look forward. It is a strange way to administer health services. The health needs of the public are immediate and urgent, but the Government has wasted time during the past four years noting reports and ignoring the evidence of its own eyes and ears. Only now is it looking forward. Such a laissez-faire attitude is unacceptable.
The deluge of evidence on the need for rapid reform has swept on unnoticed by the Government as if it were a passing shower. It seems the Minister, were he Noah faced with the flood, would have brought an umbrella rather than building an ark. I draw the attention of the committee to other bons mots of the Minister which are relevant to the allocations contained in this Estimate. On 8 May 2001 during the Fine Gael Private Members' motion debate on the national cancer strategy, the Minister said: "It is important that the public is made aware of the scope for preventing many cancers by making appropriate lifestyle changes." In the same debate he said:
With respect to the Opposition, we are reaping the negative results of a very poor lifestyle 20 or 25 years ago. That is why we are an unhealthy country today. It is ridiculous for Opposition spokespersons to attack a current Minister for factors which go back 20 or 25 years in terms of how we lived.
Those words may come back to haunt the Minister. How will the Minister's record stand in 20 or 25 years' time? In this Estimate less than £2.50 out of every £1 million is allocated to health promotion. That statement bears repetition given that the Minister has acknowledged the importance of health promotion. According to the Minister, this is a priority area, yet it gets only £2.50 of every £1 million. So much for prevention and priority.
There is another relevant fact about this miserly allocation. In 2000 the Government increased the price of cigarettes by 50p per packet of 20. I welcomed this increase which gave the Government an additional £132 million. The same amount is anticipated this year. Despite the fact that 6,000 Irish people die each year from cancer and other diseases directly attributable to smoking, the Government is making just a little over £2 of every £1 million in this Estimate available for health promotion. It receives £132 million in excise duty but spends less than £10 million - the exact figure is £9.852 million - on health promotion.
Let us look at another interesting figure. When the rainbow Government was in power, a five storey extension allowing for 98 extra beds at Longford-Westmeath General Hospital in Mullingar was completed in 1997. The estimated cost of equipping that brand new building in 1997 was £11 million. More than four years later that building is not so new, but it is still empty because the Government could not make up its mind what to do. The 98 beds have not been provided, the main hospital remains overcrowded and the cost of equipping the four remaining floors is estimated to be £40 million at 2001 prices.
In the Estimate the Government has increased the allocation for building and equipping hospitals and other health facilities by only £32 million in 2001. That entire increase over last year's spending would be wiped out if only three of the empty four floors at Longford-Westmeath General Hospital were opened this year. The Government's increase disappears in one hospital with a 75% complete extension, for which people have already waited four years. The people of Longford-Westmeath can have no confidence that their hospital improvements will happen this year either. The rest of the country's facilities must be awaiting developments with baited breath.
The Irish health care system is increasingly flawed in terms of equity, efficiency and quality. A fundamental aim of reform must be to ensure that health problems are dealt with at the level of least complexity appropriate to the situation. I only have a minute or so left so I will make just one further point. I am absolutely aghast to find from a parliamentary question last week that the proportion of the population currently covered by medical cards is 30.3% whereas the agreement with the IMO allows for cover of up to 40% of the population. At times the figure has been as high as 39%. This means that a single person on £101 is disqualified from holding a medical card even though there is an agreement with the IMO that such persons, and others on higher income, could be allowed qualify.
One in every four persons covered under the IMO agreement with the State is not allowed medical cards. The effect has been to keep medical card thresholds so low that a person on £101 a week is disqualified from holding a medical card. Consequently, entertainment for people who cannot afford to go to the Riviera for their holidays or join a sports club consists of a packet of cigarettes. Their health further deteriorates, they cannot go to their GP and they end up in hospital queues. The Minister says waiting lists have decreased by 30,000 or more. That is mainly due to verification, which means sending out letters and taking those people who do not reply off the list.
This totally unjust system is apartheid ridden and the Minister has done very little about it, despite his shenanigans before the meeting in Ballymascanlon when he tried to bounce his colleagues through a series of leaks to every Sunday newspaper before emerging shame-faced, having been put in his place by the Minister for Finance, Deputy McCreevy. The procedures for dealing with these matters are here at this committee. If the Minister wants to deal with the issue he should present his Estimate to the committee and have it voted through before taking it to the Dáil for endorsement.
Before proceeding to provide the services, the Minister should devise a strategy, but he does not have one. The 59 sticking plaster review groups that he has set up are costing us a fortune. He is unable to make any strategic decisions. That is the essential difficulty we face with the health services. The Minister can choose to treat this committee with contempt by putting down as nonsense all that is said here. We saw the outcome of treating people with contempt last week. That is where the Minister is going if he continues to treat this committee with contempt. It is my duty and that of my colleagues, to raise questions at this committee and it is proper that the Minister answers them.
There is an irony in the fact that we are debating these Estimates prior to the Minister's departure to receive a report on North-South health which, if the newspaper reports are to be believed, is the most telling indictment of the Government's failure to meet the needs of the health service. Today's report shows that Irish mortality rates are significantly worse than the EU average, rates in the Republic are 6% worse than in Northern Ireland and approximately 6,000 people a year die prematurely here. The people most at risk are generally poor, living in bad housing and in many cases abusing drugs. They are at the butt end of the increasing divide in society that the Government has not only presided over, but actually exacerbated. It is a terrible indictment that we have arrived at a position where people are badly losing out at a time of great prosperity. Many of the people at risk are already on hospital waiting lists.
I ask the Minister to state the reason the normal procedure for providing information on hospital waiting lists has been abandoned. The Department normally releases figures on a quarterly basis. It is an unsatisfactory arrangement because the information is out of date by the time of release. Even today the Minister is referring to figures from December 2000. I have still not seen figures for March 2001. That is unprecedented. Why is that information being suppressed when there is information in the media indicating that in certain major Dublin hospitals waiting lists are increasing, not falling. At the very least, the taxpayers are entitled to know what is going on, how their money is being spent and what the return is on that money. I have tabled parliamentary questions to find out the updated figures on hospital waiting lists and am still being given figures from last December. I have to presume that these figures are being suppressed. It is unprecedented and inexcusable that a Department which should be publicly accountable is acting in this manner.
There were further leaks in the media indicating that the Estimates emanating from the Department of Health and Children for planning and provisions would require increased funding of £2 billion on expenditure and £8 billion on capital expenditure under the national development plan. This is information that is dripped out in the media. As a member of the Oireachtas health committee with a duty to the public I ask the Minister to arrange that Department officials would brief us about these Estimates. I do not refer to the Estimates we have here but to the work they presented to the Ballymascanlon meeting - unfortunately with no product at the end of it. This information was collated by his Department and is still unpublished and unavailable to the public. Will the Minister ensure that we, as Oireachtas Members with specific responsibility for this area, have this briefing to ensure that the secrecy within the Department is dealt with. It is disgraceful that this type of information is being drip-fed to the media.
I have certain questions and there is a need for answers. I understand that an additional 12,000 staff have been employed in the health service since 1996 and I would like clarification as to the accuracy of the figure and the breakdown. What element of that staff increase has gone on administration and what element has gone on health care professionals and providers? An assessment of the figures up to 1996 showed that there was an increase of 53% on the administration side and a drop of 4% in terms of nurses. They are old figures now and I want up-to-date ones.
I find it extraordinary that every time I try to engage in a debate on the possibilities, merits and demerits of a universal health insurance, the key objection raised by the Minister is that it might increase administration costs. Let us have some real information about how much is going on administration in terms of manpower and costing, because these Estimates are certainly showing an increase in administration costs that is considerable and is very difficult to justify. I am interested in hearing an explanation and a justification from a Minister who refuses to look at alternative ways to deal with the serious and central issue of equality in health care. The only mention that is given to it is the weasel words the Minister produces in terms of a health strategy - having listed out all the various cross-sectoral issues he says he will place a strong focus on equity. Excuse me if I am not impressed. That means nothing to anybody any longer - the debate has moved on. We have had 12 months of serious debate in the media and among the public, and there is great concern among the public about the issue of the two-tier nature of our system.
I would be grateful if the Minister would ensure that we have a briefing from his Department on the bed review analysis and the work that has been done on that. We are entitled to have that information at the earliest possible date and not to wait months for reports to be published. Very often by the time they are published the Minister has ensured that everything he wants to put a spin on has already been in the media and has become old hat.
The situation, particularly in the Eastern Regional Health Authority area, is extremely serious in terms of bed capacity. The ERHA has itemised the problems and I would like to know, not just in the ERHA area but across the country, how many more beds will be made available and how many more nurses will we have this year. It is a bottomless pit. We are providing more nurses who are free to get out of the country and the profession as they choose and it is important to know how many beds, nurses and health professionals will be provided. It is not just a matter of providing nurses, but the focus has been on them. In one of the medical papers there is a reference to 45 vacant junior hospital doctor posts and I would like the Minister to comment on that.
The Mid-Western Health Board reckons that it needs 107 occupational therapists alone over the next seven years and there are already vacancies for current posts. We need to know how this year fits into the longer timeframe in providing the additional bed spaces and professionals in terms of medical, nursing and allied staff that are so necessary. Will the Minister comment on building inflation? He is proud he has provided increased funding for building and he has itemised the hospitals that are included for this year. I cannot find a figure here for building inflation - obviously that is a significant figure. Deputy Gay Mitchell's points with regard to a particular hospital are valid with reference to seeing what this means in real terms.
The Minister makes great play about the additional money he is spending, and nobody is arguing that fact, but the difficulty is that it is still not enough. We are way down the league, bouncing along near the bottom of the EU table with a couple of other countries regarding the amount of money that is spent as a percentage of GDP. We do not appear to be getting the return for the money that has been spent in terms of patient satisfaction, significant reductions in hospital waiting lists or in terms of a much greater emphasis on primary care or rehabilitation beds. Is the Minister aware that it is reported that there are 80 beds in St. Mary's Hospital in the Phoenix Park that are not being used? I will be delighted to withdraw that remark if it is not the case, but that is my understanding. These beds could be occupied by people who are in tertiary hospitals such as the Mater or St. Vincent's, people who are unable to be moved out - there could be 80 in the Mater for all I know, there are certainly 50 or 60 patients who are actually discharged but cannot be moved out. At the same time beds are lying vacant that cannot be used for this purpose, while people are waiting, sometimes on trolleys for days at a time, in accident and emergency departments or on waiting lists.
We should remember that when the Minister talks about reducing the number of people on hospital waiting lists, when the figures are assessed and analysed - it would be useful if the Department in future presented this analysis instead of reporters and TDs having to dig this out every time hospital waiting lists are produced - half of the people taken off the waiting lists at the time we discussed the last Estimate of 13 December did not receive treatment. They may have gone private, gone away or, sadly, passed away, but we need to be sure that when we are talking about delivering additional services and making money available to do this we can stand over those statements.
We will proceed into a general discussion on the Estimates. I suggest that we do so in order, beginning with subhead A, and avoid jumping from one to the next. The first subhead relates to the administrative budget and while a number of questions have been posed under that heading perhaps Deputy Gay Mitchell would like to add to that.
Why has there been a 23% increase in travel and subsistence under this heading? According to the note, a substantial part of that relates to EU travel. Will the Minister explain why there is such a substantial increase in EU travel and why a 205% increase in consultancy services is forecast for this year? I would have thought the 59 or 60 reviews the Minister has undertaken would be sufficient. We have had enough reviews and consultants. What will we do with all the extra reviews?
Will Minister tell us about his consultation with the Attorney General regarding the Dutch ship that is proposing to visit the Irish shore to carry out abortions? Does he agree that, under his administrative powers, it would be a good time to introduce the new agency to support mothers with crisis pregnancies? Should that be our response rather than other approaches? He has the administrative power to do so. Will the Minister indicate that he will do so before the House goes into recess? It would be timely to provide funds in the budget if we are to support women going through crisis pregnancies, as recommended by the constitutional review group. My party has been advocating that for some time.
Deputy McManus had at least two serious questions on administration, on the bed review and the percentage involved in administration within the system.
I was also curious about consultancies. The background information itemises some issues, the VFM audit and VHI advisers. Various consultancies have been considered at once without costing them - they amount to almost £1 million. Are other consultants' services included in that figure that have not been itemised? Additionally, there is no mention of IT consultancy services. Will the Minister comment on that, because he was very committed to the development of these services when he took over two years ago?
Is Deputy Mitchell referring to a 25% increase in EU travel? In other words, we are going from £68,000 to £100,000——
The figure for the increase in travel generally——
I am not travelling a lot anyway.
I must apologise - I was looking at the wrong heading. Salaries, wages and allowances went up by 23%. What is the main increase under that heading in terms of administration?
The overall figure for administration, as a percentage of overall expenditure - these are 1999 figures - is about 4.9% in the health boards and 2% in the general medical service payments board. On salaries, there are always ongoing increases in terms of additional staff and the fulfilment of the PPF increases in salaries throughout the service.
The Minister mentioned additional staff working in the office of the Registrar General. How many are involved?
I do not have the exact figure, but I can forward it to the Deputy when it becomes available, with a unit-by-unit breakdown. There is a general increase of 23% in salaries, wages and allowances.
Does this include the additional staff working in the office of the Registrar General?
Generally, where increases in salaries and wages are concerned, they are accounted for in terms of the pay agreement we have to fulfil. I can acquire the breakdown of the figures in subhead A1 for Deputy Gay Mitchell.
Is any of that back pay for a previous year?
It could be, but I do not have a breakdown to clarify that.
The Minister and his four officials, coming before an Estimates committee, should have that information.
What information?
The information demonstrating what the expenditure was for.
It is for salaries, wages and allowances within the Department——
The Minister says it relates to additional staff in the office of the Registrar General. How many staff?
I did not say they were in the office of the Registrar General, but that they were additional staff generally. I will check that for the Deputy.
That will be too tardy.
I think not.
We have to vote on the Estimate.
The Minister will provide the information to the committee.
In terms of consultancies——
Before the Minister discusses that, will he state to what degree the increase in staff in the service relates to administrators and how much to those delivering the service?
I hope to have that figure before the conclusion of the debate. It is not what is being suggested, but is on a par with usual administration percentages. I have seen a pie chart of the percentages, which does not correspond to the statements that were made regarding a preponderance of officials being appointed as opposed to medical staff, nurses and paramedics.
The Minister does not even know the answer.
Off the top of my head, I do not have it, but I will forward it to Deputy McManus. On consultancies in 2001, I have a list of costs: health insurance, the insurance actuarial cost, £125,000; national children's strategy consultation, from £2,000 to £5,000; PR for the national children's strategy, £10,000; secondary care, case-mixed statistics, £62,000; secondary care, inspection of medical devices, £30,000; finance unit spreadsheet for voluntary hospitals, £48,000 etc.; finance and planning, public management research, £40,000; change management and change management projects, £80,600; corporate services, internal personnel involved in developing a human resources strategy, £9,600; external personnel workforce planning survey, £30,000; IMU information strategy, £50,000; external personnel and FY training, £4,000; health insurance and health insurance case-mix project, £40,000; value for money audit of health service, £226,000. The health insurance VHI cover——
I hope they are value for money.
I hope they are too. We will soon find out. The cost of the corporate project for the VHI will be approximately £650,000. The cost of external personnel contracted for the enterprise liability project, another significant issue, will be approximately £386,000. Those costs are carried over from last year, but there are costs that will have to be met in 2001. New costs of projects pertaining to this year include the following: the child care information management project, £300,000; HPO, the NDP software system, £13,000; the chief medical officer project concerning a comparative study of health legislation, £3,000; national health information strategy, £37,000; general evaluation of personnel, including the post of chief executive officer, £1,500; and systems internal and IT project, £30,000. I have a detailed list explaining each project that I can forward to Deputies.
Will the Minister answer my question on the agency to assist women with crisis pregnancies?
I do not intend to respond to the arrival of a particular ship in Ireland. It is trying to garner publicity for a particular cause with which I do not agree. Nonetheless, I am operating under the aegis of the interdepartmental committee that is considering the recommendations of the all-party committee that considered the issue of abortion. We are considering a range of proposals concerning crisis pregnancies. The recommendation from the all-party committee is that we should establish a national agency with substantial funding to administer a much greater crisis pregnancy programme in the future. We gave this some consideration on Committee Stage and feel that the best way to establish that agency is under the Health Act, 1970. Our intention was to bring a full report to the Government and, in turn, the Oireachtas, encompassing all the issues which were considered. One of those issues was the establishment of such an agency. We have made a great deal of progress in drawing up the terms of reference and will be in a position shortly to produce that report, but that will not be before the end of this term.
It is not appropriate to respond to the arrival of a particular ship in a panic or in a reactionary way. We have to do our work in a coherent way. The Department currently provides funding for crisis pregnancy agencies across the country and have done so for some years. The idea is to use a national agency to co-ordinate that and become more coherent in terms of the development of such a programme.
I think we could do much more to support agencies which try to help women with crisis pregnancies, we are not doing nearly enough. I do not want to make a party political issue of this. I hope this proposal will be brought forward by the Minister sooner rather than later. When it is, I hope a Supplementary Estimate will be introduced. We will strongly support any such measure.
Far from there being a knee-jerk reaction to the Dutch proposal, those of us who are taken for granted and often try to promote a reasoned and reasonable debate on this issue will not be stampeded into anything by anybody. It does not help that having gone through the thoughtful process of the Constitution review group people approach this issue in such a crude manner. Above all, we should be thinking about women with crisis pregnancies, their children and what we can do to support them. I hope that agency will be set up and properly funded before the year is out.
I endorse what the Deputy has said on how we should approach this issue. As long as a ship is in Irish waters it is subject to Irish law. In international waters it is subject to Dutch law.
That is not what today's newspapers have reported. They reported that as well as being subject to Irish law in Irish waters, it continues to be subject to Dutch law because it is flying a Dutch flag. The Dutch Minister has taken a strong position on this and opposes the activities of this ship because it runs counter to Dutch law.
We have received legal advice from the Attorney General and are monitoring developments. I would like to return to some issues which were raised earlier.
No, the Minister has already responded. I would like to raise something which I feel is a more important issue relating to abortion. There has been a debate and changes have occurred within the Medical Council. Quite clearly there is disagreement between members of the council regarding the guidelines that are currently in place.
Where does this arise under the subhead "administration"?
I am sorry, but a Dutch boat which intends to come and go is relevant. The Medical Council which represents the medical profession is particularly relevant and I want to ask a question of the Minister for Health and Children.
How do I know it is something obvious? It is probably under "administration".
As I said, if the Dutch boat comes under "administration" I want to ask the Minister a question which is relevant to women's lives and I would be grateful if the Chairman would give me permission to do so.
I have no problem with the Deputy doing that. I just wonder where it fits in under "administration".
I do not know. I am sure the Chairman can find out. Administrators in the Department of Health and Children will manage this issue. I want to talk about the Minister's response to the sub-committee of the Cabinet. We are all in agreement about the agency, it is only a matter of sorting out the details. What is at issue is a referendum. If the Government intends holding one there are medical implications that will inevitably put women's lives at risk. This is something which is subject to a lot of debate and difficulty within the Medical Council. Is the Minister bringing to the sub-committee the health concerns of women?
Of course, and every member of the sub-committee is concerned. The health of women has always been central in previous debates. It was a major consideration in the context of the constitutional amendment which was passed in the 1983 referendum. People have different perspectives on the debate and argue on all the issues, including the health of the child and of the mother. The deliberations within the Medical Council are germane in the debate and have certainly raised new issues. One would have thought that the conclusions that emanated from the Oireachtas committee were informed by comprehensive and good submissions made by professionals in this field. That cleared the air for many people on the committee and for the public. A new twist has been added arising from the deliberations within the council which do not seem to have concluded yet. That is something which we will watch. When the Government came to office it wanted to achieve as much consensus as it could. Previous Governments dealt with this issue as far back as the early 1980s. It is not something that has ever been solved without some degree of debate, and indeed controversy and rancour, and it is not something which can be solved simply. The interdepartmental committee is conscious of that as indeed I am. The health of women is key in anything we do.
Deputy Mitchell asked about the increase in salaries. I am informed that the information was given to the Chairman and it may have been circulated under the Revised Estimate. There is a table under the heading "administration" with the figures for 2000 and 2001. The Minister's office, the Office of the Minister of State, and central secretariat are staying as they were in 2000. There are two additional staff in the management development office and one additional member of staff in the strategic policy development section. There are seven additional members of staff in the finance, planning and international section and four additional people in the primary care section, up from 56 to 60. There are three new staff members in secondary care, up from 35 to 38, there is no change in the continuing care-personal and social services section at 54. There is one extra member of staff in both the hospital planning (20) and medical officers and support staff sections. Oifig an Ard-Chláraitheora gets a significant increase - the staff numbers are up from 88 to 123 - and the numbers in the Adoption Board remain the same as last year at 19. There is a figure for overtime and employers' contribution.
I am tempted to ask the Minister how many people are working in his constituency office, but I do not wish to offend the Chairman and Deputy Dennehy.
I would like to ask the Minister a question not in relation to nursing staff, doctors or consultants but about the administrative staff. Recently the Western Health Board appointed extra programme managers and another assistant press officer. It now has more managers than Manchester United. Manchester United is delivering but the health service is a disaster. I tabled a Dáil question and in reply I got so much rigmarole that three students and I are going through it trying to work it out. There is a ratio of at least 4:1 in terms of administrative and medical staff at the hospital. There are no doctors, no consultants and no nurses. Are the chief executive officers of the health boards out of control? If they are, why does the Minister not just abolish them and start again.
Let me give an example of how services are run in the Western Health Board. This is in the Department's favour, not in mine, because as an Opposition spokesman it is better for me to criticise rather than praise the Minister. This morning a constituent phoned me, having received a letter from the Western Health Board a year after her son had completed his orthodontic treatment asking her if he still wanted to avail of the orthodontic service. With all its managers, programme managers and assistant press officers and so on, my constituent still got that letter. It is no wonder people who had to wait three and a half years now have to wait four and a half years. If this continues the waiting time will be five and a half years next year.
I want to know what the Minister is doing about this top heavy situation in terms of administrative staff who are still not doing their job. What is happening? Has the Department lost control of the chief executive officers of the health boards? If he has he should start at the beginning again and bring the service back on an even keel because the chief executive officers seem to be running the show and are acting like gods.
The language used by Deputy Ring is very interesting. He says I have lost control. The issue he has raised is very serious. However, when the 1970 Health Act established the health boards, it was not the idea that Ministers should control every chief executive officer of the health board or every board. The Oireachtas devolved power and gave statutory authority to health boards to deliver health services within their regions. That is the fundamental issue. Health board members often table parliamentary questions asking me about the health boards in their constituency.
I was never a member of one, but I would love to be.
It is extraordinary that they do not table questions to the chief executive officers at health board meetings. When they ask a parliamentary question they get a parliamentary reply with a letter affixed to ensure it goes out because in one case last year it did not go out and we were criticised for that. We then send a letter to the chief executive officer informing him of the question the Deputy has asked and requesting a reply as a matter of urgency. That procedure needs to be reviewed. We set up statutory agencies but Members of the Dáil who are also members of health boards ask parliamentary questions about their own health boards which they should be asking the health boards. There are many public representatives on health boards, but one would imagine when certain things happen that they had no input into the decision-making that takes place at local health board level.
The fundamental issue is that we have a regional health structure which is primarily the vehicle for the delivery of services. The health strategy on which I am currently working is examining the issue of delivery systems generally, how we deliver services on the ground to people. Deloitte & Touche were employed to carry out a value-for-money audit. They have also looked in some detail at that issue and are making recommendations in relation to it which will feed into the strategy which I will bring to Government in a number of weeks. The issue of how we deliver services generally, and that involves the Department as well, is under examination. The Deputy may think it involves quick decisions by one or the other. I am sure he remembers that before the health boards were established we had county health boards.
They worked.
Times change.
Like everything that works, we changed it.
They would not survive today. Today's health system could not be run on a county basis.
At least it would be possible to identify a person and hold him responsible.
It would be impossible to do it because of the increased sophistication of medicine, the emphasis on trauma centres, acute hospitals, proper centralisation of expertise and so on. It would not be feasible.
I should declare my interest. I have been a member of a health board for 20 years and have chaired the Southern Health Board on four occasions. It is important to raise the ability of health boards to do their job and the role they play. Deputy McManus is right when she says the issue of health has been debated in the media and by the public. Only six weeks ago the public decided that successive Governments since 1985 had failed the health service. However, no one Government was responsible and parties that no longer exist were part of those Administrations at times.
We must ask whether we are spending money properly. On administration, I am concerned that the health boards will become an easy target. Deputy Ring thought county boards were successful. However, he has also said that there are too many health boards - there are eight. On the other hand, he thinks it would be all right to have a health board in each county. There is a conflict here.
I want a service that works.
Material emanating from any Minister's office to a state board or body gets priority and other issues are dropped, as any programme manager will tell the Deputy. People who are members of health boards table questions in the Dáil and they must be answered within three days. The Minister's Department writes to the health board and important work is dropped by the people who are now being criticised for not administering schemes properly in order to answer these questions. We need to first examine our own role in the House. The thousands of questions that are asked are often unnecessary and many have a political slant.
The health boards have worked, generally speaking. I am only familiar with the Southern Health Board and not with the other seven. It seems they are becoming a target for some people and I would not like that to happen. Deloitte & Touche, the group who are reviewing the health boards, could be asked to examine the administrative side and their role in the examination of the health boards and where they are going. The health boards should be treated fairly. It is not fair to say all the chief executive officers are acting like gods.
The Deputy should not praise them. I am sick and tired——
(Interruptions.)
We are dealing with a very important issue. We are dealing with a system that has worked fairly well since it was set up. There will always be complaints. There are different systems in the UK and elsewhere and there are complaints about the health service. We should at least carry out a fair analysis rather than saying they are all wrong. Many people work in the health boards and they are doing an excellent job. If there are weaknesses, let the independent body examine them.
The bottom line seems to be whether there is anybody to monitor the managerial appointments that have been made at health board level. Is there anybody, other than the chief executive officer, to say that these are needed?
The personnel section of the Department liaises very strongly with health boards in terms of additional posts on an ongoing basis. Most posts that are advertised have to be sanctioned by the Department.
What about press officers and whether there is a need for them? There is a need for orthodontic and health services.
The health boards cover huge areas and very often suffer from poor communications strategies. The good things that are happening are never communicated. To a large extent for many years they have been shy about selling the good things. We know there are many difficulties.
When the Minister meets the people at election time, he will know what it is like.
Nevertheless many good things are happening. I would not object to any chief executive officer of a health board appointing a good communications team to handle the multiplicity of queries that come in on a daily basis from the media generally. As a Minister I could spend my entire day responding to media queries. I can only imagine what it is like at regional level with the multiplicity of provincial newspapers, radio stations, etc.
The Minister has never had time for proactive leaks.
No. May I answer a question I was asked earlier about a breakdown of the number of posts? In 1997 there were 8,793 in management administration while in 2000 there were 12,000; in medical dental there were about 4,975 in 1997 and in 2000 there were 5,600; in nursing there were 27,426 in 1997 and 29,190 in 2000 and that number will have increased significantly by the end of this year. In the professions allied to medicines there were 5,969 in 1997, there are now 7,600. A key figure in terms of administration is that there are only 1,800 managers within the complement of 12,000 management administrative grades. A large percentage of the growth between 1997 and 2000 in the area of management administration relates to nursing support posts, such as ward care assistants, ward clerks, etc., which are sought at the request of nursing and medical staff. People often forget that if one puts in a consultant or additional nurse specialists they demand additional clerical assistants or administrative supports as part of the overall multi-disciplinary team. Invariably when we put in additional medical consultant posts we are putting in additional administrative staff. It is imperative that we do that but it is often lost sight of in terms of the global figures. I can supply those figures in written form.
There were other queries including some relating to St. Mary's in the park. As of 9 May 2001, out of a total complement of 289 beds for older people, 230 were occupied leaving 59 vacant. This was due to a shortage of nursing staff. The Eastern Regional Health Authority and the Northern Area Health Board have commenced a recruitment drive overseas to get the staff required. It plans to open the beds as follows: on 23 July, 18 beds, mid-September, 28 beds and at the end of October, 13 beds by which time the 59 beds will be occupied.
There have been 1,500 authorisations in terms of nursing alone but some of those work permits and authorisations have still to come on stream. Even though they have been authorised it could take three or four months for people to come. A question was raised about IT. The bulk of that spending is under the national development plan. In terms of the allocation of the capital under the national development plan we gave a significant allocation to IT last year and this year. The IT consultants are paid by the NDP and we gave an allocation of £20 million in 2001 for IT development across the system. There is a commitment of about £140 million for IT throughout the national development plan between 2000 and 2006.
In terms of the Estimates, if the national development plan money is not included in these Estimates——
It is in the capital plan.
I take it that it is on administration.
Yes.
We are on administration. We shall move on to subhead B which deals with grants.
On administration, all I will say is that on Sunday week last, in the Sunday Independent there was an allegation that the staffing levels in administration as against the total staffing of the health boards was available only from 1997 and that there were no later figures. Is that the case?
I have just given the figures. What the Deputy said is not true.
Subhead B.
I congratulate the Minister on the substantial increase in the Estimates. Deputy McManus mentioned the national development plan under which there is an increase of 17%. I hope this will continue given that the cost of many capital projects has increased. The 17% increase is welcome. I wish to ask about two separate issues. I note that the allocation for national cancer strategy in 1997 was £6 million and that £19 million will be added this year. Obviously it is a huge issue which affects most people either directly or a family member. The North-Western Health Board has not had the BreastCheck pilot scheme. How is it proceeding? When will it be extended to the rest of the country? Perhaps the Minister can provide some information on cross-Border co-operation in regard to cancer services which might be included in the Estimates and expand on what the progress has been made on the cancer strategy.
Funds for services for the elderly have increased from £35 million to £57 million. The Minister may have alluded in his contribution to the fact that the elderly are taking up many hospital beds. On a daily basis I come across elderly people who are ill but not in need of hospital care and there is no place to which to move them. I am pleased at the significant increase in services for the elderly. Where possible, people should be looked after at home. Are there enough incentives for people to develop nursing homes? It is obvious there are not enough step down places. I am aware also that there has been controversy about step down places. Many district hospitals appear to be trapped with many elderly people so that when people who need immediate attention come in there is no alternative for them.
I have a couple of questions. The grants to health boards are up 58% on last year. In relation to the illegal activities of health boards in assessing the families of those in nursing homes, excluding the pocket money calculation of residents in nursing homes, it seems to me that the refund of moneys to hospitals and the redressing of the injustice done is not uniformly followed throughout the health boards. Has the Minister handed down a policy in this regard and, if so, can we expect the health boards to refund moneys illegally deducted? Has provision been made for this in the Estimates or are health boards expected to provide for it out of their own budgets? In response to a recent parliamentary question concerning the Southern Health Board the Minister said:
I am aware that the issue of paying enhanced subventions has been raised in the Southern Health Board area and in this regard officials of my Department are in regular contact with the boards' officials to monitor the situation. Is that situation being dealt with?
There is a report in The Irish Times today on health inequalities highlighted by the Institute of Public Health, the body set up under the Good Friday Agreement. The report states that there would be nearly 6,000 fewer deaths prior to people reaching the age of 65 if we reduced the death rate for everyone in the Republic to that of the highest occupational class. I raised this matter with the Minister in the past . The figure for those dying aged 55 or over is 13 per thousand in the higher professional classes whereas it is 36 per thousand, almost three times that figure, in the lower socio-economic groups. This research bears that out. The elimination of inequalities in the service alone would result in a reduction of 6,000 premature deaths every year. What will happen as a result of this research by the Institute of Public Health which is partly funded under this heading? Are we to act on these statistics and say, yes, we will eliminate the inequalities? Why has the VHI not accepted St. James's Hospital's case for cover in respect of out-patient MRI scans, but instead has decided to provide cover for MRI scans performed only during medically necessary in-patient stays? Why are people who pay insurance not covered for MRI scans by the VHI as out-patients in St. James's Hospital? What powers does the Minister have to put what seems to me to be a great injustice and anomaly right?
A range of questions have been asked. In relation to Deputy Keaveney's question about the breastcheck screening programme, it covers the ERHA, Midlands Health Board and North-Eastern Health Board. Some difficulties were experienced at the start in the recruitment of staff, particularly radiologists, but they are generally satisfied with the progress that has been made. I have asked the board that administers the BreastCheck programme to bring forward proposals to me as early as possible for the expansion of BreastCheck across the country in the remaining health board areas that are not covered by it. The board that administers BreastCheck is anxious that before we roll out the programme into phase two all the i's are dotted and the t's crossed in terms of the programme and that follow-up care is available. There is no point in screening thousands of women if the follow-up treatments are not in accordance with the protocols that have been laid down within the BreastCheck programme, for example, that one will be guaranteed treatment after so many weeks of diagnosis and so forth. It is the first programme of its nature ever introduced here. The board is satisfied with the uptake from women within the target age group. I hope that by autumn I will have a report from the board on the expansion and roll out of the programme.
I hope the Minister will be busy with that because the programme is respected and its expansion throughout the country is awaited.
It is linked to the establishment of centres of excellence for breast care across the country. I made £4 million available to the six health boards this year for the development and commencement of seven centres. We have progress reports from each of the health boards in terms of the implementation of the breast cancer symptomatic disease centres initiative. While some are making faster progress than others, we are keeping the pressure on to make sure that we get the commencement and delivery of services in the seven areas we identified this year. It is our intention in the next round to add six more, which would bring us in line with the 13 that were recommended by the report of the sub-group of the National Cancer Forum.
In terms of co-operation with Northern Ireland, there has been a joint consultant medical oncology appointment between Letterkenny and Northern Ireland. There is ongoing work up there and I discussed that recently with the chief executive officer of the North-Western Health Board. We are anxious to get a regionalised response there that gets rid of the Border in one sense but that gives a proper service to the people within the catchment area. In relation to symptomatic breast cancer services, we are working with our northern counterparts on that.
I thank the Minister for his reply. I emphasise that in our area we have 80 miles of border with the rest of the North and very few miles of border with the rest of the Republic. Previous Ministers have under-estimated our geographic location in terms of the number of miles of border with the Six Counties, the few miles of border with the Republic and the fact that we consider Derry and Belfast as much a hub as coming to Dublin and much quicker to get to and from. I appreciate the efforts the Minister is making, especially on cross-Border participation.
The Minister for Health in Northern Ireland, Bairbre De Brún, has been in regular consultation on this and other issues. We are giving full support to the health board to pursue the links which make obvious sense from our point of view and we will make the resources available to do that.
In terms of the individual boards, the ERHA got funding for two centres this year, but it is still consulting with each of the five hospitals that were mentioned in the report for the development of specialist units and it is currently preparing a submission. The South-Eastern Health Board is at an advanced stage in its development of a special unit and it has already received approval for additional specialist breast surgeons and a second post of medical oncologist. The Southern Health Board has adopted a report in terms of its two specialist units and plans are currently at an advanced stage and it has got additional posts sanctioned for the development of a centre there. The Western Health Board has submitted a proposal and we recently gave £1 million to the Western Health Board to develop a centre. The Midland Health Board and North-Eastern Health Board are still considering the report. I would prefer if they were at a more advanced stage in developing services given that they were given the money six months ago. There is room for more proactive action there.
Deputy Mitchell raised the issue of the legal activities of health boards or the fact that over the past ten years since the nursing home subvention scheme was introduced they operated regulations under successive Governments without authority in relation to the means testing of families of applicants for nursing home subventions. The Government and I are committed to repaying all the money that was not given to the families concerned or to families who were written out of the subvention because of them being means tested. We will meet the arrears that will accrue. The work involved in that is enormous. We set up a national committee co-ordinating all the health boards. Deputy Mitchell may smile at the mention of the establishment of another national committee but, on the other hand——
Are there 65 at this stage?
The Deputy has asked for a national uniform policy; he cannot have it both ways The only way we can draft national guidelines and so on is to bring the health boards together in terms of common practice.
I was in the Western Health Board headquarters recently and I met the three officials involved who have been put into a room to go through all the applications for the past ten years and to assess those who are entitled to arrears. It is a mammoth task, but we have provided funding within the overall estimate to accommodate that. We have given a commitment to meet arrears on that.
In terms of the out of pocket issue, about £1.2 million has been repaid so far on that. We have been chasing the health boards on any outstanding issues on that. There were various commentaries on the fact that £4 million was allocated at the time, but that was to cover other issues not just the £1.2 million out of pocket money expenses. We are following up with health boards that have not fully met their obligations in terms of people who have not got back that money to make sure that that they get it.
In terms of the ongoing issue, various Departments commission expenditure reviews on a range of programmes from time to time. One such expenditure review was commissioned on the nursing home subvention scheme in advance of the Ombudsman's report. It is a significant review in itself and will be brought to Government. One of the issues to be considered is how best the nursing home subvention scheme should be modified or reviewed in terms of the overall care of the elderly.
There is approximately £57 million extra in the Estimate this year for the elderly, of which £15 million will go to the nursing home subvention scheme. The graph for the scheme in recent years shows a figure of £12 million in the early 1990s rising to £52 million this year. The expenditure review states we must be careful because, in the past ten years, the nursing home subvention scheme has absorbed resources for the elderly to the detriment of the provision for community care infrastructure and helping people to remain at home. There were reviews in 1988 and 1997 and successive Governments have operated the philosophy that people should remain in their homes for as long as possible and as many supports as possible should be built up in the community.
Using both the Ombudsman's report and the review, I want to establish a policy framework that takes cognisance of the recommendations of the expenditure review. It covers the issue of helping people to remain in their homes longer which is provided for in the national development plan. The review also covers the issue of providing proper supports in the community. This must be balanced against the ongoing funding of the subvention scheme.
The Deputy mentioned enhanced payments for nursing homes. In 1996, the then Minister provided a facility whereby the chief executive officers of health boards may in certain circumstances allocate an enhanced subvention to certain people. This system has been in operation up to now in a consistent manner among health boards. There have been no major departures in terms of its application. The Estimates agreed with health boards last December reflected past experience in terms of the application of the scheme. However, there has been a huge increase in the Southern Health Board area this year in the number of enhanced subventions. The health board concerned was told to look over the number of qualified applicants and there was a significant increase.
I want boards to have a more detailed look at the numbers involved, but also the circumstances involved and the criteria used. The problem with the policy emerging on that front is that if the system continues to meet the difference between the basic subvention rate and the charges of nursing homes, they will increase their rates without reference to anything else. I cannot countenance a policy departure of that nature and will not be bounced into taking that route by accident.
By Deputies or anybody else?
By anybody. On the other hand, there are issues which must be examined quickly in terms of the immediacy of genuine hardship cases that must be alleviated. The main issue raised by representatives in the House and the nursing home sector before Christmas related to increasing the rate which was increased by 25%.
The issue of MRIs is a matter for the VHI. A similar situation applies to an MRI in the South Infirmary Victoria Hospital in Cork. It appears that the more MRIs are funded, the more the costs increase. This is a matter for the VHI and I would prefer if it communicated with the committee separately on it in terms of its rationale for its actions. In the context of our strategy, many people have told me that there is a need to improve regional diagnostic facilities. Such facilities would improve the rate of diagnosis and provide greater access. It is interesting in the case mentioned by the Deputy in St. James's Hospital and also in the South Infirmary Victoria Hospital in Cork that, as a result of the agreement, public patients are getting much faster access to MRIs than private patients. However, the VHI has indicated that it may go to tender next year for the provision of MRI facilities. It may ask the companies which own the MRIs to compete for the business.
To which companies is the Minister referring?
Some of the MRIs are owned by private companies which have contracts with public hospitals.
Who owns the one in St. James's Hospital?
I do not know off hand. The one in Cork is owned by a private company.
What about the one in St. James's?
It is in public ownership. However, there is a privately owned machine in a clinic outside which the VHI has supported for some time. There is an issue in this regard in terms of insurance companies running the health system in the future and who will determine what happens and where.
There are benefits. For example, public patients are getting access.
That is great for public patients and I hope it will continue.
I asked about the elderly occupying beds in district hospitals, particularly in cases where people cannot return to their spouses. Are there black spot areas where there are no nursing homes and facilities are needed? Are any incentives available?
There are incentives. In a budget some years ago, the Minister for Finance provided tax incentives for the construction of nursing homes. When representatives of the nursing home sector met us last year, they argued that there were too many nursing homes in rural Ireland. A sum of £200 million has been provided under the national development plan for the establishment of community nursing units throughout the country.
Our view is that there is a need to significantly increase the public sector complement of nursing homes. Successive Governments did not do this in the 1980s and 1990s with the result that private nursing homes filled the gap in the intervening decade. The bottom line is we would have been in major trouble without the private nursing home scheme in terms of looking after the elderly.
There is a transfer from subhead B4 to B1 in relation to the changes in the ERHA. What is the percentage increase in relation to the provision for voluntary hospitals and joint board hospitals in the ERHA? This is not clear - it is difficult to figure it out from the way the information is presented.
The issue of cancer screening was raised. That, inevitably, is leading to greater demands on hospitals, such as the Mater where BreastCheck is feeding into the system. Is extra funding being provided in addition to the provision being made to the ERHA for that purpose under the cancer strategy?
I have been informed that depreciation costs in hospitals are not taken into account in budgeting. This appeared odd to me and I ask the Minister to clarify the matter. When one goes into hospitals, one often sees problems in terms of shabbiness and the need to upgrade facilities. I am not clear whether depreciation of technology is factored into budgets.
The Minister for Finance has made a certain amount of play about taking private patients out of public beds. Perhaps the Minister could indicate his view on that and whether it will be developed during this year.
As regards the GMS, the Minister has allowed for a 15% increase. I presume he is taking it that the difficulties experienced by those over 70 will be factored in and resolved. If that is the case, I am not sure the Minister is providing enough to meet the needs of the increased drugs costs. Is he allowing for a 15% increase on the basis of including the over 70s but excluding other people from the GMS because of greater employment? Is that the way it will be?
No.
An increase of 12.8% is allowed in the community drugs scheme. Is that related to the cost of drugs or to population growth? It seems the 15% is for the increases in the GMS, including drugs and the additional population, namely, the over 70s. Yet, when one looks at the drugs scheme, the increase is 12.8%. That only leaves 2.2% if we are trying to match like with like. Some time ago the Minister indicated he was considering introducing addictive drug budgeting for the community drugs scheme and for general practices. Perhaps he could comment on that. It applies to GMS patients, but will it now apply to everyone?
The Minister did not deal with the question I asked about the figures for Northern Ireland and the Republic.
As regards the GMS, Deputy Gay Mitchell said both here and in the Chamber that there is an agreement with the IMO for 40% cover for medical cards. Is that correct and, if so, why is there an objection to including people over 70 years of age? Is it a question of remuneration? No one here has a monopoly on this issue as we have all battled for medical cards for people over 65, 70 or 80 years of age. There is no objection to that. If Deputy Gay Mitchell is correct, why is the IMO objecting to the inclusion of people over 70 years of age? It is critically important to include these people. Many of them, such as the wives or husbands of gardaí or teachers, may have two pensions but many others are facing hardship. Is it correct that there is 40% cover for medical cards?
Has the Minister any plans to facilitate easier access to the GMS for young practitioners? Is it still a closed shop or does the Minister intend to open it up?
Deputies have asked many questions. As regards the North-South mortality differences, for a number of years the chief medical officer, particularly in his annual report in 2000, referred to health inequalities and the fact that social class and economic status have a significant bearing on health outcome and life expectancy. That is not a secret. The report I will launch later this evening is the first major research in modern Ireland on a North-South basis. It demonstrates the value of the North-South approach and the Institute of Public Health is a North-South body. It highlights differences in mortality rates between the North and the South over the past ten years. We could get political about it, but that will not serve any purpose.
There is an intersectoral approach to this issue. The health strategy is not just about health services alone, although health services and access to them can have a bearing on successful treatment and outcomes. The three key areas are cancer, heart disease and accidents and these were identified by the chief medical officer in his annual report. We have provided strategies for them. The cancer strategy is designed to meet the issue of cancer deaths in this country and to reduce the incidence of cancer. The cardiovascular strategy is designed to deal with heart disease. Significant funding has been available to tackle one of the major issues in terms of Irish mortality. Our life expectancy has increased significantly over the years. However, it has not increased at the same rate as our European partners.
We must be careful about the figures in reports. The report warns that differences between mortality rates should be treated with some caution. The report found that the death rate from pneumonia was 163% higher in Northern Ireland than in the South. We would be a long time working that one out. The death rate from accidental poisoning was 138% higher and the death rate from alcohol abuse was 32% higher in the North. There are different statistics for the North and South. We are largely the same as regards cancer and heart disease.
We will get the figures for the RHA budget for Deputy McManus in terms of the split between voluntary hospitals and transfers. As regards the depreciation of costs, they have not been allowed in terms of public sector bodies or institutions and that also applies to hospitals. That is also raised in the value for money audit in terms of the health infrastructure over the past 20 years.
As regards private patients in public beds, we are looking at that in the context of the strategy. There is an 80:20 split at present in public hospitals. We are not satisfied that public patients are getting fair access or maximum returns on that.
Does the Minister agree with the Minister for Finance?
I am seriously considering the issue of whether we increase the capacity for public patients. We cannot do that in isolation and there are many things to work through, but it is an issue we are considering in the context of the health strategy. The sub-group on eligibility is about fairness and access based on need. The public-private interface is a key issue. We are not ruling anything out and we will be back to that issue.
The GMS is a demand led scheme. If there are increases over and above the Estimates, it is provided for in Supplementary Estimates at the end of the year. That was the position last year and up to now, although we have provided for the over 70s issue. We were given funding in the budget for the extension of the medical card to over 70s. I agree with Deputy Dennehy that it is an important issue. It is not only Government policy as the Oireachtas has also agreed it. There is no agreement that we must have 40% cover for medical cards with the IMO. The agreement in 1970 was that it could not go above 40%. It is a different spin than what was put on it.
No.
It was not that we had to have 40% and nothing less.
Up to 40%. It was as high as 38% in the past.
We had an agreement that under the scheme, as currently structured, it could be up to 40% of the population. That is not to say we do not have to agree rates of payment with the IMO for this 40% and particular elements of it. In other words, if we went over 40%, we had to go back into negotiations. There was a certain implication that we were in breach of an agreement when that was not the case.
I am making the Minister out to be stingy. A single person on £101 is disqualified.
This is the first Government to significantly increase the provision of medical cards to people over 70. The economy has been driving on and more people are in good remunerative employment, which has pushed them over the limit. That is the main factor behind the 40% decreasing to 31%.
I am talking about a person on £101.
Deputy Dennehy asked why general practitioners are against the extension of the medical cards. They have articulated their reasons for that. The Deputy's point is valid in that if we want 40% cover, this would significantly help. The IMO, which represents GPs, would differ with me and others in the House as regards the nature of that cover. In other words, their view is that elderly people would create a greater demand on the services and might be more likely to use GP services than a 25 or 40 year old.
I am sorry for their problems.
They believe they should be compensated for this.
The Minister is giving misleading information and leaving it at that.
I am not.
He knows, as everybody else here does, that——
The Deputy should let the Minister answer.
No, because he was moving on to another item.
I am not. With respect, I am still on No. 70.
We want the Minister to explain the IMO position rather than select what suits him.
We are in the middle of negotiations with the IMO. Deputy Dennehey asked if it was a question of remuneration. Yes, the question at issue is one of remuneration. The big issue is what rate we should pay GPs for taking on the over-70s and how much we should pay them. That is the bottom line pertaining to the issue of extending medical card services. That is what we are negotiating about and let nobody be under any illusions about it. That has always been the case.
They are refusing to sign the forms.
We are in negotiations about the extension of the service to the over-70s. As the Deputy is aware, a capitation system has been in place for some time and should continue. We have made an offer to the IMO in relation to it and are in discussion with it but the key issue is remuneration.
This is a critical sector of our society. Whatever people's own interests or backgrounds, they should give unanimous support to this from the Oireachtas.
Would the Deputy explain what he is talking about? What background is he talking about?
I will explain exactly what I mean. Whatever their party stance is on the issue and whether they support the concept of giving older people automatic cover——
Did we not pass the law?
——the message should go out loud and clear that that is the wish of the elected Members of this House. I do not want anyone giving sympathy to the IMO or any other group interested in the care of the elderly.
They did not pass the law.
We have paid lip-service to the elderly for years and this is the first time a Minister has taken the matter on. We have increased medical card loans for the past three years. I want the Minister to receive full support instead of being told that we are being misled.
We have passed a Health (Miscellaneous Provisions) Act to give legal effect to this. Would Deputy Dennehy join the rest of us who want to double the income limits from £101 to £200 to give poor people the opportunity to obtain a medical card as well?
The Minister has been accused of misleading the committee.
He gave the good answer.
He has been accused on this issue.
I am raising the matter realistically. The key issue the IMO has raised with us is that the private fees they have been receiving from the over-70s are far higher than the capitation rate. They are looking for compensation for that loss.
In relation to Deputy Mitchell's point, this has implications for any future extension of medical cards. One has to be extremely careful in terms of how one proceeds. When the Government and the Oireachtas make a decision on this it will be implemented. We will work constructively on it. Last year and this year we have negotiated a range of agreements with the IMO on increasing funding for a range of services.
The issue of money would not have arisen had the Minister decided to target poor families just above the income limit.
One hundred and one pounds.
They would have qualified under existing negotiations. What the Minister has done instead is to provide for the over-70s. While we all want to see the over-70s looked after, we want others to be looked after as well. Such people are in greatest need but they will not be provided for this year because the Minister has decided to provide for a category who, on income terms, are better off than poor families. We all support the over-70s but, unfortunately, Deputy Dennehy does not keep track of what goes on in the Dáil. The issue is still the same - the Minister would not have to remunerate in this way if, for example, he had decided to increase the income limit to deal with the absolute scandal to which Deputy Mitchell referred where young families cannot afford to see their GP on any terms because they simply have not got the money.
Perhaps the Minister could respond to both of us together.
There is a fundamental inconsistency.
For Deputy Dennehy's information, we want to provide a free GP service for everybody aged 65 years and over but they want to give the medical card to those on £200 a week, not £101.
Will the Minister, please, wrap this up?
In fairness, anybody directly named here should be allowed to say something. I was out of this establishment for a little while, Chairman, but kept a very close eye on it. I tracked the Dáil very carefully from 1994 to 1997 and did not see any effort being made to give the over-70s medical cards.
We cannot say, on the one hand, that we are all in favour of the over-70s and, on the other, that there is no need for renegotiaton. By definition, if one is extending the medical card to the over-70s, there has to be a change in the way things are done.
Fine Gael's policy is to renegotiate, it is in our document but we will give it to poor people as well. Why can the Minister not do so?
Deputy Dennehy's point is very valid. Why the hell did you not do it when in power for three years up to 1997?
We were in power for 30 months.
The bottom line is that you had the money to do it.
The Minister has the money but does not know how to spend it.
May I call the meeting back to order, please? Will the Minister answer the question?
I have answered it.
It is a mean, stingy policy - £101.
That argument plays right into people's hands. If one increases across age limits by income eligibility alone, that suits the IMO and general practitioners and will cover certain families under the threshold. We must always remember, however, that the health boards have discretion in issuing medical cards.
Deputy Brady's friends, the chief executives.
The reason it suits is because many within the 20 to 70 year age group will not be calling regularly to their GPs and capitation grants are paid out regardless.
Some of them cannot do so when they are sick.
There are two strategic approaches to medical cards.
The Minister knows that he is on weak ground.
One can take a number of approaches to extending the medical card scheme.
That is the reason 6,000 poor people are dying - because they cannot access a medical card.
One could be the free-for-all approach which would cost about £800 million. I personally would not support this. The other approach would be to go for those who need medical cards more than others. Clearly young and older people do so. They have far greater recourse to GPs.
And poor people.
I am talking about poor young people and poor old people.
But the Minister is not giving it to all of them.
There are other arguments that Deputy Ring and others have raised in the House. There are groups suffering from specific diseases and conditions which argue that they should automatically receive a medical card. Therefore, there are three different strands. I generally favour an increase in the income eligibility threshold but the Government has clearly said and will stand on its record that older people will get a better deal from the Government than any previous one. In the budget we made it clear that older people will get a better deal and are delivering on this across the social welfare schemes.
Poor people are getting the worst deal.
We gave the Minister the power. We voted it through for him and he left poor people out.
Poor people have done very well from the last budget because, both in terms of child benefit and a range of other services, we have provided for record increases to advance social inclusion.
The Minister is in a hole and keeps on digging.
Because of the time factor I will ask three questions and not make a speech. As regards the elderly, there is no inspectorate for public nursing homes, although there is for private homes. The time has come to have an independent inspectorate for nursing homes. I am receiving daily reports of elderly people being abused in public nursing homes, yet they have nowhere to turn to. They cannot turn to those who are abusing them because they will not respond. The Minister recently established a committee concerning abuse of the elderly which has met on a number of occasions. I am aware that it did not meet more frequently due to the foot and mouth disease outbreak. I would like to see that problem being dealt with.
Another serious issue is that of prostate cancer. What plan does the Minister have for a campaign on men's health issues? We are often afraid to respond to these issues and men are afraid to go to hospital. If they had to have the babies there would be none in this world.
That is the quote of the afternoon.
There would be no waiting lists.
The reality is that men do not look after their health. What plan does the Minister have to launch a promotion to encourage men to look after their health, particularly in relation to prostate cancer?
Has the Minister had any negotiations with the Irish Pharmaceutical Association relating to extending the number of pharmacies and relieving restrictions on the opening of new pharmacies? Last year the Inspector of Mental Hospitals reported that 300 people with an intellectual disability were in psychiatric homes. They do not have a mental illness that needs treatment and are not ill. They need appropriate accommodation. The Minister planned that none of those would be in psychiatric institutions by the end of this year. What progress has been made on this and will there be any people with intellectual disability in psychiatric hospitals?
Deputy Ring asked a very valid question on the inspectorate for district hospitals and nursing homes. We intend to give powers to the social services inspectorate to inspect health board nursing homes. Initially the emphasis of the social services inspectorate was on children and child care centres. Our intention is to expand the staff to enable them inspect health board nursing homes.
On men's health, the National Cancer Forum will examine the issue of prostate cancer and propose plans for a national screening programme. The reluctance of men to visit GPs and access health services is accepted generally. We do need to focus more on men's health as part of our strategic approach and we will pursue that.
We are not in discussion per se with the Irish Pharmaceutical Union although I had a meeting with them recently where I discussed the issue of additional pharmacies or liberalisation of the existing regulations which were passed in 1996. When the OECD published its report recently on regulatory reform across the economy, pharmacies were part of its consideration. The Government established a high level committee to examine its recommendations on regulatory reform. Pharmacy falls within the remit of that committee. We will make proposals and be in discussion with the committee. The recent Miscellaneous Health (Amendment) Act passed legislation that has a bearing on the situation. We indicated then that we would commence a review of the 1996 regulations which are restrictive and cumbersome. That review will be within the broader context of the OECD report.
Since 1997 the Government has invested significantly in people with intellectual disabilities. About 89.8% of the total population on the national intellectual disability database are in receipt of services as of April 2000. That number will increase this year. The investment programme will invest £76.7 million in revenue and £75 million in capital in the services between 2000 and end 2001. More than 800 new residential places, 1,400 new day places and 260 new respite places, including 40 places specifically for persons who require more specialist placement, will be created. We will give an enhanced level of health related support services for children. We are working with a national monitoring committee, the health boards and the voluntary services, etc., to make sure we can get the necessary recruitment in place for personnel.
Not everybody who is inappropriately placed in psychiatric institutions will be moved to appropriate placements in 2001. In Portrane, for example, where significant numbers are located we have provided funding for the Eastern Regional Health Authority to relocate people to more appropriate placements. However, because of the need to develop an overall controlled plan for the entire Portrane site, the construction of the bungalows and units that are to be used was delayed. I understand now from the Eastern Regional Health Authority that these will be accelerated this year and into 2002. I can provide the exact figures for the Deputy if required.
Will that include autism or is that a separate category?
It will include autism in certain instances. Some older residents in some of the psychiatric institutions, particularly Portrane, would have conditions on the autistic spectrum and they will be relocated. In reply to Deputy Ring's question on abuse of the elderly, there is a working group on this. It has already established two pilot schemes - one in the south and one in the western health board area - to make sure that there are proper procedures and guidelines in terms of identification, assessment and management in cases of abuse of the elderly.
We will move on to subhead C through to subhead J.
May I reply to Deputy Neville? In 1996 there were 970 persons with an intellectual disability accommodated in psychiatric hospitals. This number had been reduced to 645 by April 2001. In 2001 a further 148 persons will move to new accommodation with another 43 persons moving towards the end of this year or early in 2002 as facilities for them come on stream. The health boards are working with the Department which has implemented plans for the remaining 454 so that at the end of this year——
The report from the Inspector of Mental Hospitals says there were just 300.
We have up-to-date figures from our people working on the scene. They say 450 with 261 of these in the RHA region with 245 in St. Joseph's service and St. Ita's in Portrane. I have already explained the situation there. Further facilities, either through the refurbishment of existing facilities or new accommodation, would be required both on and off the campus to provide for the remainder of this group.
Can we move on to subheads C to J? Deputies Mitchell and McManus.
Chairman——
We have only ten minutes left and must cover these questions.
There are certain retired nurses who did not get parity when they retired. Will the Minister consider their case sympathetically? I am very concerned about the physical state of Our Lady's Hospital for Sick Children in Crumlin and also the Cork Street nursing home. Both are in need of major overhaul and refurbishment. In order not to delay the meeting I would appreciate a note from the Minister informing me of his plans for both institutions.
In relation to the 128% increase to the Food Safety Promotion Board will the Minister confirm that provisions are in place for the board or an accounting officer thereof to account to the Oireachtas? These North-South boards are very welcome but I would be anxious to ensure that both the board working within the State and the North-South board are accountable.
The Minister is aware of an instance last year where a doctor in another jurisdiction was found guilty of the murder of a large number of his patients. Extraordinarily, the statistics did not show up any undue trends which would have been otherwise picked up. I know that the Minister, with the Minister for Social, Community and Family Affairs, has taken an initiative regarding the registrar's office and I note that the superintendent and district registrar's budget will increase by 75% in the current year, from £4 million to £7 million. Would the Minister confirm that he will take the opportunity of this new procedure, and also the fact that the records are being computerised, to put in place a system which would throw up a distortion in statistics, which might either give rise to concern, as happened in the Dr. Shipman case, or which might reveal a new disease which otherwise might not come to light until it is too late? In other words, will he ensure that the figures and the statistics are marshalled in such a way that anomalies of this kind show up and alarm bells ring?
An issue regarding indemnity cover for obstetricians has arisen, about which the Department was well warned, and the AMDU has said that the cost of insurance cover for an obstetrician consultant is £400,000 a year. Is there any provision being made for this in the Estimates? I understood that the Department was trying to come to some arrangement with hospitals on this issue. Perhaps the Minister could give us some information about that and any cost implications arising from it.
Comhairle na nOspidéal is getting additional funding this year and I am sure it needs it, but would the Minister explain why it takes so long to appoint one consultant? No doubt he will recall that in October he announced a winter beds initiative and some of the places still have not been filled. It seems extraordinarily inefficient to have such long delays, even in the case of filling vacant posts not to mention new posts. Why did we not receive the hospital waiting list figures for March? Can we have a briefing from the officials on the projections for the seven years to 2011 on which the Minister has worked? Such a briefing would be immensely helpful to the Minister as well as to us.
There is a 9% increase for voluntary hospitals in the RHA for 2001. That reflects the emphasis supporting the community care programmes for the elderly, the disabled, child care, etc.
On the question of retired workers, my officials have met with the group once and I am due to meet them shortly. Obviously the broader pay policy will govern that particular issue.
On Our Lady's Hospital for Sick Children, Crumlin, I recently made £3 million available for extra equipment. I visited the hospital some time ago and at that stage we had not received any plans from the hospital or, indeed, from the ERHA for its development. That is something I raised both with the board of management of the hospital and with the ERHA, and I am continuing to raise it with them because I am very concerned about it. I must work through structures also and my view is that it does need significant development.
We have moved on paediatrics and I hope we helped to facilitate a breakthrough in the overall structure of paediatrics within the Dublin region. Again in that regard, I am subject to other authorities, not least the statutory authority of Comhairle na nOspidéal, the ERHA and others.
Will the Minister send me a note on the Cork Street issue?
Yes. The promotion board will be as accountable to the Dáil as any other semi-State body, although there are different accounting arrangements with the northern parties.
There is a national disease surveillance centre which monitors any new diseases which may come into the country. On the issue of statistics, to which Deputy Mitchell referred, obviously the CSO and, indeed, the GRO will have a much more modern system but that has to do mainly with servicing the public.
If a case like the Dr. Shipman case arose here, would it be thrown up by the statistics?
I cannot give a definitive answer to that question.
Would the Minister look into it?
I certainly will. The chief medical officer and the public health division of the Department would have a key role there.
As there is a vote in the Dáil, perhaps the Minister would respond to the questions——
Why not continue?
Do you want to come back to it?
I would like my questions answered.
We are not suppressing information on waiting lists. As soon as we have them collated, we will forward them to the Deputy.
Does it take six months?
It is three months in arrears. That is the way it works out. Frankly waiting lists should not be produced every three months. Whoever introduced that system was crazy. They should be produced either at intervals of six or 12 months.
I want the Minister to send me a note specifically on my question about the Dr. Shipman case. There is an opportunity now to build in checks and balances.
What about the briefing I sought?
Those projections were conducted in the context of the strategy for the Cabinet. It is not normal to reveal every document brought before Cabinet. Many of the figures are in the public domain in any case. At present we are proceeding with the strategy.
Is the Minister refusing my request?
I am not.
We are in danger of being late for the vote.
Will the Minister please give this committee a briefing?
There is an extra £4.3 million for medical indemnity in 2001.
Is the Minister saying "No" to a briefing?
No, I am not.
Is he saying "Yes" to a briefing?
I am considering the Deputy's request.
Will he come back to me on it?
Will the Minister send me a letter on my question regarding the Dr. Shipman case?
The answer to Deputy Mitchell's question is "Yes".
I thank the Minister and his officials and the members for attending today's meeting.