I am grateful for the opportunity to bring this Supplementary Estimate before the committee for examination. The sum required is a net additional figure of £58.804 milllion. In 1993 the original gross sum provided by the Government for health services was £1,746.952 million. When account is taken of the Supplementary Estimate, the total gross provision for the health service in 1993 will be £1,805.756 million. The additional moneys now sought are necessary in order to fund adequately a number of items within the health services which have given rise to additional expenditure which was unforeseen or could not be computed accurately when the original Estimate was passed by the House earlier this year.
By far the single largest item in this Supplementary Estimate is the provision of £33.075 million to cover the payment of arrears due under the Programme for Economic and Social Progress to public servants in the health servides. Pay increases due to public servants under the Programme for Economic and Social Progress in 1992 and 1993 were capped at £5 and £6.50 per week respectively. In accordance with the Minister for Finance’s statement on public sector pay on 17 January, 1992 and the subsequent agreement with the Irish Congress of Trade Unions, losses of income arising from the capping of public sector pay will be recouped to public servants in 1993 and 1994. The Supplementary Estimate provides for the recoupment of these arrears in full for health services personnel before the end of this year an in part for civil servants employed in the Department of Health. The balance outstanding to staff in the Department will be paid early in 1994.
In addition a further £5.198 million is sought to meet increases to general operatives following an understanding which was framed between the ICTU and the public service employers on pay for general operatives employed outside the Dublin area as part of the agreement on pay and conditions under the Programme for Economic and Social Progress. Following conciliation talks an agreement was reached to introduce a phased increment of £16.04 per week for this group. Phase 1 of the increment, £6 per week, is due to be implemented with effect from 1 January 1993.
In this Supplementary Estimate I am seeking a total of £21.656 million in respect of demand led schemes which are the responsibility of my Department. These schemes include the drug refund scheme, the drug cost subsidisation scheme, long term illness scheme, disabled person's maintenance allowance and a number of other smaller allowances. The additional funds now being sought are to cover shortfalls in the funding of these schemes for 1991, 1992 and 1993. The figures originally submitted for the 1991 and 1992 Supplementary Estimates were the best estimates that could be made by the health boards at that time. The subsequent outturn figures which were audited reveal the shortfalls in 1991 and 1992 to be some £7.654 million more than had been estimated.
The 1993 vote provision was computed on an agreed basis. There were however, no provisions made for growth in volume or price increases. I explained that to the committee when I introduced the original Estimate. The additional revenue now sought is based on the most up to date information from the health boards on the likely year end outturn. My Department is undertaking a number of studies in order to ascertain the contributing factors to the continued rising costs of these schemes.
In the area of child care services I am looking for an additional £5 million. In the area of child care and protection the Government responded swiftly and decisively to the central recommendation in the report of the Kilkenny Incest Investigation that the necessary resources be provided for the implementation of the Child Care Act, 1991, particularly those provisions which will greatly strengthen the powers of the health boards and the Garda to intervene effectively in cases of child abuse. The committee will be aware that the Government has agreed to my proposal for the full implementation of the Child Care Act over a three year period and have made available to me an additional £5 million to begin this process. That is the £5 million now before the committee for sanction. I would remind the committee that this is the largest ever investment of resources in the child care area in a single year and demonstrates in the most tangible way possible the commitment to the development of a comprehensive range of services and supports to assist children and families in need.
I have approved a package of new developments for each health board area which are being funded from this special allocation. The developments are preparing the groundwork for the assignment of additional functions under the Act to health boards and will greatly enhance their capacity to respond to the needs of children and families. The scale of these new developments is unprecedented and includes the creation of over 100 new posts of social worker and child care worker; the creation of three new posts of consultant child psychiatrist for the child and adolescent psychiatric services; the creation of over 20 new posts in the child psychology services; the expansion of the home maker and home help services to assist families in difficulty; the establishment of community mothers' programmes in a number of health boards; increased financial support for pre-school services in disadvantaged areas; additional hospital places in services for homeless children; improvements in services for victims of family violence in rural areas; the development of foster care services and the improvement in staffing levels in a number of children's residential centres.
I have asked the health boards to take urgent steps to put these developments in place as quickly as possible and I am confident that the various new initiatives which I have appproved will result in significant improvements in child care and family support services in each region and will lay a sound foundation for further developments in future years.
A sum of £3.906 million is required to meet the cost of subscriptions to the medical defence organisations. Hospital consultants in the public health service are required by their contracts of employment to indemnify themselves against claims for negligence, etc. Their contracts also provide for between 80 per cent and 90 per cent of the cost of subcriptions to medical defence organisations to be reimbursed by their employer. In 1992, the medical defence associations announced increases in the region of 40 per cent in their subscription rates for 1993. A sum of £4.350 million represents the cost to health service employers of the reimbursement to consultants. Provision is also included for the payment of premia for general practitioners under the GMS scheme.
Increases in annual GMS drugs expenditure for the year 1989 to 1992 have been between 10 per cent and 13 per cent per annum. In late 1992 agreement was reached with the Irish Medical Organisation to the effect that there were opportunities for rationalising State expenditure on drugs and medicines under the scheme. It was agreed between the parties that target expenditure for 1993 should be based on the 1992 outturn figure which at that time was projected at £132.5 million.
The indicative drug target scheme, which was introduced in January 1993, has resulted in GMS drugs expenditure to the end of September 1993 amounting to £103.581 million as compared to £99.215 million in the same period last year — an increase of 4.4 per cent, as compared to an increase of 12.5 per cent in the same period in 1992. It is estimated that if this trend continues excess expenditure on drugs and medicines in the GMS in 1993 will amount to a net £5.6 million over the target originally set.
This excess is being partially offset in 1993 through the once off payment of a cost over-run rebate by the pharmaceutical industry through payment of the increased manufacturers rebate which was negotiated as part of the new FICI agreement.
The Government has decided to grant a bonus of 70 per cent of a week's allowance to social welfare recipients and those in receipt of health cash allowances, subject to a minimum of £20. The cost of implementing the decision for those in receipt of health allowances is £1.85 million.
It is proposed to allocate an additional £560,000 for AIDS/drug abuse services. Drug misuse continues to be a serious social and public health matter and our strategy is geared towards addressing this together with the associated problem of the spread of HIV. A significant part of the funds now being voted will be allocated towards meeting the unavoidable additional costs of satellite clinics which have been established in the Dublin area.
These clinics provide treatment services for drug abusers including methadone maintenance, urine analysis, free condoms, needle exchange and counselling as well as outreach services for specific groups such as gay men and prostitutes. Not only do the clinics provide a treatment service for drug abusers but they form an important element in the battle to prevent the spread of HIV since 51 per cent of those who are HIV positive are IV drug abusers whose behaviour can often put them at risk. The strategy of dealing with combined problems of drug abuse and the spread of HIV is, of course, based on the recommendations of the National Co-ordinating Committee on Drug Abuse.
The provision of additional satellite clinics in the Dublin area as well as the extension of other services available for drug abusers will continue to have a high priority in the allocation of funds in the coming years.
The 1993 Estimate provided £116.908 million for balances due to health agencies for services provided in previous years. The figure in the 1993 Estimate was calculated prior to the inclusion of the special pay arrears in the 1992 Vote at the end of last year. Based on the final out-turn, a further £1.532 million is due to health agencies in respect of balances.
An outbreak of hepatitis A occurred among the haemophiliac population in a number of European countries including Ireland which may have been related to possible contaminated Factor VIII and Factor IX blood products. The Blood Transfusion Service Board immediately suspended use of the products obtained from the then supplier. Similar action was taken about the same time in other European Union countries. It was necessary to immediately place a short term contract with an alternative supplier to ensure the continued supply of quality products. The only alternative supplier was on average 28 per cent more expensive with the result that there has been an additional cost of £1 million to the health service.
In 1992 an agreement was concluded with the Irish Haemophiliac Trust, approved by Government, to pay compensation to haemophiliacs who contracted AIDS from blood transfusions prior to 1986. The agreement covered 103 cases. After the agreement was completed and compensation paid another case was discovered. Compensation of £77,000 has been agreed to on the basis of the original settlement.
The income under Appropriations-in-Aid is now likely to be greater than was originally anticipated and this is now reflected in the adjustment of £17.9 million shown in the Supplementary Estimate. This adjustment is mainly accounted for by higher receipts from health contributions than had originally been estimated. This increase in receipts is due to buoyancy in tax receipts and to a technical adjustment in the percentage being paid by the Revenue Commissioners in respect of health contributions. There has also been an increase in the amounts paid to the Department by the United Kingdom in respect of the recovery of health costs under European Union regulations.
This Supplementary Estimate reflects the commitment of the Government to adequately fund and maintain the highest level of care within our health services and, where necessary, as for example in the case of child care, to expand and develop these services to ensure the health and welfare of those in need. I, accordingly, recommend the Estimate to this Select Committee for its approval.
