Limerick East):I will read the preliminary statement as you requested, Chairman, and I have a brief on the various issues which people will want to raise. I will be calling in the officials to give extra details so the committee will forgive me if it becomes a little informal at that stage.
I am pleased to present to the committee the details of the Health Estimate for 1996. First, I reiterate my continuing personal commitment and that of the Government to the principles outlined in the Health Strategy, as stated in the Government Programme A Government of Renewal. As the committee is no doubt aware, the strategy’s central objective is to promote greater levels of efficiency, effectiveness and accountability in the health services by reshaping the way the services are planned and delivered. It places the concepts of health gain and social gain at the centre of the health agenda and highlights the need to adequately identify the population’s health needs, setting clear objectives and the attainment of measurable targets in all areas of the health services. The strategy is based on the three key principles of equity, quality and accountability. It also contains a four year action plan which sets out specific targets for developments across a wide range of services designed to achieve these goals.
The 1996 Estimate is designed to achieve further progress in meeting the targets set out in the action plan and reflects the fundamental values set out in the strategy. As every Member is acutely aware, the Government faces strict targets in relation to public expenditure arising from the need to meet the Maastricht criteria to enable this country to enter the Economic and Monetary Union which is vital for our future prosperity. This has implications for all public expenditure, including expenditure on the health services. However, I am pleased to inform the committee that within the limitations imposed by the policy in relation to the management of the public finances, the resources provided will enable further progress to be achieved in developing services, particularly those for children at risk, the mentally handicapped, the physically disabled, the elderly and other groups with special needs. It has also been possible to provide for additional developments in the acute hospital sector to meet the critical service pressures on these services, including the continuation of the hospital waiting list initiative.
One of the central elements of the health strategy is the emphasis on encouraging people to take more responsibility for their own health. To achieve this we must provide people with the necessary information and support to help them take that responsibility. I am pleased, therefore, to announce that I have been able to provide again this year some additional funding for health promotion, to enable my Department's Health Promotion Unit and the health boards to continue their vital work in this area.
The 1996 gross Health Vote is just over £2.4 billion which represents nearly one-fifth of all Government spending on supply services this year. This is nominally a decrease of £32 million, or 1 per cent, on the 1995 outturn. However, in comparing the provision for health services for the two years it is necessary to take into account the fact that the 1995 figure includes £60 million for disabled person's maintenance allowance payments which are now the responsibility of the Minister for Social Welfare and the £60 million allocated to the Compensation Tribunal for those who contracted hepatitis C from blood products supplied by the Blood Transfusion Service Board. When these are taken into account, there is an actual increase of £88 million or 4 per cent. I do not propose to go into the details of the Estimate as I am conscious that our time is limited. I want, however, to touch on some of the main aspects.
With regard to services for children at risk, I emphasise that this Government is committed to completing the implementation of the Child Care Act, 1991, by the end of the year. The final phase of implementation involves the commencement of Parts VII and VIII of the Act which deal with the supervision and inspection of pre-school services and the registration of children's residential centres operated by voluntary bodies, respectively. I am pleased to report that we are on schedule to achieve our target for this year.
Last month my colleague, the Minister of State at the Department of Health with special responsibility for children, Deputy Currie, launched a detailed child care action plan for 1996 which sets out the new child care developments approved for each health board area. The plan includes a number of initiatives ranging from an increase in the fostering allowance for children aged 12 and over to £60 per week to increased funding for preventative services, such as family resource centres, youth projects and day nurseries. Nationally, 50 extra posts have been approved bringing to over 900 the total number of new posts created for the child care services since 1993.
The full year cost of the measures in all health boards is £5 million. In addition, £3.5 million has been made available for capital projects. This investment brings to £35 million on an annual basis the total additional revenue funding provided since 1993 to develop child care and family support services and to strengthen the capacity of the health boards to meet the demands imposed by the implementation of the 1991 Child Care Act. However, I am conscious of the pressures on our child welfare services. There are still needs which must be met and new pressures are emerging which call for the investment of further resources. I am preparing proposals for Government for financing a new child care programme for the period 1997 to 1999 which will be brought to Government shortly.
I also take this opportunity to bring Members up to date with a number of other initiatives in relation to child care being undertaken in the Department of Health. My officials are currently working on the details of establishing the social services inspectorate which I recently announced. While the inspectorate will be initially concerned with child care, it will in time take on responsibility for other vulnerable groups such as the dependent elderly and persons with disabilities. I envisage that the principal functions of the inspectorate will be the quality assurance and audit of child care practice and I know it will contribute substantially to the overall quality improvement process and the promotion of good practice. The inspectorate will also be charged with undertaking inquiries on behalf of the Minister.
As regards the consultative process on mandatory reporting, the closing date for the receipt of submissions in response to Putting Children First, the discussion document on mandatory reporting launched in February by the Minister of State at the Department of Health, Deputy Currie, was reached last week. I am pleased to report that approximately 125 submissions were received in response to the discussion document. While they reflect the diversity of views on mandatory reporting, all share a common commitment to the welfare and protection of children. All submissions will be closely examined over the next couple of months and the Minister of State, Deputy Currie, will provide a forum for all interested parties to come together to debate the complex issues involved following an examination of all the submissions.
There have been significant developments in recent years in the level of services available to persons with a mental handicap. Additional funding of £44.58 million was invested in the development of services in the period 1990-95, which has enabled the health boards to put in place over 1,000 additional residential respite places and 2,100 new day care places. A further £12 million is being provided in 1996 to continue this ongoing development programme. I am satisfied that this additional funding has made a significant impact on the numbers of persons with a mental handicap awaiting services. However, I am aware that more needs to be done. The Government is committed under its programme, A Government of Renewal, to the continued development of the services as resources become available.
That commitment is reflected in my decision to prepare a five year development plan to meet the needs identified by the new mental handicap database which will provide my Department with a more accurate estimate of current and future needs. A preliminary report on the information on the database was published last week. The number of people with a moderate, severe and profound mental handicap identified has increased by 29 per cent over the 1974 census. This increase can be explained by better identification and by the increased longevity of this group. Most of this increase has taken place in the 35 to 54 age group and indicates decreased mortality among those with more severe levels of mental handicap. The high prevalence rates among young adults will mean increased pressures on adult day services and an increased need for residential services for this group. The five year plan will identify the needs of the different groups to a degree of sophistication not previously possible.
The plan will be based on regional plans which the health boards are currently compiling. A number of health boards have already submitted draft plans to my Department and the remaining boards are in the process of completing theirs. I expect the national plan to be ready later this year so that it can play an important role in the Estimates discussions. It is my intention to seek additional funding in 1997 and future years for the continued development of services to persons with a mental handicap based on the needs and priorities identified in the plan.
One of the major issues we face is the continuing problem related to drug abuse. In the original allocation for 1996 a sum of £1.655 million was provided for HIV AIDS and drugs services. This was to meet the full year costs of certain developments which commenced in 1995, as well as funding new developments in 1996. However, in recognition of the serious drug problem throughout the country and in response to a proposal which I put to it in February, the Government announced a package of demand reduction measures to prevent drug misuse. The total cost of this package in 1996 will be £3.5 million. The sum is in addition to that provided in the Estimates.
The problem of drug misuse arises at two levels. First, the misuse of so-called soft drugs, such as cannabis and ecstasy, which is widespread and, secondly, heroin misuse, which is confined mainly to certain areas of Dublin and is a major concern. To tackle these problems, the health response is based on two key considerations. The first is to reduce the number of people turning to drugs in the first instance through education and prevention programmes and the second is to provide a range of treatment options, including methadone maintenance, detoxification and other programmes for those addicted to drugs, especially people addicted to heroin.
The main components of the Government package include a major public media awareness campaign which will commence at the end of June. The committee will be aware that my Department has been working on the development of this campaign, which will include television, cinema, radio and poster messages. It has been tested on a number of focus groups and has been favourably received. A drugs information line will be provided in parallel with the first run of the campaign. A range of information will also be available to those seeking it. In addition to the national awareness campaign, each health board will play a more active role in local education and prevention initiatives. Deputies will be aware that the commencement of the television advertising campaign will coincide with the semi-finals of the European Cup and will continue through the final stages of that competition.
We also made a decision about the appointment of a programme manager in the Eastern Health Board, with specific responsibility for the development of prevention and treatment services, and the appropriate authority is in the final stages of the selection process. The expansion of the Eastern Health Board services, such as increasing access to methadone with the opening of two more treatment centres, will increase the number of patients on treatment from 1,400 to 2,500.
Other elements of the programme encourage more GP involvement in the treatment of addicts, the establishment of an intermediate treatment centre for young people, a seven day service to be offered in drug treatment centres and a special programme to be targeted at young people who smoke heroin. Deputies will be aware that smoking heroin is becoming an increasing problem as distinct from the injection of heroin which is the more traditional method. We have also decided that rehabilitation places will be increased from 60 to 250, outpatient detoxification facilities in community drug centres will be extended, parenting programmes will be provided for drug using parents in the north and south inner city and an information database will be established. We have also decided that a regional telephone helpline will be established, that each health board will establish local co-ordination committees and involve voluntary and community groups in the decision-making process and that a new unit will be established to ensure that the businesses involved with controlled drugs comply fully with the terms of the Misuse of Drugs Acts, 1977 and 1984, and the UN Convention on Narcotic Drugs and Psychotropic Substances.
My Department is actively engaged in a multifaceted approach to tackling the drug problem. The Government has provided the resources to build up prevention and treatment services. It is now up to everybody involved in the fight against drugs to work in a concerted, coordinated fashion to eliminate this scourge from our society.
The extension of the dental treatment services scheme to certain additional categories of adults with medical card entitlement came into effect on 1 June 1996. Routine dental services now available to the 16 to 34 age group and full denture treatment for persons with no natural teeth is being extended to all persons with medical card entitlement. Under the scheme services are provided by private practitioners at their practice premises and by health board dental surgeons at local clinics.
Emergency dental treatment for the relief of pain or urgent denture repairs is available to all persons who are 16 years of age or older with medical card entitlement who require urgent dental treatment for the relief of pain or urgent denture repairs. Routine dental treatment is now being provided to persons with medical card entitlement in the age groups 16 to 34 years of age, inclusive, and 65 years and over. This will be extended at a later stage to other age groups on a phased basis. The phasing depends on the availability of resources. That is why we are implementing this change on a phased basis. Priority full denture treatment will be provided to all persons with medical card entitlement who have no natural teeth. These dentures will be provided mainly at health board dental clinics.
The full year cost of implementing phase 2 of the scheme will be £3 million. This is in addition to the current provision of £6.8 million provided on a full year basis for Phase I of the scheme. The extension involves the introduction of an additional 300,000 medical card holders into the routine element of the scheme. Dentures will now be available for all medical card holders who are without any natural teeth. The scheme to date has provided treatment for over 130,000 medical card holders.
The Estimate includes approximately £10 million to cover the costs in 1996 of developments in the acute hospitals sector. This includes the roll forward costs of developments already initiated and new developments, including the continued development of the ambulance service and the breast screening programme which is at present established on a pilot basis. I have also allocated a further £7 million to continue the hospital waiting list initiative. In addition I am in a position to provide additional funding for accident and emergency services including £1 million for acute hospitals.
In respect of services for the elderly, Deputies will be aware that life expectancy in Western societies has increased substantially. While in Ireland the age profile is still younger than that of the European Union generally the number of elderly as a proportion of the population is growing. It has been estimated that between the years 1981 and 2006 there will have been an increase of 20 per cent in the number of persons over 75 years of age and an increase of 28 per cent in the number of persons over 80 years of age.
The objective of Government health policy in relation to the elderly as set out in the report The Years Ahead is to support the care of dependent elderly at home for as long as possible and ensure that when they can longer be cared for at home, there are appropriate specialist and extended care facilities to meet their needs. As part of the continuing development of these services £2.5 million has been allocated to further develop community nursing units, day centres and community services for the elderly.
Since taking office I have been conscious of the need to address specific issues in relation to cancer services. Cancer was identified in the health strategy as one of the three major causes of death in the under 65 age group in Ireland. The strategy set a target of reducing the death rate from cancer in the under 65 age group by 15 per cent in the ten year period from 1994. I am conscious of the considerable effects of cancer on health status in this country. For example, the disease accounts for about one third of all deaths in those under 65 years of age. There are about 18,000 new cases of cancer in Ireland each year. Last year alone there were over 49,000 hospital episodes due to cancer. The health strategy also pointed out that Ireland has a higher mortality from cancer than the average for European Union countries. Our death rate per 100,000 in the years 1988 to 1992 was 273, compared with a European Union average of 245 per 100,000.
With these factors in mind, I set about preparing a national cancer strategy last year. My Department has consulted widely on how best cancer services should be provided. The consultative process included discussions with a group of cancer specialists whose views were very useful. The strategy will deal with the full continuum of cancer services, ranging from health promotion, screening and early detection, to treatment services, rehabilitation and palliative care.
Its principal objectives will be to take all measures possible to reduce the rates of illness and death from cancer, in line with the targets established in Shaping a Healthier Future, to ensure that those who develop cancer receive the most effective care and treatment and that their quality of life is enhanced to the greatest extent possible. I am now finalising the strategy and hope to publish it without delay.
As I already indicated, the Government is operating to strict limits in relation to public expenditure. Given the significant demands for health services and the limited resources available, it is important to ensure those resources are used to best effect in the provision of a quality healthcare system. The best use of available resources must be maximised. The health strategy recognises that and highlights the need for systems to evaluate economy, efficiency and, increasingly, effectiveness in the provision of quality health services.
One such area which receives particular attention in my Department relates to value for money. Spending must be carefully monitored to ensure that the health services, the patient and the taxpayer get the best possible value. This is extremely important and subject to close and critical scrutiny at a number of levels, including by my political colleagues and others interested in the health services. To underline the importance of value for money, the Government decided that in 1996 savings equivalent of 0.7 per cent of the 1995 outturn be identified in relation to health expenditure and that those savings be applied to service developments in 1996.
All the health agencies co-operated in this exercise and identified the required savings in their service plans. My Department will be monitoring the savings as the year progresses.
Furthermore, the health services are responding to the needs of a changing environment and developing systems which allow for greater co-operation between health boards and other health agencies with a view to ensuring the most economical use of resources. This is clearly the way to proceed and offers major benefits for all involved.
Healthcare evaluation is a central part of my Department's health strategy. Much is already being done in this regard and more will be done in future. My Department is at present examining further ways in which it can help ensure that the limited resources available are used to best effect to deliver a quality service for all concerned. That can only be achieved if healthcare evaluation remains at the centre of our strategy for the future and I am committed to ensuring that it does.
The Health (Amendment) Bill, 1996, has three main objectives: to improve financial accountability and expenditure control procedures in health boards, to clarify the respective roles of the members of health boards and their chief executive officers and to begin the process of removing the Department of Health from detailed involvement in operational matters.
The first of these objectives, to strengthen the financial accountability arrangements in health boards, is the most pertinent to today's discussion on the Health Estimates. The Government is determined that health boards will, in future, operate in an environment of service planning aligned to strict financial control and accountability.
The Bill aims to modernise the planning, management and accountability systems in the health boards. It will change the way health boards conduct their business. It will require them to work within a planning framework which is linked to clear objectives and specific resources. It brings accountability much more to the fore both in planning and reporting terms. It also reflects the Government's Strategic Management Initiative with its emphasis on making the public service more responsive, accountable and open.
In short, the Bill is at the very centre of the process to require health boards to carry out their tasks in a context which emphasises planning, strategic management and accountability. The Bill is due to come before this committee shortly and I look forward to discussing details of its provisions with Members.
I have outlined the main areas of this years Estimate. There are, of course, many initiatives which are being undertaken which I do not have time to go into. My principal objective is to provide a high quality service for those who will come into contact with the service. In framing the 1996 Estimate, the Government has provided the necessary resources to facilitate the achievement of this objective. I, therefore, commend the Estimate to the committee.
