asked the Minister for Health if he will state the total amount of deficits he expects will have to be met in the accounts of the voluntary hospitals for the years 1950, 1951 and 1952, and the amount which will have been contributed by local authorities in these years, by way of the additional charge of 10/6 per week for maintenance of patients in hospitals.
Ceisteanna—Questions. Oral Answers. - Deficits of Hospitals.
asked the Minister for Health if he will state, arising from his decision to authorise the increase of the capitation rate payable by local authorities in respect of the maintenance of patients in hospitals from £3 13s. 6d. per week to £4 4s. 0d. per week, whether this increase to reduce deficiencies payable from Hospitals Trust funds is to be borne by the rates of the local authorities, or whether a percentage will be recouped by the authorities from the Exchequer, and to what extent.
asked the Minister for Health if he will state what economies he expects to be able to enforce on voluntary hospitals, without affecting the efficient and smooth running of these institutions, in order to reduce deficiencies, up to the present made good from the interest of invested moneys in the hands of the Hospitals Trust Fund.
I propose, a Chinn Chomhairle, with your permission, to take Questions Nos. 54, 50 and 51 together.
I have no information as to the size of the actual deficits of the participating hospitals in 1951 and 1952. The only information I have in respect of 1950 is on the basis of estimates submitted by the hospitals to the Hospitals Commission in the latter part of last year. The aggregate of these estimates is £474,000, but that figure necessarily takes no account of the increased income accruing from the decision to authorise an increase of 10/6 per week in the capitation fee paid by local authorities in respect of their patients or of a decision of the Minister for Social Welfare to increase the capitation fee paid for National Health Insurance patients from £2 12s. 6d. to £4 4s. 0d. a week or of other measures recommended to the hospitals as a means of increasing income or of the saving of overdraft interest resulting from much earlier payment of deficit grants (45 per cent. of the estimated 1950 deficit has already been paid and a further 45 per cent. will be paid on 30th September whereas in respect of previous years no payment was made until March and April of the year following) or of economies which hospitals may be able to effect without interfering with the standard of the services provided.
I wish to make it clear that the increase authorised in the capitation rate payable by local authorities was intended primarily to bring that rate more into line with present-day costs of hospital maintenance and treatment. The ascertained cost of maintenance in some of the Dublin hospitals is considerably in excess of the figure now authorised.
Public assistance authorities are under a statutory obligation to provide medical care and attention for every person who is eligible therefor in their public assistance districts and to make due provision for that purpose. In the performance of their statutory duties public assistance authorities send patients for maintenance and treatment to voluntary hospitals, and it was never the intention that the Hospitals Trust Fund should be entitled to subsidise public assistance authorities in the performance of their statutory duties.
It is estimated that the increase in the capitation charge payable by local authorities will amount to £50,000 a year.
Under the Health (Financial Provisions) Act, 1947, any increase in expenditure by local authorities on recognised health services (including maintenance of their patients in voluntary hospitals) over that incurred by them in the standard year 1947-48 will be met, initially in full and later as to 50 per cent., out of the health grant. The full amount of the increase in respect of the year 1950 will be borne on the Vote for Health for the current year and appropriate provision has been made in the Estimate which will shortly go before the House. Accordingly no part of the increase will fall on the local rates. The same position will apply in respect of most, if not all, local authorities, in respect of the two following years.
It is not my intention to enforce any economies on the voluntary hospitals, but I presume those hospitals, in the interests of efficient management, will have due regard to any suggestions which may be made to them from time to time by the Hospitals Commission.
To remove a misconception arising from the Deputy's statement that deficits "up to the present" have been "made good from the interest of invested moneys in the hands of the Hospitals Trust Fund", I should, perhaps, say that the income which accrued to the fund from investments has never exceeded £330,500 and that the sum previously notionally set aside in the fund as an endowment for payment of deficits was of the order of £5,720,000, producing income of only £201,413.
In conclusion, I would like to quote the following extract from the circular issued by the Hospitals Commission in connection with the present deficits scheme:—
"The commission is aware that hospital authorities have been keenly alive to the extreme seriousness of the deficit position and, from time to time, representations have been made by members of hospitals boards that more effective measures of internal control of expenditure might be achieved if hospitals were informed in advance of the amount of the grants they might expect to have paid to them in respect of the following year's deficits. It was contended that the current system of paying the deficits tended to sap the initiative of boards of management, since under it there did not appear to be the required incentive to economise."
It will be apparent from that extract that hospital authorities themselves were of opinion that the previously existing practice of payment of hospital deficits without limitation was bad and should not continue.
Arising out of the Minister's rather lengthy answer to what he calls my five statements, might I first of all point out to him that they were not five statements but five questions? Is he aware that these questions were framed by me from the circular to which he referred which was sent to each of the hospitals? Does he not agree that the whole system is being changed, and that the amount of money that was being built up for the purpose of producing an annual rate of interest to meet the deficits of the hospitals is now disappearing, according to the circular of the Hospitals Commission, and disappearing very rapidly? Further, is he not aware that certain hospitals in the City of Dublin are apprehensive of what is meant in the circular by the suggestion that there will have to be reductions in cost of administration which, in a number of hospitals, is as low as possible? Further, is he not aware that hospitals have agreements with, for instance, the Transport Workers' Union, whereunder they take in members of the families of union members at two guineas a week and that they will now have to break that agreement and to charge the union members four guineas for treating members of their families? I should like the Minister to understand that it would be impossible for me to deal adequately with his answer at the present moment, and I will wait for the Estimate for the Minister's Department, when I will be in a position to deal with this matter in more detail.